In any case, they should just stop trying to market new opiates as “less addictive” – most of the time they aren’t, and even if the risks are a bit lower, the withdrawals can be an unpleasant surprise to the unprepared. Painkillers are life-savers for people with serious pains, but no one should be deluded into thinking that there isn’t any (and in Oxycodone’s case, BIG) potential for addiction. I’ve heard of many people who were prescribed opiates or benzos without being fully informed of the risks.

Citation needed.

You admit he’s good and then diss him with no evidence.

” OK, they’re full of shit and promote a bogus theory… but at least they only peddle sugar pills”

Sorry, but homeopathy is such a kluge of non-science that you can’t trust it to be harmless. Putting the magic words “homeopathic” on something in the US essentially gives it a free pass from regulation, and not all homeopathic remedies are ultra-diluted into nothingness, as people who may have lost their sense of smell due to “Homeopathic” Zicam have found out. Zicam contains ” slightly diluted zinc acetate (2X = 1/100 dilution) and zinc gluconate (1X = 1/10 dilution);[2]” http://en.wikipedia.org/wiki/ZicamAssuming something is safe because it says “homeopathic” on it is a fools game.

And, for your “try with enough subpopulations” point, it is called multiple comparisons for which there are statistically-valid adjustments for multiple comparisons that can greatly reduce your odds of seeing a significant effect by chance, and my experience has been that weaker adjustments (Bonferroni) have largely been abandoned for stronger ones (Tukey’s).

The two cases I know of where this kind of fraud occured, those responsible were a small group within the organization operating without the knowledge of management.  Since these crimes cost the company hundreds of millions to billions, our ethics education programs only got more hardcore over the years.

I could make your same extrapolation about non-profits or churches where criminal activity has taken place repeatedly.  Small businesses have the same incentive to commit arson and insurance fraud because they can’t afford to lose all the money they invested in the business.  This criminal activity happens a lot, but the whole small business system is not fraud bait.

Financial incentives exist for ALL criminal activity, but it is all exactly that – criminal activity.

The vast majority of drug development activities do not involve criminal activity.

That’s a faith-based statement. The financial incentives to only look at data that supports the drug in which you’ve just invested a fortune mean that the whole system is fraud-bait. And drug companies have repeatedly proven their willingness to act unethically. They have motive and opportunity.

Drug companies do all the clinical trials on their new chemical entity (NCE) because they hold the patent and will make all the money if the drug works.  Why would anyone want to do research on someone else’s product?

Drug company scientists and physicians are often co-authors and co-investigators on clinical trials because they are the world experts on the molecule and on all the animal and human data gathered on the NCE to date.  This also means they have some say in any manuscripts the same way academic collaborators have a say.

Studies sponsored by drug companies generally support the NCE efficacy for reasons that are not necessarily sinister:

1) The company only publishes studies from drugs that work and it wants to sell.  An academic researcher will publish all the good and bad data about all 20 compounds she tested.  An industry researcher tests 2000 NCEs in one assay, tests two of those in another assay, tests for safety in humans, tests for preliminary human efficacy, and, after all of that data comes back positive, tests for full human efficacy and finally publishes it.  If the NCE had failed any of those preliminary steps, nothing would be published, or, to put it another way, the chance that the NCE was going to fail in the end is much lower after going through this process.

2) Academic and government researchers don’t start working on the new drug until after it is on the market and they have some reason to doubt its efficacy or to test it against other drugs or off-label.  All of these lines of investigation have a relatively low odds of success with regard to supporting the new drug’s efficacy.  These lines of research are not biased against the new drug, they are just asking questions that aren’t nearly as slam dunk as the approval process.

3) Medical journals also influence new drug publications based on the drug’s novelty, performance versus standard of care, and/or the response of the disease or disorder to previous treatments (if any).  Weaker studies on a hot medical topic have an advantage in the review process, and drug companies focus their discovery efforts on hot medical topics for the most profit.

There are bad actors in any industry or area of work, and those bad actors may give us a really bad impression of their whole industry.  It may help to take a step back, look how the responsible parts of the industry operate, and maybe have a different take-away message.

Then again, there is that saying about not wanting to know how sausage is made or else you will never want to eat it again!  At least it isn’t criminal sausage (dibs on this as a band name!).

So I critically appraised the articles finding superiority of escitalopram over citalopram. ALL of them were sponsored by Lundbeck, the manufacturer of escitalopram, and also the maker of the brand name of citalopram before its patent expired. The patent expiry of brand-name citalopram (Celexa) coincided with the release of this “new” drug, escitalopram.

One of the psychiatrists on my committee contacted me privately to say that I was right; that the endpoints in trials of antidepressants are based on many subjective outcome measures so it’s kinda sticky to say one antidepressant is marginally “better” than another. But if we excluded escitalopram, and a pt we substituted citalopram attempted suicide, we’d be vulnerable from a litigation POV, given the data finding superiority for escitalopram, nevermind the data finding an association between SSRIs and suicide.

We were lucky, he is fine, many children died from the use of the drug and some of the families were accused of harming their children (Munchausen by proxy syndrome) with little evidence. One doctor had six mothers he accused of harming their children in a single year. Think of the almost statistical impossibility of that. The  very good documentary Mama/M.A.M.A. covers the fallout ,and lawsuits.

(Yes, I know how you meant it.))

There. Fixed that for ya.

Oxycontin, it is amazing to me that they were able to promote it on the same basis that morphine and heroin were first pushed, back in the day: each was supposed to be far less likely to cause addiction than its predecessor opiate.

Hilarious, since oxycodone and hydrocodone are more addictive.  They are really useful, however, since they make many people slightly speedy, meaning that you can function when you’re taking them.

I’m also convinced that there’s some Jekyll/Hyde thing depending on the audience.  We had inservices to nursing staff from drug reps all the time, and they were generally really useful and informative.  And then the same rep skitters down to the doctor’s office and turns into a scam artist.

And @ Boris, agreed about the relative harmlessness of homepathy. Reminds me of the Northern Exposure episode where the Native American receptionist woman was giving something to people with a bad flu and it worked for them, and Joel the doctor wanted to have it analyzed to see if it was a quack cure. The point was it really didn’t matter much since the people were cured, even if it was psychosomatic. “The human body is an amazing self healing machine”, as they put it.

Oh. Wait a minute. I already posted this in the Archie thread.

Oh well. Here is a video to cheer everyone up, while remembering that DMT is part of human DNA already.
http://www.youtube.com/watch?v=RRtj0eabApo