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(Medpage Today)   Doctor explains how pharmaceutical research trials work, and how the Oakland Raiders went an undefeated 16-0   (medpagetoday.com) divider line
    More: Strange, Academic publishing, Oakland Raiders, Publishing, Clinical trial, Pharmacology, Research, medical study, Publication  
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2745 clicks; posted to Main » on 08 Mar 2019 at 12:50 PM (11 weeks ago)   |   Favorite    |   share:  Share on Twitter share via Email Share on Facebook   more»



34 Comments     (+0 »)
 
View Voting Results: Smartest and Funniest
 
2019-03-08 12:51:35 PM  
What a strange metaphor...
 
2019-03-08 12:57:19 PM  
Cherry pick the favorable data that backs what you are trying to accomplish or gain support for.

revolutionary
 
2019-03-08 12:58:28 PM  
Nah pharm trials are like:

Pharm Company: Hey FDA! We made a new drug that stands to makes us a ton o' cash!

FDA: Does it kill people?

Pharm Company:  It doesn't NOT kill people!

FDA: Approved!
 
2019-03-08 01:00:25 PM  
So every drug you see advertised to the public.
 
2019-03-08 01:02:10 PM  
Reading that article may give you rectal bleeding, reduced appetite and oily discharge. NOW BUY, BUY, BUY!
 
2019-03-08 01:11:43 PM  
Unless it were some rare disease with no other treatment, you'd never get approval based on post-hoc analysis.
 
2019-03-08 01:12:17 PM  
This is why we go to school for 13 years -- to develop critical thinking skills.  Any study/drug/product I see, the first thing I do is start punching holes in it.

Sales reps love me.
 
2019-03-08 01:13:55 PM  
Ahh the Raiders. The team with the worst fans.

As a person who has to regularly deal with traffic near the coliseum (I don't know or care what it's called now), all I can say about that team leaving is

img.fark.netView Full Size


Oh yea, and advertising in all it's forms is the greatest evil of mankind.
 
2019-03-08 01:17:37 PM  
I work for a medical device manufacturer whose products are used in late phase drug trial studies, so I'm getting a kick (back) out of this.
 
2019-03-08 01:20:28 PM  
RRRRAAAAAAAIIIIIIDDDDDEEEEEERRRRRRRRRS​SSSS
 
2019-03-08 01:20:29 PM  

Banned on the Run: This is why we go to school for 13 years -- to develop critical thinking skills.  Any study/drug/product I see, the first thing I do is start punching holes in it.

Sales reps love me.


It works with hypothetical studies as well. For instance, the article mentions the Raiders beat the Steelers on the road. But that game was actually played in Oakland so their outcome is based on flawed data that is easily discredited.
 
2019-03-08 01:29:10 PM  
The article touches on some truths about publishing in the scientific literature but it shows almost no understanding of the drug approval process where changing endpoints is not so easy.

It's true that if a drug fails to meet an endpoint (usually a measure for if this drug/formulation/drug administration regime is better than currently available therapies), teams of statisticians will be released to mine the data and look for other ways that the drug may be potentially useful.

One way to "rescue" a failed drug is to look for subpopulations where the drug worked. Maybe it appeared to work better for thin people, or people with a high BMI, or younger/older people. And in today's world, there will probably be some form of genetic screening that will be used to see if there's some genetic background that segregates between people who responded well to the drug and those who didn't.

For these new cases where the goal is to show that the drug worked will for subpopulation XYZ, the study will almost certainly be underpowered, which is a concept in statistics that mean you didn't test enough people in subpopulation XYZ to produce a statistically significant result.

Ultimately, a new study will have to be done to confirm the effect. And to get a drug approved, this process has to be done in collaboration with the FDA who need to approve of the new study design to test for the new endpoints. You can publish a speculative paper about how your drug appears to be effective in some subpopulation but that's just an academic game of little interest to most people. And so this article is likewise a sidebar to what matters.
 
2019-03-08 01:33:06 PM  
Because Vaccines cause Autism.
 
2019-03-08 01:40:24 PM  
Yet shockingly, western medicine works.  

It's almost like instead of reading a single journal article to approve a drug, the FDA has a rigorous process that they have done more than once.  It's almost like the claims made for the drug to be approved for a primary use need to have been demonstrated beyond outcome switching.  It's almost like if your primary outcome didn't work, there is valuable information in leads toward other uses.

