[RUSH TRANSCRIPT BELOW] “We get a lot of inappropriate over-prescribing for almost everything,” says drug policy researcher and journalist Alan Cassels.

Cassels is the co-author of “Selling Sickness: How the World’s Biggest Pharmaceutical Companies Are Turning Us All Into Patients.”

For Cassels, it was one disease in particular—osteoporosis—that changed his entire view of medicine.

Based on changing definitions of the disease, large swaths of Americans could suddenly be declared sick and in urgent need of drug treatment.

They “medicalized normal aging of basically the entire female population. Overnight,” he says.

In our interview, we discuss the influence of the pharmaceutical industry on overdiagnoses and prescriptions, and how the criteria for many diseases can be expanded arbitrarily.

“When you look closely at the quality of prescribing, a lot of times, the decision-making is not really driven by evidence. It’s driven mostly by … marketing, biases, influence from thought leaders, and influence from guidelines, medical guidelines themselves, which are often appallingly biased,” he says.

Many doctors, Cassels says, know little about the adverse effects of the many drugs they prescribe to their patients.

We also dive into the connection between psychiatric drug prescriptions and violence, how psychiatry labels normal behaviors as abnormal, and how exaggerated statistics are used to sell theories of disease and drug treatments.

Views expressed in this video are opinions of the host and the guest, and do not necessarily reflect the views of The Epoch Times.

RUSH TRANSCRIPT

Alan Cassels, such a pleasure to have you on American Thought Leaders.

Alan Cassels:

It’s great to be here.

Mr. Jekielek:

So what’s the answer to the question: Are we looking in the right place for answers to violent attacks?

Mr. Cassels:

So when you think about violent attacks, you think of people who have psychiatric problems, for example, and oftentimes when they investigate it, they look at the kind of psychiatric care a person might be under. What they’re not questioning, though, is the quality of the prescribing that goes into a lot of psychiatric care. And in fact, we know that one of the main adverse effects related to psychiatric drugs—I’m speaking broadly here, but specifically say antipsychotics or antidepressants—is violent behavior, suicide, homicide. These are all known dangers of these drugs. Oftentimes, when these violent attacks happen, such as we had in Canada where a person drove a vehicle into a group of people having a street festival, when they examine this, nobody is sitting down and asking what kind of drugs the person was taking and what kind of prescription they were experiencing. 

And I think that’s probably the first place you should look, and oftentimes it gets overlooked altogether because people will assume that whatever psychiatric care they’re under must be sort of guideline care and approved, but really we have to step back and say, look, we’re probably causing a lot of the psychiatric outbursts by the kinds of prescribing that we do. 

Mr. Jekielek:

Now, is this because of rare effects that maybe even some of the doctors might not be aware of, or is that the reason? 

Mr. Cassels:

Well, doctors’ lack of cognition around adverse effects related to drugs is well known. I mean, this has been well studied. Physicians don’t learn about the adverse effects of drugs largely because they’re not exposed to that through a lot of the marketing that they get. And of course, a lot of the information that physicians get around drugs comes from the hands of the pharmaceutical companies.

Mr. Jekielek:

And they’re not exactly promoting the adverse effects of their drugs. Is there some way to quantify how big a problem this is? Like how often the drugs might have been responsible or partially responsible in situations where that hasn’t been looked at? 

Mr. Cassels:

That’s a good question. I don’t think it’s been adequately studied, but I think if you talk to the experts that are, you know, well-versed in sort of the adverse effects of psychiatric drugs, they would say most of the time you can draw conclusions by looking at the drugs that the person is being prescribed.

Mr. Jekielek:

So maybe dig into that a little because what you’re describing is not something that’s obvious.

Mr. Cassels:

Yes, it’s not obvious, but I mean, let’s put it this way: we assume, as consumers and as patients, that when we’re presented to a physician with a particular disease, the decision-making around your condition and how to treat it—in terms of some kind of therapy or drug that you might get—is evidence-based. It’s based on a physician’s careful assessment of the science and an assessment of your disease. Though when you look closely at the quality of prescribing, a lot of times that decision-making is not really driven by evidence; it’s driven mostly by, sometimes, marketing, biases, influence from thought leaders, and influence from medical guidelines themselves, which are often appallingly biased. 

