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Sibyl Piccuillo
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Before I review Deadly Medicines and Organised Crime, I wish to state unequivocally that I agree with Gtzsche on many fundamental points. I think that industry funded research is inefficient and systematically favours the products of the sponsor. I am appalled by pervasive hidden trials data and publication bias. As receipt of information from industry appears to be harmful, I think industry should play no role in medical education. The current model is clearly broken and some of the solutions Gtzsche suggests, for example requiring independent trials before licensing medicines, are good ones.
Given the importance of raising these issues, particularly with prescribers, and the obvious expertise Gtzsche had to draw on, it is a real shame this is not a better book. The sentences are long and often muddled. Chapter three, in particular, is almost unreadable. The superlatives and hyperbole are pervasive, tiresome and, in places, a little offensive:
Often I found claims unconvincing but did not know enough to be sure. Occasionally I did know a little of the literature and could be more confident I was being given an incomplete picture. For example, studying the association between antidepressants and falls is difficult. In observational studies, it is hard to adjust for clinicians favouring particular medications in frail patients they feel at high risk of falls.
Whilst I am unfamiliar with the study cited by Gtzsche to support his claim, I know that case only methods, which theoretically deal with this form of confounding better, find SSRIs and older antidepressants increase the risk of falls to similar extent. From a founder of the Cochrane Collaboration, I would have expected a more rounded account of the literature.
To be fair, there are some fascinating ideas in this book. The section on active placebos (p. 49) is great; the extent of the publication bias in trials of granisetron for post operative nausea and vomiting (p. 96) startling; some of the leaked industry documents truly frightening (for example, the table on page 239); and I really like the idea that scientists involved in important trials should conduct the analysis whilst still blinded to the treatment allocation, write two versions of the paper and only unblind the data when all co-authors have approved the manuscripts (p. 266). The reference lists are also likely to be useful to those taking more than a passing interest in these issues.
Tom Yates is a clinician, currently studying TB transmission in rural South Africa. He is a member of Healthy Skepticism and has supported both the Bad Guidelines campaign and the (currently inactive) Conflict Free Conferences project. Tom has worked on studies supported by Pasante, GSK and Sanofi. He has not benefited financially from these relationships.
I wrote the book in English and it was accepted by the publisher without hesitation. After having translated it into Danish and submitted it one afternoon, I got an email next morning saying that the editors had been reading it all night and were very enthusiastic; they called the book outstanding. The Danish version has been on the bestseller list for many weeks and has sold over 5,000 copies, which is a lot for a country with only 5 million inhabitants. Furthermore, a person who has spent his whole life in the drug industry has bought a special edition of the book, which he is currently giving away for free to the Danish general practitioners because he finds that they and their patients are the primary victims of the criminal behaviour of the drug companies.
I have received praises from other publishers and the book is currently being translated into Spanish, French, German, Finnish, Russian and Korean, and there is interest in having also a version in Portuguese and Italian. I have been contacted by 18 TV crews from five countries that want to make documentaries and two fictition writers are developing plots based on the book.
I am glad the book is doing well. Whilst we may disagree about style and over some details, I believe you are fundamentally on the right side in this debate. I hope many of the arguments that you make so forcefully gain wider acceptance.
Start with medicine. Modern techniques have clearly saved a lot of lives. If memory serves me, survival rates for premature babies have skyrocketed from 10% to 90%. You probably know someone who is alive today as a result. I thin my twins qualify.
My colleague Robin Hanson introduced me to contrarian research on both health and the family. The orthodox views, of course, are that medicine is the primary cause for rising life expectancy, and good parenting is the primary cause of happy, successful kids. The contrarian views reply that medicine has little effect on health, and parenting has little long-term effect on kids\u2019 intelligence, income, personality, or happiness.