It's almost like being a physician who comes up with a clever comparison is different than being an organic chemist or molecular biologist who specializes in this very specific condition and drug for their career then submits a paper for peer review.

My god, just imagine if the drugs you were prescribed had more to do with a hot young pharmaceutical rep buying your doctor lunch and giving them a pen was the norm, rather than what we know to be the truth, clinicians like him read every single journal article published with a skeptical eye!  Good thing someone published a half-assed metaphor in an online magazine, which I'm sure will NEVER end up on their resume!
 
2019-03-08 01:44:16 PM  
It's reports like this that fuel mistrust in our medical system, further fueling anti-vaxxers.  They need to clean that shiat up.
 
2019-03-08 01:45:25 PM  

Dangerous_sociopath: Oh yea, and advertising in all it's forms is the greatest evil of mankind.


I agree.  And I apologize.  The longer I'm in the business, the more I regret being in the business.
 
2019-03-08 01:51:23 PM  

Dangerous_sociopath: Ahh the Raiders. The team with the worst fans.


As of February 2019, average rent for an apartment in Oakland, CA is $2947.

Yes, I'm sure all those six-figure earning engineers / programmers that can afford to live in the Bay Area are all hoodlums.

/Sure, some are not from Oakland, and travel in from the slums of Sausalito or Palo Alto or Los Gatos, but still...
 
2019-03-08 01:58:15 PM  

wademh: The article touches on some truths about publishing in the scientific literature but it shows almost no understanding of the drug approval process where changing endpoints is not so easy.

It's true that if a drug fails to meet an endpoint (usually a measure for if this drug/formulation/drug administration regime is better than currently available therapies), teams of statisticians will be released to mine the data and look for other ways that the drug may be potentially useful.

One way to "rescue" a failed drug is to look for subpopulations where the drug worked. Maybe it appeared to work better for thin people, or people with a high BMI, or younger/older people. And in today's world, there will probably be some form of genetic screening that will be used to see if there's some genetic background that segregates between people who responded well to the drug and those who didn't.

For these new cases where the goal is to show that the drug worked will for subpopulation XYZ, the study will almost certainly be underpowered, which is a concept in statistics that mean you didn't test enough people in subpopulation XYZ to produce a statistically significant result.

Ultimately, a new study will have to be done to confirm the effect. And to get a drug approved, this process has to be done in collaboration with the FDA who need to approve of the new study design to test for the new endpoints. You can publish a speculative paper about how your drug appears to be effective in some subpopulation but that's just an academic game of little interest to most people. And so this article is likewise a sidebar to what matters.


Thank you.  For any NDA (New Drug Application), it is vital that the test approach and outcomes focus on a particular endpoint, i.e., a drug to treat hypertension actually reduces hypertension.  Now we have to have a sufficiently-large population to trial our drug, some of which will include people who - for reasons potentially unrelated to our drug - will die under treatment, or experience other health-related effects due to preexisting conditions.  If our drug is approved by the FDA, we indicate the usage of that drug in the labeling, prescribing information (this is VERY important) and advertising (the crackdown is the reason all the drug ads in the last 15 years are listing EVERY potential side effect, even if done by a speed talker or shown in 2-point footnotes).  I worked at several companies and heard of others where label claim fraud cases were rampant, and caused the company millions of dollars in fines and recalls.  Like many government agencies, the FDA usually works well, except when it doesn't.

In some cases, clinical trials produce alternate, positive outcomes.  Pfizer identified a drug in the late 80s for use in treating angina and pulmonary hypertension, but found among male clinical trial patients the side effect of significant, prolonged erections.  This is how we got Viagra (sildenafil).  Since prescribing revenue was more profitable with wieners, they switched their labeling and prescribing approaches to market in that industry.  Long-term use and abuse was associated with secondary illnesses, which forced them to add sterner warnings to the label and prescribing information.  Same goes for minoxidil; another older hypertensive drug was found to cause hair growth, hence taking it out a whole new door.

ALL of this data had to be reported with clinical and animal trial results, and as wademh stated, new treatment outlets require NEW testing trials and an amended drug approval application.  Yes, there are often attempts to bury negative data (a company I worked at did this very thing and were eventually caught down the line).  It results in hefty fines and criminal prosecution, not to mention audit blowback (consent decrees) on companies so their practices can be remediated and closely monitored by the FDA.  The difficulty comes in the time to market, how often a drug has to go through supplemental trials, cost to the drug company, and any audits that affect it's release and marketing.  Proving fraud, especially with statistical data, is not easy, and this review paper indicates that while it does happen, methods to detect it are low.

