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This article continues the work started previously, which can be found here.
Here are a few less known facts about “the legal drug industry”, in other words – Big Pharma.
The amount usually claimed to be spent by the industry in order to develop a new drug is 1 billion dollars. Some respectable sources go beyond that: an average of 4 billion and up to 12 billion (for an approved Astra Zeneca drug in 2011). These figures speak for themselves and explain the need to set high prices for new drugs in order to keep profits on an ascending trend. But are these figures accurate?
First of all, all Research & Development figures are graciously provided by the industry, for there is no legal constraint to publish them. It is hard to be unbiased in these circumstances for we might not all have the same definition of what is an R&D-related cost (see more here).
One thing that is easier to check though are profit margins for these companies. In 2014, they averaged 20%, a figure only matched by the banking industry! (source: bbc) And this is not a new trend, for the drug industry has been extraordinarily profitable since 1982, with an average return on revenue three-times the one of other industries in the US (source here). Is manufacturing new drugs a risky business? All these companies are so solidly profitable!
Another thing that we know is that the drug industry spends up to twice as much on marketing drugs than on developing them. The ethics are difficult to grasp in their way of prioritizing resources. Speaking of ethics- drug promotion at any cost is also the reason why drug companies are most often fined. Bribery might be illegal in most Western countries – it is common practice in other parts of the world (see for instance the 490 million dollar fine for GlaxoSmithsKline’s bribery attempt in China in 2014 (bbc)). But this is one tactic among many others worth knowing (especially if you desire to improve your multinational thug skills).
R&D is also subsidized with taxpayer money to an unknown extent (not easy to find using free internet searches). Nevertheless, public subsidies for drug research mean that “taxpayers pay twice, first for research and development, and then they pay high prices at drugstore” (said in 2011 Marcia Angell, former editor of the New England Journal of Medicine).
Finally, R&D is a tax-deductible expenditure. After tax deductions, the actual cost of R&D is a quarter to a third of the initial amount. Drug companies have an effective tax rate way below other industries (source). To this we can add various strategies to avoid paying tax, like piling up money in untaxed locations and using it through elaborate schemes like inversions or by reducing apparent earnings. Earnings can be easily reduced through paying royalties to one’s own subsidiaries. Inversions are a different take on the same tune: they are done by acquiring a smaller company and moving headquarters to the new location, accessing off-shore money in the process (for more see here).
We have assumed all the way that R&D was designed to produce new medicine, with a potential benefit for all mankind in terms of better curing awful diseases like cancer. Less than 1 in 4 new drugs are truly new – the rest are “me-toos” or very modestly active (see here and here).
All these aspects paint a picture of an industry that has more to do with banking (besides the astounding 20% profit margin they share) than with the genuine concern to cure and alleviate pain. It is no coincidence that banks are the main shareholders in this industry. Is this the way we want our health managed? Are we ok with the monsters we feed?
For those interested in more, please google “venture philanthropy” and “pay to keep healthy”. Have a safe journey!
Cancer is the world’s leading cause of premature death.
That being said, let’s cut to the chase: the public is under the impression cancer is routinely cured by evidence-based medicine (aka mainstream, occidental medicine). Is this really the case?
First of all, what does it mean, to cure cancer?
For most of us, it would mean to be free of cancer cells in the body, without any symptom associated to their existence, and stay this way indefinitely, until death occurs from unrelated causes. In reality, current cancer treatments are more about attempting to increase survival together with maintaining quality of life, when compared to patients receiving other drugs. This means that a good treatment for cancer is able to make us get through a few more months than another drug already in use, ideally without taking what’s left of fun out of them.
Big money has been invested and big pharma has delivered a certain number of drugs – chemotherapy – as well as other cancer-breaking strategies (mostly through radiation). The number of FDA-approved anti-cancer drugs went from 69 (between 1965 and 2000) to 153 in 2015 (source Sloan Kettering). These drugs, associated to the improvements in overall diagnosis and patient care, are quite effective in terms of survival – treated cancer patients tend to live longer. There has been an average of 1.6% decrease in cancer death rate in the US between 2002 and 2011 (source). This has to be put into perspective with the astounding 40% of the worldwide population concerned with cancer at some point during their lifetime (source).
