Sep 26 2013

The Pharma Shill Gambit and Other Nonsense

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28 Responses to “The Pharma Shill Gambit and Other Nonsense”

  1. locutusbrgon 26 Sep 2013 at 9:39 am

    So frustrating how effective these gambits are. The countless deaths from laetrile, antineoplaston, or chronic lyme treatment et al. All the proponents use these gambits extensively. Yet somehow they get a pass, it’s ok to kill people if you are telling people what they want to hear. My personal favorite is when the chronic lyme proponents use the big pharma shill gambit. I mean, because drug and medical device manufactures hate to sell IV supplies and antibiotics right?

    Common deceit tactic if you have no evidence and no argument attack the messenger.

  2. ccbowerson 26 Sep 2013 at 9:58 am

    “In addition, they tend to use the same fallacious arguments against us over and over again, as if they are reading from the same script.”

    It reminds me of how the internet is not just a place that allows for the easy transfer of information, but this information is clustered, which allows for an echo chamber effect. These small clusters can create their own ‘facts,’ and ideas that would have been urban legends in the past get passed around to a much higher level.

    Because most people do not fact check everything they here (skeptics aside) when a person encounters an idea repeatedly, they tend to lend it legitimacy whether it is warranted or not. This results in many people within that cluster believing the same things, which are a mix of truth and fiction. I think it is also important to remember that many of these topics are specialized ones, and the average person does not have the knowledge to properly and fully evaluate each topic. That is one reason why critical thinking is important because it cuts across topics, and it can allow an individual to better evaluate information in topics for which specialized information is not needed.

  3. oldmanjenkinson 26 Sep 2013 at 11:42 am

    How I see alt med apologists:

    AltMed: If A then B. A therefore B

    Medicine: What is your evidence?

    AltMed: Strawman! Ad hominem! Circular logic! Wash, rinse, repeat.

    http://upload.wikimedia.org/wikipedia/commons/a/a7/Graham%27s_Hierarchy_of_Disagreement1.svg

  4. acm37on 26 Sep 2013 at 12:21 pm

    Hi Dr. Novella — I’m an MD/PhD student at your school, currently working on my neuroscience PhD. It’s been amazing how many bizarre conversations I have had since starting med school with family members and friends that show terrible misconceptions about how their body works. Granted, that isn’t their field, so I totally understand why — but your writing has been really helpful in allowing me to have tactful, sensible conversations with them about why certain things work and why other things may not.

    I appreciate it and will continue to follow! Work like this helps me construct better arguments against the crazy…

  5. jim barclayon 26 Sep 2013 at 12:52 pm

    These people baffle me…your argument is so bulletproof its astounding that anyone wouldn’t be swayed by reading it

  6. BillyJoe7on 26 Sep 2013 at 4:46 pm

    acm37: “… since starting med school with family members and friends”

    You and your family and friends must be a talented lot (:

  7. tmac57on 26 Sep 2013 at 8:42 pm

    Sadly,it is not just that we are living in a world of alternative ‘medicine’.

    It is now very clear to me that we are living in a world of alternative ‘facts’.

    Social media has clearly exposed the dark recesses of what comes from the manipulation of the frailties of human cognition.

    Maybe I am too pessimistic,but I don’t see that rationality is winning the day.

    I hope that I am wrong.

  8. Brad Smithon 26 Sep 2013 at 11:06 pm

    I see the same types of arguments made not just by CAM proponents, but by those belonging to the anti-GMO, anti-Vaccine, climate change deniers and conspiracy theorists. It’s exactly the same type of rhetoric and fallacious arguments that get repeated time and time again by all of those groups.

    The pattern of it all is absolutely astounding.

    tmac57: Spot on. My friends back home had never really been interested in skepticism, or the position from the other side. It wasn’t until I moved to Oz and met another Brit (who has incidentally become my best friend) that I realized how widespread all this misinformation actually is. He was constantly liking and commenting on all the anti-GMO, anti-Monsanto, Sandy Hook/911 conspiracy theory and other wacky Facebook pages. Thankfully, I managed to change his mind on a few issues by writing some blog posts for him.

    The internet is an amazing place in which information can be retrieved, but we have to approach absolutely everything with at least a little bit of skepticism if we are to sort the truth from the utter crap.

