A sanitary revolution in the works

It’s time for healthcare to wash its hands of Big Pharma’s influence

DRUG BUST by Alan Cassels

• The people’s briefing note on prescription drugs
Portrait of columnist Alan Cassels

Charles Delucena Meigs (1792-1869) was a very well regarded American obstetrician with some very strange ideas. He might be best known for saying anaesthesia was not appropriate for women in labour because, he reasoned, it contravened the laws of God. His enlightened perspective on the sanitary practices of his own profession, however, is what makes him most unforgettable. In the 1840s, he quite famously said, “Doctors are gentlemen and gentlemen’s hands are clean” and he showed a vocal contempt towards anyone who suggested doctors could be hurting patients through slovenly sanitary practices.

When childbirth was beginning to be institutionalized, women were encouraged to give birth at newly created maternity hospitals where the finest medical technology of the day could be used to extract the child from the womb. The problem was these new large maternity wards had intolerably high death rates.

In fact, puerperal fever (or childbed fever), a bacterial infection that often infected women during or after childbirth, was frequently fatal. This fact was not lost on a young Hungarian obstetrician named Ignaz Semmelweis, who, in 1846, was appointed to the Vienna Maternity Hospital, the world’s largest at the time, with two maternity clinics. Semmelweis discovered the death rate among birthing women was nearly 20 percent in the clinic staffed by doctors and medical residents and about three percent in the clinic staffed by midwives. What was going on?

Nobody really knew. Women were assigned at random to either ward as they arrived to give birth so Semmelweis hypothesized it was something the doctors were doing that was leading to such carnage. Since the doctors spent their mornings doing autopsies and their afternoons examining women and delivering babies, he thought they must have been carrying something deadly on their hands, which he called “cadaverous particles.” When he instituted a program requiring the physicians to wash their hands in a chlorine solution after performing autopsies, the death rate on the doctors’ ward plummeted to the same level as it was with the midwives.

What happened next is the most interesting part of the story. Was Semmelweis embraced as a hero? Celebrated as a medical genius? Promoted and respected amongst his peers? Absolutely not. He was reviled, challenged, ridiculed and, worst of all, ignored. By all accounts, the outspoken obstetrician wasn’t a master of diplomacy, but the reaction of his profession was legendary. They felt it was inconceivable that respectable gentlemen physicians could be responsible for killing their patients. At age 47, Semmelweis died alone and shunned in an insane asylum.

It took a long time for the medical profession to adopt Semmelweis’ idea of aseptic measures in medicine even though others, such as famous poet and physician Oliver Wendell Holmes, were coming to similar conclusions at about the same time.

With some things, orthodox medicine is notoriously slow to change. Sometimes a slow evolution of medical practice is a good thing; at other times, a revolution is required, especially in cases where it becomes obvious that certain practices are killing patients.

Today, medical practice has embraced Semmelweis’ advice. Sanitary measures are part of the bedrock of medical care (even though some research shows it is still a challenge to get doctors and nurses to wash their hands). There is, however, an overwhelming need for another type of revolution in sanitation – not concerning germs, but rather the risks and harms of infected (financially conflicted) medicine.

Every day in the world of pharmaceuticals, we see potentially harmful, conflicted medicine. Drug company influence seems to be everywhere: shaping the definition of diseases and the writing of prescribing guidelines, funding political campaigns, inserting themselves into the education of our doctors, carrying out research that only gets published when it paints the drug in a good light, paying for ghost-written articles in medical journals and on and on. To top it all off, we have TV drug advertising and the drug industry’s support of astro-turf patient groups, all of which shape and distort peoples’ expectations of drugs.

The worst, and perhaps most avoidable harm, revolves around the marketing of drugs directly to doctors, as more than half of our physicians have frequent contact with drug industry sales people. Industry representatives will tell you their strategy of plying doctors with food, flattery and friendship is a thing of the past and I will state, point blank, they are lying. That is, and has been for a long time, the dominant business model used to get your doctor to use new drugs.

I do, however, sense that a revolution is in the works. There are a growing number of modern-day medical rebels who are alarmed at the system we have and calling for a new one.

