709: John Abramson | How Big Pharma Broke American Health Care

709: John Abramson | How Big Pharma Broke American Health Care

[00:00:00] Jordan Harbinger: Coming up next on The Jordan Harbinger Show.

[00:00:03] John Abramson: Here's the problem, Jordan, the drug companies have paid for the research. The drug companies have analyzed the research. The drug companies have written up most of the research. These written-up manuscripts that are brief summaries of the whole study are then submitted to journals for publication. When they're submitted to journals and the peer reviewers and the medical journal editors look at these manuscripts, they don't get to see the underlying data. I can't say that anymore clearly.

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[00:01:30] Today, Dr. John Abramson, he's a family physician on the faculty of Harvard Medical School for the past 16 years. But interestingly, he consults as an expert in litigation involving the pharmaceutical industry and has served as an unpaid consultant to the FBI and the Department of Justice. And that is kind of where we're going with the show today.

[00:01:47] It's hard to remember sometimes that the purpose of healthcare companies is to make money for their shareholders, not to actually make us more healthy. I think we're starting to come to that realization now with the opioid crisis and some of the stuff we've seen around, well, pretty much every healthcare decision, especially here in the United States or policy, anyway. The goal, of course, is to live long and healthy, not to invest so much in fake innovation that we can't afford to do anything else, which is what our country seems to be doing now.

[00:02:15] Dr. Abramson and I are going to discuss why this trend appeared and how things continue to shift away from making us live longer, healthier lives. And now that we're talking about all this, it does seem really, really easy to see why Purdue pharmaceuticals and OxyContin were sold as this cure-all, that was non-addictive. And it took us so freaking long to get the memo because it's so easy to make up a bunch of BS and hide the ball if you're a drug company with a ton of money. And that's what we're going to be exploring here today. It's a pretty scary episode, but I think it's important to open people's eyes to the sort of, well, corruption and bad policy. That's led America to have one of the most costly healthcare systems in the world while providing some of the worst outcomes of any developed nation on the planet.

[00:03:00] Now, here we go with Dr. John Abramson.

[00:03:06] It looks like our life expectancy is going down, especially in comparison to other, let's say, developed countries. But our health consumption expenditure, as a percent of GDP, so the amount we spend on healthcare, is going up much higher than other countries. I'm no statistician, okay, but the graphs appear to show that the more we spend on healthcare as a country, the shorter our lives are, or the faster we seem to die, especially in relation to other countries.

[00:03:35] John Abramson: Yeah. It's in relation to other countries, you have to be careful about that. And from 2014 on, we've not improved. So when Obamacare came on board and 40 percent of uninsured Americans became insured, age-adjusted mortality did not improve while the other countries continued to improve.

[00:03:55] Jordan Harbinger: Yeah. That doesn't make any sense, right? I guess it must make sense somehow. It just doesn't make sense if you're looking at it like, well, more people have healthcare, shouldn't more people be healthy and getting their health issues taken care of?

[00:04:05] John Abramson: Correct. So I think it's a very powerful testimony of the fact that our healthcare system is not as well oriented towards producing health as the healthcare systems of the other wealthy countries.

[00:04:19] Jordan Harbinger: And that's disturbing because we spend what like a trillion dollars or something on healthcare every year. I mean, it's a ton. You must have those figures actually. How much is it?

[00:04:28] John Abramson: Yes. Well, no, we're spending about four trillion a year in healthcare, but we're spending—

[00:04:31] Jordan Harbinger: Oh, wow.

[00:04:32] John Abramson: —about 1.6 trillion extra compared to the other countries.

[00:04:37] Jordan Harbinger: Wow.

[00:04:37] John Abramson: So that's 1.6 trillion, that's like 10-year Building Back Better Plan. Every year we are spending in excess while our death rate continues to get worse than the other comparable countries that are spending the equivalent of 1.6 trillion less.

[00:04:54] Jordan Harbinger: So not only is our quality of healthcare bad, but it looks like we're falling behind at a faster and faster rate, which is also sort of mildly terrifying. Like we're not catching up, it's getting worse.

[00:05:05] John Abramson: You could say, oh, well that's all pre-COVID, but we jumped on the vaccines and we were good. Prior to the pandemic starting Americans lived 3.3 years less than the citizens of 19 other wealthy countries. And in those two years of the pandemic, 2020, 2021, that 3.3 years less grew to 5.3 years less.

[00:05:29] Jordan Harbinger: So our life expectancy is, I guess, you would say shrinking in comparison to other countries or possibly, actually just shrinking.

[00:05:36] John Abramson: Both.

[00:05:36] Jordan Harbinger: Not good.

[00:05:37] John Abramson: Not good. That's the summary. That's the summary.

[00:05:39] Jordan Harbinger: The summary is we're dying faster and spending more to do it. And it's not just a little bit faster. It's a lot faster. And it's also spending a lot more, not just a little bit more. Am I close?

[00:05:50] John Abramson: That's absolutely correct. And that is the introduction of the conversation about why is this happening. How could this possibly be happening?

[00:05:58] Jordan Harbinger: So I don't want to draw a causal relationship that's not there by bringing this up now, but I'm going to bring this up now anyway. We're one of, I think, two countries in the world that allows pharmaceutical companies to advertise. And the other one is New Zealand, right?

[00:06:13] John Abramson: Right.

[00:06:13] Jordan Harbinger: But New Zealand seems to have a ton of oversight when it comes to this. Whereas we're just kind of like, "Hey, put whatever the hell you want on TV."

[00:06:20] John Abramson: That's exactly right. And more important than the oversight of the advertising. New Zealand has an active pharmaceutical, national pharmaceutical plan that provides oversight to ensure that their doctors are prescribing the most effective and efficient drugs. And we're among the only, perhaps the only wealthy country that doesn't have that kind of oversight. And that's a key problem. It's called health technology assessment, where you have an independent governmental or quasi-governmental body that assesses all the available data and compares new therapies to previously available therapies and makes recommendations for doctors and coverage and so forth about the rational use of drugs. We don't do that.

[00:07:07] So our wild west mentality of allowing however much direct-to-consumer advertising you want and letting the drug companies charge three and a half times more for brand name drugs than the citizens of other OECD countries. We have this system where we are enormously rewarding, aggressive marketing of drugs that are no better than previously available drugs. Whereas the other countries are evaluating the effectiveness and the cost of the new drugs so that they spend their money rationally.

[00:07:42] So New Zealand and the US are the only two countries that allow direct-to-consumer advertising. We have by far the highest drug spending per capita. New Zealand has the lowest drug spending per capita. So you certainly can't draw a causal relationship just based on whether direct-to-consumer advertising is allowed or not. It's the context into which it's allowed that makes the difference.

[00:08:06] Jordan Harbinger: This seems like one of those things that once the money is in the system, it's just super freaking hard to take it out of the system. And I don't just mean the ad dollars on television, but the fact that they are able to spend so much money on national advertising campaigns. I mean, I know what a national ad campaign costs just on this podcast. So when you're running ads for, we were joking around, pre-show like bladder drugs for men when you're running those 50 times an hour on news channels that are national. This is hundreds of millions of dollars in advertising, if not billions.

[00:08:40] John Abramson: But again, we need to expand this because we're talking about marketing as advertising.

[00:08:45] Jordan Harbinger: Right.

[00:08:46] John Abramson: But we've got to think about the drug company marketing as everything from deciding their research agenda, deciding how they're going to set up studies, who's going to control the analysis of the studies. Publications in medical journals are treated as if their marketing material by the drug companies, not by the doctors. The doctors think that's evidence-based medicine. And if it's peer reviewed, that means that it's accurate, and that should guide their practicing. The doctors do not understand that the peer reviewers don't have access to the data from the clinical trials. 86 percent of which are sponsored by the drug companies. The drug companies have one primary mission — we've got to remember this — their mission is to maximize their profits and deliver those profits to the shareholders and investors. That's their job. It's not to make us healthier. It's not to improve the quality of our lives. It's to maximize the financial returns to their investors. And they do it very well.

[00:09:47] Jordan Harbinger: The advertising on TV people probably would say, "Well, what about cigarettes and alcohol? You can't advertise those on TV and I looked this up, because I was like, oh yeah, you know, as a lawyer, I'm like, why is that? Well, one it's free speech. You can sort of advertise almost anything you want, but they banned alcohol and cigarettes saying there's absolutely no — these are vices, right? There's no therapeutic benefit from it. No one's going to argue, well, at least not now. Finally, no one's going to argue that these things have any other benefit other than it's something that you shouldn't do but that humans like because of the way our brains are wired. Whereas these drugs, they argue, "Hey look, these have therapeutic benefits. You can't block us from advertising. It's a breach of our civil rights, essentially, our right to free speech." I get that argument, you know, from a legal perspective. But man, is that a slippery slope?