I'll give you an example: someone who presents with high blood sugar, you know, might be a precursor to prediabetes or diabetes. A physician will assume that, because of the guidelines, this is the level at which you should start taking some kind of treatment to alter your blood sugars, without knowing that the people who wrote the guidelines are heavily funded by pharmaceutical companies.

In fact, the Canadian guidelines’ conflicts of interest of the authors fill up 15 or 20 pages. So what’s clear to us who independently look at this kind of thing is that the pharmaceutical companies are very good at putting their own people on guideline committees. And that’s why we end up in a situation where we get a lot of inappropriate and overprescribing for almost everything.

Mr. Jekielek:

Now, with that particular scenario, I recall some instance—and maybe it was a different drug—but where the level of blood sugar was moved to something lower, right?

Mr. Cassels:

You would not believe how often they move the goalposts. To give you an example, probably the best example of blood sugar is blood pressure. Okay, so 20 years ago, if you came in and your doctor said your blood pressure is 150/90, they would say it’s a little on the high side, no problem; you know, maybe you should exercise some more and reduce the salt in your diet. Today, now, over time, that 150/90 has been lowered to 140, to 130, and now it’s around 120. 

Mr. Jekielek:

When you lower the level at which you start treating someone or telling someone that they’re ill or potentially ill from high blood pressure, you expand the massive pool of people that become patients. And this is one of the key things behind disease mongering: when you change the definitions of what the disease is, you expand the pool. They never change the definitions that reduce the size of the pool because, again, the pharmaceutical companies are very, very involved in the writing of the guidelines, but we document that in selling sickness how, by just lowering, say, the level at which we would consider high cholesterol to be a condition, overnight they would expand the number of Americans who would be treated for cholesterol-lowering drugs by 25 million people, just by changing the definition. 

Mr. Jekielek:

So, I mean, you’re describing, I think, a very powerful incentive structure to do precisely that. 

Mr. Cassels:

Exactly. The incentives are all in the direction of the pharmaceutical companies and for those who are funded by the pharmaceutical companies, including the patient groups and specialty societies and so on, absolutely. But what’s missing from this situation is that you don’t have enough people, perhaps like me, who are critiquing this and saying, just hang on a second, you just moved the goalpost. You’re not actually expanding the number of people who are going to be considered well; you’re expanding the group of people who are considered sick. 

So you’re actually creating illness. You’re creating a sense of ill-ease amongst the population when you start telling people your blood pressure needs to be at this level; otherwise, you’re unhealthy. And this idea that telling people that they’re not healthy when they otherwise are is really the essence of disease mongering. This is something that I’ve written quite a bit about.

Mr. Jekielek:

This is your term, I think. You coined the term disease mongering.

Mr. Cassels:

I wrote the book, yes. So I wrote a funny little book called The ABCs of Disease Mongering because I wanted to describe in 26 letters how we see this kind of creation and marketing of illness from cradle to grave, from babies to people who are at the end of their lives, where normal human changes in physiology and your life as you age become another reason for which another drug might be prescribed. So, you’re right. There’s definitely a campaign, shall we say, to get more and more of us to become ill.

Mr. Jekielek:

So one thing comes to mind. In the U.S., there’s been a lot of discussion about autism rates growing in a way that’s frankly shocking when you look at these graphs. Now, what’s very curious about this is that I think it’s actually kind of the industry that’s saying this is a function of precisely what we’ve just been describing of the goalposts being moved. So now we’re just overdiagnosing autism a lot more.

Mr. Cassels:

Absolutely. It used to be, for example.

Mr. Jekielek:

But this is a curious situation because I think it’s the industry that’s saying that, whereas it’s the people who are like yourself, like activists, who are saying the opposite, no, that this is actually a real shift.

Mr. Cassels:

On this point around autism, same with attention deficit disorder, I would agree with that, where they have changed the goalposts on what used to be considered autistic behavior, or say on the spectrum, 15 or 20 years ago. There might be, say, 15 to 20 different symptoms. And of this checklist of symptoms, if the child exhibits 10 of them, for example, they might be considered to have autism. 