Many of these therapies have been used long enough to notice there are not only acute side-effects (the well-known vomiting-diarrhea-hair loss picture we all have in mind) but also long term effects: more cancer. Bitter sweet irony! The world invests colossal sums of money in cancer research, the industry develops the cures which we pay again in order to benefit from them, we go through hell and back, hopefully don’t die in the process, get on with life, only to get vacuumed once more in this death trap because of a new cancer, this time related to the cure of the first one….
The strange life of surrogates
Needless to say – this didn’t look good, so scientists went back to the bench and tried to find something that could predict which patients would most benefit from a particular treatment in order to target them specifically. This is how the search for predictive markers began. We nowadays have a wide variety of them, spanning from easy ones like metastases in lymph nodes to the sophisticated search of specific mutations in the genome of a specific tumor, inside a specific patient (overview here).
Predictably, things got even more complicated: some very accurate predictive markers proved to be difficult to work with. For instance, in order to measure them, one would need to inflict a risky procedure to the patient. So this is how we began searching for surrogate markers of predictability. This is one of the reasons why medical imaging (such as CT scans, MRIs, PET scans) has tremendously developed over recent years.
The compass is broken
There has been a shift in our collective reasoning. Somewhere along the road, we found it is time- and resource-consuming to directly measure the number of days a particular cancer treatment adds to a patient’s life. There are now surrogate markers of survival and of life quality – such as Progression Free Survival. You need to know about this one, for this is what doctors hear about on a daily basis from the industry.
“Progression Free Survival (PFS) rate is the number of people who still have cancer, but their disease isn’t progressing. This includes people who may have had some success with treatment, but the cancer hasn’t disappeared completely” (Source: Mayo Clinic). This might seem a good surrogate marker for survival – if only a high PFS rate were actually linked to a better rate of survival….but it’s not. Why? it is hard to explain since scientists don’t fully understand it. Nevertheless, the shift has been operated and PFS has become the main “end-point” in most clinical trials. New treatments are developed to slow down cancer progression whether this translates into a longer and better survival or not.
One more thing: all these rates are calculated on a 5-year basis. This does not mean that cancer cannot occur afterwards. It is an agreement between medical and industrial worlds to use the 5-year deadline in studies, for it is less expensive to use in trials.
One can only respect and encourage the efforts of the ones engaged in this mind-boggling work. Nevertheless, these people might have lost track of the essential point at the heart of their work. Slowly, we see a shift in the way cancer is measured and referred to – lowering expectations from new anti-cancer drugs in the process. A fairly good drug today, is a drug capable of improving PFS by, let’s say, 4 months, regardless of its effect on actual survival or quality of life (example here). And this drug will soon become part of international guidelines for cancer treatment, which means that oncologists all over the world will be bound to prescribe it to their patients.
In 2009, two brave oncologists published an article that called medical community to embrace an ethical approach and challenge the validity of official guidelines regarding cancer drugs with limited benefits.
If we allow a survival advantage of 1.2 months to be worth $80 000,and by extrapolation survival of 1 year to be valued at $800 000, we would need $440 billion annually — an amount nearly 100 times the budget of the National Cancer Institute — to extend by 1 year the life of the 550 000 Americans who die of cancer annually. And no one would be cured.
Yes, you’ve read it right: And no one would be cured.
Whatever your type of diet is, this is for you if you’re sweet toothed!
It is a recipe by Cocobakes LA. If you’re in LA, go see them, if not, you might also want to try their curry sauce featured on their blog….They make gluten free, dairy free products. This means anybody can enjoy them as long as they taste right!
Here is a vegan brownie recipe one could die for.
