It is simply no longer possible to believe much of the clinical research that is published, or to rely on the judgment of trusted physicians or authoritative medical guidelines.

1. A Promulgation Of Incredulity In
The Pharmaceutical Industry

2. “It is simply no longer possible to believe much of the clinical
research that is published, or to rely on the judgment of trusted
physicians or authoritative medical guidelines. I take no pleasure
in this conclusion, which I reached slowly and reluctantly over
my two decades as an editor of the New England Journal of
Medicine.”
– Dr. Marcia Angell, a physician and longtime editor-in-chief of
The New England Medical Journal (NEMJ)
From The Mouths Of…

3. “The case against science is straightforward: much of the
scientific literature, perhaps half, may simply be untrue.
Afflicted by studies with small sample sizes, tiny effects, invalid
exploratory analyses, and flagrant conflicts of interest, together
with an obsession for pursuing fashionable trends of dubious
importance, science has taken a turn towards darkness.”
Dr. Richard Horton, the current editor-in-chief of The Lancet
From The Mouths Of…

4. “There is increasing concern that most current published research
findings are false.”
• We now have a large amount of evidence, and statements from
experts that come directly from the field, which paint a very
concerning picture. The science used to educate doctors and
develop medicine is flawed.
• We are only ever exposed to studies that have been sponsored by
big pharmaceutical companies, but these studies are not designed
to take the long view.
Dr. Peter Rost, MD, a former vice president of one of the
largest pharmaceutical companies in the world (Pfizer):
From The Mouths Of…

5. “There is increasing concern that most current published research
findings are false.”
• They are not designed to detect problems that can occur years or
even decades after a treatment, or examine the risks of taking a
drug for long periods of time.
• Nobody ever seems to mention or acknowledge the many studies
which clearly show significant risk associated with many of the
products that pharmaceutical companies are manufacturing to
help fight disease.
Dr. Peter Rost, MD, continued:
From The Mouths Of…

7. • What is even more concerning is the general population’s lack
of awareness when it comes to these facts.
• This issue is definitely not going to be addressed in the
mainstream news, and despite plenty of
evidence to support it, some people will
refuse to even look at or acknowledge
that it exists.
• This is a big problem, our world is
changing and we must keep an open
mind and be open to new possibilities
regarding the nature of our world.
Blinded By Science?

8. • It’s 2018, and as we keep moving forward there will be more
information coming out that challenges the deeply held,
engrained belief systems of many.
• It’s okay to look at information that goes
against what you believe, in fact, it’s
needed if we are going to move forward
and create a better world for ourselves.
Blinded By Science?

9. • This is why alternative media is
important, especially in a time where
more and more people are waking up to
what is really happening.
• It’s time to examine the research that’s
being conducted all over the world, from
experts (scientists) at various
institutions, that is not sponsored by
“Big Pharma”
• The independent literature.
• Brilliant work is being published
regarding various drugs, cures,
treatments, vaccines, and more.
Blinded By Science?

11. • A review of routine audits of leukemia trials conducted by the
Cancer and Leukemia Group B, one of the multicenter cancer
clinical trial groups sponsored by the National Cancer Institute,
reported an incidence of fraud of 0.25%
• Similarly, a report of audits in the United Kingdom revealed that
only 0.40% of the contributed datasets were fraudulent
• In the first 10 years of reports from the Office of Research
Integrity, there were 136 findings of scientific misconduct
(again using the PHS definition); 36 (26%) of these were in
clinical trials or other clinical research)
Clin Investig (Lond). 2015; 5(2): 161–173.

12. • A survey of members of the American Association for the
Advancement of Science (AAAS) in which 27% of the scientists
reported having encountered some type of misconduct;
• A survey of research coordinators in which 19% of respondents
reported first-hand knowledge of misconduct within the
previous year – and that only 70% of these were reported;
• A study of Norway medical investigators in which 27% of
investigators knew of instances of fraud;
Surveys of scientists and medical investigators routinely
report high levels of misconduct or knowledge of misconduct
Science. 1992 Mar 27; 255(5052):1636.
Nurs Res. 2010 Jan-Feb; 59(1):51-7.

13. • A survey of members of the International Society of Clinical
Biostatistics, in which over 50% of respondents knew of
fraudulent reports
• A survey of medical institutions in Britain in which more than
50% of respondents knew or suspected misconduct among
institutional colleagues
• A survey of New Scientist readers, in which a remarkable
92% knew of or suspected scientific misconduct by
colleagues
Surveys of scientists and medical investigators routinely
report high levels of misconduct or knowledge of misconduct
Control Clin Trials. 2000 Oct; 21(5):415-27.
Br J Surg. 2000 Dec; 87(12):1605-9.