Well, they’ve changed that over time, so now they only have to exhibit 6 of them or 4 of them. And so when you, again, when you do that, you’re expanding the pool of people who begin to take this label and perhaps to be accepted for treatment for it. And, as you know, there’s a whole industry around autism. 

At the same time, you have to ask yourself if there are actual things in medicine or in society that might be causing neurodevelopmental problems in children, and that’s when you start looking at things like drugs or perhaps vaccines, right? Just putting that out there that those things need to be adequately studied in order to be able to determine what is actually causing this apparent rise in autism or ADHD [Attention deficit hyperactivity disorder].

Mr. Jekielek:

So basically you’re saying that both things can be very much true; that there could be a rise in these neurodevelopmental issues, but at the same time, autism itself could be overdiagnosed because it serves the interest of people who want to provide drugs around that. 

Mr. Cassels:

Absolutely. You hear anecdotes of parents who want a diagnosis for their child because that’s going to get them special care or extra help in school and so on. You certainly see that in the area of ADHD, where it actually comes as a relief to some parents that, oh my goodness, my son now has ADHD and therefore is eligible for some extra help in school. Explain to me, you kind of describe this almost like assistance.

Mr. Jekielek:

I guess this disease mongering is a systemic thing. It’s something that’s almost done in every area. Give me some examples where we see that.

Mr. Cassels:

Again, it’s a cradle-to-grave phenomenon. I maybe start from closer to the end of people’s lives. And this is something that I became aware of 30 years ago. And when I started becoming aware of this one disease and to see to which the industry had infiltrated itself into the definition of the disease, it changed my whole view of medicine. And that was osteoporosis. And, you know, in the early 90s, a major pharmaceutical company in the U.S. created a new drug to treat this condition, osteoporosis, which at that point wasn’t very well understood. 

In fact, there wasn’t really an agreed-upon definition. There was a meeting convened at the World Health Organization [WHO], and at that meeting, there were officials, endocrinologists, and others, as well as representatives from pharmaceutical companies that were making drugs to treat this condition. There, they set the definition at a certain level of bone density. 

This is the density of your bones as you age; they set it at a certain level in a way that would have diagnosed something like 50 percent of the female population over 70 with having this condition. They set the definition that way and basically said overnight that this portion of the population that has bone density below this now has this condition called osteoporosis. Or if it’s close to that, they might have something that is pre-osteoporosis or known as osteopenia. 

What you ended up doing is medicalizing normal aging of basically the entire female population overnight. That drug became a blockbuster drug, prescribed widely. The company that was marketing it bought bone density testing equipment and distributed it through all the clinics and hospitals throughout the U.S. and basically overnight created a condition that is a normal part of aging and really medicalized one’s bones. 

That has gone on to be extremely controversial because that drug, you know, after time, when you get millions of people taking a drug, that’s when you start seeing the major problems—severe problems with swallowing, esophageal burning, over the long term. This is cruel and ironic at the same time. Those drugs are called bisphosphonates. It was found that drugs in that class actually make people’s bones more brittle, and more prone to breaking.  

Admittedly, elderly people falling and breaking a hip can be quite a serious problem. Oftentimes that can lead to, you know, disability, nursing homes, and sort of the beginning of the end of a person’s life. Absolutely, you want to do what you can to reduce the sort of problems of broken bones in elderly people. But preventing falls should be the focus, not using a drug that’s going to alter the chemical composition of your bones, which ends up making your bones more brittle. Again, that was, from start to finish, I would say a pharmaceutical industry construct. 

And now they’ve moved on to other classes of drugs, but still, I have friends of mine who are my age, in their 50s and 60s; they’re on a bicycle, they fall off, and they break. their wrist or they’re skiing or they’re in an accident, they get sent to their doctor. The first thing they do is send them for a bone density test, and they'll say, oh, you have pre-osteoporosis. It drives me crazy because they are using the broken bone as a pretext for explaining to a person that they now have this disease and that they possibly could be a candidate for a drug. 

Mr. Jekielek:

I mean, this is, forgive me, I’m going to play advocate to the devil here a little bit, but some people have low bone density and probably need some kind of help, but it’s never the drug that will be helpful for this in your view? 

