By Putting Big Pharma’s
Patents Before Patients, Doctors Will Further
Erode Trust in Expert
By Jonathan Cook
February 27, 2021 "Information
Clearing House" - I
have spent the past several years on this blog
trying to highlight one thing above all others: that
the institutions we were raised to regard as
authoritative are undeserving of our blind trust.
It is not just that expert
institutions have been captured wholesale by
corporate elites over the past 40 years and that, as
a result, knowledge, experience and expertise have
been sidelined in favour of elite interests – though
that is undoubtedly true. The problem runs deeper:
these institutions were rarely as competent or as
authoritative as we fondly remember them being. They
always served elite interests.
What has changed most are our
perceptions of institutions that were once
beloved or trusted. It is we who have changed more
than the institutions. That is because we now have
far more sources – good and bad alike – than ever
before against which we can judge the assertions of
those who claim to speak with authority.
Hanging out together
Here is a
personal example. When I started work as an
editor at the foreign section of the Guardian
newspaper in the early 1990s, there were few ways,
from the paper’s London head office, to
independently evaluate or scrutinise the
presentation of events by any of our correspondents
in their far-flung bureaus. All we could do was
compare the copy they sent with that from other
correspondents, either published in rival newspapers
or available from two or three English-language wire
services.
Even that safeguard is far
less meaningful than it might sound to an outsider.
The correspondents for these
various publications – whether based in Bangkok,
Amman, Moscow, Havana or Washington – are a small
group. Inevitably they each bring to their work a
narrow range of mostly unconscious but almost
identical biases. They hang out together – like
any other expat community – in the same bars, clubs
and restaurants. Their children attend the same
international schools, and their families socialise
together at the weekends.
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Correspondents from these
various newspapers also have
similar backgrounds. They have received much the
same privileged education, at private or grammar
schools followed by Oxford or Cambridge, and as a
result share largely the same set of values. They
have followed almost identical career paths, and
their reports are written chiefly to impress their
editors and each other. They are appointed by a
foreign editor who served a decade or two earlier in
one of the same bureaus they now head, and he (for
invariably it is a he) selected them because they
reminded him of himself at their age.
The “local sources” quoted by
these correspondents are drawn from the same small
pool of local politicians, academics and
policymakers – people the correspondents have agreed
are the most authoritative and in a position to
speak on behalf of the rest of the local population.
Nowhere in this chain of news
selection, gathering, editing and production are
there likely to be voices
questioning or challenging the correspondents’
shared view of what constitutes “news”, or their
shared interpretation and presentation of that news.
Working in the guild
This is not the news business
as journalists themselves like to present it. They
are not fearless, lone-wolf reporters pursuing
exclusives and digging up dirt on the rich and
powerful. They comprise something more akin to the
guilds of old. Journalists are trained to see the
world and write about it in near-identical terms.
The only reason the media
“guild” looks far less credible than it did 20 or 30
years ago is because now we can often cut out the
middleman – the correspondent himself. We can watch
videos on Youtube of local events as they occur, or
soon afterwards. We can hear directly from members
of the local population who would never be given a
platform in corporate media. We can read accounts
from different types of journalists, including
informed local ones, who would never be allowed to
write for a corporate news outlet because they are
not drawn from the narrow, carefully selected and
trained group known as “foreign correspondents”.
A partial picture
In this regard, let us
consider my own area of specialist interest: Israel
and Palestine. Jewish settlers in the West Bank have
been beating up and shooting at Palestinian farmers
trying to work their land or harvest their olives
for more than half a century. It is one of the main
practical means by which the settlers implement an
ethnic cleansing policy designed to drive
Palestinians off their farmland.
The settlers have thereby
expanded their “municipal jurisdictions” to cover
more than
40 per cent of the West Bank, territory under
Israeli occupation that was supposed to form the
backbone of any future Palestinian state. This
settler violence is part of the reason why
Palestinian statehood looks impossible today.
But until a decade or so ago
– when phone cameras meant that recorded visual
evidence became commonplace and irrefutable – you
would rarely have had a way to know about those
attacks. Correspondents in Jerusalem had decided on
your behalf that you did not need to know.