The only advice I've recommended for people is to read, read, read.  Read about the drugs your doctor may prescribe you.  Ensure they've looked @ side effects related to other medications.  Report any serious side effects, and if they're not on the prescribing info or a known effect, every drug company has a customer phone line (and a division) for pharmacovigilance to document any new issues with their medication.
 
2019-03-08 01:58:52 PM  

DrKnow: Yet shockingly, western medicine works.  

It's almost like instead of reading a single journal article to approve a drug, the FDA has a rigorous process that they have done more than once.  It's almost like the claims made for the drug to be approved for a primary use need to have been demonstrated beyond outcome switching.  It's almost like if your primary outcome didn't work, there is valuable information in leads toward other uses.

It's almost like being a physician who comes up with a clever comparison is different than being an organic chemist or molecular biologist who specializes in this very specific condition and drug for their career then submits a paper for peer review.

My god, just imagine if the drugs you were prescribed had more to do with a hot young pharmaceutical rep buying your doctor lunch and giving them a pen was the norm, rather than what we know to be the truth, clinicians like him read every single journal article published with a skeptical eye!  Good thing someone published a half-assed metaphor in an online magazine, which I'm sure will NEVER end up on their resume!


Yeah, just look at anti-depressants.  So Very clear doctors truly scrutinize all the data and don't follow the herd or get convinced by pharmaceutical companies.
 
2019-03-08 02:01:50 PM  

th0th: wademh: The article touches on some truths about publishing in the scientific literature but it shows almost no understanding of the drug approval process where changing endpoints is not so easy.

It's true that if a drug fails to meet an endpoint (usually a measure for if this drug/formulation/drug administration regime is better than currently available therapies), teams of statisticians will be released to mine the data and look for other ways that the drug may be potentially useful.

One way to "rescue" a failed drug is to look for subpopulations where the drug worked. Maybe it appeared to work better for thin people, or people with a high BMI, or younger/older people. And in today's world, there will probably be some form of genetic screening that will be used to see if there's some genetic background that segregates between people who responded well to the drug and those who didn't.

For these new cases where the goal is to show that the drug worked will for subpopulation XYZ, the study will almost certainly be underpowered, which is a concept in statistics that mean you didn't test enough people in subpopulation XYZ to produce a statistically significant result.

Ultimately, a new study will have to be done to confirm the effect. And to get a drug approved, this process has to be done in collaboration with the FDA who need to approve of the new study design to test for the new endpoints. You can publish a speculative paper about how your drug appears to be effective in some subpopulation but that's just an academic game of little interest to most people. And so this article is likewise a sidebar to what matters.

Thank you.  For any NDA (New Drug Application), it is vital that the test approach and outcomes focus on a particular endpoint, i.e., a drug to treat hypertension actually reduces hypertension.  Now we have to have a sufficiently-large population to trial our drug, some of which will include people who - for reasons potentially unrelated to our drug - will die under treatment, or experience other health-related effects due to preexisting conditions.  If our drug is approved by the FDA, we indicate the usage of that drug in the labeling, prescribing information (this is VERY important) and advertising (the crackdown is the reason all the drug ads in the last 15 years are listing EVERY potential side effect, even if done by a speed talker or shown in 2-point footnotes).  I worked at several companies and heard of others where label claim fraud cases were rampant, and caused the company millions of dollars in fines and recalls.  Like many government agencies, the FDA usually works well, except when it doesn't.

In some cases, clinical trials produce alternate, positive outcomes.  Pfizer identified a drug in the late 80s for use in treating angina and pulmonary hypertension, but found among male clinical trial patients the side effect of significant, prolonged erections.  This is how we got Viagra (sildenafil).  Since prescribing revenue was more profitable with wieners, they switched their labeling and prescribing approaches to market in that industry.  Long-term use and abuse was associated with secondary illnesses, which forced them to add sterner warnings to the label and prescribing information.  Same goes for minoxidil; another older hypertensive drug was found to cause hair growth, hence taking it out a whole new door.

ALL of this data had to be reported with clinical and animal trial results, and as wademh stated, new treatment outlets require NEW testing trials and an amended drug approval application.  Yes, there are often attempts to bury negative data (a company I worked at did this very thing and were eventually caught down the line).  It results in hefty fines and criminal prosecution, not to mention audit blowback (consent decrees) on companies so their practices can be remediated and closely monitored by the FDA.  The difficulty comes in the time to market, how often a drug has to go through supplemental trials, cost to the drug company, and any audits that affect it's release and marketing.  Proving fraud, especially with statistical data, is not easy, and this review paper indicates that while it does happen, methods to detect it are low.