- 3 teaspoons of water
- 1 and 1/2 teaspoons chia seeds
- 1/2 cup (120 g) coconut oil
- 1 cup (180 g) sugar
- 3/4 cup (90 g) gluten free flour
- 1/2 cup (150 g) apple sauce
- 1 and 1/2 cups (180 g) almond flour
- 1/2 teaspoon baking soda
- 1/2 teaspoon salt
- 3/4 cup (90 g) chocolate
- melt the chocolate with the oil in a bain marie (over boiling water)
- mix the chia seeds with the water and set aside for at least 5 minutes
- mix evenly all dry ingredients in a bowl: the flours, baking soda and salt
- mix the melted chocolate with the sugar, then add the apple sauce and the chia seeds
- pour and mix the ingredients in step 4 into the bowl of step 3
- line your pan with baking paper and bake in the oven at 350°F (180°C) for 30 to 40 minutes depending on the size of the pan
A few remarks:
- use 100% cocoa mass, unsweetened chocolate or decrease the quantity of sugar by half. Don’t worry it will still be very sweet.
- if you mind your insulin levels use coconut sugar – it doesn’t taste like coconut but caramel! and has a beautiful color
- coconut oil is expensive – you can replace it or mix it with a good extra virgin olive oil without any significant change in yumminess
- gluten free flour can also be an obscure mix of ingredients. To keep it simple, use buckwheat flour.
- apple sauce is not always as healthy as it would seem (lots of sugar and additives you wouldn’t even dream of). You can replace it with a large fresh apple you grate over the warm, melted chocolate
- chia seeds are full of healthy nutrients
- if you can, use organic ingredients
- anyone gets this recipe right
Go thank the chef Coco Kislinger!
David Bowie’s passing this week has been a shock to many – the release of his latest album just a few days before his death gave the impression he was very much alive and well.
What makes a man dying of cancer go on, make an album, create a musical, think about the next album, smile with all his heart?
Some might say he kept busy and refused to face the cruel reality. Others might say he was insuring his family’s financial health by delivering one last dazzling image of himself to the people willing to pay for it. After all, he was one hell of a businessman – he sensed the perfect moment to issue his famous Bowie Bonds.
Others might think he ultimately found God. After all, his wife Iman did say
” The struggle is real but so is God”
on her Instagram account the very day he died. One very interesting thing to say, don’t you think?
David Bowie was a complex human being and we all saw the part of him which resembled us most.
But what do we have exactly? We have a man with many faces, always willing to explore some other part of himself. Never stuck in a particular moment of his fame, always flowing and evolving, understanding more and more about who he is and his place in this world. A truly free spirit backed by flawless vision: he had no trouble recognizing his soul mate and life partner when he met her (Iman), he accurately understood where technological evolution was headed, he was not ashamed to grow old. And no doubt many more – the ones that really knew him would know.
For us who didn’t know him, there’s his music. His music is his diary, it reflects his journey across the sky. Not a blazing comet, but a breathtaking set of fireworks. Sometimes way too much. Silent and contemplative in between.
As Joni Mitchell would probably say, Ziggy Stardust found his way back to the garden.
Good bye old boy! May we be inspired by you.
Thought of the week:
The poor are also the many. They are not represented. They are not the ruling class. The poor are 99.9% of the population: they are workers – be it in factories (not many humans work there any more), hospitals, courts of law, banks, television, you name it. They are the ones with no money or no time of their own – or both.
Until not so long ago the many felt isolated and depressed. They felt they were alone, left to struggle in a world gone irremediably wrong. The supposedly independent media added to that feeling: economic crises, deadly diseases, deadly weapons in the hands of the amoral made up the menu of every single day. They went every day to work, a meaningless job they didn’t dare to hate because they knew damn well they could lose it at any moment. There was alcohol, Prozac, Mary Jane, Viagra and holidays to help them keep going.
And then there was the Internet.
A place where all questions get immediate answers, where everybody is the expert in some unique field, everyone can share a thought, an idea, a new way to open a coconut, a new improvement for a Molotov cocktail… The place where eyes can be opened on planetary problems. The place where people find coaches who tell them there is much more to them than what they have been previously taught.
Note that it’s not at all easy to use it. The Internet was very rapidly flooded with outrageous pornography, useful idiots, paranoiacs gone off medication and about any type of propaganda you can think off. Not to mention all the actual products that can be bought with a click. Not to mention Google and its ranking algorithms. Not to mention the social media and virtual life traps.
Nevertheless, over the years, in all the chaos, there has been a growing feeling of togetherness, people have started to slowly realize they face the same problems. They start to heal. They feel empowered. They start to search the origin of their problems. They start to be politically aware. They start to hold some people accountable. They start to point fingers in the same direction.