[00:10:36] John Abramson: I agree with your analysis. I'm not a lawyer, but my understanding from good lawyers is exactly what you say. And furthermore that the United States Constitution is different than the constitutions in other countries. And that probably the right to advertise drugs is by a reasonable analysis baked into our constitution.

[00:10:57] I can accept that. But the FDA pretends it's overseeing the information that's delivered in those advertisements, by making sure the ads conform with certain regulations. What they're not doing is making sure that they leave viewers with an accurate impression of the benefit they'll derive from the drug, how many people have to be treated for one to improve whether lifestyle modification will do as well or better than the drug and how much the drug actually costs, not just the copay, which they're very happy to tell you is very low, but the total cost of the drug. So that you'll know what the impact of your use of that drug is going to be on all of our insurance premiums and taxes in the future. The regulations for the advertisements could easily be drawn up to say, okay, we're stuck with this. I mean, I think you and I would agree that we'd be better off without it, but we're stuck with it.

[00:11:55] For example, Humira was the most advertised drug for many years.

[00:11:59] Jordan Harbinger: What does that one do?

[00:12:00] John Abramson: It's primarily for rheumatoid arthritis, but it has eight other indications.

[00:12:04] Jordan Harbinger: Okay.

[00:12:04] John Abramson: It decreases the level of inflammation in the. And it's very expensive. It costs like $70,000 a year.

[00:12:10] Jordan Harbinger: Whoa.

[00:12:11] John Abramson: It used to be very inexpensive, like only $20,000 a year, but they became the biggest advertiser and they raised their prices year by year, as their advertising became more successful. So it's been for many years, the best-selling drug in the United States and in the world. Now, it's replaced by the COVID vaccines, but the primary use of Humira at least originally was for rheumatoid arthritis. And that's the way most people know it. And it's advertised for rheumatoid arthritis.

[00:12:38] Now, if you look at the first-line drug therapy for rheumatoid arthritis, there's one chart in the FDA label that actually compares Humira alone to methotrexate alone, an older anti-inflammatory drug. And what it shows is that despite the fact that Humira costs about $72,000 a year and methotrexate costs about $480 a year, and they seem to have the same number of side effects. That methotrexate is not inferior. In fact, it is slightly better, not statistically significantly better, but slightly better than Humira.

[00:13:15] Jordan Harbinger: The idea that there's something that can be so much more cost-effective and do the same thing, or maybe be better at doing that same thing, it's what the conspiracy folks say about a lot of drugs, man. You know, I'm not going to lie. It's like, this is where the rubber meets the road. And we think, well, wait a minute, maybe these companies are being a little bit misleading and try just doing it to try and make money.

[00:13:37] And I know from your book that, that there's a lot of that. And now I'm not just talking about the voiceovers on the ads, right? Where people are dancing with their grandkids and having fun while the voiceover guy talks about how it might kill you in a hundred different ways and it makes you suicidal. I mean, this is actually almost like they're innovating for the purpose of just having something new that they can charge more money for.

[00:13:57] John Abramson: Let's stop there. Innovation is used by biotech to imply that we are providing more effective healthcare all the time, that is leading to better health for Americans. That's not what innovation means. Innovation means it's a business concept and it means that currently used products are replaced with more expensive products and more profitable products. And we've got to get over this notion that somehow we know pharmaceutical companies are greedy and sometimes they lie, but they really can't really be fundamentally just interested in their own money. And that's what we've got to get over. That's their job. That's what they do. They do it, they are world class.

[00:14:41] And until we Americans are willing to be honest about this simple fact, we're not going to try to put guardrails back on this system that the United States is unique in not having. Guardrails that mean that the drug companies have to tell the truth and that they subject their data to independent analysis. So doctors can know what the best therapies are. They don't do that and they fight tooth and nail against it. And as you were saying, the wealthier they get, and they're pretty damn wealthy right now, the more money they have to fight anything that's going to threaten their profits.

[00:15:17] Jordan Harbinger: Right. Because they can throw money into lobbying. Imagine that spend.

[00:15:22] John Abramson: Yeah. And it's bipartisan. I was looking at the 2020 election cycle drug spending and eight out of the 10 recipients were Democrats.

[00:15:31] Jordan Harbinger: Yeah. I want to want to point to one side, but I think it is important to say both because it's really easy for people on one side of the aisle to say, well, it's the other guys doing that.

[00:15:38] John Abramson: Right. And it's a political theater that is dedicated to not accomplishing meaningful reform.

[00:15:44] Jordan Harbinger: I want to highlight something though. Most doctors are just trying to be good doctors, but is it that they're naive to the power and nonsense that drug companies pull, or what? because it seems like drug companies have essentially just hijacked evidence-based medicine.

[00:15:58] John Abramson: Drug companies have hijacked evidence-based medicine. Almost all the doctors are trying to do their best for their patients and are sincerely committed to their life mission of helping their patients to live the healthiest lives they can. I've been on the hot seat. I was a family doc in private practice for 20 years. I know how the medical community works. Almost everyone's trying to do the right. But the problem is that they're being fed bad information. And it's so deep that when you say, and you're correct, I'm not being critical of what you're saying, but when you say aren't most doctors committed to practicing evidence-based medicine.

[00:16:34] Well, the definition of evidence-based medicine is that they're reading their journals, the peer review journals, and they're looking at the quality of the trials. They got a little bit of knowledge about research techniques and so forth. And the trials look like they're high quality and they're peer reviewed. And so you can read those and you can integrate that and you prescribing habits. And then you look at the guidelines that are published by experts. And those become fairly clear-cut about how you should practice medicine. And that good doctors we say are practicing evidence-based medicine because they follow both of those sources of information.

[00:17:13] Here's the problem, Jordan, the drug companies have paid for the research. The drug companies have analyzed the research. The drug companies have written up most of the research. These written-up manuscripts that are brief summaries of the whole study are then submitted to journals for publication. When they're submitted to journals and the peer reviewers and the medical journal editors look at these manuscripts, they don't get to see the underlying data.

[00:17:40] Jordan Harbinger: They don't get to see the data?

[00:17:41] John Abramson: They don't get to see the data. I can't say that anymore clearly.

[00:17:45] Jordan Harbinger: I'm highlighting that because it sounds like the drug company pays for research. Their people do the research, they own all the data. And then they say, "Here's our conclusion." And the peer reviewer goes, "Yep, looks good." And then puts it in a journal. I mean, there's got to be a little more to it, but that's what it sounds like you're telling me right now.

[00:18:01] John Abramson: That's pretty much it. And then what happens because the evidence-based medicine movement has moved along because initially, they said all docs should learn how to read journals and should know research techniques and analysis, and should make the decisions for themselves. But there's so much information that doctors can't possibly do that. And you need at least a master's in public health to do it anyway. So the evidence-based medicine people said, "Okay, well, we see that this is too much of a burden for practicing physicians. And we'll just get them the good guidelines and we'll let them follow the guidelines." Because the guidelines will have done that work for them and they can just follow the guidelines. That's a good system. But the problem is that the guidelines are compendium of the studies that have been published that have not been peer reviewed. And the people who write the guidelines don't have access to the underlying data.

[00:18:51] Jordan Harbinger: I just can't believe — I mean, I believe you, right? But I just can't, I'm in shock that they can't look at the data. So if you want to challenge something, you just can't, and it's so easy to mess around with this and hide the ball because you don't have the data. No one can say, "Hey, you analyzed this wrong," because they just have no basis to do that.

[00:19:08] John Abramson: Correct. Now, occasionally a really good peer reviewer or a really good medical journal editor will say, "Hey, that's not clear. Will you send me some data to back that up or something?" So it's not that that can't happen in private communication but it doesn't happen in the real world.

[00:19:27] Jordan Harbinger: You're listening to The Jordan Harbinger Show with our guest, Dr. John Abramson. We'll be right.

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[00:23:02] Now back to Dr. John Abrams.

[00:23:07] The temptation then is for these companies and I'm not accusing anyone of anything, but the temptation certainly would be to manipulate the data, to get the conclusion that you want for a new drug that you just spend a billion dollars creating.

[00:23:18] John Abramson: That's exactly right. You're a lawyer?

[00:23:21] Jordan Harbinger: Yeah.

[00:23:21] John Abramson: I spent 10 years in litigation as an expert witness.