  9. Kawarthajonon 27 Sep 2013 at 4:17 pm

    It seems as though many of the people who write in to complain about your writing, Steve, are quite angry about what you have written and are quite passionate about their opposing point of view, regardless of how ridiculous their logic can be and how solid your arguments are. I have faced a very small version of that in my community, where I have criticized local council members who are promoting pseudoscience about wind turbines. I must say, I was taken aback at the ferocity of my opponents and I only had to experience this about one, small issue.

    I must say, I am impressed with how logical and calm you continue to be, regardless of what nonsense is written about you (i.e. btw, are you going to be eating babies for thanksgiving again this year? Or was it Christmas?). You do not respond to their emotional ferocity in kind, which makes you incredibly frustrating for your opponents, but also makes you an excellent advocate for logic and science. I know that I would not be able to maintain my calm under the pressure that you face! I’m not sure how you do it, but I appreciate your work.

  10. skeptasmicon 28 Sep 2013 at 6:04 pm

    I’d just like to say that I really dislike recommending people use the “What’s the harm” website as a reference. It’s not that the stories are anecdotal and unscientific. I do understand that sometimes anecdotes are the best way to get through to people, and I originally thought the website was a good idea.

    But in categories such as “evolution denial” and “moon landing denial” the harm listed is people getting attacked for their views. It seems like they are implying that people should change their controversial views to avoid being attacked, or even that these people deserved to be attacked for their beliefs. The message seems to be the exact opposite of what the website was designed to promote: forget the scientific evidence, some passionate vigilante scientists are going to injure you if you don’t change your views. How does this promote critical thinking? If they put these examples forward as examples of the harm of believing in creationism, what does that say about the harm of being homosexual/transgendered?

    Furthermore, how can you accuse anyone else of cherry picking examples when you use this as a reference? I can’t find any statistics, but I doubt that there are more people attacked for believing in unscientific views than there are for believing in scientific ones.

    I have written the website asking about these statements but have received no reply. Given that 1/4 of the links on the site seem to be dead, I don’t think the website is maintained anymore.

  11. sonicon 30 Sep 2013 at 12:46 pm

    In the interest of furthering understanding, I will attempt to explain why part of this response might be unacceptable to some outside the medical profession. Perhaps this will help make it possible to address this attack in a manner that will cause it to cease.

    I have had it explained to me this way (I left out a few curse words)—

    Every time I turn on the television, I am told “Ask your doctor… See your doctor…”
    These ads run over and over– I’m told to ‘see my doctor’ every few minutes during the sporting events that I watch.

    The companies spending the large amount of money to run those ads are directing me to the dealers of their products. “See your Ford dealer today,” is another example of this phrase in action.

    I don’t go to the Ford dealer expecting him to tell me how the other cars are better- and I expect that even his most honest opinion is colored in favor of his brand.

    When a doctor claims ‘no ties to big pharma’– oh my…

    Well, the drug companies are spending billions of dollars telling me to come see this guy. I’m pretty sure the manufacturer is sending me to his salesman with the pitch I hear on TV over and over.
    So is this guy claiming he doesn’t know he is a salesman for the drug companies? He has to know he is. Nobody smart enough to be a doctor could be that stupid.

    Is he claiming that he is not influenced by the people spending billions of dollars on his behalf?

    At this point I’d like to point out that when it comes to trying to understand a person’s motives, ‘Follow the money’ is a basic investigative technique people seem to use instinctively.
    I often read that someone who takes money from an oil company shouldn’t be trusted about AGW, for example.

    Anyway, that’s the way this situation has been described to me.
    I hope this explains why this keeps coming up–

    And I hope this helps to make it possible for a communication to occur so that this particular attack can be addressed in a manner that will cause it to cease.

  12. SteveAon 30 Sep 2013 at 2:45 pm

    Sonic: ““Ask your doctor… See your doctor…”

    Drug companies make drugs. Doctors prescribe drugs. Who else should they be telling people to go to? The local bishop? Their mailman?

    The argument presupposes that a doctor, pharmacist or any other medical professional will ‘follow the money’ to the exclusion of every other consideration, the welfare of their patients for example. Is this the real world? No, it’s not.

    The argument also ignores the fact that many drugs are marketed in competition with each other. Doctors are not car dealerships. Doctors are not tied to brands or companies. Unless we think that medical professionals are simply money-grubbing hacks who somehow auction their services to the highest bidder. Again. Not the real world.

