Drug Companies Lie To Sell Drugs

This is an ad seen a while back, touting the benefits of Lipitor.



In 2011, sales from Lipitor had averaged about $11 billion a year since 1996.
Rest assured that thousands of medical doctors saw this ad in a glossy brochure,
provided by a $100k+ a year Pfizer sales rep..

We must wonder if they would have even put it on the market if
their ad had looked like this:



When you take a look at the fine print, you see that they actually told the truth
about the drugs effectiveness in reducing risk of heart attack..




How do the math wizards at Pfizer get 36% out of a 1% difference between their drug and a placebo?

Here is a graph of the data from the study the ad is based on.



At the top, you see where the actual 3% ( placebo ) vs 2% ( Lipitor ) numbers came from.
They divided 2 by 3 and came up with 36%..

The calculation they used is to produce a number called ' relative risk ' , which has virtually nothing
to do with the actual effectiveness of the drug.

A little digging will show you how drug companies do this all the time..

Reporting the findings: Absolute vs relative risk


Since it's legal, why not? Do you give up $11 billion dollars if you don't have to.

Would you have a problem with a financial advisor who touted a 36% return on your investment,
while only showing a 1% ?
How about a Dr. who wants you to take a drug based on the same numbers?

Meanwhile, millions of people take a drug whose effectiveness in doing what it claims is questionable,
while the possible debilitating and life threatening side effects are not.

Statin side effects:


This topic was inspired by a recent lecture by David Diamond Ph.D
( A real doctorate in biology )



( If you watch the lecture, my images will look familiar.. )

Yes. For the companies it's not so important whether it works or not, but whether it makes a great profit.

So, if the drop was from 1% to 0%, it would still be a 1% drop? No, it would be a 100% drop. Their math is correct.

Let's say that 2000 people are in the study, 1000 taking Lipitor and 1000 taking a placebo. With a placebo, 3% of 1000 (30) have a heart attack. With Lipitor, 2% of 1000 (20) have a heart attack. The drop from 30 to 20 is a 33% drop, not 1%.

I'm no friend of drug companies, and they do lie to sell drugs, but I really hate innumeracy. You're barking up the wrong tree.

shemp said:

So, if the drop was from 1% to 0%, it would still be a 1% drop? No, it would be a 100% drop. Their math is correct.

Let's say that 2000 people are in the study, 1000 taking Lipitor and 1000 taking a placebo. With a placebo, 3% of 1000 (30) have a heart attack. With Lipitor, 2% of 1000 (20) have a heart attack. The drop from 30 to 20 is a 33% drop, not 1%.

I'm no friend of drug companies, and they do lie to sell drugs, but I really hate innumeracy. You're barking up the wrong tree.

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Shemp, the way I see it is that we take drugs to increase our risk of NOT getting a disease. Using the stats above, our risk of not dying of a heart attack is 97%. Taking Lipitor only improves that by 1%. And I feel that is a valid logoc for each of us as individuals. BUT I also see that drug companies, the AMA, and health insurance companies have to look at the huge number scheme of things. RR is for Epidemiological scale. Somewhere you and I have to evaluate the 1% concept. I am one of those more susceptible to Statin Myopathy, I decided that the pain is not worth the 1% gain. Which is one more reason why I champion the science of Pharmacogenetics.

Drug companies lie.

However, I think the OP missed some key aspects of their lying ways.

First, notice the absence of key numbers: the numbers of people in the various studies. tl;dr: nothing about statistical significance.

Second, how many other studies did they do, which they did not report the results of?

Surprisingly they do teach you this at medical school. medical doctors do know the difference between absolute and relative risk. A better way of looking at the effects is number needed to treat NNT. In this case 100 people would have to take the tablet to prevent one event. This can be balanced by the number needed to harm depending on the frequency of adverse events.

But you also missed out a vital piece of data, the time duration. If this is one fewer events every month that is much more important than one per ten years. So a better way of putting it is using person years. Remember benefits will be cumulative, so over ten years you may be looking at 45 person years of benefit out of a thousand person years of use even though there was only a 1% absolute benefit. Sometimes survival curves are a better way to show data.

Vaccines may have low benefits in terms of NNT, millions are being treated to prevent one case of polio. The breast cancer screening program is of minimal benefit.