There is surprisingly good evidence in favor of the contrarian views of medicine and parenting, but I\u2019m not quite convinced. Yes, the orthodox views are full of holes. And yes, the statistics for the contrarian views seem pretty solid, with lots of studies estimating effects around zero. But there are two interpretations of these zeros.
One is that there is no effect. The other is that there are both positive and negative effects \u2013 maybe large effects \u2013 that roughly cancel each other out. And for both medicine and parenting, the latter interpretation makes a lot more sense.
From this perspective, low estimates of the benefits of medicine cease to be counter-intuitive. You don\u2019t have to deny the medical miracles you\u2019ve witnessed. You only need to remember to average them in with all the disasters.
The same goes for parenting. We all know kids who let their parents plan their lives for them. Maybe it\u2019s 100% genetic, but that\u2019s a stretch. It\u2019s more plausible to acknowledge that these pliable kids exist, but point out that they\u2019re only half the story. We also all know kids who heard their parents\u2019 plans for their future, and did exactly the opposite just to spite them.
Bottom line: Contrarians often assert that medicine and parenting \u201Cdon\u2019t matter.\u201D But that is only one interpretation of their empirical findings. My interpretation is more intuitively plausible, and the data is equally consistent with it.
The volume is an anthology of essays documenting the evolution of the Holocaust, from eugenic and racial theory to enforced sterilization, leading to the medicalized mass killing of German children and adults and, inexorably, to the "Final Solution." The book is enhanced by remarkable illustrations. A particularly notable photograph (p. 122) is that of attendees at a 1937 anthropology conference in Tbingen: on the far left of the picture is the young Dr. Josef Mengele; on the right side are prominent pioneers in Nazi racial science, professors Alfred Ploetz, Eugen Fisher, and Mengele's mentor, Otmar von Verschuer.
The essays are written by outstanding historians, including the American scholars Sheila Faith Weiss, Daniel Kevles, and Henry Friedlander; German scholars Gisela Bock and Benno Mller-Hill; British historian Michael Burleigh; and French scholar Benot Massin. The basic themes of the essays are eugenics, racism, sterilization, euthanasia, and the programs of extermination leading to the Final Solution. Weiss provides insights into the evolution of eugenic and racial thinking in Germany leading up to the Hitler regime. Kevles documents universal international aspects of eugenics. Bock provides an incisive overview of eugenic sterilization and reproduction policies in Nazi Germany. Massin addresses the subject of anthropology, including the anthropological studies carried out by the Vienna Museum of Natural History and the University of Vienna. Burleigh's and Friedlander's essays deal with the evolution of medicalized killing, euphemistically known as "euthanasia," that culminated in the Final Solution. An introductory overview is provided by the exhibit's curator, Barbara Bachrach. The concluding essay, by geneticist Mller-Hill, provides an important historical and moral assessment of the implications of the Nazi experience for genetics and science today.
Each of the essays is an impressive scholarly work. Regrettably, however, there is a major omission: while the title is Deadly Medicine, the volume does not substantively address the subjects of medical practice, regulation, organization, research, and education. Some of these subjects are touched on with respect to individuals and institutions, but there is no overarching consideration of how the culture of medicine in the Third Reich became "deadly," how the medical community that gave birth to modern medical science became an agent of the Nazi state. No significant reference is made to Michael Kater's work documenting the representation and role of physicians in the Nazi Party and Hitler regime (The Nazi Party, 1983; Doctors under Hitler, 1989). No consideration is given to Robert Proctor's seminal work The Nazi War on Cancer (2000), which details the paradoxical relationship between Nazi philosophy and progressive attitudes toward public health and prevention in medical research and practice. The essays do not address the subject of physician (or scientist) education, with the inculcation of racist ideology and the exploitation of victims, both living and dead, for "teaching" and research in the German/Austrian universities, medical schools, [End Page 603] teaching hospitals, and research institutes. Using the parlance of the twenty-first century, there is no consideration of the transfer of knowledge from the scientists of the Third Reich to the practitioners.
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