You must recognize these are the symptoms of turning tides. Revolution.
You must remember that humanity has been here before. And the powers that be have already successfully reacted to the threat:
the answer is: WAR
In about 6 months we will commemorate 7 years since the death of our one and only King of Rock, Pop and Soul, Michael Jackson.
Do you remember how it was in the 80s and the 90s? There was no person on Earth, aged 4 to 94, not to be ecstatic about that man. Everywhere he went, packs of people of very different cultures would gather and try to have a glimpse of him. Old women in the remotest of countrysides would know his name and appreciate him, to the astonishment of everyone.
If you take a look at the 30 minute making of video of Thriller, you will see a group of youngsters gathered around the place where rehearsals and filming took place. They had glowing eyes and proudly improvised dance moves. Some found him sexy, others good, all incredibly talented.
And yes, Michael was on hell of a dancer. A complete showman. Since Thriller, there have been many other incredibly talented entertainers, maybe more so than Michael. But none has reached that unique status – being loved by almost all human kind.
So, his talent alone cannot explain why people loved him so much. Love is the right word to be used, his fans were like no other. For they were not regular fans -most of them did not identify with him, did not understand a word of his lyrics, never went to see him live or chase for pictures and autographs. They were nevertheless unbreakably in love with the man, at least until allegations of pedophilia were made. Why?
Maybe because he was a master of escapism, creating moments where you could lose yourself and float away from your worries. Maybe because Michael gave a little something to each and everyone of us that lingered with us through our daily life. Like a little spark of magic that told the kid inside of you “you can do it, whatever it is you need to do; you can be the best version of yourself; you can make a difference and change all that goes wrong in the world”. What a childish message! no wonder kids loved him.
You can repeat the experience even though he is dead – you can introduce a small child, let’s say 2 years old, to the music and videos of Michael Jackson. There is a good chance it will strongly react to it and you will see the same phenomenon again – sparkling eyes and being inspired to dance, to dream, to become bigger than nature.
We may not recognize it any more, but Michael Jackson has profoundly changed the lives of many people. Many have become artists thanks to his influence. Others have become workers, doctors, bank employees. Well, maybe no, not bank employees. But they all have been changed in some way, compelled to become the best and stay true to the child they once were. In this sense Michael Jackson was the biggest life coach of all times.
How did he influence you?
We all agree, children are best taken care of by their parents. We also know that sometimes, rarely, families abuse children. In this case, the victims must be taken away from their parents and placed under someone else’s care and legal authority. This is the reason Child Protection Services (CPS) exist – so that impartial professionals establish what is the nature and intensity of the abuse, who are the perpetrators, who might be the person most likely to give the appropriate care to the victim/child and for how long.
This is an extremely heavy responsibility. The CPS workers must be of sound judgment, psychologically balanced, with solid knowledge of all aspects of childhood – including psychological and medical ones. They must not act alone, but be part of larger teams of social workers, psychologists, physicians, lawyers, judges. These teams have to be able to investigate very thoroughly each case of suspicion of abuse. All parts must have the means to be heard – the children and the parents. This means that a community or a state must provide financial resources and appropriate legal grounds to make this system work.
There are a few countries that have understood the importance of this matter and allocate considerable amounts of money to their CPS. One country stands out among them as THE country where children have indeed rights and are particularly guarded against abuse: Norway. This is part of a larger agenda, Norway’s main stated priority being “strengthening the international human rights system”. Norway is and has been for many years one of the largest financial contributors to the Office of the High Commissioner for Human Rights in Geneva. Norway is the state who selects the winner of the Nobel Prize for Peace each year.
Norway’s CPS is called Barnevernet. The system is organized similarly to other CPS in the Western countries. It has several levels of decision that are independent from classic courts of law. The system is also bound to confidentiality.