  13. sonicon 01 Oct 2013 at 1:40 am

    SteveA-
    I think the problem is that the claim of ‘no ties…’ seems obviously false.
    Without drugs, doctors wouldn’t be nearly as valuable as they are. And the drug companies do spend billions directing people to doctors.

    There is a big difference between being a shill and having ties.
    But the claim of ‘no ties…’ is exactly what one expects from a shill.

    Perhaps this helps explain the perception.

  14. Bruceon 01 Oct 2013 at 5:10 am

    Sonic,

    You have two major issues with your reasoning:

    Firstly: Steve Novella has often said he has no ties to Big Pharma. I guess that means he is a shill?

    I have no ties to big pharma either… that must make me a shill. How about you? I bet you would say you have no ties to big pharma, does that make you a shill too?

    Secondly: What do you define as “no ties”? If I buy a drug made by one of the companies, does that mean I have no ties? What if I give that drug to my son, or tell my mother-in-law to buy it because it works? Does that mean I have ties? What happens if my wife works for the company? What if my cousin works for the company? What if my cousin’s room-mate’s dog’s mother’s owner works for the company?

    I think it is implicit when people say they have no ties to the company that they are saying they are not a shill and their only contact with the drug or company will be incidental and not influential in them promoting the product in any way.

    You are arguing semantics which is really quite tedious.

  15. sonicon 01 Oct 2013 at 1:00 pm

    Bruce-
    A shill is defined this way-
    A shill is a person who publicly helps a person or organization without disclosing that they have a close relationship with the person or organization.

    So the claim of ‘no ties’ is exactly what one expects a shill to say– that’s part of what makes them a shill.
    People who do have a relationship with a business and disclose this fact are called ‘associates’ or ‘spokesmen’ or ‘in the same business’ or other- depending on the actual relationship.

    A tie is something that-
    brings together in relationship; connects or unites

    There is a relationship between the drug companies and doctors. Drug companies make discoveries and new products that make the doctor more able to help a patient– making the doctor’s treatments more effective and valuable. Drug companies spend billions advertising for the doctors.

    And doctors keep up with what the drug companies have available so they can prescribe the best.

    I am not saying this relationship is evil or wrong or that any specific doctor is unduly influenced by the drug companies (although some doctors are- right?).

    But when someone who obviously has ties to an industry claims ‘no’.. well, that is shill behavior, plain and simple.

    I really do think this is a problem in perception.

    I’m beginning to think the problem lies at least partly with a doctor who doesn’t know he has ties to ‘big pharma’.

    Perhaps this conversation needs to continue…

  16. Hosson 01 Oct 2013 at 3:11 pm

    Sonic
    http://www.thefreedictionary.com

    tie (t)
    v. tied, ty·ing (tng), ties
    v.tr.

    5. To bring together in relationship; connect or unite: friends who were tied by common interests; people who are tied by blood or marriage.

    shill (shl) Slang
    n.
    One who poses as a satisfied customer or an enthusiastic gambler to dupe bystanders into participating in a swindle.
    v. shilled, shill·ing, shills
    v.intr.
    To act as a shill.
    v.tr.
    1. To act as a shill for (a deceitful enterprise).
    2. To lure (a person) into a swindle.

    I find it very interesting that you chose to use thefreedictionary.com as a source for the definition of tie, but you decided to make up your own definition for shill to prove your point. I don’t have enough evidence to claim that you did what I’m suggesting with certainty, but I think it’s probably the case.

    Reductio ad absurdum has demonstrated that your position is false in Bruce’s previous comment.
    You want another example…I’m happy to help.

    “A tie is something that – brings together in relationship; connects or unites”
    “A shill is a person who publicly helps a person or organization without disclosing that they have a close relationship with the person or organization.”
    Big Pharma makes pharmaceutical drugs
    Some people use pharmaceutical drugs
    Pharmaceutical drug users fiscally help Big Pharma
    There is a relationship between the pharmaceutical drug user and pharmaceutical drug maker
    People who use pharmaceutical drugs have ties to Big Pharma
    Some pharmaceutical drug users publicly tell others how drugs help them
    Pharmaceutical drugs users who publicly tell others how drugs help them and who don’t disclose their ties to Big Pharma, are shills