Mr. Cassels:

It depends. So what is the problem that we’re trying to solve here? There is a whole range of different bone densities. A lot of people live perfectly well and quite healthily with low bone density. It’s not something that is kind of like developing gray hair and wrinkles. Eventually, your bone density will change over time, and it will become lower than it was when you were in your 30s. 

That was the other problem with the bone density measurement: they were comparing women in their 70s to women in their 30s, and then they were pointing at them and saying, well, they have low bone density. Well, they have a lower bone density than they did when they were young, active, and probably in the prime of their life. 

So yes, is there a problem with people having low bone density? If people are repeatedly falling and breaking bones, yes, that can be a problem, but I could be wrong; I don’t believe there’s any drug in the world that’s going to prevent someone from breaking a bone if they fall. 

Mr. Jekielek:

So the idea that this drug will somehow prevent breaks when people fall, that is untrue? 

Mr. Cassels:

It’s totally untrue. I'll give you an example of how crazy this was. They marketed this drug called Fosamax; the generic name is alendronate. They marketed it as reducing hip fractures by 50 percent, and I know because I’ve used the ads that the company ran in major medical journals. I’ve used these ads in presentations that I’ve done on this very topic, and they show a person, an elderly woman bent over, and it’s like a 50 percent reduction in hip fractures. 

My question is, when somebody gives you a number like that, well, how many hip fractures were there in the placebo group? I mean, the women in the group—there were more than 3,000 women in this trial that had low bone density defined them as having osteoporosis. They had had previous fractures, they have low bone density, so they’re at high risk. How many of these high-risk women, in the course of four years, would have a hip fracture? Well, the answer was about two percent—two out of a hundred. How many had a hip fracture if they took the drug? Well, it was 1 out of 100. 

So when you go from 2 out of 100 down to 1 out of 100, that’s a 50 percent drop. And so the 50 percent was marketed to patients, to doctors, to specialists. People went away thinking this drug is miraculous. It’s going to reduce our rate of hip fracture by 50 percent. This is kind of what turned me into an activist when I saw the misuse of those numbers and how misleading that would be for my mother or my grandmother, thinking that they’re going to have a massive effect when there’s a one percent difference. 

Mr. Jekielek:

Well, and it’s also probably not statistically significant at all.

Mr. Cassels:

It’s not clinically significant. I mean, statistics is a whole other game, but they would have determined that it was perhaps statistically significant that you had fewer hip fractures in the bisphosphonate group, but at the same time, is that meaningful to have a one percent difference? How does that compare to the rate of adverse effects? 

And we know that the rate of adverse effects is much greater than one percent, right? So you’re promoting this drug on the basis of a misleading reduction, and this happens all the time. We saw this, we still see this today. You remember the 95 percent during COVID. It’s the same sort of thing. 

Mr. Jekielek:

It’s the difference between relative risk and absolute risk, absolutely. Yeah, it’s just shocking. I mean, this is a very widely prescribed drug or was; I don’t know what the status is, but I know because I discussed it with my mom at one point. These are very commonly used. How many situations like this are there?

Mr. Cassels: 

In my book about disease, we’re going to have 26 examples. But yes, this kind of using exaggerated statistics to sell theories of disease and drug treatments is ubiquitous. It’s everywhere.

Mr. Jekielek:

Before we continue, tell me a little bit about what you were doing when you said you became radicalized, you became an activist. How did you get into all this?

Mr. Cassels:

I went back to university. I was a naval officer. I went through military college and served in the Navy for 12 years. Then I went back to university and started studying a master’s program in public administration. I got asked at the time if I would be interested. in working on a project studying pharmaceutical policy in British Columbia. And it sounded really interesting, so I signed up for that. Even though I was headed for the Foreign Service, I ended up becoming a drug policy researcher and never went into the Foreign Service. 

But one of the first studies that I was asked to work on was developing a guide for consumers around osteoporosis. And that’s when I started to read and understand what a massive amount of misleading information was out there. And then I took that and I said, well, does this happen in other areas? 

And then I started looking and started working with people that were experts in hypertension, which is high blood pressure. It’s very similar kinds of things in terms of the manipulation and the use of statistics in order to increase the sort of appeal of drug therapy, the appeal of it. And even discovering the degree to which doctors are misled by the marketing materials that they are exposed to. 