One such rebel is Danish physician Peter C. Gotzsche. In his new book, Deadly Medicines and Organised Crime: How Big Pharma Has Corrupted Healthcare (Radcliffe, 2013), he says that “virtually everything we know about drugs is what the companies have chose[n] to tell us and our doctors…” In his opinion, although our doctors are very knowledgeable about some things, such as human physiology, which is vital in treating patients, “They know very, very little about drugs that hasn’t been carefully concocted and dressed up by the drug industry.”

His book is a damning indictment of modern prescribing where he musters the chutzpah to say Big Pharma is basically another form of organized crime. Gotzsche names names and points to the long rap sheets of many of the world’s major pharmaceutical companies, listing their nefarious activities of all stripes, including kickbacks, extortion, fraud, buying politicians, pressuring bureaucrats and health policymakers as well as corrupting doctors and specialists.

Gotzsche writes that the third major cause of death in the modern world today, after cancer and heart disease, is pharmaceuticals. Fortunately for us, some medicines are also very useful in keeping us healthy and well – such as insulin, asthma medication or painkillers, but when any drug is used inappropriately, he reminds us they can “kill us on a horrific scale.”

Pharmaceutical companies are among the most powerful and lucrative corporations on the face of the planet and they have become that way by medicalizing the ups and downs of normal health – convincing people there is a pill for every ill – and operating under a business model that leads to the overconsumption of drugs for almost everything.

Like Semmelweis, Peter Gotzsche and many others are calling for a sanitary revolution. The only way to clean up medicine once and for all is to get all those decision makers to wash their hands of the drug industry. It’s a simple plea: stop being bribed and seduced by organized crime.

All this bribing and seducing can create blockbuster drugs, as well as blockbuster disasters. In 2004, the pharmaceutical company Merck withdrew the drug Vioxx from the market. That one drug alone, on the US market for only five years, was responsible for more American deaths than all the American soldiers killed in the Vietnam war. And this was a drug for arthritis!

So what is a patient to do?

Just as patients today are getting more assertive and asking their doctor if they’ve washed their hands (of germs), do we need to go further and ask our doctors what they are doing to cleanse themselves from the bias and corruption delivered by the pharmaceutical industry?

It’s clear that our collective health is being harmed by far too much inappropriate prescribing. Our doctors, as our allies, have to accept not all hands are as clean as they would like to think and if patients are dying from unseen cadaverous particles, they need to do something about it.

November 16: Alan Cassels speaks at the TEDx Victoria event about the emerging world of sanitary – unbiased and unconflicted – medicine. At the McPherson Playhouse. http://tedxvictoria.com/

Alan Cassels is a pharmaceutical policy researcher at the University of Victoria and the author of several books, including ABCs of Disease Mongering: An Epidemic in 26 Letters. www.alancassels.com

2 thoughts on “A sanitary revolution in the works”

  1. But strangely Dr. Gøtzsche is very orthodox when it comes to the largest medico-pharmaceutical fraud in history, our own HIV=AIDS=Death industry. He even calls the most poisonous drug of all, AZT, “highly useful”! It’s a strange thing, which I have written to him about since one might think he would find HIV/AIDS dissenters natural allies. I have a lot of respect for Dr. Gøtzsche otherwise so sincerely look forward to hearing from him. Roger Swan, RN.

  2. Ignaz Semmelweis was not the first to identify the cause of puerperal fever. In 1843, the American poet and essayist Oliver Wendell Holmes, who was also a physician and medical reformer, published “The contagiousness of puerperal fever”. He argued (like Semmelweis a few years later) that, contrary to popular belief, Puerperal fever was due to an infection passed from patient to patient by their physicians. Despite offering a mass of evidence to support his theory, he was (like Semmelweis) met with hostility from the eminent obstetricians of the day, one of whom wrote that doctors are gentlemen, and “gentlemen’s hands are clean”. Considered controversial at the time, Holmes’s essay is now seen as a landmark in the germ theory of disease.
    Incidentally, the word “anaesthesia”, which appears in your post, was coined by Holmes in 1846.

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