The only advice I've recommended for people is to read, read, read.  Read about the drugs your doctor may prescribe you.  Ensure they've looked @ side effects related to other medications.  Report any serious side effects, and if they're not on the prescribing info or a known effect, every drug company has a customer phone line (and a division) for pharmacovigilance to document any new issues with their medication.


Are all off label uses approved by the FDA?  See this as an area pharmaceutical companies can leverage these techniques to increase usage of a drug.
 
2019-03-08 02:07:34 PM  
GummyBearOverlord:

Drug companies that promote off label use get farking WRECKED with fines. People are actually incentivized by a cut of the fines to report them.

https://bergermontague.com/pharmaceut​i​cal-sales-whistleblower-sheds-light-on​-off-label-marketing-scheme/
 
2019-03-08 02:13:15 PM  

GummyBearOverlord: Are all off label uses approved by the FDA?  See this as an area pharmaceutical companies can leverage these techniques to increase usage of a drug.


The short answer is no: The FDA does not approve off-label use.  It's a decision made by the healthcare provider in most cases, with the agreement of the patient (not the same as "informed consent"), and as the link states, off-label means the "FDA has not determined that the drug is safe and effective for the unapproved use."  This creates a number of potential outcomes:

1) The off-label use creates a positive result, which can be reported back to the drug company to go into future trials to verify the off-label use can now be approved for use by the FDA.  This addresses the leverage you indicate, and why there are so many rules (and problems) with how drug salespersons can unduly influence clinicians.

2) The off-label use has no outcome, and the clinician has to provide a different medication.

3) The off-label use has negative or disastrous outcomes, at which time the clinician can throw the drug company under the bus for manufacturing the "silent killer".
 
2019-03-08 02:32:03 PM  

GummyBearOverlord: Yeah, just look at anti-depressants.  So Very clear doctors truly scrutinize all the data and don't follow the herd or get convinced by pharmaceutical companies.


Different sort of problem. MDs are dangerous. And our system that ultimately lets MDs get kickbacks for the meds they prescribe is one of the big faults in our current for-profit system. The situation with statins is terrible. Help you lower your cholesterol "Almost as effective a proper diet and exercise". Statins should be a last resort after multiple attempts at proper diet and exercise. Statins have significant side effects that seriously reduce quality of life for older people including producing numbing in the fingers and toes and muscle wasting. Doctors and patients dismiss it as just symptoms of getting old. Doctors prescribe statins for cases of mild high cholesterol but there are few good medical studies that show a decrease in heart disease linked to that decrease when the decrease is from taking statins. In contrast, a small decrease in cholesterol numbers from improved diet and exercise is strongly linked to a decrease in heart disease. Most statin prescriptions are bloody malpractice.
 
2019-03-08 02:33:18 PM  

DrKnow: Yet shockingly, western medicine works.  

It's almost like instead of reading a single journal article to approve a drug, the FDA has a rigorous process that they have done more than once.  It's almost like the claims made for the drug to be approved for a primary use need to have been demonstrated beyond outcome switching.  It's almost like if your primary outcome didn't work, there is valuable information in leads toward other uses.

It's almost like being a physician who comes up with a clever comparison is different than being an organic chemist or molecular biologist who specializes in this very specific condition and drug for their career then submits a paper for peer review.

My god, just imagine if the drugs you were prescribed had more to do with a hot young pharmaceutical rep buying your doctor lunch and giving them a pen was the norm, rather than what we know to be the truth, clinicians like him read every single journal article published with a skeptical eye!  Good thing someone published a half-assed metaphor in an online magazine, which I'm sure will NEVER end up on their resume!


The guy who wrote the article works in a prison, so......
 
2019-03-08 02:35:57 PM  
Learned all that from Dr. Steve years ago.

/weird medicine; weekends, on s***** x* 103
//fluid
 
2019-03-08 02:46:24 PM  

th0th: In some cases, clinical trials produce alternate, positive outcomes.  Pfizer identified a drug in the late 80s for use in treating angina and pulmonary hypertension, but found among male clinical trial patients the side effect of significant, prolonged erections.  This is how we got Viagra (sildenafil).