And this really kind of shocked me because I thought, like most people, that the decisions made about the drugs that we get every day are mostly science-based and are based on a good understanding of the potential benefits and the potential harms. And I discovered over time that that kind of paradigm doesn’t exist in the real world. The paradigm that does exist is that there are many decisions that go into making prescribing decisions, and the marketing of both the disease and the treatment are a major part of it. There are other things. We can’t discount the idea of patient demand, where people are exposed to information from their neighbors, from advertising.

Mr. Jekielek:

In the U.S., from advertising, right?

Mr. Cassels:

Drug advertising. And people start seeing their own bodies through the lens of drug ads and think that if they only had that drug, their life would be better. So physicians respond to patient demands. We know this; this has been well studied.

Mr. Jekielek:

How does this apply to psychiatric medications?

Mr. Cassels:

In psychiatric medicine, again, the same sort of things apply. But what is probably the most damaging about the world of psychiatry is the labeling of behaviors that are generally within what used to be the range of normal. So you have boys who are exuberant, they’ve got lots of energy. They’re told to sit down, shut up, do your work. And it’s like, that’s not kind of how boys learn. And that’s not how boys operate. 

It’s very foreign for a lot of, and I’m saying boys, but it happens to girls as well, to be jammed into a classroom and be told to sit down and pay attention when they’d rather be running around and boys learn kinetically through movement and a boy who’s very disruptive and speaks up is going to make it difficult for all the other children to learn, and therefore there is a lot of pressure on doing something to prevent that boy’s behavior from becoming disruptive for everyone. 

That sometimes leads down the road to a diagnosis and a drug, whether it’s, you know, your son has some level of attention deficit disorder and might be helped by a drug. So the problem—and there are many problems in this pair—is that we’re creating social situations and we treat them as medical situations, right? I'll give you another example.

Mr. Jekielek:

It could also be lack of discipline, right?

Mr. Cassels:

Absolutely. It could be that the child comes from a situation at home where there’s poverty, neglect, abuse, all kinds of things which might be affecting this child’s behavior. It’s not that they have a brain disease; they’re probably reacting normally to whatever stimuli they’re getting.

Mr. Jekielek:

Just to touch on this, I don’t want to cut off your thought, but just to touch on this a little more, I mean, there’s been a change in the educational system where discipline isn’t as valued, right? Like that isn’t taught. It’s like systemically not taught at a level, say, it would have been some decades ago.

Mr. Cassels:

Right.

Mr. Jekielek:

Right. So you can imagine a whole lot more people that would benefit from such discipline being labeled ADHD and then prescribed drugs as a solution.

Mr. Cassels:

Right. Or people modeling self-discipline and saying self-discipline is actually a very good thing, right? Yes, I totally agree. But back to just one other example, and it has to do actually with ADHD. 

We did a study in British Columbia more than 20 years ago, and this was published in the Canadian Medical Association Journal. We looked at all of the children in British Columbia. We have a province-wide database; you know, there are hundreds of thousands of children in elementary school, and we looked at the prescribing of stimulant drugs for ADHD and we broke it down by the birth month. You say, what do you mean by that? 

Well, we broke it down into two cohorts: the kids that were born between January and June and the kids that were born between July and December. We found that the kids born in the latter half of the year, so the younger kids in the class, had a 40 percent higher rate of ADHD drug use than the kids born in the beginning part of the year. We were like, what’s going on here? 

There’s no difference in brain disease or mental disorder. in younger children vs. older children. No, the kids are less mature, possibly less able to follow things when they’re that much younger. Because, you know, a kid born in December is almost a year younger than the kid born in January, right? And they’re all in the same classroom. 

So when this study came out, I was asked by a reporter what’s going on here, and I said, point blank, we are treating a social situation as a medical one. And that’s simply wrong. You’re not benefiting the younger children in the classroom when you take them and say to them, a certain percentage of them, you have now a brain disease because you can’t sit still and pay attention in a classroom.

Mr. Jekielek:

You just said something very powerful. This idea, you said it twice now, but the idea of treating a social situation as a medical one.