    *slow clap*

  17. Mlemaon 02 Oct 2013 at 5:48 am

    I wonder if one reason behind these sorts of attacks is that Dr. Novella hasn’t really ever turned his skeptical eye to the problem of big pharma and how it influences research, medicine and academia. I respect his integrity as a physician, and I happen to know that lots of docs don’t really like patients coming to them, asking for drugs because they saw an ad that made them believe that they might be in need of a certain drug to improve their lives. I’m thinking of a cholesterol drug, not shown to reduce stroke or heart attack, but advertised as “getting your numbers where you want them”. The docs don’t like that the drive to develop and market profitable drugs often puts their patients at risk. More than a few doctors find themselves disillusioned when a drug marketed to THEM turns out to be a bad one, having trusted the industry and regulators to ensure their safety. Also, medicines for less-profitable but more real illnesses are unattractive to developers.

    I have no doubt that Dr. Novella has an appropriately critical attitude toward the problem, but he doesn’t really talk about it because he finds he must defend the pharmaceutical industry in general, against the attacks of those who would say that the whole thing is evil? Just a thought.

  18. sonicon 02 Oct 2013 at 2:58 pm

    Hoss-
    I used the wikipedia for the definition of ‘shill’.
    (when I google ‘shill’ that’s what comes up first and it seems appropriate.)

    I would agree that if someone claimed a drug helped them and at the same time claimed they had no interest in or relationship with the company that made the drug that person would either be:
    a) misunderstanding what it means to have a relationship
    b) acting as a shill would
    c) both a and b.

    Don’t you agree?

  19. Hosson 02 Oct 2013 at 4:42 pm

    Sonic

    “A shill is a person who publicly helps a person or organization without disclosing that they have a close relationship with the person or organization.”

    You’re not analyzing the nature of the relationship at all. All you’re doing is establishing a thin relationship(although any type would do) and applying the rest of the definition. The way you’re using definitions there is no such thing as an independent consumer or independent advocacy.

    Also you really need to add deceit to the definition of shill you’re using, which I think is one of the important defining attributes of shill.

    I’m surprised you didn’t recognize my previous example as being absurd, which I thought was obvious.
    Person uses a pharmaceutical drug
    Person tells friends the awesomeness of pharmaceutical drug without any detail about the consumer producer relationship
    Person, by your usage of the definition, is a shill

    The loose usage of the word shill you’re using(which is different from the definition you gave) makes you apply it to people who are not shills.

  20. sonicon 02 Oct 2013 at 10:23 pm

    Hoss-
    I’m laughing out loud– I just thought of this–

    All we have to do to prove we have no ties with something is to stop using it completely.
    Let’s make it illegal for doctors to prescribe drugs– we’ll let the drug companies hire people to do that directly– and they can’t hire any MD’s.

    Still think ‘no ties’? (I think this is a terrible idea- I bring it to make the point).

    Understand– I am not saying that doctors in general or that Dr. N. specifically are shills. (Let’s admit that some are, OK?) I am suggesting that if one weren’t convinced of that, then the obviously mistaken claim of ‘no ties’ might lead one to believe that the person is being less than honest– and perhaps this less than honest answer is an attempt to hide the truth.

    The relationship exists– there are ways to describe the relationship so that one can understand that a doctor is not a shill for the drug companies.

    But to deny the relationship when it id so obviously there– I don’t get it.

  21. BillyJoe7on 03 Oct 2013 at 12:50 am

    I think there are very few doctors who do not have ties to the drug companies.

    Even just seeing a drug rep is a tie to the drug company, because drug reps see doctors for the specific purpose of influencing them and doctors who see drug reps have been shown to be influenced even when they are adamant that they aren’t influenced and even when all they receive as kickbacks are pens or even no kickbacks at all.

    But a doctor who diagnoses hypothyroidism and prescribes thyroxin does not, by that act, have a tie to a drug company just because that patient will be dispensed thyroxin from a particular drug company.
    To believe so is to take this discussion down a deep dark hole from which there is no return.

  22. Bruceon 03 Oct 2013 at 5:09 am

    Mlema,

    There was a very good program on BBC last night by Dr Brian Cox called Science Britannica where he discusses the issue of “Freethinking” or “Blue Sky” science vs targetted research.

    It is certainly not an easy problem to solve and a very fine line to walk, but the “equation” is actually very simple… science costs money. Research needs to be funded, and a great part of this funding needs to come from what it produces. The ideological purity of free thinking and free flowing science is really almost impossible to maintain.