14. • A survey of NIH-funded scientists in which 33% of respondents
said they had engaged in one or more of a list of ‘top 10’
questionable behaviors ranging from approximately 16% for
‘changing the design, methodology or results of a study in
response to pressure from the funding source’ to 0.3% who
admitted to ‘falsification or ‘cooking’ research data’
• A subsequent similar survey of faculty members of top-tier
research institutions in the United States in which nearly 25%
of respondents admitted to one or more of the ten most serious
types of misconduct during the last 3 years, including 1% who
admitted to fabrication or falsification and over 7% who
admitted to plagiarism
Nature. 2005 Jun 9; 435(7043):737-8.
Acad Med. 2009 Nov; 84(11):1491-9.
Of surveys that directly ask about misconduct by
those being surveyed:

17. “‘There’s no sense in deliberate falsification, anyhow,’
said the Bursar. ‘What could anybody gain by it?’; ’It
has been done,’ said Miss Hillyard, ‘ frequently. To get
the better of an argument. Or out of ambition.’;
‘Ambition to be what?’ cried Miss Lydgate. ‘What
satisfaction could one possibly get out of a
reputation one knew one didn’t deserve? It would be
horrible …I know people do it. But why? They must
be mad.’”
Dorothy L. Sayers, Gaudy Night, 1936.

18. A Lesson From One Of
The Worlds’ Fastest Growing Economies

19. A Lesson From One Of
The Worlds’ Fastest Growing Economies
• China’s top court and prosecutor’s office have released a set of
legal interpretations aimed at tightening the screws on rogue
pharmaceutical companies and public hospitals that have been
falsifying data to get licenses for new drugs
• Researchers convicted of falsifying data in studies or
clinical trials for new medications could face up to 10
years in prison
Caixin - Aug 16, 2017

20. A Lesson From One Of
The Worlds’ Fastest Growing Economies
• The administration ordered the pharmaceutical companies
behind 1,622 drugs in line for regulatory approval to conduct
a monthlong review of their new product applications for
potentially fraudulent data in studies and trials
• The administration promised not to punish companies that
uncovered misconduct in their own reviews
• After the month was over, the pharmaceutical companies
had withdrawn their applications for one-fifth of the listed
drugs, including 948 new drugs, 503 generic medications
and 171 imported drugs, according to the CDFA
• By the end of June 2016, the pharmaceutical companies had
withdrawn nearly half their applications
Caixin - Aug 16, 2017

21. Conflicts of Interest at Medical Journals:
The Influence of Industry-Supported Randomized Trials on Journal
Impact Factors and Revenue

22. Conflicts of Interest at Medical Journals
• Publication of industry-supported trials is associated with
an increase in journal impact factors.
• Sales of reprints may provide a substantial income.
• Journals should disclose financial information in the same
way that they require them from their authors, so that
readers can assess the potential effect of different types of
papers on journals’ revenue and impact.

23. • The proportion of trials with sole industry support varied
between journals. Industry supported trials were more
frequently cited than trials with other types of support
• Interestingly, industry trials more often have positive results
than non-industry trials.
• The conclusions in negative trials are often presented in
such a way that they appear to be more positive than they
actually were.
• Positive industry trials are more cited than negative ones
Conflicts of Interest at Medical Journals
Lundh A, Barbateskovic M, Hro ́bjartsson A, Gøtzsche PC (2010) Conflicts of Interest at Medical Journals: The Influence of Industry-
Supported Randomized Trials on Journal Impact Factors and Revenue – Cohort Study. PLoS Med 7(10): e1000354.
doi:10.1371/journal.pmed.1000354

24. Conflicts of Interest at Medical Journals
• Sponsoring companies employ various strategies to increase
the awareness of their studies, including ghost authored
reviews that cite them, purchase and dissemination of reprints,
and creation of media attention.
• Such strategies are likely to be predominantly used for trials
favorable to the sponsors’ products, and this may put editors
under pressure, as they know which papers are especially
attractive for the companies
Lexchin J, Bero LA, Djulbegovic B, Clark O (2003) Pharmaceutical industry sponsorship and research outcome and quality: systematic
review. BMJ 326: 1167–1170.
Boutron I, Dutton S, Ravaud P, Altman DG (2010) Reporting and interpretation of randomized controlled trials with statistically
nonsignificant results for primary outcomes. JAMA 303: 2058–2064.