Maybe the correspondents
refused to believe the accounts of Palestinians or
preferred the explanations from Israeli officials
that these were just anti-Israel lies motivated by
antisemitism. Or maybe the correspondents thought
these attacks were not important enough, or that
without corroboration they themselves risked being
accused of antisemitism.
Whatever the reason, the fact
is they did not tell their readers. This absence of
information meant, in turn, that when Palestinians
retaliated – in acts that were much more likely to
be reported by correspondents – it looked to readers
back home as if Palestinian violence was unprovoked
and irrational. Western coverage invariably
bolstered racist stereotypes suggesting that
Palestinians were innately violent or antisemitic,
and that Israelis, even violent settlers, were
always victims.
Unreliable experts
This problem is far from
unique to journalism. There are similar issues with
any of the professions – or guilds – that comprise
and service today’s corporate establishment, whether
it is the judiciary, politicians, the military,
academics or non-profits. Those supposedly holding
the establishment to account are usually deeply
invested, whether it be financially or emotionally,
in the establishment’s survival – either because
they are part of that establishment or because they
benefit from it.
And because these
self-selecting “guilds” have long served as the
public’s eyes and ears when we try to understand,
assess and hold to account the corporate elites that
rule over us, we necessarily have access only to
partial, self-justifying, establishment-reinforcing
information. As a result, we are likely to draw
faulty conclusions about both the establishment
itself and the guilds that prop up the
establishment.
Very belatedly, we have come
to understand how unreliable these experts – these
guilds – are only because they no longer enjoy an
exclusive right to narrate to us the world we
inhabit. The backlash, of course, has not been long
in coming. Using the pretext of “fake news”, these
institutions are pushing back vigorously to shut
down our access to different kinds of narration.
Plague of deficiency
All this is by way of a very
long introduction to a follow-up post on an
article I wrote last week about the failure of
doctors to press governments to finance proper,
large-scale studies on the treatment of hospitalised
Covid patients with Vitamin D – an important
immunological hormone created by sunlight on our
skin.
The role of Vitamin D on our
general wellbeing and health has come under
increasing scrutiny over the past two decades after
it was discovered that it is the only vitamin for
which there is a receptor in every cell in our body.
Long before Covid,
researchers had begun to understand that Vitamin D’s
role in regulating our immune systems was
chronically under-appreciated by most doctors. The
medical profession was stuck in a paradigm from the
1950s in which Vitamin D’s use related chiefly to
bone health. As a consequence, today’s recommended
daily allowances – usually between 400IU and 800IU –
were established long ago in accordance with the
minimum needed for healthy bones rather than the
maximum needed for a healthy immune system.
Today we know that many
people in northern latitudes, especially the
elderly, are deficient or severely deficient in
Vitamin D, even those taking government-approved,
low-level supplements. In fact, it would be true to
say there is a global plague of Vitamin D
deficiency, even in many sunny countries where
people have lost the habit of spending time outdoors
or shield themselves from the sun.
Denied a platform
The doctors and researchers
who have been gradually piecing together the
critically important role of Vitamin D are the
medical equivalent of the dissident journalists who
try to present a realistic picture of what goes on
in Israel-Palestine.
Because Big Pharma can make
no serious money from Vitamin D, researchers into
the sun hormone have struggled to raise funds for
their work and have mostly been denied corporate
platforms from which to publicise the stunning
findings they have made. Until recently, corporate
medicine simply ignored most Vitamin D research,
relegating it to the supposedly fringe science of
“nutrition”, which is why most doctors know little
or nothing about it.
With the outbreak of Covid,
when these Vitamin D studies should finally have
come into their own, researchers found themselves
shunted further into the margins. Just as
journalists, politicians and human rights groups
trying to tell you real things about Israel get
labelled antisemites, anyone trying to tell you real
things about Vitamin D gets labelled a crank,
conspiracy theorist or Covid denier.
The desperate need for Covid
treatments has not led to intensified interest in
Vitamin D among most doctors, even though it is very
cheap, almost completely safe even in large doses,
and has been shown to help in damping down immune
over-reaction of exactly the kind killing Covid
patients.
Rather, the opportunity for
Big Pharma to develop a magic bullet to treat Covid
has led to an intensified campaign to discredit
Vitamin D research.