    I suspect Steve has not gone into the whole big pharma thing because it is probably almost impossible to untangle and is most certainly not clear cut black and white. Science has to engage in business to fund itself, and while there might be many out there who take advantage of it, without the money, no research would take place at all. At least not to the levels we have had over the past 150 years. It is not a perfect system at all, and I don’t think it is possible for it to ever be perfect and for there to never be anyone out there willing to make a quick buck off something they or someone else has discovered.

  23. Mlemaon 03 Oct 2013 at 6:41 am

    Bruce, that sounds interesting. But it’s not about free science vs targeted research. It’s about science for big profit as opposed to the advancement of human health. Now if it were just science for profit and the advancement of human health – no problem. Do you see the difference? Medical school teachers, and even deans sit on pharma boards. Schools earn royalties off drugs they help develop. Even journals can be influenced. The industry has powerful lobbyists and holds sway with the FDA through a revolving door hiring policy. It’s called conflict of interest. For every $1 spent on research, big pharma spends $19 on advertising and other promotion. Are these things not worthy of skepticism?

    I think science/medical skeptics could maybe look at some of the drugs and medical devices and the companies that have generated them and critique the scientific rationale and implementation behind them. Some of them are just as bad as the pseudoscience you see in Alt Med advertising. Check the class action suits for ideas.

  24. Mlemaon 03 Oct 2013 at 6:44 am

    I’m also skeptical about big pharma paying fines that amount to nothing more than “cost of business” when they kill a bunch of people because they didn’t properly research a drug but sold the hell out of it.

  25. Bruceon 03 Oct 2013 at 7:13 am

    Mlema,

    I have no doubt there are all kinds of shady practices, but ultimately, when you boil it down it does actually come to science for money (which is almost always targetted research) vs science for knowledge (which is almost always free thinking). Science for profit is always going to be a thorny issue and while there are many very shady practices, the fact that science gets $1 out of $20 for research still beats $0 from $0.

    I think you also miss the point that Steve and others on this blog will actually attack big pharma on their pseudoscience. Many of these drug companies are huge sprawling masses and they will have wings that produce homeopathic remedies and supplements. In my view it is really not productive to attack the very conspiracy sounding “Big Pharma” as a whole. Just because one company sells Fixitus Anythingus C30 alongside the latest drug that is clinically proven to work does not make that drug and the research behind it invalid. We are much better off spending our time looking at each drug/remedy/issue that comes from them and assessing them critically.

    What you might be better off doing is finding one of these drugs or medical devices that you think might be dodgy and post in the topic suggestions part of this site.

  26. Mlemaon 03 Oct 2013 at 3:43 pm

    Bruce, I think targeted research is good. If you are familiar with the kind of baloney research that often goes on which is justified with “freethinking” science just to acquire public grant money, you’ll realize that the restriction of “target” can be a tool of focus on what’s legitimate. What’s happening now, because of the fact that the profit motive and US law has given us gigantic profits and aggressive advertising, on top of weakening oversight – we DO have freethinking – it’s freethinking about “how many billions can we make with this?” Instead of being a targeted goal of discovery, the target is the profit itself. Comparing 1 out of 20 in dollars to 0 out of 0 is a false comparison. Targeted science is still science for knowledge, it just has the goal of solving a problem that will reap financial rewards. The financial rewards should reflect the human value of the discovery. And it’s not like “freethinking” science for knowledge doesn’t cost anything. So, again, that’s a false comparison.

    “Just because one company sells Fixitus Anythingus C30 alongside the latest drug that is clinically proven to work does not make that drug and the research behind it invalid.”

    I’m talking about the “clinically proven to work” drugs, which have reached that status through a profit-biased system that influences the direction and conduct of the direction of research, the nature of development and the publication around them.

  27. OlegShon 09 Oct 2013 at 1:08 pm

    For ordinal people an anecdotal fact from a person they know means more than any evidence-based researches. In addition, many doctors don’t have enough time or desire to educate their patients about treatment options in understandable and convincible manner.

    For example, when I got my child to physician for fever and cough the doc prescribes antibiotics and tells me to use it if after two days if my child doesn’t get better. I understand that doc tries to cover viral and bacterial infection at once.
    However, the most of people will think the doctor knows nothing about the disease and start losing their confidence in conventional medicine and turning toward CAM.

  28. Francesca Allanon 14 Oct 2013 at 12:08 am

    “electrical-based interventions”?

    Could you expand on this, please?

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