Neurontin (and later Lyrica) started as a seizure med.  Diabetics with seizures and painful neuropathy were reporting a decrease in pain.  Prior to this, neuropathic pain was very difficult to treat.
 
2019-03-08 02:53:18 PM  

wademh: GummyBearOverlord: Yeah, just look at anti-depressants.  So Very clear doctors truly scrutinize all the data and don't follow the herd or get convinced by pharmaceutical companies.

Different sort of problem. MDs are dangerous. And our system that ultimately lets MDs get kickbacks for the meds they prescribe is one of the big faults in our current for-profit system. The situation with statins is terrible. Help you lower your cholesterol "Almost as effective a proper diet and exercise". Statins should be a last resort after multiple attempts at proper diet and exercise. Statins have significant side effects that seriously reduce quality of life for older people including producing numbing in the fingers and toes and muscle wasting. Doctors and patients dismiss it as just symptoms of getting old. Doctors prescribe statins for cases of mild high cholesterol but there are few good medical studies that show a decrease in heart disease linked to that decrease when the decrease is from taking statins. In contrast, a small decrease in cholesterol numbers from improved diet and exercise is strongly linked to a decrease in heart disease. Most statin prescriptions are bloody malpractice.


*facepalm

From the anti-vaxxer thread:
img.fark.netView Full Size


I'll just call you Hoaxy Holly
 
2019-03-08 03:56:31 PM  

Banned on the Run: wademh: GummyBearOverlord: Yeah, just look at anti-depressants.  So Very clear doctors truly scrutinize all the data and don't follow the herd or get convinced by pharmaceutical companies.

Different sort of problem. MDs are dangerous. And our system that ultimately lets MDs get kickbacks for the meds they prescribe is one of the big faults in our current for-profit system. The situation with statins is terrible. Help you lower your cholesterol "Almost as effective a proper diet and exercise". Statins should be a last resort after multiple attempts at proper diet and exercise. Statins have significant side effects that seriously reduce quality of life for older people including producing numbing in the fingers and toes and muscle wasting. Doctors and patients dismiss it as just symptoms of getting old. Doctors prescribe statins for cases of mild high cholesterol but there are few good medical studies that show a decrease in heart disease linked to that decrease when the decrease is from taking statins. In contrast, a small decrease in cholesterol numbers from improved diet and exercise is strongly linked to a decrease in heart disease. Most statin prescriptions are bloody malpractice.

*facepalm

From the anti-vaxxer thread:
[img.fark.net image 560x767]

I'll just call you Hoaxy Holly


Um, saying statins are over-prescribed without regard to known side effects is hardly the same as being an anti-vaxer.

Statins are effective at lowering cholesterol and preventing death in people with dangerously high cholesterol.  They aren't a magic pill to make people who don't want to eat better and exercise more healthy.

In fact, the side effects make people feel worse, even though they are less likely to die.  They aren't a magic solution, and they *are* over-prescribed.

There was a very interesting study on it published last year.  It's medical research so behind a paywall, but here's a good article on it:

Link
 
2019-03-08 04:55:59 PM  

Dr.Fey: Dangerous_sociopath: Ahh the Raiders. The team with the worst fans.

As of February 2019, average rent for an apartment in Oakland, CA is $2947.

Yes, I'm sure all those six-figure earning engineers / programmers that can afford to live in the Bay Area are all hoodlums.

/Sure, some are not from Oakland, and travel in from the slums of Sausalito or Palo Alto or Los Gatos, but still...


I travel all the way from the ghetto of San Luis Obispo. I can't wait for the new stadium. I have to drive to Oakland, I can fly to Vegas.
 
2019-03-08 04:57:21 PM  

SafetyThird: I travel all the way from the ghetto of San Luis Obispo. I can't wait for the new stadium. I have to drive to Oakland, I can fly to Vegas.


Do you have seats (PSL)?  Or just going to single-game it?
 
2019-03-08 05:19:37 PM  

wingedkat: Banned on the Run: wademh: GummyBearOverlord: Yeah, just look at anti-depressants.  So Very clear doctors truly scrutinize all the data and don't follow the herd or get convinced by pharmaceutical companies.