Vitamin D minefield
In writing last week’s
article, I stepped into the Vitamin D minefield
fully expecting to receive as much flak as I do when
I report on Israel-Palestine. What I was not
prepared for is that the flak would be much worse.
I won’t rehearse the
arguments I made in my earlier post. You can read it
here.
Contrary to the claims of
some of those seeking to discredit my article, I
didn’t argue that Vitamin D is a proven cure for
Covid. I argued in favour of three far more cautious
positions that ought to be supported unequivocally
by anyone concerned about the large and rising Covid
death toll:
that given the exceptionally promising
results of studies into Vitamin D and Covid, it
is criminally negligent for governments not to
be funding further, large-scale research as a
priority to confirm or reject those findings;
that doctors, given their singular
credibility on medical matters with the public,
have a responsibility to lead that campaign of
pressure on governments, especially when those
same governments appear entirely beholden to Big
Pharma.
and that, given the minimal cost and
complete safety of using Vitamin D on patients,
it ought to be used on the precautionary
principle until further research is carried out.
Governments off the
hook
Instead lots of people,
doctors included, did the exact opposite. They
shifted the focus away from where it should be – on
governments to fund proper research – on to a recent
Barcelona study on Vitamin D that I had highlighted
in my previous article. That research confirmed on a
large scale dramatic and highly beneficial outcomes
for hospitalised Covid patients.
Critics wanted to nitpick
over flaws in the study’s design. I received endless
complaints that randomisation in the study was done
by ward rather than by individual patient – a less
satisfactory approach and one more likely to allow
doctors in attendance to know who was being treated
with Vitamin D and who wasn’t.
Other critics were exercised
by an anomaly: that in the Vitamin D group slightly
more patients died than had been admitted to
intensive care. Critics surmised that the doctors
involved in the study had been influenced in their
treatment protocols by knowing who was in the
Vitamin D group.
It is not that these are
groundless criticisms. Most studies have design
flaws, especially poorly funded ones that are being
carried out on the hoof in a hospital as its doctors
struggle to avoid being overwhelmed with Covid
patients.
The study’s relatively minor
flaws, however, do not invalidate its findings –
after all, rigid adherence to double-blind protocols
is unlikely to be a major factor in determining
whether patients recover from Covid. Rather, those
flaws underline the need to push for an even more
robustly designed study, properly funded by
governments, and the use in the meantime of Vitamin
D in hospitals on the precautionary principle.
Study taken down
But there is another reason
to be troubled by the chorus of criticism, much of
it led by doctors, of the Barcelona research. The
study was published as a pre-print by the Lancet,
meaning it was awaiting peer review. This is
standard practice for important studies to get them
into the public domain and encourage debate. And yet
after a campaign of pressure on the Lancet, the
editors hurriedly took down the study. They
effectively pre-empted the peer review process
because of the noisy campaign against the study.
The double standards at play
were all the more glaring because shortly after I
published last week’s post I was inundated with
correspondents praising another new study on Vitamin
D, this one carried out in Sao Paulo in Brazil. The
findings were published in the prestigious Journal
of the American Medical Association (JAMA).
It was soon apparent why this
study had attracted so many cheerleaders, especially
among the medical establishment. The Brazil study
has been used specifically to discredit the Spanish
study, suggesting that Vitamin D has no beneficial
outcome for hospitalised Covid patients. Some 17
doctors and researchers were directly involved in
the Brazil study, and additionally it passed the
scrutiny of a handful of other medical experts who
edit the Journal.
And yet despite the wealth of
medical expertise involved, even I could work out
that the study was worthless from the descriptions
provided by doctors promoting it on social media.
The major flaw in the Brazil study is so gross that
anyone who knows anything about Vitamin D
can spot it. The authors and the Journal’s editors
are apparently so ignorant about Vitamin D that they
even reveal their error in the study title.
‘Medical insanity’
Of course, I don’t expect
anyone to trust my assessment of a medical study
into Vitamin D, so I will defer to an acknowledged
medical expert on these matters, Dr Alex Vasquez,
whose
video assessment not only confirmed the major
flaw in the study I had spotted but alerted me to a
plethora of other serious failings. As he sighs his
way through his presentation in growing
exasperation, he intermittently describes the study
as “garbage”, “stupid”, “unethical and “medical
insanity”. He may be being too kind.