Mr. Cassels:

Yes. People identify with a certain diagnosis, and that becomes part of their identity. And they meet others online, and this is part of who they are. They’re grasping onto explanations of why they think a certain way or why they act a certain way. And I think for some people, having a diagnosis brings them a lot of comfort and allows them to join the tribe, if you will. 

But most of us will go through all kinds of stuff when we’re growing up, the normal ups and downs of puberty and development. But to take those normal ups and downs, say that that is a medical condition and then apply whatever pharmaceutical treatment or whatever that you can, it seems to me completely backwards. That we should, as consumers, push back against that because we have to recognize that everyone goes through the normal ups and downs of development and that you will get through it. 

I wish parents and young people just had more confidence that you’re going to get through whatever it is. You’re not going to have to resort to claiming a diagnosis that you’re going to carry around for the rest of your life. I mean, I think the harm that we do in applying labels to people is pretty serious and can be long-lasting. You tell a young rambunctious boy that he somehow has a mental deficit, and he’s going to carry that possibly for the rest of his life. 

You’ve damaged him. You haven’t provided any advance for this child. You have damaged him by telling him he’s deficient. It’s the same as if you’re telling someone, oh, you have generalized anxiety disorder. No, you’re anxious about something that you’re going to get through, but telling someone that they suddenly have this medical-sounding condition is extremely damaging. 

Mr. Jekielek:

Well, even on social media, I’ve been observing this phenomenon. There’s almost like a valorization of certain medical conditions; like people kind of celebrate, as you said, being part of the club or part of the group or whatever. It becomes this identity. What I’m thinking right now is just how bizarre it would be that we create—we basically assign a label to someone that isn’t warranted, that presumes a medical condition, and people with that label all get together to celebrate the fact that they have that label. Yes, I mean, it is kind of a mess. 

Mr. Cassels:

It is an absolute mess, but it’s also very damaging. You know, there is a study, and I have to tell you this because this is something that will affect everyone at some point in their life. One of the most common things that a physician will do when you go for a visit is to have your blood pressure checked, right? And, you know, a certain percentage of us are going to be on the high side, right? However it’s defined. I won’t give you a number because it keeps changing. We'll say you’ve got high blood pressure. 

They did a study in a steel mill in Hamilton, Ontario, back in the early 80s. This study basically took all of these steelworkers and measured their blood pressure. Some of them told the workers that they had high blood pressure and maybe they should consider seeing their doctor and getting treated. The others, they didn’t tell them. So they had a cohort; both had some level of high blood pressure, however it was defined at the time. 

People who were told that they had high blood pressure, did they do better? So they tracked them and looked at them in the long term. Did they do better in terms of job performance, life satisfaction, happiness, things like that? No, actually the people who were given the label did worse. The people who weren’t told that they had high blood pressure, they had to do something about it, actually did better. So this, to me, is really good evidence that when you apply a label to someone, you can be causing harm. 

Mr. Jekielek:

Well, and because of this, I mean, the term is placebo effect, right? The point is that and the effect that the doctor has, yes, in terms of influencing you to believe something, which is apparently huge. 

Mr. Cassels:

Yes, and the placebo effect is well known. We use it in clinical research all the time because we want to determine what is the difference between the similar types of patients, some of whom are given an active drug and some who are given the sort of sugar pill or an inert drug, because the differences in whatever outcome should be the differences caused by that treatment. That’s why we use the placebo effect. 

It’s quite interesting when you look at research around antidepressants. You know, the people who get placebos do very well as well, so when they track people over time who are given placebos in antidepressant trials, they improve and the person on the drug improves, and the person on the drug improves a little bit; however, it’s defined by a little bit more. That’s why the drug gets approved. But both patients, because they’re given treatment, perhaps because they’re given some attention, they improve.

Mr. Jekielek:

Except that in many cases, the placebo doesn’t have the side effects. Except from studies I’ve seen, which I found absolutely fascinating, that if the patients know about the potential side effects, some of them can still get the side effects on placebo.

Mr. Cassels:

Absolutely. The power of suggestion is extremely effective, right? In the sense of people being highly suggestible. People are not easy, but many people can be easily hypnotized because we’re very suggestible. 

Mr. Jekielek:

There’s a whole other realm to explore with you another time. Differences between the Canadian and the American situation?