[00:23:24] Jordan Harbinger: Mm-hmm.

[00:23:25] John Abramson: I've seen what's in the corporate computers. There's usually about 20 million documents per case in litigation.

[00:23:32] Jordan Harbinger: Literally, huh?

[00:23:33] John Abramson: Yeah, literally.

[00:23:33] Jordan Harbinger: Yeah.

[00:23:34] John Abramson: And I could query anything about those 20 million documents. It's like a kid in a toy shop. So I could ask any question of the data and, you know, the lawyer geeks, who've got the spreadsheets and the database all set will give me the documents. And if it gets too complicated for me as a family doc who did two years of a research fellowship, the lawyers hire PhD, statisticians, and epidemiologists, and so forth to work with.

[00:24:04] Jordan Harbinger: Wow.

[00:24:04] John Abramson: So I know what's in the data and I can tell you that it often doesn't represent what's going on. For example, I was in civil litigation with a drug called Bextra. It was like Vioxx, it's an anti-inflammatory drug that really provided no better pain relief and supposedly was gentler on the stomach, but that's a dubious claim. And there was a little bit of a cardiovascular issue. So I was in the civil litigation that came after Vioxx litigation. I was in that too, but the Bextra litigation was after. It was much smaller. There were 8,000 plaintiffs who alleged cardiovascular injury due to Bextra in that litigation.

[00:24:43] Jordan Harbinger: You said a little bit of a cardio — I don't mean to laugh at this. A little bit of a cardiovascular issue sounds like, is there such thing as a little bit of a cardio? Like there's a little problem with your heart, nothing to worry about, except for that it might kill you.

[00:24:54] John Abramson: No, there's no such thing as a little bit of heart problem, but there is such a thing as an expert signing a protective order and not being able to talk about what he knows.

[00:25:03] Jordan Harbinger: Got it. Okay, understood.

[00:25:05] John Abramson: Okay. So I did the civil litigation and the case settled the award to the 8,000 plaintiffs was settled and it's secret, and nobody can talk about it. And I don't know what it was, though I know what the parameters of these kinds of settlements are. But I felt that the company had not behaved in a way that represented scientific values, that honored scientific values. That was my feeling. And I got in touch with the department of justice to share that feeling without sharing any confidential information. And one thing led to another and they soon sent me a federal subpoena. Like the January 6th—

[00:25:46] Jordan Harbinger: Mm-hmm.

[00:25:47] John Abramson: —committee is sending out federal, I mean, it's a big deal. You know, a guy drives up in the car and says, "You must appear at the FBI headquarters and the Department of Justice will be there and you must bring your computer and so forth." So I go, and as an expert in civil litigation, I had spent a lot of time figuring out what I thought had happened and wrote a report about what I thought had happened. And I shared all that information and the FBI folks who were there and the DOJ folks that were there were incredibly impressive people. Many of them knew a lot about this case. They were thinking hard. They were questioning me as hard. They were pushing me as hard as a good defense attorney pushes me in deposition to kind of, you know, kick my tires and make sure that I knew what I was talking about. They did a good job. And they keep their cards very close to their chest.

[00:26:37] Jordan Harbinger: Sure.

[00:26:37] John Abramson: I didn't hear any followup.

[00:26:38] Jordan Harbinger: Yeah. The FBI's not going to keep you posted on their investigation generally.

[00:26:41] John Abramson: Yeah, exactly. Exactly. So six months later I read in the paper that Pfizer had been slapped with the largest criminal fine in US history for what they had done with Bextra.

[00:26:52] Jordan Harbinger: Wow.

[00:26:53] John Abramson: A 1.195 billion.

[00:26:56] Jordan Harbinger: Wow. But unfortunately, that's like, they can shock that up to the cost of doing business. I would assume at some point.

[00:27:02] John Abramson: Uh, that one's close and Vioxx was close, but nobody went to jail. Nobody—

[00:27:07] Jordan Harbinger: Yeah.

[00:27:07] John Abramson: They didn't lose money. So even when they blow it completely, except maybe for the Sacklers though, that's not over yet. But even when they blow it completely with a disaster, like Vioxx that killed 40,000 to 60,000 Americans even then—

[00:27:22] Jordan Harbinger: Wow.

[00:27:23] John Abramson: —they break even. Nobody went to jail about that.

[00:27:26] Jordan Harbinger: 40,000 to 60,000, let's talk about that for a second. I mean, how many people died in—?

[00:27:29] John Abramson: Yeah, that's a little bit of cardiovascular.

[00:27:31] Jordan Harbinger: That's some cardiovascular trouble. Isn't that more — how many people died in Vietnam? Do you happen to know?

[00:27:35] John Abramson: Vietnam is 58,000.

[00:27:36] Jordan Harbinger: Yeah.

[00:27:37] John Abramson: So it's that level of magnitude.

[00:27:39] Jordan Harbinger: Unbelievable.

[00:27:40] John Abramson: Yes.

[00:27:41] Jordan Harbinger: How does something like that happen? That's so massive in scale. That's not like 13 plaintiffs that suffered a rare condition that should have been caught or like 150 plaintiffs that suffered from something that was sort of rare. I mean, this is a humongous number of people. That's like the number of people that would get prescribed a drug for something and they died. Like this drug must have been everywhere and it must have killed a very significant number of its users.

[00:28:07] John Abramson: Maybe not because 25 million Americans used it. It was the most heavily advertised drug.

[00:28:12] Jordan Harbinger: Still though, 60,000 is not, I mean, that's not—

[00:28:15] John Abramson: It's huge.

[00:28:15] Jordan Harbinger: It's a huge number of people.

[00:28:16] John Abramson: It's huge. We spend gazillions of dollars prescribing drugs that have nowhere near the benefit that Vioxx caused harm. Now let me make a shameless plug and say, this story is in chapter one of my book.

[00:28:28] Jordan Harbinger: Yeah.

[00:28:29] John Abramson: This is where I opened the book. And you say, how did it happen?

[00:28:32] Jordan Harbinger: Mm-hmm.

[00:28:32] John Abramson: And I'll tell you how it happened. Merck developed this drug, Vioxx that they hoped would cause fewer GI symptoms and provide the same equal relief for arthritis and pain as less expensive anti-inflammatory drugs, ibuprofen and naproxen, Aleve. So they hoped that would happen. They knew theoretically that it was possible that there would be an effect on the blood clotting system that could tip things towards clotting. They understood that. They ran this study called the VIGOR trial to see if Vioxx reduced the risk of serious GI complications, but they did follow the cardiovascular safety data, but they did a little trick. They stopped collecting cardiovascular events a month before the trial ended. So that the number of excess heart attacks that were caused by Vioxx were reported in the New England Journal, which had peer reviewed the article, but didn't have the data and the medical editors, the journal editors didn't have the data they reported in the New England Journal of Medicine that Vioxx did not significantly increase the risk of heart attacks. They reported that.

[00:29:47] Three months after they reported it, the FDA's analysis of the data from Merck was published. There was an advisory committee meeting and this data became available on the web. It was really hard to find, but you could find it if you knew it was there. So I went at it and I found that the FDA knew that there were three heart attacks that occurred during the scheduled duration of the study that hadn't been reported. They knew that. And not only that, Merck had reported heart attack, but the endpoint wasn't just heart attacks. It was heart attack, strokes, and blood clots because those are all related to blood clotting and you get more events so you can find trouble earlier. And it turned out that in the FDA's analysis of that study that was published in the New England Journal of Medicine, it showed that the risk of serious heart attack, strokes, and blood clots more than doubled in the group that was treated with Vioxx, more than doubled.

[00:30:42] So the New England Journal editors now knew that that was the fact. That they had been bamboozled. I don't think they were in on conspiracy. I think they were just straight bamboozled.

[00:30:51] Jordan Harbinger: Yeah. They were just duped. Yeah.

[00:30:53] John Abramson: Yeah, yeah, yeah, because that's the way it goes. Remember I was saying sometimes they asked for more data, but it never happens.

[00:30:58] Jordan Harbinger: Mm-hmm.

[00:30:59] John Abramson: That was it never happens. So the New England Journal of Medicine editors find out about the FDA data. And they now know that they've published an article that doesn't even report the overall cardiovascular risk of Vioxx and that it doubled the risk of serious blood clotting events. The editors know that, but they continue to sell reprints of their article to Merck. They know that in early in 2001, and they continue to sell reprints right through 2004 until Vioxx was pulled.

[00:31:34] Jordan Harbinger: Wait. The journals sold the reprints knowing that this was not accurate, why? To generate revenue? No.