25. Medical Journals Have Become An Extension of
Pharmaceutical Companies

26. Medical Journals Have Become An Extension of
Pharmaceutical Companies
“Journals have devolved into information laundering
operations for the pharmaceutical industry”,
- wrote Richard Horton, editor of The Lancet,
in March 2004
• Up to 75% of clinical trials published in
major journals like JAMA, Lancet, NEJM,
and Annals of Internal Medicine are
industry-sponsored
PLoS Medicine October 2010 | Volume 7, Issue 10

27. Big Pharma spends about $500 million every year placing ads
about their drugs in medical journals.
• Up to 1/3 of the pages in an average medical journal are full
page ads.
• If you’re trying to sell more drugs, it does make sense to
advertise in these journals, because those who will prescribe
these drugs read these journals.
• Return on investment for journal drug ads is estimated to be
an impressive $5 for every $1 that a drug company spends on
these ads.
“Journals have devolved into information laundering
operations for the pharmaceutical industry.”
PLoS Medicine October 2010 | Volume 7, Issue 10

28. 75 percent of what is being published today in journals like
Annals of Internal Medicine, the Journal of the American
Medical Association (JAMA), The Lancet and the New England
Journal of Medicine (NEJM) are trials that have been directly
funded by industry.
“Journals have devolved into information
laundering operations for the pharmaceutical
industry.”
PLoS Medicine October 2010 | Volume 7, Issue 10

29. “The companies seem to get the results they want not by fiddling with
the results, but by the very nature of the studies”
These include:
• Conducting a trial of a given drug against a treatment known to
be inferior
• Conducting a trial against too low of a dose of a competitor drug
• Conducting a trial against too high of a dose of a competitor drug,
making the drug in question seem less toxic
• Conducting a trial that is too small to show differences from
competitor drugs
Institute of Medicine, National Academy of Sciences, National Academy of Engineering. On Being a Scientist: A Guide to Responsible Conduct in Research. 3. The National
Academies Press; Washington, DC, USA: 2009
Nothing Up My Sleeve

30. • Using multiple endpoints in a trial and selecting for
publication only those that provide favorable results
• Conducting multi-center trials and selecting for publication
only those that reach favorable results
• Conducting subgroup analyses and selecting for publication
only those that are favorable
• Presenting results that are most likely to impress, such as
showing a reduction in relative as opposed to absolute risk
These include (continued):
Institute of Medicine, National Academy of Sciences, National Academy of Engineering. On Being a Scientist: A Guide to Responsible Conduct in Research. 3. The National
Academies Press; Washington, DC, USA: 2009
Nothing Up My Sleeve

31. Thursday, May 28, 2015 by: Jonathan Benson
It's not so much drug advertising as it is sponsored trials that
corrupt medical journals
• Although pharmaceutical advertising renders the quality of
what's been published in a given medical journal questionable,
at least readers of that journal can see these advertisements
and determine how seriously to take the contained studies.
• However, when the studies themselves are industry sponsored
and this is not disclosed, things get messy.

32. "A large trial published in a major journal has the journal's stamp
of approval (unlike the advertising), will be distributed around the
world, and may well receive global media coverage, particularly
if promoted simultaneously by press releases from both the
journal and the expensive public relations firm hired by the
pharmaceutical company that sponsored the trial.”
Scrip Magazine. 1993;14(March):14–15.

33. • For a drug company, a favorable trial is worth thousands of pages
of advertising, which is why a company will sometimes spend
upwards of a million dollars on reprints of the trial for worldwide
distribution.
• The doctors receiving the reprints may not read them, but they
will be impressed by the name of the journal from which they
come.
• The quality of the journal will bless the quality of the drug.
Scientist. 1995;20:13.

34. • Journals have thus far been accepted as one of the most
trusted sources of information
• It’s clear, however, that in order to maintain that trust,
journals and editors need to continue to consider all the
pressures that can arise in publishing and put in place robust,
transparent procedures for handling all the potential conflicts
that can arise, whether they are those of authors, editors, or
the journals themselves
Journal Cell Biology, 179, 1091-1092

35. Stuart Silverman
CEO & Founder
RyMat Incorporated
stu@rymatinc.com
RyMat Incorporated