Different sort of problem. MDs are dangerous. And our system that ultimately lets MDs get kickbacks for the meds they prescribe is one of the big faults in our current for-profit system. The situation with statins is terrible. Help you lower your cholesterol "Almost as effective a proper diet and exercise". Statins should be a last resort after multiple attempts at proper diet and exercise. Statins have significant side effects that seriously reduce quality of life for older people including producing numbing in the fingers and toes and muscle wasting. Doctors and patients dismiss it as just symptoms of getting old. Doctors prescribe statins for cases of mild high cholesterol but there are few good medical studies that show a decrease in heart disease linked to that decrease when the decrease is from taking statins. In contrast, a small decrease in cholesterol numbers from improved diet and exercise is strongly linked to a decrease in heart disease. Most statin prescriptions are bloody malpractice.

*facepalm

From the anti-vaxxer thread:
[img.fark.net image 560x767]

I'll just call you Hoaxy Holly

Um, saying statins are over-prescribed without regard to known side effects is hardly the same as being an anti-vaxer.

Statins are effective at lowering cholesterol and preventing death in people with dangerously high cholesterol.  They aren't a magic pill to make people who don't want to eat better and exercise more healthy.

In fact, the side effects make people feel worse, even though they are less likely to die.  They aren't a magic solution, and they *are* over-prescribed.

There was a very interesting study on it published last year.  It's medical research so behind a paywall, but here's a good article on it:

Link


I don't disagree with you.
There was a reason I underlined part of the his post.
 
2019-03-08 05:39:35 PM  
https://www.healthline.com/health-new​s​/brand-name-statin-your-doctor-taking-​industry-money#1
https://jamanetwork.com/journals/jama​i​nternalmedicine/fullarticle/2520680
Researchers from Brigham and Women's Hospital and Harvard Medical School reviewed the records of about 1.6 million prescriptions for statins covered by Medicare Part D in Massachusetts in 2011.

Of the 2,444 doctors in the Medicare prescribing database, almost 37 percent received industry payments.
Researchers found that physicians who didn't receive industry money prescribed brand-name statins at a rate of almost 18 percent. Those who did take money prescribed brand-name drugs at a rate of almost 23 percent.

Further reading:
https://www.nejm.org/doi/full/10.1056​/​NEJMsa064508

Well documented relationships between pharma payments/kickbacks and prescription rates is not, in any way shape or form, like being an anti-vaxer no matter what your cartoon meme says. You've got a cartoon, I've got published research on prescription rates by MDs, and I preempted the other reference by detailing what the problems of over-prescribing statins are. Some punk-ass meme doesn't rank well against over a decade working in systems toxicology including work on statins.
 
2019-03-08 06:13:25 PM  
Of the 2,444 doctors in the Medicare prescribing database, almost 37 percent received industry payments.
Researchers found that physicians who didn't receive industry money prescribed brand-name statins at a rate of almost 18 percent. Those who did take money prescribed brand-name drugs at a rate of almost 23 percent.

<Snip>

Well documented relationships between pharma payments/kickbacks and prescription rates is not, in any way shape or form, like being an anti-vaxer no matter what your cartoon meme says.



Why are you assuming that it's physicians receiving a dirty kickback? The study says that 70% of those payments were meals of about $120.   If it's the doctor and sales person, that's only $60/plate.   Even the grants were only a median of $100.   An alternative explanation is that if nobody has spent time explaining the advantage of their drug for a sub population, you probably prescribe the older generic.
 
2019-03-10 12:43:25 AM  

wademh: https://www.healthline.com/health-new​s​/brand-name-statin-your-doctor-taking-​industry-money#1
https://jamanetwork.com/journals/jamai​nternalmedicine/fullarticle/2520680
Researchers from Brigham and Women's Hospital and Harvard Medical School reviewed the records of about 1.6 million prescriptions for statins covered by Medicare Part D in Massachusetts in 2011.

Of the 2,444 doctors in the Medicare prescribing database, almost 37 percent received industry payments.
Researchers found that physicians who didn't receive industry money prescribed brand-name statins at a rate of almost 18 percent. Those who did take money prescribed brand-name drugs at a rate of almost 23 percent.

Further reading:
https://www.nejm.org/doi/full/10.1056/​NEJMsa064508

Well documented relationships between pharma payments/kickbacks and prescription rates is not, in any way shape or form, like being an anti-vaxer no matter what your cartoon meme says. You've got a cartoon, I've got published research on prescription rates by MDs, and I preempted the other reference by detailing what the problems of over-prescribing statins are. Some punk-ass meme doesn't rank well against over a decade working in systems toxicology including work on statins.


From your article: The most common form of payment was for company-sponsored meals

You equate a sandwich with a "kickback"???

cdn-images-1.medium.comView Full Size
 
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