[00:31:40] John Abramson: Choose another answer.

[00:31:42] Jordan Harbinger: Yes.

[00:31:42] John Abramson: Yes.

[00:31:43] Jordan Harbinger: That's un—

[00:31:44] John Abramson: Yes.

[00:31:44] Jordan Harbinger: I'm trying to think of any sort of reasonable reason.

[00:31:47] John Abramson: No, no. And this was all unfolding — there's this guy, a wonderful guy named Richard Smith, who was editor-in-chief of the British Medical Journal for 13 years and had worked with the British Medical Journal 12 years before that he knew what was going on. And after he steps it down, he wrote an article in his blog and he said, "I finally understand what's going on." And this is part of your question about how the hell could journals publish peer reviewed articles when the peer reviewers don't have data. Richard Smith writes, "I finally understand what's going on. A significant portion of the most prestigious journals' income comes from the sale of reprints."

[00:32:24] So in 2005, maybe the last year when data was available, but The Lancet, which is almost as prestigious as the New England Journal, it's in the UK, so it's not quite as much of a presence here in the United States, but 41 percent of The Lancet's income came from reprint sales and the New England Journal and JAMA wouldn't release their data.

[00:32:46] Jordan Harbinger: Oh man.

[00:32:47] John Abramson: 41 percent.

[00:32:48] Jordan Harbinger: That is so insane. It's really shocking. Because look, we think, okay, it's an article, but this is like, you might as well be selling a drug that is contaminated because you're doing almost essentially the same thing.

[00:33:03] John Abramson: It's probably worse.

[00:33:03] Jordan Harbinger: It's worse. Yeah, it's worse actually because you're misleading doctors using it. Right? So you're actually industrializing it.

[00:33:08] John Abramson: And you know, it's actively harmful.

[00:33:11] Jordan Harbinger: Right. And instead of saying, "Hey, you know what, we can't do this." You're going, "Yeah. But our revenue might go down and then I might get asked to leave my position here." Is that it?

[00:33:20] John Abramson: Exactly, exactly.

[00:33:21] Jordan Harbinger: Unbelievable.

[00:33:22] John Abramson: Okay. But it's worse. It's worse because what happens is that there's essentially an editorial kickback system where the journals want to attract the articles that they can sell the most reprints of. So they want the drug companies to submit their commercially important articles to the big journals. And there's a real incentive for the journals, not to kick the tires too hard. You say, "Abramson, you are telling me such a crazy story—"

[00:33:54] Jordan Harbinger: Yeah.

[00:33:54] John Abramson: "—about the best medical journals in the world. Not requiring their peer reviewers to have data and knowing that it's going on." And what I say to you is not only is it going on, but the fact that it's going on distorts the knowledge that is communicated between the journals and the doctors towards the kinds of information that will sell reprints.

[00:34:18] Jordan Harbinger: It's a vicious cycle, but it's worse. I'm trying to think of another term for this.

[00:34:21] John Abramson: A market failure is what I call it. That's chapter eight in the book. Yeah.

[00:34:25] Jordan Harbinger: Yeah.

[00:34:26] John Abramson: Just a straight market failure where the journals are in on it. The doctors' professional societies are in on it. The Academic Medical Centers are in on it. The academic researchers are in on it. The nonprofit organizations like the American Heart Association and the American Diabetes Association are in on it because they're taking funding from their nonprofit, but they're taking funding from the for-profit companies.

[00:34:48] So it's this entire nexus of market failure that is designed for each of the players to extract as much money as they can. And the public gets screwed and the doctors get screwed because they're getting bad information and they're trying to help their patients and be learned intermediaries. And they're trained not to understand that they are unlearned intermediaries.

[00:35:11] Jordan Harbinger: So you can trust your doctor. The problem is your doctor can't really trust the information that he's getting because it's all—

[00:35:16] John Abramson: No, the problem is your doctor does trust the information.

[00:35:18] Jordan Harbinger: Right. But he can't, he shouldn't.

[00:35:20] John Abramson: He shouldn't but he does. He's been taught to trust that he must trust the information that he will not or she will not be a good doctor if he or she does not trust that information.

[00:35:33] Jordan Harbinger: Right.

[00:35:33] John Abramson: And practice — this is where our conversation started — evidence-based medicine.

[00:35:37] Jordan Harbinger: Oh man. And for things like this Vioxx was 60,000 deaths, nobody goes to jail. Reminds me of when I worked on Wall Street in 2006, 2007, 2008, and where the investment banks, which were our clients, you know, they start going under and we thought, I remember this conversation in the office where I said, "Man, people are going to get locked up for this. We smelled something rotten in Denmark. Now, it's all coming down." And then they all got bonuses and retired, rich or switched jobs and went consulting. And I was like, "I got to get out of here. This is just rotten to the core." And unfortunately, it was a cue for other people to stay in or get in because they knew that was the signal that they were never going to get in trouble for their shenanigans.

[00:36:14] John Abramson: Right. I worked with the Wall Street Journal writers back in 2004. I published a book in 2004, Overdosed America, and a week after it was published, Vioxx was pulled off the market. Not because of what I said about Vioxx but because I had shown that it was a problem and that they couldn't deny it was a problem. So I became the man and I was all over TV and you could see how this was my kind of baptism by fire about how all this is happening.

[00:36:45] Jordan Harbinger: You mentioned at the top of the show, most studies are not done by academics anymore, but by drug companies, at least, I think you said something to that effect, right? And the academics, they don't get the results or the data that they do for the study. And I would imagine that even when drug companies bring in outside experts and then don't give them the data, they probably don't want to put up a stink, right? Because they don't want to go, "Well, if I argue and I try and say that I want the data and yada, yada, they're just not going to work with me anymore."

[00:37:10] John Abramson: That's exactly right. And we know what's happening. There's there are good articles that explain what's happening. So in 1991, 80 percent of the drug companies' clinical trials were done by Academic Medical Centers. The drug company would turn it over to the academic medical center, let them participate or completely design the study and the doses and find the patients and collect the numbers and do the analyses and write it up, 1991, 80 percent. That went down so fast into commercial hands that by 2004, only 26 percent of the drug company studies were being done by Academic Medical Centers. And the rest were being done by for-profit contract research organizations that were hired by the drug companies. So the Academic Medical Centers are now hurting because they've lost a lot of their income from clinical trials because it's gone to these contract research organizations, but they're still doing 26 percent of the studies in 2004.

[00:38:10] So there's this wonderful article that was published in the New England Journal to give the New England Journal credit, where credits due, they published this article that examines the terms of the contracts between the drug companies and the Academic Medical Centers on these 26 percent of studies that are still done by Academic Medical Centers. And they find that 80 percent of those contracts between the drug companies and the Academic Medical Centers, 80 percent of those contracts say that the drug company will own the data. And 50 percent of those contracts say that the drug company will write up and submit the results of the study for publication. It will be shown to the academic non-drug company, employed authors. It will be shown to them and they can suggest revisions, but that's all they can do.

[00:39:02] Jordan Harbinger: Oh my god. So we just have to take their word for it. I mean, this just absolutely begs for companies to manipulate or defraud the public. I mean, is it going too far to say that manipulation of data is almost — it's just a part of the business model? Is that going too far?

[00:39:17] John Abramson: No. And I mean, that's, that was my job in litigation was to get to that point, but the cases were always settled.

[00:39:24] Jordan Harbinger: Look, it seems like people joined drug companies and journals and medical schools and things like that in order to help other people. Sure, there are some business people that are out for profit only, but it seems bizarre to me that we have these companies that are founded and run by people that want to help others but then we have these disastrous outcomes.

[00:39:43] I did an episode with someone named Brian Klaas, where we talked about corrupt systems, corrupting people who joined these systems, right? Whether it's the police or the government in state, in India, or whatever. In other words, maybe the people at the top are motivated by profit. They're playing by different rules. And those rules actually end up changing the outcome that we see on the surface. Right? So if you join as a research scientist or a journal reviewer, but then the people at the top are like, "Yeah, yeah, yeah, but we're trying to make a billion dollars so I can get a hundred million bonus," that changes the whole system. And you sort of end up falling into that system. Because I'm trying to rationalize people going to work at these companies and thinking, "I want to help people who have myocarditis, you know, survive, because I've got all these skills and I'm going to research new drugs." And then it comes out that they just end up murdering 60,000 people through negligence or deliberate acts of misconduct.