Out of 1,000 women aged 50 to 69 years invited every second year, 781 are alive with screening and the same number without screening over the course of 20 years. Correspondingly, 985 women and 982 to 983 women without screening will not die of breast cancer aged 55 to 74 years. Negative framing: out of 1,000 women aged 50 to 69 years invited every second year, 204 women will die with screening and the same number without screening. Correspondingly, 15 women with screening and 17 to 18 women without screening will die of breast cancer between 55 and 74 years old. Number of women dying among women aged 55 to 74 years is based on the observed mortality rates in England and Wales in 2007

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The consequence of the event is also important, a 1% benefit for preventing a cold is different from 1% reduction in death. This is why benefits may be framed in terms of DALYs disability adjusted life years. This can take account of the combined benefit of reducing death from a heart attack and disability from a stroke.

In other news, statistics don't lie, but liars use statistics.

Oddly, I think the use of statistics and graphs in the OP are more misleading.

Tsukasa Buddha said:

Oddly, I think the use of statistics and graphs in the OP are more misleading.

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To what end?

shemp said:

So, if the drop was from 1% to 0%, it would still be a 1% drop? No, it would be a 100% drop. Their math is correct.

Let's say that 2000 people are in the study, 1000 taking Lipitor and 1000 taking a placebo. With a placebo, 3% of 1000 (30) have a heart attack. With Lipitor, 2% of 1000 (20) have a heart attack. The drop from 30 to 20 is a 33% drop, not 1%.

I'm no friend of drug companies, and they do lie to sell drugs, but I really hate innumeracy. You're barking up the wrong tree.

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If you can't see his point, he is not the one that is il-numerate.

Both the OP and Big Pharm use good math. But big pharn chooses to represent the numbers in the way that makes them look best.

So far as the efficacy of Statins, if EVERYBODY took them, our life expectancy would go up by two weeks. The don't actually prevent death (the death rate remains ONE) the only postpone it.

Funny that after decades of Statin use, we don't hear anything about their efficacy in actual clinical practice. If they were say, 37%, it would be trumpeted from every hospital roof in the country. I suspect they do show good, but much less than that 36% in the stats above. Maybe 10%? So make that two weeks I mentioned only 5 days?

I'd love to hear actual numbers from an entity divorced from Big Pharma, an HMO maybe? I know Kaiser keeps data... which makes me think the 10%.

casebro said:

<snip>
Funny that after decades of Statin use, we don't hear anything about their efficacy in actual clinical practice. If they were say, 37%, it would be trumpeted from every hospital roof in the country. I suspect they do show good, but much less than that 36% in the stats above. Maybe 10%? So make that two weeks I mentioned only 5 days?

I'd love to hear actual numbers from an entity divorced from Big Pharma, an HMO maybe? I know Kaiser keeps data... which makes me think the 10%.

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All the research I've read shows that statins have efficacy in preventing cardiac/stroke events in people who are at higher risk for them. I'm not sure where you get your own numbers from but the American College of Cardiology states the following:

In a meta-analysis of 27 randomized trials and 174,000 participants, for every ~40 mg/dL LDL-C reduction with statin therapy, the relative risk of major adverse cardiovascular events is reduced by ~20-25%, and all-cause mortality is reduced by 10%. More intense statin regimens yield a 15% further proportional reduction in major adverse cardiovascular events compared to less intense regimens.

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So depending on the reduction in LDL-C achieved and how intense the statin regimen is, there is a pretty significant reduction in cardiovascular events and all-cause mortality -no matter how you want to play with the actual statistics, lives are saved.

Skeptical Greg said:

To what end?

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Why graph the number of patients without events when we are trying to compare the numbers of those with events? It's a silly technique to try to minimize the RRR. Yes, when there is a low risk of events, the RRR is greater than the ARR. Why is one the "truth" and one "has virtually nothing
to do with the actual effectiveness of the drug"?

It is well recognized that how efficacy and safety data is presented to physicians, patients and health care policy makers influences their decisions. In fact, most studies suggest that all 3 groups make more conservative decisions about therapies when they are presented with numbers needed to treat than when they are presented with the same data presented as relative risk ratio. However, it is not entirely clear that a more conservative decision is necessarily the right one. For example, many British patients with atrial fibrillation who were likely to benefit from anticoagulant therapy because of their risk profiles and their similarity to the participants in randomized trials supporting the efficacy of warfarin declined warfarin therapy when presented with the data about their absolute risks and benefits.

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Linky.

And this isn't something the "math wizards" at drug companies do. Most journals report RRR too.

