This is old, but regardless, one thing I've noticed in the Covid Era is that there are many people giving pharma companies the benefit of the doubt, when there's plenty of evidence suggesting that we should instead be constantly skeptical of them. It's not cynicism when there's history to point to.

I had a close circle of friends that were pretty anti-establishment in ~2010. We bonded over beers and whiskey, and deep discussions of the news media control of information and thought, and the lobbying power of big pharma.

Many of them don't really talk to me much anymore. I've grown more skeptical of the news media and big pharma. A few of them are silent only because they're dead after moving from recreational prescription opiates to heroin and eventual overdose. But the majority that I don't see anymore, I suspect their reasoning is that I'm too far "alt-right", or "anti-science". At least based on their social media posts before I deleted my accounts. I still don't trust big pharma any farther than I can throw a multi-billion dollar industry. And I still believe the same logic we all shared, that the news media's top shareholders and board members are not primarily interested in the free exchange of information.

I don't doubt that I've shifted positions in 10 years. Though, I feel they have somehow shifted position even more. It saddens me to have lost those close friendships. I think society is changing at a more rapid pace than it did previously. The internet and social media are likely partially to blame.

I'm not sure where I'm going with this. It's my day off and I've had a couple afternoon beers while doing chores. Probably just getting something off my mind on what was one of the few remaining rationalist websites. Though I feel like even here the tide is changing. Sad times, friends.

It's pretty depressing when friendships end over something as shallow as political opinions but I've seen it several times. One day people are going to have to realize that your allegiance to the guy right in front of you matters more than your allegiance to some guy who wouldn't even want to meet you if he ever heard of you.

Political opinions aren't just allegiance to some guy you haven't met. That's party allegiance. True, core, political opinions are much more about allegiance to principals and ways of thinking. IMO that's much more important than allegiance to individuals.

If I witnessed a family member commit murder, what's ultimately my core political views are what would determine if I did or did not turn them in for it. And I probably would turn them in.

It is possible, and rational, to be skeptical and trust others simultaneously. Life is more fun if you do not believe everyone is out to get you, and that there are shades of gray.

I dislike that phrase. I've heard it a lot. Believing everyone is out to get you. Nobody is out to get you, because you're a nobody. There's no grand conspiracy to take down some internet shitposter.

People are out for themselves. And if someone is in your way, and takes some hit because you have the Chevy Suburban and they're on a Honda SuperCub, so be it. It's not that you hate their beautiful red and beige paintjob, it's that they were in the wrong lane at the wrong time when you decided to overtake whoever was in front of you. Colloquial pronouns, of course.

That is a good point. I guess a better way of saying it is that I assume (or hope) most people are behaving mostly well most of the time and at least in the short term interest of most people.

This is also an assumption that is a luxury due to me living and growing up in a stable and prosperous country, and I can certainly see different circumstances producing different mindsets.

But I also think there is plenty of good being done by organizations (at least the ones I’m familiar with in the US) to justify giving them some benefit of the doubt.

I think this is naive. Individuals are probably overwhelmingly good, but a corporation generally gets away with as much as it possibly can. I think this is because you can diffuse personal responsibility to a much greater extent when you are acting on behalf of a corporation. Corporations probably do good things insofar as they provide them cover to act increasingly selfishly. An individual on the other hand runs into their own conscience much more frequently when they're acting on their own behalf.

In the spirit of rifting and drifting... If you're losing friends over shifting position about science, economics or somesuch then you're doing it wrong.

I've maintained close friendships to people who've gone literal flat-earth for several year spans. It's not the content that drives rifts, it's delivery. After work bar chats with friends are even better when the friends disagree, I find.

If you can't hold a pleasant adversarial conversation, I reckon you can't be good at skepticism. The two are linked.

I think you're assuming that his delivery was wrong, when in fact it's quite likely that a group formed over shared opinions would have some fairly proactive ideological policing.

Key word is "friends."

The key is humility. By accepting there's a possibility you are wrong and letting others know, you can get away with most beliefs.

I agree with your statements. But it's not that I am shunned from the group, it's that some have self-shunned. What was a batch of friends that could fill a backyard BBQ with 30+ people is down to about 10. I'm still the most left field of the bunch. There's still a literal communist (which I find abhorrent) that I love and see at least once a month. But there's also a bunch of people I really enjoyed hanging out with that I now only see rarely, and definitely not when I host an event.

I think what you may be onto there, is that some of those people were not really your friends, in the sense you thought they were.

The ones that don't come over anymore are the ones that think about it and decide they don't want to see you bad enough to take the time. Doesn't mean they hate or despise you. They may still consider themselves your friend, but they're not, at least in the way you had thought.

Ten loyal friends is a big number :-)

I like you

You cite no real evidence of 'big pharma' evil. What specifically is so 'evil' about an industry that saves the lives of hundreds of thousands of people every year?

You will hate 'big pharma' until you get breast cancer...

We should be skeptical of them. Though, very few of us have the knowledge, expertise, or resources to do so effectively. Better to pool our resources and create an organization to handle that for us.

It's not a perfect system, but the general trend over time has been for it to get better. One of the great ironies here is that, the better the FDA gets at finding problems, the more people criticize it for not finding problems. It's so difficult to consistently remember the full implications of the principle that absence of evidence is not, in and of itself, evidence of absence.

This case is particularly interesting because it happened immediately before the Food and Drug Administration Amendments Act of 2007, which included a considerable strengthening of the US's preregistration requirements. This clamped down on a way that pharmaceutical companies game the system that the general public, and even the majority of doctors, is ill-equipped to even understand, let alone push back against.

Granted, that act didn't, I don't think, include anything specifically about off-label usage. So it's somewhat tangential to the issue in question. I'm more trying to point out the shape of the situation. It's sort of a game of 4D chess, and, if one side were to be playing it in a purely "Twitch plays Pokémon" fashion, it would be at a severe disadvantage.

I think one reasonable and effective way to act in this sort of complexity is to reduce your dependency on pharmaceuticals as much as possible. It may not be doable for some, but those that can stay healthy while avoiding pharmaceuticals are likely to be better off.

There's an almost solipsistic angle to that. "I'm young and healthy so I'm gonna just check out of the situation," only works for as long as you can remain young and healthy. As soon as that stops being the case - which could be any day now - you might find yourself being much more personally interested in having an effective system for getting new treatments onto the market while maintaining reasonable standards of safety and efficacy.

Avoiding drugs doesn't require you to give up on the system. You can avoid drugs and act to make the system better.

Very few people possess the knowledge and expertise to judge the actions of pharma companies. Their only option is to demand transparency and trust the vetting at multiple third parties who do have the knowledge and expertise, such as FDA, CDC, WHO, NHS, or other similar organizations.

All of the third parties you cite have had their own scandals and betrayals of trust over the years.

Sadly I'm left trusting none of them. I rely on my own judgement, which is mostly informed by looking at motivations and past behaviors.

Similar to pretty much all other tribes. Of course, it's up to individuals to decide how much weight to give their own judgment versus how much to trust others, but it is an objective truth that one person cannot possibly have enough knowledge to never have to trust someone else.

I would also argue that, in the long view, some level of scandal is a good thing.

It's simply inconceivable that any organization of that size, that wields that much power, wouldn't attract abuses of power. Which means that failing to ever find any would be suspicious in the extreme. And, for that matter, in an organization of that size and complexity you're also pretty much guaranteed to have some good old-fashioned fuck-ups. Life has a distressing tendency to just happen sometimes. I can't really come up with any plausible scenarios for how an organization like the FDA could consistently avoid public embarrassment that wouldn't involve far worse corruption than any of the scandals they've experienced in my lifetime.

what expertise? having a three letter agencies magically makes them "experts" in vetting science?

what about conflicts of interest? who is the main person heading drug approvals? ex pfizer exec

https://www.linkedin.com/in/patrizia-cavazzoni-2752071b1/?tr...

People are not all bad, and not all good, and not the same all the time. You can intensely focus on all the bad and choose to view the world through those lens, but I prefer to look at the good also, and assume that people are not solely without concern for others.

At this scale it doesn’t really make sense to think in terms of good and bad people, but good and bad cultures. Scandal after scandal is a sign of a bad culture, and steps should be taken to correct it.

At this scale, I would expect the inevitability of scandal after scandal. My only hope is the culture gets more and more transparent, and the scandals continue to be exposed.

Ignoring negative outcomes makes you vulnerable to negative black swan events.

You should not ignore negative outcomes. And you should not ignore positive outcomes.

Yes, there's lots of money involved in FDA approvals. Yes, there has been and will continue to be corruption. But over my short life, the access to information has gotten better. The knowledge has gotten better. Most medicines have gotten better.

There was the opiate crisis. There was the nutritional pyramid nonsense. There was the ignorance of sugar and erroneous focus on fat. There was also the shingles vaccine, hep C treatments, fixes to the nutritional recommendations and acknowledgement of problems with sugar.

But I do not have a better option. I certainly am not capable of understanding the human machine by myself. My only hope is that multiple organizations consist of multiple people who are mostly good and mostly right most of the time. And that is something, I think, Americans can be proud about with regards to their civilian agencies.

"big pharma" saves hundreds of thousands of people's lives every year and then gets shit on by people who think they understand how the drug business works because some politician sent a mean tweet about a pharma company.

There has also been fraud where clinical trials are held in China with questionable results. Pay for good results being the allegation. Discovered this after having crazy side effects to eliquis. A number of my doctors have noticed problems with it, but prescribing doctor was in full denial of problems.

https://www.fiercebiotech.com/r-d/fraud-found-at-china-site-...

Johnson&Johnson has certainly had their own troubles in the past.

After the number of deaths and the complete turn around thanks to vaccines it’s not giving the benefit of the doubt, it’s just common sense. Yes we should all be skeptical of big pharma but it doesn’t mean we should throw out the baby with the bathwater and discount the amazing medical advances coming out the research happening either.

We should be skeptial of any organization who's primary purpose in exicting is to extract as much money from us as possible.

However, the fact we have 'big pharma' is what let us ramp up the vaccine program and save an awful lot of lives. Not just 'the lives' - but society would have had some serious issues if we had to decide to keep people in or let them out to die (only need to look at Brazil or India, where lack of vaccines and populism didn't work out well)

Summary: "Once approved, the drug may not be marketed or promoted for so-called "off-label" uses – i.e., any use not specified in an application and approved by FDA. Pfizer promoted the sale of Bextra for several uses and dosages that the FDA specifically declined to approve due to safety concerns."

Bextra was approved: "for the treatment of osteoarthritis, adult rheumatoid arthritis, and primary dysmenorrhea." [0]

But was marketed for: "In such documents, PHARMACIA marketing team stated as the “intended” use and message for Bextra that Bextra was for “acute pain.”" [1]

[0]: https://en.wikipedia.org/wiki/Valdecoxib#Uses_until_2005

[1]: https://archive.is/20091207084948/http://www.usdoj.gov/usao/...

It's almost as if prescription drug marketing were inherently a severe conflict of interest that represents a danger to public health, and should therefore be much, much more tightly restricted.

Prozac was created for use as an anti-psychotic but filed with the FDA for use as an anti-depressant. Because there are soooo many depressed people which means more money for the same drug. Wikipedia says it is the 23rd most prescribed drug in the US(wtf).

Do you have a source for that? I couldn't find any mention of that in the Wikipedia article (https://en.wikipedia.org/wiki/Fluoxetine#History), and it seems, from the history I've tracked down, like SSRIs were specifically developed with an intent to treat mood disorders.

There does seem to be a combination drug that includes prozac and olanzapine that's used to treat psychotic disorders. It's been on the market for a while; maybe that's resulted in some confusion?

Should add (2009)

As someone who has recently gotten the Pfizer vaccine, this title alone damn near made me evacuate my bowels

The biggest lawsuit judgments are qui tam cases, or “on behalf of the king”, more commonly known as “whistle blower” cases and come from the pharmaceutical industry. What this means is there is always a bad act involving money over health (typically also involving a fraud of some kind), an employee that attempts to bring the fraud/bad act to the attention of supervisors (not knowing the company is fully and intentionally engaging in the unlawful act), and then retaliatory action by the company against the employee/whistle blower.

Just 2 years after this case, Pfizer was the defendant in another qui tam case for…off label marketing of another drug.

https://en.m.wikipedia.org/wiki/Qui_tam

Based on a whistleblower tip. Pretty cool.

Is this part of the billions of dollars they say it takes to develop new drugs?

> ...in Its History

So how much fraud has it committed?

The actual headline is Justice Department Announces Largest Health Care Fraud Settlement in Its History, so the it refers to the JD, not to Pfizer. The headline posted on HN does not follow HN guidelines.

dang?

English FTW.