[00:40:34] John Abramson: Well, those people don't. So the Wall Street Journal was writing about Vioxx and they were doing a very good job writing about Vioxx. And they got in touch with me because I had written the last book about it. They published an email from Merck's president of research. I believe it was president of research. I'm not a hundred percent sure. That he looked at the data first from that study that showed that there was more than a doubling of the incidence of serious cardiovascular events with Vioxx. He looked at that data on March 9th, 2000 when the study was finished and opened up. And he said, "It's a shame that the cardiovascular events are there. They appear to be a class effect, but the drugs will do well and we will do well. And we will do well."

[00:41:23] Jordan Harbinger: Uh, I mean, how do you—? There's only one way you can really interpret that one.

[00:41:28] John Abramson: Yeah. And he did not go to jail. He's a very prestigious scientist.

[00:41:32] Jordan Harbinger: Oh man. That's hard to hear. It's easy to go like, okay, they got these drug reps and they're using influence to get people to prescribe drugs. And it's not a bribe. It's a little more subtle, you know, great sales is not a crime, but it just, when you put all these things together, it just starts to become more and more obvious why so many well-meaning doctors prescribed so much freaking OxyContin, for example.

[00:41:55] John Abramson: Yeah. They're just trained to believe what the marketing people say. What happens is I have a diagram in the book and in the second chapter, which is the Neurontin litigation where I don't talk about excusing myself.

[00:42:07] Jordan Harbinger: Is that the Alzheimer's drug?

[00:42:08] John Abramson: No, no, no. It's an old drug. It's an older drug, but — I lost my train of thought here. I need the Alzheimer's drug. Okay, we showed a slide that showed how the drug companies developed key messages. So the marketing people do these groups, opinion groups, focus groups to find out what messages would get the consumers or the doctors to either want to use or want to prescribe the drug. They find that out independent of what the science shows.

[00:42:42] So we're not asking, "Does the science show that the drug does that?" We're saying, "What messages would improve our drug sales if we propagate those messages?" And then they show a nice chart where they have results from a clinical trial. And if they don't put their clinical trial results through a filter that only lets the key messages come out the other side, then they will develop discordance between what's published in the medical journals and what their marketing messages are, and that's bad for sales and they don't want that to happen. So the company, the medical communications company is teaching Pfizer, how to make sure their message is unified by running all the data through that filter first time around. That's what got the jury to find Pfizer guilty of fraud and racketeering violations.

[00:43:37] Jordan Harbinger: This is The Jordan Harbinger Show with our guest Dr. John Abramson. We'll be right back.

[00:43:42] This episode is sponsored in part by IPVanish. Do you browse online in incognito mode? Because you think you're being clever, you're protected from hackers, advertisers, and prying eyes. Not so. If you want to stay truly private and secure on the internet, you really need to get a VPN. And IPVanish is a VPN service that helps you safely browse the internet. It encrypts a hundred percent of your data, any private details like passwords, communications, browsing, history, and more is all going to be completely shielded from falling into the wrong hands. IPVanish makes you virtually invisible online. It's simple to use. Tap a button you're instantly protected. You won't even know it's on. I use IPVanish everywhere, especially at coffee shops and airports, oh, and hotels.

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[00:46:07] Jordan Harbinger: Thank you so much for supporting the show. Thank you for listening to the show. I hear from a lot of you all the time, really, really rewarding. The advertisers are the people that pay the bills, pay the salary for all the team that helps make the show here, and keeps the lights on in the studio. So if you really want to support the show, please do check out our deals page. That's where all of our discount codes are and all those deals from the sponsors, jordanharbinger.com/deals. You can also go to jordanharbinger.com, use that search box, search for any sponsor right there on the website as well. Please consider supporting those who support this show.

[00:46:39] Now for the rest of my conversation with Dr. John Abramson.

[00:46:44] And racketeering for people who are like, "Wait, I've heard of that?" Yes. That's what they use when they prosecute mafia gangsters, right? They use RICO—

[00:46:51] John Abramson: Correct.

[00:46:52] Jordan Harbinger: which is an anti-mafia statute that we have in the United States where damages are tripled.

[00:46:56] John Abramson: Exactly.

[00:46:56] Jordan Harbinger: And you can get people who are normally would be too tangential to a crime. You can nail those folks and get them to flip or put them in prison due to the RICO statute. And it's used — the design was let's take down the Italian mafia and we need different laws to do it.

[00:47:12] John Abramson: That's exactly right. In the Neurontin case with Pfizer, the entities that were involved in the RICO enterprise were, their work product was brought in. And the chart that I was just telling you about key messages, making sure that the clinical trial results were run through a filter of key messages. That company was in as part of the RICO enterprise but it wasn't, they didn't go after them. So they weren't named as RICO co-conspirators. It was just Pfizer that was named as the RICO conspirator.

[00:47:44] Jordan Harbinger: It's just insane though, like in the fine that they got, is it true that it was like less than a year of the profit they got from selling the drug they lied about?

[00:47:52] John Abramson: Yeah.

[00:47:52] Jordan Harbinger: This is basically like a true conspiracy theory. I'm not one of those guys, but when you look at things like this and they're using conspiracy statutes and racketeering statutes, like RICO to go after a drug company, it's really hard not to get my tin foil hat, I start folding up my tin foil hat.

[00:48:08] John Abramson: Well, let's separate it out. It's close to a conspiracy theory, but it's following the financial incentives. And the people around them, there is this nexus around them that is also following their financial incentives — the medical marketing company or academic researchers or the journal editors who aren't insisting upon complete transparency. They're following their economic benefit. So I would replace conspiracy, which sort of has—

[00:48:40] Jordan Harbinger: Yeah, it's got a stigma attached to it.

[00:48:42] John Abramson: Yeah, well, it's got stigma. Yeah, really, they need PR consult.

[00:48:46] Jordan Harbinger: Yeah, they need to rebrand that.

[00:48:47] John Abramson: But conspiracy sort of implies a nonsensical misinformation and this isn't nonsensical at all. This is just totally disciplined and purposeful.

[00:48:57] Jordan Harbinger: If I'm a doctor, how do I see through drug company nonsense and make better care recommendations for my patients? I mean, that's probably a whole show, but do you have some thoughts on that kind of thing? Because if I can't trust the medical journals that I'm supposed to read, what the hell else am I supposed to do? Do I have any other options?

[00:49:13] John Abramson: Well, yes, there are some options, but first we got to understand how bad it is. I mean, it's like a dentist drilling out of cavity if you don't get to the bottom. Let me just finish my story about—

[00:49:23] Jordan Harbinger: Sure.

[00:49:23] John Abramson: —clinical practice guidelines. So the docs are told to follow the clinical practice guidelines. And there's a lot of conflicts of interest amongst the people who are the chairs and vice chairs of the guideline panels and the worker bees and the guideline panels. And there's conflicts of interest with the sponsors of the guidelines, like the American Heart Association or the American Diabetes Association. They take money from drug companies. So there's a lot of conflicts of interest around.

[00:49:49] So the National Academy of Medicine used to be called the Institute of Medicine, got interested in this issue and they made guidelines for guidelines about conflicts of interest and the separation of money interests and academic interests. They didn't go after the data, but they made pretty good recommendations. So within the government, the agency for healthcare quality research, I think set up a national clearinghouse for guidelines. I think they set it up in 2017 and it was a very good site. 200,000 people were going there each month to get information about what the guidelines are for the particular issue that they're dealing with doctors and patients.

[00:50:28] And they made a rule that at the top of the webpage that would present a guideline, they would present an assessment of how much the guideline had complied with the guidelines from the Institute of Medicine, about financial conflicts of interest and independence and so forth.

[00:50:46] Jordan Harbinger: Okay.

[00:50:47] John Abramson: It was called how trustworthy the guideline was.

[00:50:49] Jordan Harbinger: Right. It's like a score—

[00:50:50] John Abramson: A score.

[00:50:51] Jordan Harbinger: —right?

[00:50:51] John Abramson: Yep. Yeah.

[00:50:51] Jordan Harbinger: Okay.

[00:50:52] John Abramson: So I believe that was implemented in 2017. In the middle of 2018, the website went dark. Zero funded, gone disappeared.

[00:51:03] Jordan Harbinger: Okay. Surprise, surprise, I suppose, right?

[00:51:05] John Abramson: Well, you hope you hit a bottom at some point, but that wasn't it.

[00:51:09] Jordan Harbinger: Geez. We don't want this score because the scores on our stuff isn't going to be good. So let's just defund the scorers.

[00:51:15] John Abramson: Precisely.

[00:51:16] Jordan Harbinger: This brings up uncomfortable questions, right? Like how do we trust vaccine info and trials then? And I'm not an anti-vax guy at all. I'm quite the opposite, but I'm like, you know, I, I'm starting to understand why people distrust drug companies and it makes me — you know, I'm vaxxed and boosted, but now I'm supposed to give that to my kids too. It's a little nerve-wracking when you hear stuff like this, right?

[00:51:34] John Abramson: That's exactly right. And the vaccine — I'm not an anti-vaxxer. Vaccination is enormously important. Vaccination by July, June, 2021, the date at which all American adults could have been vaccinated if they wanted to be vaccinated, the vaccines had saved a million American lives. The vaccines are hugely important and the vaccine companies are hoarding their vaccines to sell to wealthy countries. So now low-income countries have a 12 percent vaccination rate. And the world health organization has said that it had to be a 60 percent vaccination rate, or we're going to keep getting hit with these variants and it's 12 percent.

[00:52:19] Jordan Harbinger: Right.

[00:52:19] John Abramson: So we got more variance coming. And while the drug companies, this is the kind of complexity of understanding how bad the drug companies are and yet how good medical science can be. So they're making a great vaccine, but because they're leaving the underdeveloped world unvaccinated. They're virtually assuring that these variants will keep coming back to us Americans who are vaccinated and will evade our immunity at some point. And we're going to be back starting all over again. So because they're grabbing so much money out of this and are so intent on just selling as much drug as they can to the countries that can pay retail, they're going to leave us exposed to the risk of the variance that are going to ricochet back.

[00:53:02] Jordan Harbinger: Well, why not? They're selling us the booster too. So it's actually a win-win for them at that rate. Is it not?

[00:53:08] John Abramson: It is a win-win and that's the key issue. That key issue is that they are doing their job. Government is not doing its job. Their job is to make as much money as they can. The CEO of Moderna is now worth about 5.3 billion dollars. A hundred percent or approximately a hundred percent of the development costs of Moderna's vaccine were footed by the United States government. And the CEO is worth 5.3 billion dollars while the third world is wicked and dangerously under-vaccinated. But they are doing their job. The job of a corporation, at least in the United States is to maximize its profits. The problem is that we don't have guardrails. Not only do we have corporations that are just profit-seeking, but we have a government that won't get in and regulates the situation so that the market works to serve the public interest. That's the problem.

[00:54:06] Jordan Harbinger: So taxpayers fund vaccine development for Project Warp Speed. We come up with the mRNA vaccine. So the NIH does most of the work. The pharma companies make 60 to 80 percent profit. I looked this up on the vaccines. The government tolerates this because of lobbying and money and politics. Then we don't use that same miracle of medical science to get the rest of the developing world those vaccines. So now, coronavirus is endemic, but that's okay because they get to sell us the booster too. And all of this is so funded by us as taxpayers, the companies take these big margins, then they misuse the product essentially so that it doesn't protect us that well, because that will also make them more money and screw all of us. You know, people in developing worlds who die from this and people here who have to continue to get more and more drugs bumped into us because we didn't just stamp this thing out. It's really hard not to become a conspiracy theorist when these companies are shipping me, my tin foil hat via FedEx, overnight delivery here.

[00:55:02] John Abramson: Yeah, yeah, yeah. Same-day delivery. You've got it a hundred percent right. But the important message, this is the teachable issue right now. And it goes back to what the hell do we do, doctors and patients. The key message here is not that the vaccine makers are so greedy that they're screwing us and they're making, you know, tens and tens and tens of billions of dollars that they never thought they'd see. But for their good fortune, the coronavirus came our way. The message is that in the United States, all scientific therapeutics, medical science therapeutics come through the commercial side and the commercial side will do everything it can to maximize its financial advantage. And yet there are good products.

[00:55:46] So in this crazy situation where the variants are going to keep coming back and biting us in the butt because we're not making sure that somehow the world works together to get low-income countries vaccinated, we're going to have to deal with COVID for many years. And that's not a good thing, but that doesn't mean that the vaccines don't work when they get put in your body. And we've got to be smart about this. It's sloppy to just get pissed off and say, "Oh, it's a freaking conspiracy. And they're just out to hurt us."

[00:56:16] Jordan Harbinger: Right.

[00:56:17] John Abramson: "They want to have more COVID and it's all a system and I'm not going to get the vaccine, because I'm not being part of this system." That is not a smart way to deal with this very serious situation. We've got to be smarter, not dumber confronting this situation. And we've got to understand all these things wrong with vaccine and there's more, we haven't talked about the quality of the data and, and there's plenty, more problems I can, we can have two more shows about it. But the bottom line is that the evidence is clear that getting vaccinated and one booster is helpful for adults. And don't deprive yourself of that because these guys are just grabbing money and our government is helping them. That's no reason to deprive yourself of the protection that the vaccine will provide.

[00:57:01] Jordan Harbinger: Thank you for clearing that up because I really wanted to be careful not to deliver the wrong message with this episode, but I also really wanted to cover this topic. So you just nailed that and I appreciate that. I want to thank you for that.

[00:57:13] John Abramson: Thanks for the opportunity.

[00:57:15] Jordan Harbinger: Yeah, of course. No, I want people to, it's hard to educate about these topics because it makes people go, "Well, it's hopeless. And the thing is now you should just rub essential oils on everything and you'll be fine instead of using modern medicine because it's all a big sham. And that's not it. And so I had to get off the fence on this topic, but then I read the book and I was like, I have to talk about this because the cost of bad healthcare in the United States is obscene as per of those charts. That will again be linked in the show notes.

[00:57:43] What did the nations that are doing well with healthcare do differently? We mentioned pharma can't advertise, but we also sort of said, "Hey, that's not just it." New Zealand, I assume Switzerland is up there because they're always up there with everything. You know, Singapore is probably up there with good healthcare. What do these countries, what do they have that's so obviously conspicuously missing in the United States? You mentioned guardrails. I assume they have an agency for this or something, yeah?

[00:58:08] John Abramson: Yes. It's called health technology assessment. So as part of the government relationship with healthcare, there's an institute or an agency, that collects the best data available. And sometimes it's not perfect, sometimes they don't get the original data from the studies, but they do the best they can. And they make recommendations about what doctors should prescribe, what drugs are going to be effective and efficient. I just want to put a placeholder in because we've got to talk about the misdirection of our healthcare towards expensive therapeutics instead of healthy lifestyle.

[00:58:46] But before we get there, I want to talk about insulin, the United states' insulin problem. From the perspective that you just asked, what are we doing differently that's causing American healthcare to be so much more expensive and so much less effective? When we look at insulin, I mean, it becomes a hot issue because people are really getting hurt when they have trouble buying their insulin because of the high prices of the insulin analogs, the latest generation of insulins in the United States. And we do not have health technology assessment. There's type 1 diabetes and type 2 diabetes. Type 1 diabetics need insulin from the first day of diagnosis and they'll die if they don't get insulin. Type 1 diabetics only account for about 20 percent of the insulin that's used in the United States. There are so many more type 2 diabetics than type 1 diabetics that even though only a quarter of type 2 diabetics require insulin, they still use 80 percent of the insulin that's prescribed in the United States.

[00:59:45] So now we've got 90 percent of the type 2 diabetics who are using the insulin analogs that cost up to $300 a vial. They're not using the first generation of bioengineered insulin called recombinant human insulin, which can cost $35 a vial, $50 a vial, something like that. So there's a movement now to help patients with their insulin copays. So that they don't have to pay the high price of the insulin, the government or the insurer will pay. The problem here is that there is no evidence that insulin analogs are better for people with type 2 diabetes than the original bioengineered insulin called recombinant human insulin. There's no evidence that it's superior. It's a fiction.

[01:00:37] And the American Diabetes Association recommended the expensive insulins until 2018. And the American Association of Clinical Endocrinology recommended it through about 2017 or 2018. Almost all doctors believe that insulin analogs provide their patients with better care in the United States. But in England, if you look, you can go to this on the web and look at the National Institute of Clinical Excellence. They say that insulin analogs are not shown to be superior for type 2 diabetes to start your patients on recombinant human insulin and you'll save approximately 90 percent, and so does New Zealand and Canada and Germany. The companies that have health technology assessment are informing their doctors, that the marketing of insulin analogs for type 2 diabetics doesn't make sense. And that the first-line drug should be recombinant human insulin.

[01:01:32] Jordan Harbinger: Right. The marketing doesn't make sense because it's marketing. So you can safely ignore it in all of most of these cases. And I assume that these agencies, these health technology assessment agencies also don't allow things. I read this in your book, there's insurance co-pay managers that will get rebates and like kickback systems going—

[01:01:50] John Abramson: Mm-hmm.

[01:01:50] Jordan Harbinger: —to place drugs on insurance coverage lists. Not because they're the best drug for the job, but because they're expensive. So the insurance will cover it, which just distorts the market and leads to less effective treatments. Correct?

[01:02:03] John Abramson: That's precisely right. And that's the consequence of not having a guardrail to ensure that doctors have access to accurate information and not marketing-driven information. That's a perfect example of a guardrail that we don't have.

[01:02:20] Jordan Harbinger: So if the government spent the money, they spend on insulin, the new fancy schmancy, but does the exact same thing of insulin for diabetics, if they spent that money instead on, I don't know, wellness programs, physical fitness to prevent diabetes for the same amount of money we could cover the entire country. Is that correct? Or did I misread that?

[01:02:38] John Abramson: That's almost correct. We could provide lifestyle programs to all the people at increased risk of diabetes in the United States.

[01:02:47] Jordan Harbinger: Mm-hmm.

[01:02:47] John Abramson: We could liberate approximately 20 billion a year if we just got to rational use of insulin.

[01:02:53] Jordan Harbinger: And that's one drug for one disease.

[01:02:55] John Abramson: Yes.

[01:02:56] Jordan Harbinger: $20 billion.

[01:02:57] John Abramson: Yes. To go back to your question, this is why it's so expensive, but why are we not getting good health? It would make sense if we were wasting money, at least we'd be getting good health, but paying too much for it but our health is going down. And this is a perfect example because the money to be made here is by peddling insulin analogs to doctors who prescribe for type 2 diabetes when half of diabetes can be prevented by adopting a healthy lifestyle. We know this from a randomized controlled trial that was published in New England Journal in 2002, the diabetes prevention program. The intensive lifestyle counseling that you can provide at your local YMCA prevents half of high-risk pre-diabetics from going on and becoming diabetic.

[01:03:45] But because there's so much money, we're distorting the allocation of our resources, our national allocation of resources into developing and then selling these very expensive drugs when type 2 diabetes is primarily not entirely, but primarily a consequence of being obese and not living a healthy lifestyle and being poor to be fair, but we're not addressing that. There's no financial reward for addressing that. The financial reward is for manipulating people's minds to think that insulin analogs are going to provide better care. The profit that can be made from pedaling, the overly expensive drug is like a magnet or a thought-changing machine. So it focuses us on biotechnology instead of the fact that most of the type 2 diabetes is a product of a holistic way of life. But there's no money in that.

[01:04:44] So we have in the United States to get back to your original question of why is our health so bad, we've got a reversal of our allocation of national resources from the kinds of social and lifestyle issues, that account for 80 percent of our health, but we draw those resources into our healthcare. So we have flipped the ratio of medical spending and social lifestyle spending.

[01:05:10] Jordan Harbinger: Right. So, unfortunately, all the money goes into the pockets of the investors and the executives at the drug companies, instead of going to people who actually need lifestyle — it's almost, it's like a wealth transfer from people who really need lifestyle help, and people who need actual care to people who provide fake, and sometimes often, very often real, but very often also just fake innovation that's designed to just make money.

[01:05:35] John Abramson: That's exactly right. And just so you know what company you're in, Angus Deaton, who's a professor of economics at Princeton and a Nobel prize laureate said exactly that. Our healthcare is an exquisite method of wealth transfer.

[01:05:49] Jordan Harbinger: Let me flip this. Where does capitalism do well with respect to healthcare? We do create absolutely amazing things like mRNA vaccines. So I don't want to say like, "Uh, you know, hashtag communism, this is all a big sham," right? We do a lot of amazing things that no one else can do.

[01:06:05] John Abramson: Well, the mRNA vaccines were communism or socialism. I mean, it was the National Institute of Health that developed it, not private enterprise. We don't need this much innovation. We need targeted innovation. We need oversight so that we don't get these absurd drugs like Aduhelm for Alzheimer's disease. We allocate our research funding by private enterprise, deciding where they're going to make the most money. That's the extent of the planning that goes into this. And what we need is a national program to decide how to allocate our medical research investment, to produce the most positive results in our society. That's the problem.

[01:06:46] Jordan Harbinger: Where do you see this all going? Do you see this problem continually getting worse with people, extracting rents from all of us as consumers to the detriment of society at large? Or are we looking at some reasonable reforms and regulations coming out to play here?

[01:07:01] John Abramson: We are not looking at reasonable regulations with our current way of doing political business. They are not going to get there. They're going to say there should be a $35 copay on insulin analogs. And let me just tell you about that one thing very quickly. That's a sham. Because a $35 copay on insulin analogs for people who don't need insulin analogs means the drug companies continue to make all their money. And the consumer gets protected from higher copays. The consumer only pays $35. The insurance company has to pay the rest of the copay. They don't have to pay and the drug companies make their money.

[01:07:41] But the sham of it is that there are biosimilar insulin analogs that are going to come online very soon, a year or two from now. And they're going to cost $35, not copay. They're going to cost 35. You can make these $300 a vial insulins for 35 bucks and make money and that's what's going to happen. So if the drug companies can foe yell and scream that they're getting socialized and allow this $35 copay plan to come in, which will help some people. I'm not saying it won't, but if they can do that, what they're going to do is if you fast forward two years, they're going to create a market where the consumer who's been very happy, the type 2 diabetic, who's been very happy on his or her insulin analog, that's costing $5,000 a year, they're going to be able to stay on their insulin analog for 35 bucks. So their doctor won't be able to switch them over to a biosimilar product, which is equally effective. But the drug companies are going to be saying that they're not equally effective.

[01:08:44] So this plan to have $35 insulin copays is a plan that's designed to protect the brand name, insulin analog manufacturers. And that is proposed by Democrats. And the drug companies are saying, "No, that's socialism." They may not be saying it explicitly about this, but they're going to fight it tooth and nail.

[01:09:05] Jordan Harbinger: It's interesting because all this protectionism for these specific brands is really it's the opposite of capitalism. And then they're saying, "No, no, it's socialism if you make us actually compete fairly."

[01:09:16] John Abramson: Yes. And in the book I quote Milton Friedman who says, "Look, government shouldn't do very much, but it should make sure markets work and it should make sure contracts are honored." And we're just not doing that.

[01:09:26] Jordan Harbinger: The problem is market failures don't correct themselves. If I remember anything from Econ 101.

[01:09:31] John Abramson: You got it.

[01:09:31] Jordan Harbinger: They just get worse.

[01:09:32] John Abramson: They don't correct themselves. And Americans don't believe in government and pharma owns the PR microphone and we don't have a solution. There's only one way out of this. I'm not saying that it would be easy and I'm not saying that the odds are good, but the only way out of this is for the public to become educated enough so that they can create more pressure on their politicians than the money and the lobbying does from the pharmaceutical side. The public has to stand up and represent its interests. The doctors need to join them. The healthcare purchasers, the companies that are buying health insurance need to join them. But that tripartite coalition of consumers, purchasers, and healthcare providers has to become a stronger political force than the pharmaceutical industry. And we are very far from that.

[01:10:25] And the reason why I'm doing this podcast, and I hope why you're doing it is because this is the only way that we can start to build a knowledgeable base that can then go ahead. People can then go ahead and inform themselves. And start to move towards a coalition that can become politically strong enough to force change.

[01:10:48] Jordan Harbinger: Are you hopeful at all? Because I don't want to leave on this, like really sort of depressed. Like, hey, we have to just fight these multi-billion-dollar behemoths or we're all screwed. Is that where we're leaving it?

[01:10:56] John Abramson: That's where we have to leave that but I do want to leave on a much more upbeat note.

[01:11:00] Jordan Harbinger: Yes.

[01:11:01] John Abramson: Because most of what we know comes from the drug companies and we know it because it's going to make them money. What we don't know is that 80 percent of our health is determined by how we live our lives. And those of us who are fortunate enough to be able to live in a community that has decent food and allows you to exercise safely are the 80 percent, all on our side. So when we're worried about whether we should take a statin, for example, to prevent heart disease, we could do a whole show. We could do a five-hour show on statins. I'd be happy to do it with no notes, but that's not the problem. The problem is the drug industry has gotten inside the consumer's heads and the doctor's heads. So they spend their time at the doctor's visit the physical exam or whatever, deciding whether somebody should be taking a statin or not. And following the guidelines and all that stuff about statins.

[01:11:49] And the truth is that we should be asking a different question, not, "Should I take a statin?" but, "How can I minimize my chance of developing heart disease?" That's the real question. Because if you have a heart attack and you have a low cholesterol that low cholesterol doesn't help you very much.

[01:12:04] Jordan Harbinger: Right.

[01:12:04] John Abramson: So the question is not, "Should I be taking a statin?" The question is, "How can I minimize my risk of heart disease?" Maybe 20 percent of that question, the answer to that question ought to be addressed to statins, but 80 percent of it ought to be addressed to how healthy your lifestyle is, and then not stop there. But what are the impediments that you have to adopt a healthier lifestyle?

[01:12:29] And as a family doc, I took this very seriously. And when I would engage, say a new patient in a conversation like this and tell them what I'm telling you. And I would say, "Look, you know, if you want to reduce your risk of heart disease, you've got to make lifestyle changes and you've got to exercise five times a week and not smoke and drink in moderation and eat a healthy diet." And they would say, "Sure, doc. Sure. I'm going to do that." I'd make a return visit for a month. And they'd come in in a month and they would, 95 percent of the people would say, "I didn't make those changes." And I would say, "I didn't expect you to, but now you're starting to gain some knowledge about why you couldn't make those changes." Now you're starting to see how to proceed towards really making those changes.

[01:13:12] The drug industry spends a lot of money creating the MIMO, people won't change so give them drugs. They will change. It's been proven they'll change and double-blind studies might change, but the doctors have to get on board and partner with their patients to reframe that conversation. So it's epidemiologically accurate, and we don't spend all our time talking about statins. We spend 80 percent of our time talking about how to adopt a healthy lifestyle and how to overcome our individual resistance to that.

[01:13:44] Jordan Harbinger: Dr. Abramson, thank you so much for your time here and your expertise. It is a little bit of a downer, right? Because it seems like a very, very hard battle to win, but education here — and the reason I'm doing this podcast is so that, you know, a few, a hundred thousand more people are aware of what's going on here and are educated enough to say, "Wait a second, maybe I don't want this in my community."

[01:14:05] John Abramson: Right. And let me just reiterate it is a downer. I'm telling you a downer about the totality of the impact of the biotech industry on American healthcare and financial wellbeing. It's a downer, but it's also a liberating upper to understand and liberate yourself from this sort of spider web of misinformation. And look at your doctor in the eye and say, "Doc, I'm not here to ask you for the latest medicine. I'm here to ask you on the totality of your knowledge, what should I do to make myself healthier with regard to the issue we're talking about?" And if you can help your doctor reframe that question, you've gone a long way towards improving your healthcare system.

[01:14:50] Jordan Harbinger: Thank you so much.

[01:14:51] John Abramson: My pleasure. Thank you for the opportunity.

[01:14:56] Jordan Harbinger: Now, I've got some thoughts on this episode, but before we get into that, here's what you should check out next on The Jordan Harbinger Show.

[01:15:03] Matthew Walker: Sleep is not an optional lifestyle luxury. Sleep is a non-negotiable biological necessity. Sleep is a life support system. It is mother nature's best effort yet at immortality and the decimation of sleep throughout industrialized nations is now having a catastrophic impact on our health, our wellness, as well as the safety and the education of our children. It is a silent sleep loss epidemic. And I would contend that it is fast becoming the greatest public health challenge that we now face in the 21st century.

[01:15:35] The evidence is very clear that when we delay school start times academic grades increase, behavioral problems decrease, truancy rates decrease, psychological and psychiatric issues decrease. But what we also found, which we didn't expect in those studies is that life expectancy of students increased. So if our goal as educators truly is to educate and not risk lives in the process, then we are failing our children in the most spectacular manner with this incessant model of early school start times. And by the way, 7:30 a.m. for a teenager is the equivalent for an adult waking up at 4:30 or 3:30 in the morning.

[01:16:16] If you are trying to survive or regularly getting five hours of sleep or less, you have a 65 percent risk of dying at any moment in time. When you wake up the next day, you have a revised mind-wide web of associations, a new associative network, a rebooted iOS that is capable of defining remarkable insights into previously impenetrable problems. And it is the reason that you have never been told to stay awake on a problem, instead you're told to sleep on a problem.

[01:16:50] Jordan Harbinger: For more on sleep, including why we dream and how we can increase the quality of our sleep. Check out episode number 126 with Dr. Matthew Walker here on The Jordan Harbinger Show.

[01:17:03] Like I said, folks, yikes, this is the sort of thing that keeps me up at night, especially raising two kids in this sort of situation, along with my aging parents. You know, another problem we didn't have time to touch on was the revolving door of the FDA and pharma companies. These guys they'll approve something or they'll push something through and then go consult on some advisory committee. They'll either push some useless drug through or they'll stonewall progress on something better because it can't be made profitable and it's truly, truly alarming.

[01:17:33] People, including doctors, focus often on using drugs to help us versus lifestyle changes because they think the drugs are more useful than they actually are because of the janky studies designed to show that the drug works and deliberately ignoring lifestyle factors. It's not necessarily the doctor's fault. I mean, the whole system is kind of rigged against them as practitioners and us as patients. Now, these companies just have so much money, they can influence not only their market and not only the people who are going to take their product but the people who are going to regulate them as well. Everyone is feeding at the trough of big pharma cash and it's freaking terrifying folks. The key here, 80 percent of health is lifestyle. So eat those veggies y'all and stay in shape.

[01:18:17] And by the way, the best thing I've ever done, I would say at least in the past few years, besides having kids was getting a trainer, and if you want a referral to my trainer, it's all online. It's not pre-recorded classes. I really work out with a real person online. Email me, jordan@jordanharbinger.com. I will happily refer you. This has been a game changer for my mobility. All my blood markers are healthier. My blood pressure is down. I look great. I feel great better than I have in my whole life. Honestly, I look better than I did in high school. A lot better actually. And I feel a hell of a lot better as well. So if you want a referral to my very reasonably priced online trainer based out of Canada, please do email me. I would love to see more of you get in the kind of shape that I know you can be in. And, yeah, maybe add a few years to your life. jordan@jordanharbinger.com if you want that.

[01:19:03] Thanks again to Dr. John Abramson. All things Dr. John Abramson will be in the show notes@jordanharbinger.com. Books at jordanharbinger.com/books. Hey, please use those website links if you buy books, even if you're in another country, even if you're buying an audiobook, even if it's a Kindle thing, it helps support the show. Transcripts are in the show notes. Videos are up on YouTube. Advertisers, deals, and discount codes are all at jordanharbinger.com/deals. Please consider supporting those who support this show. I'm at @JordanHarbinger on both Twitter and Instagram or connect with me right there on LinkedIn. I always love hearing from you. You guys are so interesting.

[01:19:38] I'm teaching you how to connect with great people and manage relationships using the same systems, software, and tiny habits that I use every day. Our Six-Minute Networking course, I talked about at the top of the show, that's all free over at jordanharbinger.com/course. I'm teaching you how to dig the well before you get thirsty and build those relationships before you need them. And hey, most of the guests you hear on the show, they subscribe and contribute to this course. Come join us, you'll be in smart company where you belong.

[01:20:04] This show is created in association with PodcastOne. My team is Jen Harbinger, Jase Sanderson, Robert Fogarty, Millie Ocampo, Ian Baird, Josh Ballard, and Gabriel Mizrahi. Remember, we rise by lifting others. The fee for this show is that you share it with friends when you find something useful or interesting. Hey, if you know somebody who would benefit from this or who is scared to death of the healthcare system, or a doctor who might not know this stuff, share this episode with them. The greatest compliment you can give us is to share the show with those you care about. In the meantime, do your best to apply what you hear on the show, so you can live what you listen, and we'll see you next time.

[01:20:41] This episode is sponsored in part by Court Junkie. If you're a fan of true crime check out Court Junkie. Court Junkie is a true-crime podcast hosted by Jillian Jalali that covers court cases and criminal trials. Learn about a nurse at a Texas hospital who is charged with murdering his patients. We did a show about that as well. Prosecutors claim he's a serial killer, but of course, he says he's innocent. Hear from a local reporter who gives his perspective on the case. And what happened to 13-year-old Dylan Redwine? Dylan's father Mark went on trial last year for his murder, hear all of the important testimony from both the prosecution and the defense. Host, Jillian Jalali, who in my opinion, is very sharp and smart and interesting. She uses audio clips and interviews to focus on the facts of one true-crime case per episode. In the end, the listener can decide did the criminal justice system actually work. Subscribe to Court Junkie on Apple, Spotify, or wherever you get your podcasts.