Mr. Cassels:

American medicine is, as you know, on steroids. We live in a very commercial culture. Public health, for the most part, I mean, in terms of where compared to other countries, the U.S. has a system that is very fractured. It’s very private. And you allow certain things in the U.S. that you don’t allow in other countries. And one example is drug advertising. 

So you see, if you’re exposed to television or possibly the internet, there are a lot of drug ads. And a lot of times these drugs are for very rare and sometimes unheard-of conditions. And the powerful effect of a drug ad on consumers works in two ways. 

One is that there’s the suggestion that a person might be ill and could benefit from a treatment. The pharmaceutical industry would defend that and say, oh, we’re just doing disease awareness advertising. Okay, well, sure. Well, granted, that might be helpful for some people. But generally, you’re increasing the pool of people who are exposed to disease mongering.There’s that happening.  

At the same time, when you allow that amount of pharmaceutical advertising to influence the media, you find that the media does not really, they cannot do the kind of hard-hitting journalism that you want to see because of the influence of the advertisers. And people would say, what do you mean? Major journals like the Wall Street Journal or the New York Times, they get drug ads, but also they have critiques.  

Yes, I would say that if you had no drug advertising or no influence of the pharmaceutical industry on the editorial decisions of any news outlet, you would see a whole different range of reporting. Look what happened during COVID. Virtually those who were dissidents or those scientists who were questioning a lot of the public health measures, including vaccines, were censored. They were not allowed to give their opinions in a lot of the mainstream medical or mainstream media organizations. 

And so the influence of drug advertising in the U.S. is quite pernicious, not only in disease-mongering, but also in influencing editorial decisions around what kind of critiques Americans get. So I did this little experiment with friends of mine. 

A few months ago, I went to a reunion of a bunch of old Navy buddies, right? So these are guys who were in their 60s, successful businessmen. Some are doctors, some are lawyers, businessmen, and so on. I asked them, I think in a small group, because they asked me, what do you do for a living? 

And I said, did you guys ever hear of the term Vioxx? They said, well, what’s that? I said, Vioxx. Then I said, have you ever heard of the Vietnam War? Yes, of course, we’ve heard of the Vietnam War; everyone’s heard of the Vietnam War. Well, did you know that Vioxx, which was a major pharmaceutical in the early 2000s that was taken by hundreds of thousands of Americans, killed 60,000 Americans in three years from excess heart attacks and strokes? 

The Vietnam War took 12 years of American involvement to kill about 60,000 Americans. So Vioxx did in three years what took the Viet Cong 12 years in terms of killing Americans. And what was so astonishing about this is that this has been, this is probably the biggest drug disaster probably in our lifetime, and these guys hadn’t ever heard of it, right? 

Mr. Jekielek:

And you’re asking yourself why is that? How could it be, exactly? 

Mr. Cassels:

Educated, well-read people had never heard of what is considered, in my view, the biggest drug disaster. So how is it that we can take something that has had such a profound effect on mortality from a drug and then bury it in a way that no one has ever heard of it? It’s amazing. 

Mr. Jekielek:

It is amazing, and I think it’s very telling what you’re describing because that’s not a, there’s no contention around it even. It’s universally agreed upon to be reality.

Mr. Cassels:

Exactly. Just like the mortality, the death count in the Vietnam War. I use this comparison. I gave a lecture in Sweden a few months ago, and I use this comparison because Vioxx and Vietnam both start with V. That’s what they have in common. But what do they really have in common? They have a death count that, on one hand, is highly recognized and has had a major influence on American foreign policy. The other is virtually unheard of by even very educated people.

Mr. Jekielek:

And why don’t you tell me how much impact it has had on U.S. and Canadian drug policy?

Mr. Cassels:

I would say that there was a lot of talk about how we should tighten regulation around drug discovery, drug marketing, and drug approval. But I would argue that those changes are not noticeable. We have a system in which most people who have looked at this would argue that the drugs that we approved by the FDA [U.S.Food and Drug Administration] have sometimes been inadequately tested, perhaps not tested in the right population, for too short a period of time, or the company took the data and hid part of it or published only the more favorable things. I mean, there are a million ways to bias clinical research. 