A few dozen cases since the beginning of modern Barnevernet in 1992 got the attention of international media. Most of these cases concern immigrants (from Eastern Europe, India, Africa and other). These cases start to paint a certain pattern in the way the system works that should be of concern. There are a few common points to all these stories:
-there is usually an anonymous tip or a concerned teacher at school who alerts the Barnevernet
-the children are always separated from one another and placed in foster families;
-they lose all contact to their native cultural background including their mother tongue;
-the parents have the right to a free legal counsel;
-the parents usually report they do not feel their interests are well represented by the legal counsel;
-the appeal procedures are usually very long;
-diplomatic and international interventions do not usually make the procedure shorter nor appear to change the outcome;
-parents are never prosecuted in a regular court of law for the abuse that led to the separation;
-spending years in procedures claiming their children were unjustly taken away from them does not constitute a proof of innocence for parents;
-even in the cases where the system admits an error has been made, the children are not always returned to their parents – separating the children from their foster family after several years is deemed not in their best interest.
Several points need to be addressed:
First of all, confidentiality issues make it difficult to get a good sense of any of the cases: the media only report the parents’ view on the matter – a highly subjective one by nature. Also, without a public account emanating from the CPS on specific cases, one can only judge of its reliability through general statistics. On one side, we have a mother who claims her daughter was taken away from her because she didn’t have enough toys for the child or because the mother will be soon too small to adequately raise the child – reasons so preposterous they automatically tend to discredit the parent. On the other side, we have a powerful system of a wealthy country whose figures show its efficiency. To sum it up, there is a dark side to confidentiality – the lack of control from the public.
Secondly, it has been argued that although other family members such as aunts and uncles come forward and claim temporary custody of the children, the system widely prefers foster care. Foster care system in Norway is largely private. There are private companies managing state funds for foster families as well as their selection. There are advertisements to become foster parents. Harboring a child grants a substantial increase in income. There are political figures involved in the foster care business. Yes, foster care is a business and, like all businesses, there is a profit to be made out of it. There is also a pressure for the business to continuously grow. How can it grow when the rate of abuse is actually very low and constant over the years?
Third, the best interest of a child is, like good parenting, difficult to define, especially from a legal point of view. There are obvious cases – like sexual abuse with a child directly pointing the finger at the parent and exhibiting injuries – where the best interest of the child is crystal clear. Most of the cases are on the contrary in a gray zone: what about mild physical punishments? What about religion? Where does religious indoctrination start? What about feeding from one’s hand, is it force-feeding? What about having an obese child? Doesn’t that imply improper feeding? What about being poor? Doesn’t that represent a loss in terms of chances to become a healthy, well-educated person? In order to prevent misinterpretation and abuse in the name of the law, all these questions and many more should be clearly explained by the legislator. We have to know where we draw the line of unacceptable. We also have to prepare for unexpected consequences, one being taking away the desire to have children of your own in a world that leaves less and less educational choices to the parent.
Forth, there is the question of the acceptable margin of error from a child protection service. When does it stop being a service? If child abuse detection were anything like cancer detection, one would want to set up a system capable of accurately detecting all cancers with the risk of an acceptable amount of false positive results. Cancer is a big deal, like child abuse, so one would want all actual cases to be detected. Unnecessary cancer treatment can lead to very serious side effects. These effects are nonetheless outweighed by the seriousness of leaving cancer untreated. Whereas having even one child’s life unjustly destroyed as a collateral damage in a system that accurately detects all abused children is or should be unacceptable. Statistically speaking, this will only add to the absolute number of damaged children.
Which leads us to the fifth point: what are the outcomes of abused children? What are the outcomes of children in foster or institutional care? There is growing social and scientific evidence that children are best taken care by their biological parents. Unbelievably, the children are sometimes better off with parents who abuse them than in the hands of strangers. Institutionalized kids are a complete mess. In the case of foster care, many children present traumatic disorders which are difficult to link to the abuse in their biologic family or to their new life in foster care. We do know that difficult children are more readily abused by caregivers. It is a spiral of violence that could be ended with immense love and dedication, two things hard to find in “prepaid parents”.
Finally, in all cases where the children are irrevocably separated from their parents there should be a full trial leading to the conviction of the guilty parent. The abuse justifying such a drastic decision must be very damaging and should be illegal.
Most of us have never been in contact with CPS in any country, just like most of us have never been in contact with mental disorder facilities. But they exist and evolve with time. Norway’s Barnevernet is something we all have to question. Is this what we want?
Here are some links to look it up yourselves: