Eliminating Conflicts of Interest in Medical Research

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Why Doctors are So Drug Happy

Who funds most of the studies that show drugs are safe and effective? The drug companies themselves. This is the topic of my video Eliminating Conflicts of Interest in Medical Research.

“It is self-evidently absurd to look to investor-owned companies for unbiased evaluations of their own products…One result of the bias in this literature is that physicians learn to practice a very drug-intensive style of medicine. Even when lifestyle changes would be more effective, physicians and their patients often believe that for every ailment there is a drug.” It’s gotten so bad that “[p]hysicians can no longer rely on the medical literature for valid and reliable information.” That’s quite an accusation. Says who? Says a long-time editor of the New England Journal of Medicine, one of the most prestigious medical journals in the world.

To help expose some of the conflicts of interest corrupting the medical profession, the Drug Company Gift Disclosure Act was introduced in Congress where it died year after year until it was successfully integrated into the Affordable Care Act. Now, there’s a database detailing which doctors get the billions of dollars that are dished out, “permit[ting] patients to make better informed decisions when choosing health care professionals and making treatment decisions.” (I explain how you can easily look up your own doctor in my video Find Out If Your Doctor Takes Drug Company Money.)

In 2008, medical groups endorsed a version of the Act that didn’t require public disclosure unless doctors got at least $500 in gifts, but the 2009 version got stricter, requiring disclosure if you pocketed even $100, leading groups like the American Academy of Family Physicians to start to get a bit nervous. The final wording in Obamacare, however, requires disclosure of even a $10 meal, leading countries around the world to look to the United States for leadership in healthcare ethics. You don’t see that every day!

Now that we have this massive public record, we can really see how honest doctors have been. The financial disclosures by the authors of all the American College of Cardiology and American Heart Association guidelines were matched to the public disclosures of the hundreds of thousands of dollars they received from Big Pharma. The result? “The overall agreement between author and company disclosure was poor.” Nationally, female physicians each received thousands of dollars less than male doctors on average from drug companies each year, though it’s not clear if this is because the women were more ethical or the industry was sexist.

What about conflicts of interest for online clinical support websites? “Point-of-care evidence-based medicine websites allow physicians to answer clinical queries using recent evidence at the bedside” of a patient. Clinicians caring for patients are increasingly reviewing treatment recommendations on these sites to make clinical decisions in real time. For instance, if you’re with a patient, you can just whip out your phone and check one. It’s important that “[m]embers of groups developing formal clinical guidelines are discouraged from interacting with the health industry in a manner that may create a conflict of interest.” Researchers examined one such website called UpToDate, which seemed to provide the most comprehensive diagnoses. Did they find any conflicts of interest? Yes, in every single UpToDate article they examined.

So what do we do with this information? Let’s say we see an article claiming that candy consumption is not associated with health risks and the authors disclose that their research was supported by the National Confectioners Association, a group that used to run ads that said things like: “Put candy in their school lunch. It’s good for them.” We may want to take the results of that article with a grain of salt.

“The problem with financial COIs [conflicts of interest] is that you simply don’t know what to believe.” Maybe this “preoccupation with disclosure hijacked the debate…” Maybe, as Dr. Kassirer, the former chief editor of the New England Journal of Medicine, critiqued, the focus instead should be on eliminating commercial conflicts, not just disclosing them. It’s like campaign finance reform, where the issue is managed more by public disclosure rather than getting money out of politics. Indeed, he writes that “the vast attention paid to failure to disclose conflicts of interest is misplaced, and that more attention must be focused on the financial conflicts themselves.”

After Dr. Kassirer effectively resigned from the New England Journal of Medicine, disillusioned with the direction they were taking, Dr. Marcia Angell took over. She was the first female chief editor in the journal’s hundred-year history and lasted about a year. Medical journals “consistently refer to ‘potential’ conflicts of interest,” she wrote, “as though that were different from the real thing, and about disclosing and ‘managing’ them, not about prohibiting them. In short, there seems to be a desire to eliminate the smell of corruption, while keeping the money. Breaking the dependence of the medical profession on the pharmaceutical industry will take more than appointing committees and other gestures. It will take a sharp break from an extremely lucrative pattern of behavior.”


Why do funding sources matter? See my video Disclosing Conflicts of Interest in Medical Research.

The shameful practices of supposed science-based medicine websites, like UpToDate, are the very reason I started NutritionFacts.org in order to share the best available evidence without corrupting commercial influence. If you value my work, please consider becoming a supporter by making a recurring monthly donation to the 501c3 nonprofit that keeps NutritionFacts.org growing and thriving.

In health,
Michael Greger, M.D.

PS: If you haven’t yet, you can subscribe to my free videos here and watch my live, year-in-review presentations:

Discuss

Michael Greger M.D., FACLM

Michael Greger, M.D. FACLM, is a physician, New York Times bestselling author, and internationally recognized professional speaker on a number of important public health issues. Dr. Greger has lectured at the Conference on World Affairs, the National Institutes of Health, and the International Bird Flu Summit, testified before Congress, appeared on The Dr. Oz Show and The Colbert Report, and was invited as an expert witness in defense of Oprah Winfrey at the infamous "meat defamation" trial.


114 responses to “Why Doctors are So Drug Happy

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  1. Dr. G., maybe you should change the title to “Why Some Doctors are So Drug Happy.” Otherwise, it sounds like you’re throwing them all into the same pot.

    (Not meaning to stick up for the docs, mind you; I avoid them myself.)

      1. Lida, I figured Fumbles would miss me — again. :-D

        Today on the street I saw a T-shirt saying “Admit it; Life Would Be Boring Without Me.” :-) (And the other day I saw a rawther naughty one worn by a pervert-looking guy, saying “Spank Me; I’ve Been a Very Naughty Boy.”

  2. My doctor sure isn’t drug happy. Patients are more likely to be handed a ‘to-do’ list than they are a prescription. He has an expectation that patients will actively participate in a plan for good health and well being.

  3. I need to bring up a touchy subject.

    Can somebody explain how articles like these are acceptable but questioning vaccine safety is not? Am I missing something? If so please share as I cannot see how we should be wary of drug prescriptions given to sick people but not be inquisitive about drugs given to healthy people.

    Is it because with drugs there’s often an alternative (nutrition) but with vaccines there is not? Please help me understand.

    Thanks.

    1. I am a layman but making an attempt.

      As I understand it, vaccines were created to prevent some awful and often, if not highly, contagious diseases. That is not to say that heart disease and cancer, etc., are not horrible, but they don’t have a contagious factor to them that puts many more at risk.

      Additionally, I see vaccines as part of an overall protection plan that also includes a nutritional diet and healthy lifestyle choices.

      1. Thanks.

        I hear what you’re saying. But what if one of the drugs Dr. Gregor (or most of us on this site) are wary of, is discovered to prevent Polio. Would we all of a sudden forget the safety questions we have because now the drug is preventing a contagious disease?

        Or lets reverse it, what if the Polio vaccine is now found to cure heart disease. Would we not question it, or would we give it the same skepticism we give to other drugs on this site?

        I am trying to reconcile to seemingly different view points. What am I missing?

          1. Thank you, that first link was actually quite useful. Do you have something like it for all vaccines? It seems to hyperfocus almost solely on MMR and Thimerosal which isn’t really used much anymore otherwise.

            In any case, my original question wasn’t if they are safe or not, it was if you (not YOU specifically) question seemingly everything drug companies do but not vaccines, then why? If the answer is because vaccines are much better studied then I can accept that.

            Admittedly I am not a research expert, does something like lipitor not also have 20 studies showing it is safe? A quick pubmed search seems to suggest that indeed there may not be many.

            1. Yes, it probably does. Why woulf you think that Lipitor is a problem though?.

              Admittedly, there are probably even more anti-statin cranks than there are anti-vaxxers but that means nothing. What does the evidence and the science show should be the question we ask ourselves, rather than what do strange people on the internet claim.

              in any case, the answer to your question surely is that it is good science to question everything ….. but we should make decisions based on the best evidence available to us.

              As that UK report I posted earlier noted, there is no evidence of (net) harm from vaccines but we should continue to monitor the evidence/data. That seems entirely reasonable to me.

              I have serious doubts about annual flu vaccines because of reports I have read and because of evidence summaries published by the independent Cochrane Collaboration eg
              https://www.cochrane.org/news/featured-review-three-updated-cochrane-reviews-assessing-effectiveness-influenza-vaccines

              …… however we shouldn’t throw the baby out with the bathwater. The evidence for the efficacy and safety of eg polio. TB, smallpox, HPV and measles vaccines is overwhelming.

              Nevertheless, we should continue to monitor vaccine safety and efficacy because of contamination and other manufacturing risks and because of the possibilty that microbial evolution may allow those diseases to develop resistance to existing vaccines.

              As for similar data on other vaccines (than MMR), no I don’t have that on hand. If I had time to search for such reports I’d probably begin with the Cochrane Collaboration, World Health Organization and CDC before casting a wider net.

              1. Thanks for the reply.

                I chose Lipitor randomly, no real reason. I agree to “not throw the baby out with the bathwater”, as well as the need for ongoing safety monitoring.

              1. Mia

                That sounds like crazy talk.

                Vaccines are generally safe and under constant worldwide surveillance.
                https://www.who.int/vaccine_safety/en/

                Have you ever wondered why every single government around the world, and every professional medical assocaition, has come to this conclusion after reviewing the evidence?

                The only people who believe otherwise seem to be cranks who determinedly ignore the evidence or proven fraudsters like Andrew Wakefield

                1. Tom,

                  I don’t disagree with what you’re saying but want to point something out.

                  Every government doesn’t fully agree on the vaccination schedules. The US in particular has many vaccines that other countries either don’t have or don’t promote. Japan in particular comes to mind as one that briefly adopted the MMR but then decided it’s safer to keep the split M, M, and R shots. The UK doesn’t have the chickenpox vaccine on the childhood schedule. There are other examples.

                  This doesn’t mean every vaccine is bad (as you said, don’t throw the baby out with the bathwater), but people on both sides of this discussion need to careful with blanket statements as it may cast doubt on otherwise good point.

                  1. Yes agreed, but we weren’t discussing the amount/frequency/schedule of vaccinations justb their safety and efficacy..

                    my point was simply that every government around the world has concluded vaccines are safe and effective (by and large).

                    That doesn’t mean to say that the vaccines appropriate for Finland will be the most appropriate for eg Nigeria. So, yes, there differences but they don’t affact the questions of safety and efficacy.

                    Scgheduling and targeting are different questions.

                    Wriiten woithout my reading glasses …………..

    2. Sal,

      I am a layman but making an attempt.

      As I understand it, vaccines were created to prevent some awful and often, if not highly, contagious diseases. That is not to say that heart disease and cancer, etc., are not horrible, but they don’t have a contagious factor to them that puts many more at risk.

      Additionally, I see vaccines as part of an overall protection plan that also includes a nutritional diet and healthy lifestyle choices.

      (I don’t know if this came out as a general comment or a reply to Sal, or what the difference is.)

    3. Because Dr. Greger is all about science-based evidence. Science-based evidence shows vaccines are safe and effective for nearly everyone. There will always be outliers…but vaccines save lives. Just like nearly everyone can eat nuts without a problem, you have outliers that have an allergy.

      We’ve eradicated smallpox and polio because of vaccines. The childhood diseases we vaccinate for today aren’t annoying rashes that go away after a few days. They can cause blindness, deafness, encephalitis.

      Dr. Greger is pro-vaccine because science says they are safe and effective.

      1. Exactly, but this post right here says how we shouldn’t trust studies funded by the drug companies, and that conflict of interest can skew results.

        Is there science not funded by the drug companies showing vaccines are safe? I am not trying to be inflammatory I am just trying to understand how the questions presented here (and overall on NutritionFacts which questions the “norm” in terms of diet) doesn’t apply to vaccinations.

        From what I understand Dr. Gregor is all for vaccination (or at least not against it), so I’m curious how posts like these don’t apply to vaccines. He must have a good reason.

        Vaccines are a hot topic now and the last couple of days I’ve been getting the emails from NutritionFacts with subjects like “Why Doctors are So Drug Happy” and “Dishonest Doctors”. I’m just trying to reconcile the seeming discrepancy.

      2. Yeah, but … The same medicine shows drugs are effective and safe, often with a much higher standard of evidence than vaccines (eg. statins). So why shouldn’t the doctors be drug-happy? This double standard doesn’t make sense, if you treated statins and vaccines equally without bias, you would mandate doctors to prescribe them and punish patients not taking them. Because statins save lives too.

        That’s why I don’t like those conspiracy theories about doctors having conflicts of interest with Big Pharma. If I had a disease, I would certainly want my doctor to try every tool in the box, including drugs. And these should be tried before some “lifestyle” advice esp. if the latter means in fact ruining the life of the patient.

        Imagine a patient who likes cycling or swimming, but has asthma (maybe exercise induced). You could give them lifestyle advice that effectively makes them a couch potato and worsens their life in many aspects (including general/CV health), but manages their flares. Would you say this outcome is better than giving them an inhaler? I don’t think so. And don’t you think this example is somehow improbable; it does happen even if the lifestyle advice overtly isn’t against physical activity, but makes it effectively impossible.

        We should always remember that healthy lifestyle is mighty, but has its limits.

        1. Excellent point JP. I was in that situation this past spring and gratefully accepted the inhaler my doc prescribed. Anything to keep me “in the running” so to speak, including the daily aspirin, statin, and bp med I take unapologetically.

        2. JP,

          Conflicts of interest are not conspiracy theories.

          The fact that the majority of studies can’t be replicated is because it is more than just doctors who have conflicts of interest.

          Every time I have brought up nutrition with doctors or with my dogs get, they push away from it entirely and say, ”Don’t believe everything you read on the internet.”

          All of my friends have said that doctors have used that same sentence.

          People like my brother have been told straight out that diet had nothing to do with his cancer and changing his diet would not help.

          1. > Conflicts of interest are not conspiracy theories.

            COIs exists, that is for sure. Your waitress in the restaurant has conflict of interest. The car mechanic at your garage has conflict of interest. Your financial advisor has conflict of interest. Any salesman paid by commission has conflict of interest.

            The conspiracy theory is that doctors (on average) are drug shills who prescribe drugs because of their self interest, and more importantly, to the detriment of the patient, either of their health or wallet. Mostly, doctors want to treat their patients as effectively as possible. That this means prescribing drugs is simply because drugs have the most evidence (and the best kind of evidence) to show for it. And often, they are cheaper than alternatives. For instance, I checked some prices and 1 whole year (!) worth of statin is roughly equal to a single session with a registered dietitian. And that’s comparing a proven medicine with counseling of very uncertain outcomes.

            Not denying there are some bumps on the road. Like the recent opioid crisis in USA. But bear in mind that that was a case where the crucial piece of evidence was basically lacking, there were no good studies about the key statements used to promote them. Given that, you must understand doctors are reluctant to link disease (esp. treatment) with diet, where evidence is of much lower standard than drugs have.

            > Every time I have brought up nutrition with doctors or with my dogs get, they push away from it entirely and say, ”Don’t believe everything you read on the internet.”

            And that’s correct, the internet is filled with dubious statements about nutrition.

            > The fact that the majority of studies can’t be replicated

            Which majority of studies? Do you mean the scandal in psychology? Or some arcane basic cancer research, where replication efforts have been recently undertaken? None of those relate anyhow to drugs.

            > … it is more than just doctors who have conflicts of interest

            eh? wouldn’t it be rather because the culture of experiments in life sciences is piss poor, which was bemoaned (I think) even by Feynman decades ago? (which won’t change until we, the funders of such science and more directly reviewers of such science do something about it)

            > People like my brother have been told straight out that diet had nothing to do with his cancer and changing his diet would not help.

            If he had cancer, that’s entirely correct. Simply changing your diet in the phase of active disease won’t do a thing and relying on it for treatment is hazardous. Another thing may be population levels and risk factors, which can be changed by diet, but that must happen years before you see that doctor.

      3. Dr Greger is an expert on nutrition but not vaccines. Like most doctors he would know very little about them, until he investigates the truth himself. Doctors are taught next to nothing about vaccination, except to believe that they saved the world. It is an article of faith, not evidence.

        1. Yes but doctors aren’t taught much about nutrition either and that didn’t stop Dr Greger from breaking through the BS and finding the truth. My question is considering that mentality, there must be some questions about vaccines and seeing as how he seems to be fine with them, he must have a reason.

          Obviously I don’t expect random blog readers to speak for Dr Greger (although some have offered decent theories) but I was hoping perhaps a staff member can weigh in.

      1. There isn’t, that’s my point. Do we question vaccination less because it offers a benefit that cannot otherwise be achieved (unlike some drugs)? I just want to know how these posts apply to drug and food studies but not vaccine studies.

        1. Sal,

          Vaccines have a long history of effectiveness, and safety. Many of these studies were not industry supported. Vaccines confer immunity against infectious diseases, without the necessity of first acquiring the disease — which also confers immunity, if the patient survives the disease. Though survival is just the start; many of these disease have serious complications and adverse effects.

          The drug industry in its current form is relatively new; it’s power and influence are also relatively recent. Their interest is profits (actually before people or patients). They develop drugs to help combat so-called “lifestyle” conditions (obesity, cardiovascular disease, high BP and cholesterol, T2 diabetes, etc) because so many people have these diseases, so there is a huge pool of potential victims — er consumers — er patients. Which can result in huge profits.

          So they fund their own studies, to show the efficacy and safety of their drugs. Drug trials are very expensive, as is the development of new drugs. So it’s important to recoup this cost, as well as generating large profits. So, drugs sold to large numbers of patients are much more profitable than drugs sold to a small number of patients.

          Another aspect is that many newer drugs are only as effective, or perhaps slightly more effective, than older drugs. But the push is toward the newer drugs as “better.” But the safety risks of newer drugs are not as well established as older drugs. Though the profit margins of newer drugs is definitely “better.”

          This is a nutshell summary. There is a vast treasure trove of data and evidence about these topics out there.

          1. Thank you Dr J!

            You make a good point about the drug industry of today versus the drug industry of 50 years ago.

            Based on your response, do you think it would be warranted to be skeptical about NEW vaccines more than the old ones? Or would you say even new vaccines are still not the same as the rest of the current drug industry, and if so, why?

            1. The consequences of a failure to take specific medicines or drugs normally only affect the individual patients concerned (certain highly infectious conditions, such as sexually transmitted diseases, excepted).

              In the case of vaccines, the children of anti-vaxxer parents may be affected and there is also the loss of ‘herd immunity’ which puts many more people at risk.

              In the case of people with highly infectious diseases, who refuse treatment (eg Typhoid Mary, people with eg AIDS who have unprotected sex but do not tell their partners their condition), legal remedies are available. This si the precedent which presumably informs current cionsideration of applying penalties to those who refuse vaccinations for their children.

              May I suggest that you read and work your way through this

              https://www.cdc.gov/careerpaths/scienceambassador/documents/herd-immunity-2013.pdf

              1. Please show proof of herd immunity. You cannot, nor can anyone, because it does not exist. It is, like the belief that vaccines led to the reduction in mortality, an article of faith, not evidence.

                1. More gaslighting.

                  Anti-vaxxer true believers ignore the evidence and simply repeat false claims over and over again.

                  ‘CONCLUSIONS: The impressive decline in varicella deaths can be directly attributed to successful implementation of the 1-dose vaccination program. With the current 2-dose program, there is potential that these most severe outcomes of a vaccine-preventable disease could be eliminated.’
                  https://pediatrics.aappublications.org/content/128/2/214.abstract

                  1. Let me address this recurring herd immunity discussion. I think this is yet another case where there are valid points but both “sides” don’t want to hear the other.

                    To say herd immunity is not real is ridiculous. The whole main “anti vax” argument is that they prefer natural immunity which lasts longer and is superior to artificial immunity. Why do they want longer immunity? To protect themselves AND the herd. So to say the CONCEPT is not real is doing a disservice to some otherwise valid “anti vax” points.

                    So, what DO they mean? (Or rather – what more valid point can be made)?

                    The MMR is a great example. When it was first introduced in the US it was introduced as a one dose series. Later it changed to a slightly more effective two dose series in the late 80s, early 90s. This means people born in the 70s or so would have only gotten one dose. We also know that it can wear off, even after two doses. Perhaps over 20 years, perhaps even 50 years. The point is this. Children (who would enjoy the highest rate of immunity from having recently gotten the MMR) make up 25% of the US population (2010 census). So we can say 25% of the population is very likely immune to measles. Another 15% or so is over 65 and likely immune from having HAD measles.

                    This gives us 40% of the population with likely immunity, and a remaining 60% where it is unclear.

                    The question then becomes, if herd immunity is SO vital to something like measles prevention, why are the figures for cases in the US pretty low (even this year where it was the highest in decades, the actual count was somewhere around 1000 cases, or 0.00033% of the population), considering that a large part of the population (way more than 5%) is likely not immune or not sufficiently immune.

                    Now, you may have answers (I have some myself), but I humbly believe THAT is the real question. To say “herd immunity isn’t real” on one side, and to say “95% needs to be covered to stop disease” on the other, are both opposite ends of the spectrum, while the reality is likely somewhere in the middle.

        2. Do we actually question vaccine safety lees than we do drugs?

          There are highly active and vocal anti-vaccination groups and individuals that have questioned the safety and efficacy of vaccines for many years.

          I think previously provided a link to the WHO page describing its vaccine safety monitoring process. Here is the CDC’s page on vaccine safety research
          https://www.cdc.gov/vaccinesafety/research/index.html

          Here is a NY state government one-pager summarising the issue
          https://www.health.ny.gov/prevention/immunization/vaccine_safety/proof.htm

          This Oxford University site is also quite helpful but notes ‘Like everything else in life, vaccines are not completely risk-free. However in the case of all the vaccines used in the current UK routine schedule, the overwhelming evidence is that vaccinating is safer than not vaccinating.’
          http://vk.ovg.ox.ac.uk/vk/vaccine-safety

      2. In 3rd world countries, where people don’t eat a whole food plant based diet, there immune systems are not strong enough to fight off disease, so vaccinations make sense there-
        However, making them mandatory for “everyone”, regardless of how healthy you are, is overkill… In any disease outbreak, including the “Black Plague”, there are always survivers, even people that worked in those hospitals, but never got sick-
        Why? Because they had immune systems strong enough to fight it off…
        So maybe instead of our government thinking of making vaccinations mandatory, they should make a whole foods plant based diet mandatory.
        My ex-husband used to lecture at a place where he saw HUNDREDS of families all with same story… Took healthy child in for the shots, and the child was never the same again… I don’t care what they say about studies- The “numbers” of families with the same heartbreaking story, speaks for itself.

        1. I just want to clarify – I wasn’t trying to turn Dr. Gregers post into a vaccine post. I am merely trying to understand how one can question studies about food and drugs, but when it comes to vaccines all of a sudden it’s not ok to wonder.

          Maybe vaccines aren’t safe, maybe they are, that’s not my point. My point is if you have such questions about foods and drugs, even though studies say they’re safe, wouldn’t you have questions about vaccines too?

          And if you DO have the questions, but determine vaccines are fine unlike some foods and drugs, I want to hear why. “Dr J” brought up a good point about the drug industry changing over the last 50 or so years (so mainstream vaccines are that old or older), but that still leaves the question open about newer vaccines.

          Dr Greger clearly knows his research, so I would love to hear how he or somebody similar reconciles questioning foods and drugs but not vaccines.

          For all we know we did question them but determined they are fine, I’m not here to point fingers. Just trying to reconcile a discrepancy.

        2. Layla Shanti,

          The immune system is incredibly complicated, and we are continuing to learn about it every day.

          As you note, SOME people survived the “Black plague;” but many, many did not. Would you want to risk a high probability of death from exposure to it? I sure wouldn’t. “The Black Death is estimated to have killed 30% to 60% of Europe’s population.“ (Wikipedia). As to why some people survived: they might have been exposed to a related infectious but less deadly agent, which conferred partial immunity. There could be other reasons.

          Some diseases seem benign, but that’s because we’re not familiar with them. I have a friend who was partially paralyzed by polio; she recovered, but not completely. My mother suffered shingles in her 60s, which is a recurrence of the chicken pox virus which stays in our nerve cells in a dormant state; it sounded dreadful, the pain awful. Measles can be fatal, and may have serious complications. Also, it dampens the immune system for a few years after recovery, leaving it’s victims susceptible to other diseases. And these are viral diseases, so they are not treatable with antibiotics, which attack bacteria, but not viruses. (The Black Plague is apparently bacterial, so it can be treated with antibiotics. At least for now. Antibiotic resistance is on the upswing.)

          The benefits of vaccinations far outweigh the risks. They are one reason why our population is exploding: people aren’t dying nearly so much from these infectious diseases.

          1. I know this is not in direct response to me but I wanted to make one point. Blood pressure drugs and statins can work too, yet still here we are on a relatively mainstream blog questioning them.

            If the answer is “benefits outweigh risks”, then ok, that’s an answer. I just feel like the risks, however small, don’t seem to be acknowledged. Try having even a shred of doubt on vaccine safety and you are met with fierce criticism. Why can we question Lipitor and Butter but not vaccines? That is the question I am trying to ask.

            Given Dr Greger’s track record of really going through the data I was hoping for some insight.

            1. Hi Sal. Another point to consider is that vaccines work completely differently than typical drugs do. Vaccines work by teaching the body’s own natural immune system to recognize a danger, giving it a chance to learn in a safer situation so that it’s much better prepared to face the real danger later.

              Think of it like this: If you show a child a dead snake and tell her that snakes with this color pattern are venomous, she can learn to recognize venomous snakes BEFORE she ever encounters a live one. This protects her from dangerous snakes. Similarly, firefighters are trained in virtual reality simulators, or with small well-controlled test fires, to prepare them for when they eventually encounter a much more dangerous real fire.

              Vaccines work the same way. Vaccines show the body’s immune system a dead or severely weakened pathogen, or just a recognizable piece of one. The immune system learns what it “looks” like and will immediately recognize the real pathogen as dangerous if it sees something that looks like that again.

              Vaccines are immune-system teachers. And immune systems are good learners; one (or a small number) of lessons are all it takes.

              Many drugs, on the other hand, just alter some chemical pathway, bind to some receptor, compete for some cellular uptake, etc. This makes it more likely that they’ll have unanticipated effects. It also means they must be taken over and over and over again to maintain their effects. It’s much more lucrative to sell someone hundreds of pills than it is to sell them a couple injections of dead virus.

              1. Yes, it is true — vaccines work differently than pharmaceutical drugs, however, don’t forget that vaccines also contain many different excipients (fillers) that can alter chemical pathways, just like pharmaceutical drugs.

                The influenza vaccine called Flublok — contains the following excipients: sodium chloride, monobasic sodium phosphate, dibasic sodium phosphate, polysorbate 20 (Tween 20), baculovirus and Spodoptera frugiperda cell proteins, baculovirus and cellular DNA, and Triton X-100. Granted, the amounts of excipients used in vaccines are tiny, but in my opinion, these excipients should be extensively and continuously studied for safety; and, safer alternatives to many of these excipients (such as Tween 20, Triton X-100, or formaldehyde — which is used in the Tdap vaccine) should be considered whenever possible. Formaldehyde (a preservative) and Triton X-100 (an emulsifier) cause cell lysis. As a person who has experienced a year-long nightmare of an adverse event after receiving the Tdap vaccine, I became quite interested in excipients and am here to say that despite their tiny amounts, their effects are not necessarily trivial.

                Furthermore, the MMR vaccine contains the following excipients (as of January 2019): “vitamins, amino acids, fetal bovine serum, sucrose, glutamate, recombinant human albumin, neomycin, sorbitol, hydrolyzed gelatin, sodium phosphate, and sodium chloride.” The fact that the MMR vaccine contains fetal bovine serum might be of concern to persons with the autoimmune disease of Type 1 Diabetes, as some of these persons have been found to produce antibodies in response to bovine proteins. Dr. Greger has many videos related to the safety and effects of animal proteins on autoimmunity.

                More troubling is that the excipients used in various vaccine preparations may change, and the list of excipients provided on the CDC website is updated regularly to reflect these changes. This is rarely considered when discussing the relative safety of vaccines. The MMR may be considered “safe” but the excipients used in it’s formulation are different from year to year, and sometimes from month-to-month. Consider that in October of 2018, the CDC website listed the MMR excipients as the following: “chick embryo cell culture, WI-38 human diploid lung fibroblasts, vitamins, amino acids, fetal bovine serum, sucrose, glutamate, recombinant human albumin, neomycin, sorbitol, hydrolyzed gelatin, sodium phosphate, and sodium chloride.” If a different formulation of the vaccine is used three months later (the chick embryo cell culture and WI-38 human diploid lung fibroblasts were not used in the January 2019 formulation which is quoted above), how can we discuss the safety of the vaccine in an apples-to-apples comparison? How would we know if newer excipients used in an “older” vaccine are safe, or if the older excipients were problematic? Is someone keeping track?

                I am also of the belief that vaccine manufacturers (which are one in the same as Big Pharma — Merck makes the MMR vaccine, after all), should be “on the hook” for vaccine adverse events and safety. Currently, manufacturers have blanket liability protection from being sued if someone experiences an adverse event or if the vaccine does not confer protection. By having this blanket liability protection, vaccine manufacturers, like Merck, do not have as much incentive to ensure the safety of their product, including the safety of the excipients they choose to use.

                Questioning vaccine safety does not equate with being an “anti-vaxxer.” I am pro vaccine and I also believe we should always demand safer and fewer excipients whenever possible. Furthermore, I believe we should never shut down the discussion of the safety of drugs or vaccines. Excipient formulations change, and the safety of those excipients needs to be discussed, extensively studied, and carefully considered.

                See this link for the current full excipient list… I encourage all to download this list and watch how many excipients change with each new posted update:
                https://www.cdc.gov/vaccines/pubs/pinkbook/downloads/appendices/B/excipient-table-2.pdf.

    4. In reply to Sal. I have the same question. Vaccines make buckets of money for pharmaceutical companies, they keep the CDC in business, and make pediatricians with their “well-visits” a ritual in nearly every parent/child relationship in the western world. The vaccine schedule has increased dramatically since the early 90’s, no doubt because of the 1986 Childhood Vaccine Injury Act that relieved pharmaceutical companies from having to defend their products from pesky lawsuits. What about the growth of pediatrics since that time? Children are vaccinated throughout their infancy and childhood, over and over again. (My child visited a pediatric office 17 times in his first year of life.) I have watched ACIP meetings (the committee that decides which vaccines go on the schedule) and can tell you that the safety studies are a joke. If test subjects have adverse reactions, or die, the presenting drug company scientist will say “cause unknown” or “we should follow up with post-market studies.” The safety trials nearly always compare one vaccine to another, or else to a so-called “placebo” that contains the junk that’s in the vaccine minus the antigen. I’m not sure how they get away with calling it a placebo, but the rules are even more lax for vaccines than for other pharmaceutical products because they are not considered “drugs.” If drug studies are not reliable, it stands to reason that vaccine studies are even less so.

      1. A couple years ago I participated in a medical study as a healthy control. (I’ve done a few over the years to make some $). In order to study an inflammatory response, I agreed to be given a typhus vaccine. (I also got an additional $100 for doing so). By the end of the day, and for the following week, I felt like shit; headache, fatigue, chills, like the flu or a bad cold. I communicated with the study nurse about it, and my query about it being a reaction to the vaccine was an unequivocal NO…not probably not, or possibly, or it sometimes happens. Just, gee what a coincidence. (I also had an adverse reaction to a DPT vaccination in high school.)
        Upon reflection and with some research, I’ve concluded that most in the medical industry don’t want to admit to any possibility of anything bad or negative regarding vaccines, which makes me feel very uneasy about the push for me to get flu, pneumonia, or shingles vaccines. I’ve not had them, and am disinclined to ever get them.

        I am not anti vaccination, just pro information and education.

            1. What do you mean ‘of course not’?

              I’m no public speaker but I’m not known for keeping my mouth shut when cranks and nuts peddle false claims, either.

              Wakefield is a known fraudster in any case – it is very telling that this is the kind of person that crackpots choose to cite to support their refusal to acknowledge the evidence.

              https://en.wikipedia.org/wiki/Andrew_Wakefield

              1. Perhaps because they read Mark Twain

                ‘“Never argue with stupid people, they will drag you down to their level and then beat you with experience.”

                ― Mark Twain

                1. This was in answer to Dawn who wanted to know why reputable scoentists and doctors won’t debate issues with cranks and fraudsters.

      2. So true Donna. No wonder no doctor will publicly debate the vaccination issue with people like Del Bigtree and Robert Kennedy Jnr- they would get embarrassed.

    5. Also, please be aware that a lot of vax misinformation is put out there by the same folks who put out false propaganda during the 2018 elections. Their only purpose is to sow distrust in our institutions.

  4. I’ve been blessed with reasonably good health. Although a few years ago I did catch a heart virus; lucky me. I survived and was put on a program of drugs for the rest of my life. I filled the first monthly subscription for $600. Luckily I was off work for a few months so had time to research. Found good foods, and other natural remedies for my suspected illness. After three months I returned to the specialist for a checkup. He was amazed at my progress. It was then I told him what I had done. He kicked me out of his office. That was 20 years ago and I haven’t looked back.

  5. I wrote prescriptions for my patients to attach to the refrigerator for the purview of their families such as Mary must meditate in peace for 30 minutes a day, John must walk 30 minutes in nature every day, and Frank can not cook red meat so that their families would not make them feel guilty for managing their health. Even when prescribing medications, I usually used the oldest forms that were cheap and just as effective as recent types that cost a fortune. I also chose those with side effects that were therapeutic in a specific patent: chronic diarrhea from irritable bowel = med causes constipation, chronic insomnia = med causes sedation, take at bedtime. One med instead of many.

    1. Robert Haile,

      What a great idea! I wish more doctors did this.

      I asked my doctor for a prescription of exercise, so she wrote one out for me on her prescription pad: “This patient must exercise.” (I wish she’d used my name.) I taped it to the inside of my medicine cabinet, where I would see it every day, when getting my toothpaste.

      And I did start exercising more.

      Then we remodeled the bathroom, and I lost my “prescription.” But I think I don’t need another one.

  6. Dr. Greger is who he is. He loves vegetables, but fears foraging for them, and won’t advocate for it. On some things he is a rebel (eating meat). On others, he is a curmudgeon and status quo defender (raw food, Seasonal eating, questioning any vaccine procedures, organic food, permaculture, non-corporate health care , like acupuncture, naturopathic, Eastern medicine, ayurvedic medicine). I think he only selects the research that his viewpoint is willing to consider, which is pretty narrow.

    1. John S,

      Your comments are entertaining.

      Dr. Greger is providing evidence based information. He reviews nutrition research papers published in peer reviewed journals. Much of what you list — acupuncture, for example — has little to no evidence of efficacy.

      As a research scientist, I’ll stick to the science for health information. Though I do enjoy imagination and fantasy in art, music, literature, etc.

      1. Dr. J,
        Your comments are insulting. You need to get out and read a broader range of information. Do you think that foraging is a fantasy about art? I am sad that you haven’t looked into the extensive research on acupuncture. Many researchers just stay stuck in their little narrow vein. You ought to get out more. I might consider taking your ideas more seriously if they were a little more seriously stated. Maybe you should just stay stuck in the lab ivory tower instead of venturing out into the real world. There are too many gray areas that are hard to deal with.

  7. Just wanted to say thank you Dr. Greger. Your view of the world is very altruistic and inspiring. Thank you for looking out for the rest of us!

  8. When regulators are openly, legally purchased with “campaign contributions”, don’t expect the system to protect the 90% disorganized, voiceless masses. The system serves big business. Big business want big profits at any cost. That is why life systems are threatened by big business everywhere as the heat and chills progressively get worse and corporate wars escalate to global wars. May the the FORCE of collective action save us.

  9. Dt. Marcia Angell later (2004) wrote a book “The Truth About Drug Companies how they deceive us and what to do about it” Also, she gives talks around the country. Having become acquainted with her
    talks and book, I’d say she’d agree with you and your article, today.

  10. How much funding do the medical schools receive from these same drug companies? Why is the same group that was formed to make oncology profitable, designing the curriculum for oncologists? Is it okay for physicians to lie about a patient’s chances of being cured by a certain course of drug therapy–when they really don’t seem to know
    ?

  11. Hi there… Yes, it does seem like Doctors are more focused on ‘doing to’ and drugs. My partner was diagnosed with Idiopathic Central serous chorioretinopathy this week. He was told nothing can really be done for it. That it may clear up on it’s own in 2-3 months and may or may not reoccur. We were told he might be able to get laser and there are some drugs but none that have been reliably effective but we don’t really want to go down that path. We asked the Doctor about nutrition, are there any links to diet and/or if there’s anything natural he can take that would assist and help him get his vision back. He’s only 33yo. Any advice would be appreciated so so so much.

  12. Thank you for this incredibly informative article Dr. Greger. Thank goodness for the day a friend turned me on to your site. I struck gold. Eternally grateful.

  13. I think my dog is going to die soon.

    He has been extra affectionate this week, and very hungry.

    I have been feeding him as much as he asks for, but tonight, he didn’t ask.

    I guess I will find out what happens.

    1. Well, if this is near the end, I can say that it isn’t that bad.

      My dog is such a sweetheart. He is lying there calmly and peacefully and looks up at me every 3 minutes to make sure I haven’t gone to work.

      He isn’t eating but doesn’t seem to be in all that much pain or discomfort.

      Without expensive tests, I can’t find out what it really is and he is an old guy.

      I tried antibiotics and water fasting, but it only helped a little bit.

      Then, he started wanting to eat double his normal food and now he is the one choosing water fasting.

      I don’t think there is much longer, but he doesn’t look all that miserable, except for when I open the door for anything. Don’t leave me alone right now is the very clear message.

      1. You like wearing two hats, huh Bonny-Deb? Reminds me of the guy on the bus the other day. Handlebar mustache, suspenders, plaid pants…. Atop his head he wore three (count ’em three) hats. We do get some very interesting characters on those buses.

        When the time is right for Doggie, he will have a peaceful death. Just go with the flow, as they say. Often, animals like to hide somewhere when they’re ready to die. Depends on the critter, I guess. Your Doggie knows you’ll probably miss him a lot, so he’s biding his time for when he thinks you can handle it better. (If indeed he is getting ready to depart….)

        1. Thanks, YR.

          I thought about him being a service dog and I am the one he takes care of.

          He hasn’t eaten or moved all that much, but he genuinely looks up at me and links eyes every 2 or 3 minutes and I realized that he probably looked at me all day at work, but I wasn’t paying the same attention.

          He is going to make sure that I am okay.

          1. He is not eating or moving but he never stops smiling. I got some good photos.

            I don’t understand if he is going to die or not.

  14. I was a huge fan of Dr. Greger’s. I learned so much from him so I trusted his opinion on vaccines. Then I started to do some real research on the subject. The facts are almost unfathomable. I started listening to the independent scientists, doctors, journalists, lawyers, and most importantly the parents who are all desperately trying to sound the alarm about the harms caused by vaccines. These people are the brave ones who have risked (and often lost) their reputations, careers, and financial security to speak the truth. I’d love nothing more than to see Dr. Greger finally look into this issue, dig up the facts, and speak out.

    1. Okay, can you list specifics of who you are following and what specific harms you are talking about?

      That issue is quite complex on the internet and we have to look at specifics.

      1. Thanks, YR.

        I read it and what I know is that there are all of these conditions and nobody knows what is causing them and vaccinations are one of the things people point to.

        I have people with autism in my life and one mother has other young children and was worried about vaccinations and autism, but Dr. Greger has covered that and there wasn’t a correlation.

        Autism, if I remember right, when they looked at the studies and tested for the mercury in the vaccinations in children, mostly there was no correlation with autism and in 3 studies the correlation with the mercury from the vaccinations was protective, one study there was a correlation, but every other study there wasn’t or it was protective and that makes it highly likely to not be it.

        https://nutritionfacts.org/video/the-role-of-pesticides-and-pollution-in-autism/

        RoundUp was MIT’s theory if I remember right. Glutamate, I think.

        I could have Glutamate on the brain, but it is involved in so much brain damage and I have brain damage and look up things like that.

        1. Okay, we can cross autism off the list.

          I will look up a few other things, like ADHD.

          I feel like those two are overdiagnosed, but that might be the people around me.

          1. Allergies, eczema, so far, I found a study from Australia where there was no association and a study from France where the people who were vaccinated were LESS likely to have

            “Vaccinated adolescents were significantly less likely to have asthma, allergic rhinitis, and eczema than those who were not vaccinated.”

            I will try to go condition after condition, but mostly, it is that kids have these conditions and the parents and scientists are trying to figure out if it is RoundUp or Vaccinations or what is going on, and that part needs to be handled with care.

            Parents are so emotionally frustrated and don’t feel like their children are safe.

            I know that pet owners go through the same thing. With that, what I will say is that the fact that the cancer rates in dogs decrease by 90% if the dogs are given vegetables, it would not be vaccinations causing dog cancer.

            1. I read a whole lot more allergy and asthma studies and most of them were not correlated, but there were a few where delaying the vaccinations may have helped with asthma and hay fever, but they weren’t sure because sometimes the parents are delaying because of health conditions in the first place.

              I looked at Type 1 Diabetes and found a study where:

              “The study evaluated 739,694 children for 4,720,517 person years of follow-up. Overall, 681 cases of type 1 diabetes were identified from the Danish National Hospital Register, 26 of whom (4,208 person years) had a sibling with type 1 diabetes. This study found no association between childhood vaccination and the development of type 1 diabetes, even among children who had a sibling with diabetes.”

              1. I looked up epilepsy and found a Denmark study where they said,

                “It is not clear why the immunized children had a decreased risk of epilepsy. This may have been due to unmeasured confounding factors, as the investigators did not address whether children with a high risk of developing febrile seizures or epilepsy (such as children with preexisting neurological disorders) were less likely to have been vaccinated.”

                  1. I wouldn’t suggest getting into the rabbit hole of VAERS. While I am the one who brought up the question on vaccines, the issue with VAERS is that there isn’t much control as to what gets in there and if you read through it I think it will start creating a bias which will be hard to overcome.

                    Good work on the other research you found. I would just like to offer one piece of advice. Don’t rely on just conclusions, try to take a look at the design of the study. While we are not researchers, it can sometimes be clear that some studies are better designed than others. When discussing a hot topic like this you want to be sure you use the best data available. Quality over quantity.

                    1. Sal,

                      Thanks for the encouragement.

                      You have given good wisdom.

                      Yes, I know that we shouldn’t rely on conclusions alone, but that is where we have to start the process. I also agree with the quality over quantity, though when you go to PubMed, they don’t arrange it in a quality over quantity way and it is a genuinely big process, so first, I feel like I just look for any studies showing a strong correlation, and that isn’t easy to find. Or, if it really was causal of some of these things like autism, I would think it would show up much more as a red flag world-wide, and, so far, I don’t see it.

                      I feel like I want the people who are afraid to have a discussion. I want to hear their evidence. I want to listen to them and look things up with them, because I know that the parents of autistic children often have heard that it was from vaccinations and vaccinations were on the “list” of potential things, which lined up with the change in the rate of autism after 1989, so I understand the very real fear.

                      I really want the parents to feel safe discussing this because there are so many fear-mongering sites on the topic and some of the logic was before studies started really examining it, so it was a good idea to look at them.

                      This year, in my state, children died from not being vaccinated and their conditions were contagious and other children died.

                      My heart utterly broke for the parents because I know that they were trying to save their children from danger and their children died and they were under the hot seat for not vaccinating.

                    2. I have tried to unsubscribe from this and it won’t allow me. Please unsubscribe me from these notifications immediately.

                      Thank You.

    2. Dr Greger looks at what the sceince shows eg studies like these

      ‘We identified 1702 potentially eligible articles for this systematic review and meta-analysis, and included 65 articles in 14 high-income countries: 23 for HPV infection, 29 for anogenital warts, and 13 for CIN2+. After 5–8 years of vaccination, the prevalence of HPV 16 and 18 decreased significantly by 83% (RR 0·17, 95% CI 0·11–0·25) among girls aged 13–19 years, and decreased significantly by 66% (RR 0·34, 95% CI 0·23–0·49) among women aged 20–24 years. The prevalence of HPV 31, 33, and 45 decreased significantly by 54% (RR 0·46, 95% CI 0·33–0·66) among girls aged 13–19 years. Anogenital wart diagnoses decreased significantly by 67% (RR 0·33, 95% CI 0·24–0·46) among girls aged 15–19 years, decreased significantly by 54% (RR 0·46, 95% CI 0.36–0.60) among women aged 20–24 years, and decreased significantly by 31% (RR 0·69, 95% CI 0·53–0·89) among women aged 25–29 years. Among boys aged 15–19 years anogenital wart diagnoses decreased significantly by 48% (RR 0·52, 95% CI 0·37–0·75) and among men aged 20–24 years they decreased significantly by 32% (RR 0·68, 95% CI 0·47–0·98). After 5–9 years of vaccination, CIN2+ decreased significantly by 51% (RR 0·49, 95% CI 0·42–0·58) among screened girls aged 15–19 years and decreased significantly by 31% (RR 0·69, 95% CI 0·57–0·84) among women aged 20–24 years.
      Interpretation
      This updated systematic review and meta-analysis includes data from 60 million individuals and up to 8 years of post-vaccination follow-up. Our results show compelling evidence of the substantial impact of HPV vaccination programmes on HPV infections and CIN2+ among girls and women, and on anogenital warts diagnoses among girls, women, boys, and men. Additionally, programmes with multi-cohort vaccination and high vaccination coverage had a greater direct impact and herd effects.’
      https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(19)30298-3/fulltext

      He places less credence on unsubstantiated claims made by highly opinionated people. As for seizures in some children following vaccination, this si well known and has been studied …. just like the autism clIMS MADE BY ANTI-VAXXERS.

      https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4657773/

  15. I realized today about glutamate being lowered by turmeric that I was thinking how do you get it in the brain of stroke victims and diffusion working means you don’t have to, right?

    Does turmeric essential oil have the same benefits as turmeric?

    If a relative has a stroke, could they put turmeric essential oil under their tongue?

    1. Tonight, I was looking up the other foods like blueberries, ginger, and propolis which are protective against damage from a glutamate storm and there was a study that B-vitamins and choline reduce glutamate damage and immediately, I searched for homocysteine and homocysteine increases glutamate cytotoxicity.

      So if you can fix glutamate the exact same way you fix homocysteine, then is homocysteine going to be the thing to look at. Further upstream in the process?

      Or is glutamate ever raised without homocysteine?

      Does stroke raise both? Or only sometimes maybe when homocysteine was part of the problem?

      1. I just looked it up and high homocysteine is linked to a much higher stroke risk, so sublingual B Vitamins might be good to have in the medicine cabinet if your loved one has a stroke.

        1. If the B Vitamins work, I am going to hypothesize that when Homocysteine was a risk factor, maybe glutamate damage would be higher lasting longer if they don’t ALsO deal with Homocysteine. If Homocysteine raises it, leaving Homocysteine elevated could be why the storm lasts for days or something like that?

        2. Deb

          I don’t think that anybody knows for sure if high homocysteine levels are a causal factor for stroke or a simply a marker or indicator of stroke risk.

          Certainly trials of B vitamins etc to lower homocysteine levels and thereby stroke risk have at best been inconclusive. They have lowered homocsteine levels but not stroke incidence, I believe.

          Mendelian randomisation analysis suggests that it may be affecting risk in one small subtype of stroke but not the others. It also found that ‘Genetically higher vitamin B12 levels were not associated with any stroke subtype.’
          https://onlinelibrary.wiley.com/doi/full/10.1002/ana.25440

  16. Lame gender pay gap argument. Men probably get more drug company money because more male doctors involved in the research trials. And of course it can be many other reasons besides “women doctors were more ethical or less corrupt.” I practiced medical malpractice law on both sides for years and I can Tell you there are plenty of unethical or incompetent female doctors as well.

    Cmon. Also, while there are clearly conflicts of interest, many drugs do work. Creator works better in low doses than any vegan diet- even though I subscribe to a vegan diet, it barely lowered my weight or cholesterol. We know statins drop LDL overnight and it’s just a question of dosage.

    Biologics meds for inflammatory bowel disease and rheumatoid arthritis work far better than diet, though with some work, diet can sometimes help with IBD.

    1. It’s possible that more female doctors than male pay doctors work part-time and this could explain the ‘pay gap’.

  17. Thank for your informative articles especially this one. For many years I pleaded this case to fellow nurses and to medics and others in the mental health services where I worked. I watched too many patients get worse in the long term on psychiatric drugs with dubious evidence, prescribed unequivocally by consultants who were receiving money and other supports to fund research studies and ultimately academic papers in prestigious journals. It made me sad and angry, now I feel uplifted that so much work is being done to follow truth rather than greed. I guess you know of Drs Joanna Moncrieff and Duncan Double to name a few, also professor Ivor Browne, whose courage under fire gives me great hope for the future, as do you sir, deep bow and many thanks.

  18. I have tried to unsubscribe from comments on this post but wasn’t able to from my emails or didn’t know how, so I am adding this comment to try to activate the unsubscribe button below.

  19. This piece states that other countries are looking to the US for ethics re gifts from drug companies. The UK has APBI rules-we are not even allowed to take a pen from a drug company and if we are supported for a conference, we must apply for the money aNd supply receipts. Hotels we stay at cannot say ha e ‘luxury’ in their title and alcohol can only be given with an educational dinner (no cocktails!). This has been the case for years

  20. Why aren’t there diet and lifestyle marketing representatives visiting GPs? Set up a non-profit to get volunteers to do it. That might keep costs low.

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