This is the statin I take, having being prescribed it when a routine physical at age 60 showed a cholesterol level of 9.1 despite no obvious lifestyle cause. There's early stroke and heart disease in my family so, after reading up on statins, I decided to take it provided I experienced no significant side effects. The evidence of benefit isn't exactly conclusive, but on balance I think it's more likely to do me good than harm.

xjx388 said:

All the research I've read shows that statins have efficacy in preventing cardiac/stroke events in people who are at higher risk for them. I'm not sure where you get your own numbers from but the American College of Cardiology states the following:

"In a meta-analysis of 27 randomized trials......,"


So depending on the reduction in LDL-C achieved and how intense the statin regimen is, there is a pretty significant reduction in cardiovascular events and all-cause mortality -no matter how you want to play with the actual statistics, lives are saved.

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But ALL of that data is from Big Pharma studies. I want data from actual clinical use. Key word is "randomized". REAL clinical use is not randomized .

I'm not saying that there is no benefit, I'm saying the real benefit is less than the 30-something % often quoted. And it may be so small that any individual is not likely to see the benefit at all. But HMOs and insurance companies would be thrilled at 5%.

Something like a study Kaiser did a few years ago. Unrelated to Statins, but they looked into the records of 8,000,000 actual, real, not 'subjects in a study', patients. Leessee that for Statins.

xjx388 said:

...So depending on the reduction in LDL-C achieved and how intense the statin regimen is, there is a pretty significant reduction in cardiovascular events and all-cause mortality -no matter how you want to play with the actual statistics, lives are saved.

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From your link:

Statin therapy reduces major adverse cardiovascular events (myocardial infarctions, strokes and death) and all-cause mortality in patients with or at risk for ASCVD.

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In my experience, doctors prescribe statins solely on the basis of elevated LDL-c ( a very dubious measurement ), and not the criteria listed above.

casebro said:

But ALL of that data is from Big Pharma studies. I want data from actual clinical use. Key word is "randomized". REAL clinical use is not randomized .

I'm not saying that there is no benefit, I'm saying the real benefit is less than the 30-something % often quoted. And it may be so small that any individual is not likely to see the benefit at all. But HMOs and insurance companies would be thrilled at 5%.

Something like a study Kaiser did a few years ago. Unrelated to Statins, but they looked into the records of 8,000,000 actual, real, not 'subjects in a study', patients. Leessee that for Statins.

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I've never read anyone who generally ranks RCT meta-analysis below observational in the hierarchy of evidence. The problem with large "real" use is the opportunity for uncontrolled bias in the data.

As to the title, NO ******!!!!!!!!!!

The problem isn't that they lie. The problem is that they have a direct forum to consumers at all. Of major world economies, only the US, Brazil and New Zealand permit direct drug advertising to consumers. Hong Kong sort of does but has some regulations. An average person without scientific or medical training is simply not equipped to sort through the results of drug studies. There's a reason doctors in the US have seven years of post secondary education and several years of on the job training.

Tsukasa Buddha said:

I've never read anyone who generally ranks RCT meta-analysis below observational in the hierarchy of evidence. The problem with large "real" use is the opportunity for uncontrolled bias in the data.

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and geee, there is NO chance of bias is studies sponsored by Big Pharma. No sirreee, none at all. Not even if the meta study looks at 27 studies all paid for by drug companies. Because umm, umm, more of the same = something NOT the same?

casebro said:

But ALL of that data is from Big Pharma studies. I want data from actual clinical use. Key word is "randomized". REAL clinical use is not randomized .

I'm not saying that there is no benefit, I'm saying the real benefit is less than the 30-something % often quoted. And it may be so small that any individual is not likely to see the benefit at all. But HMOs and insurance companies would be thrilled at 5%.

Something like a study Kaiser did a few years ago. Unrelated to Statins, but they looked into the records of 8,000,000 actual, real, not 'subjects in a study', patients. Leessee that for Statins.

Click to expand...

The real effect may also be greater, often people with greater risks, elderly, poor, those with more than one condition are excluded from trials. Drug trials tend to choose healthy people who are relatively low risk. A good example is the trials of flu treatment, mostly done in the community, people with a low risk of dying of flu. The benefits of treating flu in healthy people are little. Real world use of flu treatment in people requiring admission to hospital suggests it decreases flu related deaths, but this is not an RCT so has confounders.

Insurance systems or charities or universities or government could fund more drug trials; some are funded by them. Most trials in TB treatment were not drug company funded (MRC and USPHS). Many malaria trials are funded by charities. The construction of many trials is defined by drug licensing rules, that may insist on a placebo controlled trial rather than versus current best treatment. That is not the fault of the drug company but the 'law'.