That the study is so bad
suggests one of three logical possibilities:
a) profound medical
incompetence by a wide array of doctors;
b) a conspiracy of some sort
by these doctors to deceive their readership;
c) or far more likely, a
groupthink cultivated in these doctors by a lifetime
of working in the service of corporate medicine that
has left them ignorant, dismissive and unconsciously
hostile to a supposed “nature cure” like Vitamin D.
I recommend you watch the
whole 40 minutes of Dr Vasquez’s video to get a true
sense of how outrageously bad this Brazil study is,
even though it is published by the Journal of the
American Medical Association and is being widely
promoted by doctors, chiefly as a way to dismiss the
more robust Spanish study.
But on the assumption you
don’t watch it, here is a brief overview of the most
catastrophic flaws in its design:
The doctors gave patients a single dose, one
that barely qualifies as a high dose despite the
study description, that earlier research on
Vitamin D, conducted four years ago, proved
doesn’t work. In other words, they designed a
study that was entirely unnecessary because the
outcome was known beforehand. The research was a
complete waste of everybody’s time and a
betrayal of the patients who took part because
nothing could be learnt from it.
Even worse, the form of Vitamin D the
researchers gave the patients needs 10 days to
become available in their bodies, far too late
to help these seriously ill patients in their
battle against Covid. Another form, calcifediol,
which is available for use by the immune system
immediately, should have been given instead, as
it was in the Spanish study.
In addition, not only was the wrong form of
Vitamin D given but it was administered to
patients 11 days after the onset of their
symptoms – a huge time lag that, as Dr Vasquez
observes, would ensure that many established
drug treatments – for illnesses such as
influenza, for example – would be guaranteed to
fail too.
The combined delay in treatment and the
delay in the Vitamin D becoming active meant the
patients had to wait three weeks before their
Covid was being treated in any meaningful way.
But that was the point at which the study ended
and an assessment was drawn about Vitamin D as
an ineffective treatment.
Patents over patients
The wildly differing
receptions these two studies have received should
raise serious suspicions.
One, the Barcelona study, has
flaws but none serious enough that its dramatic
finding – a finding supported by other studies –
should be discounted: that dosing with active
Vitamin D is likely to offer significant benefits to
hospitalised Covid patients. And yet this study is
being nitpicked to death and has been pulled from
publication by the Lancet as though it is a danger
to public health.
Meanwhile, a thoroughly
worthless Brazil study, so bad even non-doctors like
me can see what is wrong with it, is being lauded
and promoted. It is attracting almost no criticism,
no scrutiny by doctors apart from those who have
been marginalised, and is being weaponised to
discredit the far more serious Spanish study.
What we are seeing here is
entirely unrelated to evidence-based medicine.
Rather this is guild politics at its worst. Medical
protectionism. It is a turf war. Describe it any way
you wish. But this has nothing to do with medicine,
public health, fighting Covid, or savings lives.
The very different treatment
of these two studies suggests instead that the
majority of doctors – like the majority of
journalists, politicians and academics – have been
captured by corporate interests. Whether they
understand it or not, many doctors are in thrall to
guild interests, defined by Big Pharma, that benefit
not patients but patents and profits. Doctors have
largely been trained into complicity with a medical
money machine.
This is not just bad science.
It is self-sabotage. As public trust wanes in all
types of expertise and authority, widespread
disenchantment fuels the rise of charlatans like
Donald Trump, Boris Johnson and Jair Bolsonaro.
We long ago lost trust in
journalists and politicians. Academia now appears
cloistered and irrelevant, while judges all too
readily flaunt their privilege. All seem divorced
from the concerns of ordinary people.
With a pandemic raging,
doctors should be uniquely favoured. Now is a time
when they can prove that they at least are deserving
of our trust, that they are fighting for our
interests, not corporate interests. Instead they
risk following these other professions into guild
protectionism and disdain for those they took an
oath to help.
Jonathan Cook won the
Martha Gellhorn Special Prize for Journalism.
His books include “Israel and the Clash of
Civilisations: Iraq, Iran and the Plan to Remake
the Middle East” (Pluto Press) and “Disappearing
Palestine: Israel’s Experiments in Human
Despair” (Zed Books). His website is www.jonathan-cook.net.
If you appreciate his articles, please consider making a donation
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