But you need a regulator that is strong enough to challenge the pharmaceutical companies and say, look, that’s not good enough. If this drug is going to be taken by millions of Americans, we need good data to prove that it’s going to be safe. 

Mr. Jekielek:

So there’s an example just recently with the flu vaccine about the sort of the over-65 cohort being the data set being left out here in the U.S.

Mr. Cassels:

That’s one of a number of problems with flu vaccine research. One of the biggest problems is that when you look at meta-analyses, you don’t just cherry-pick studies. If you want to look at the flu vaccine, you have to look at all the studies, positive and negative. You put them together into a systematic review, and then you come up with what we hope is the best answer, whether the flu has benefits. When they do that with the flu shot, they find no benefit in the cohorts to which it’s most marketed. And that would be elderly people, middle-aged working people, almost no effect of these annual flu campaigns. And I’ve studied this; I’ve looked at this over the years. 

You know, what’s an interesting comparison is when you look at those jurisdictions that have high coverage, say a higher proportion of their population getting the annual flu shot compared to those jurisdictions that have low coverage. In some states in the U.S., you would have more than 50, possibly 60 percent of the working-age population getting their annual flu shot. In some states, you might have 30. Well, that’s quite a difference, right? What would you expect? Those states with the low flu shot coverage would have a massive influenza problem—more deaths, etc. When they do these interstate comparisons, there’s no difference. 

So you ask yourself, let me get this straight: even though you had high coverage in this state, you have had no impact on the rate of flu-like illness, hospitalizations, or deaths related to flu. Right? So what you’re doing is you’re running a campaign that’s spending a fair bit of money driving a certain amount of fear among people, thinking that if they don’t get their annual flu shot, they’re going to get the flu and die. And then you’re showing no impact on the spending of that money.

Mr. Jekielek:

Almost unbelievable.

Mr. Cassels:

Yes, so this is one of my themes: if we keep spending money on low-value care—when I say low-value care, that would be things like flu shots for relatively healthy people, ADHD drugs for rambunctious children, osteoporosis drugs for people who have normal bone density for their age, treatment of high blood pressure for someone who has generally normal or within a normal range of blood pressure—when you treat people unnecessarily, then you’re wasting money that you could be using on things that are actually really important, right?

Mr. Jekielek:

And you’re also, by inference, harming people that might not need to be harmed.

Mr. Cassels:

Yes, and you’re not just harming them medically or physically; you’re harming them financially. I mean, some of the biggest scandals in medicine have to do with people who do have very serious diseases, say cancers, terminal cancers, and they prescribe drugs that we know are going to accelerate the cancer instead of reduce it. And those drugs cost hundreds of thousands of dollars. 

So you’re not only having no effect, perhaps, on the length or the quality of a person’s life, but you’re also bankrupting them financially. And I think that’s unconscionable that we allow that in this country, that people at the end of their lives become bankrupt because they’re desperate, but they’re being prescribed treatments that don’t increase the value, quality, or length of their lives.

Mr. Jekielek:

That’s, I mean, this is a whole other thing to unpack here. Perhaps I'll have to invite you back to discuss that. This has been an unbelievable conversation, in some cases, literally. A final thought as we finish?

Mr. Cassels:

I think a lot about what people should do. And that’s not an easy answer. I don’t really like to tell people what to do. But if I could leave one piece of advice to most people, it is to stop allowing yourself to be made afraid by those who are selling treatments. Stop allowing yourself to be influenced by those who are selling you theories of disease and drugs at the same time. I think that we have to become much better healthy skeptics. We have to think if someone’s coming at you with a prescription pad; you know that there’s something behind that. Whether it’s real or relevant to your life, you have to sit back and think about things. 

I would also say that most of the time, if you’re facing the sharp end of a prescription pad, you have time to think about it. Most of the time, not always, most of the time decisions around whether you start a chronic drug for a chronic disease are not an emergency situation. You have time to do some research, maybe watch a few of your programs. You have time to do a little bit of research. So don’t feel like the sale ends tomorrow. You have to get on board now. You have time to stop and think.

Mr. Jekielek:

Alan Cassels, it’s such a pleasure to have had you on. 

Mr. Cassels:

Thank you for having me. 

This interview was partially edited for clarity and brevity.