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THE NEW ENRON JOURNAL OF MEDICINE
An Ulcer Drug for the Prevention of Heart Disease
On January 19, 2005, I had an interesting dream. Then amazingly, the dream came
true the next day when I went to my office, but in a most unexpected way. Has
that ever happened to you? I mean did you ever dream of something during the
night and then saw that dream come true the next day, but in a weird way?
I dreamt that I was in a country called New Enron. Yes, a country called New
Enron! I was among a large crowd in an enormous plaza. Many people were rushing
to a massive building, just like I had seen the Chinese in Tiannemen Square in
Beijing rushing to the great People's Hall. But there was a difference. These
people were impeccably dressed in dark business suits and carried expensive
black leather bags. They all looked like Wall Street types.
Curious, I followed them into that building. I found myself in a vast hall.
There was complete order in there. On the middle of a large podium was seated a
man of obvious authority, dressed in white. On both of his sides stood men in
black suits, with their heads slightly bowed. One of them spoke on a microphone.
I walked to a side wall and started inching up towards the podium. When up
close, I saw that the man in the white had a ruddy face, a nodular nose, and
greased upturned moustache. I could tell he was not happy. He sat frozen,
staring into space. The men in black on his two sides stood stiff and
motionless. Listening to the speaker, I realized that it was a meeting of a
corporation and began to understand why everybody in the great hall was in
distress. The speaker spoke about the gathering dark clouds over the future of
the Corporation. The Corporation was facing heavy losses from its leading
arthritis drug. Some nefarious agents had been spreading rumors that the drug
had caused thousands upon thousands of heart attacks and strokes. Then the
speaker delivered another blow to the Corporate minions that packed the great
hall: the Corporation had no other drug to replace the billions made with its
arthritis drug! At one point, the speaker addressed the man in white as
President Money Lover.
Money-Lover! What kind of name is that?, I asked myself, then thought I must
have heard it wrong. Some moments later, the speaker repeated the name Money
Lover, and I realized that indeed was his real name.
"President Money Lover, sir, but I do have a plan to save the Corporation," the
speaker said at one point.
A plan! A plan for saving the corporation! There was a loud rumbling among the
Corporate minions. Then a silence upon the great hall as all eyes turned to
President Money Lover. Several moments passed. Then Money Lover sat up with a
force of authority that was palpable throughout the hall. He leaned forward and
spoke into the microphone:
"Speak, Vice President Money Maker. Tell us about your plan, the plan to save
the Corporation."
So that's his name: Money Maker. And that's who he is: the vice president of the
Corporation, I told myself. Vice President Money Maker for President Money
Lover! What a pair of names!
"The corporation plan, President Money Lover, is to sell its ulcer drug to
healthy persons to make up for the lost billions from the sale of its arthritis
drug," Money Maker spoke slowly, letting each word sink in, for the president,
as well as for the Corporate minions.
"What?! A drug for healthy persons? An ulcer drug for those who do not have
stomach ulcers? Is that what you propose?" the president asked, evidently
dismayed at the proposal.
"Yes sir, President Money Lover, that's exactly what my plan is," Money Maker
replied, unperturbed by the president's tone.
"That won't fly, will it?" the president asked, doubt rising in his words. "Why
would people take the Corporation's ulcer drug when they do not have stomach
ulcers?"
"Sir, I think this is do-able," the vice president held his ground. "The
Corporation can get people who do not have ulcers to take its ulcer drug. Sir,
simply stated, the Corporation has the muscle to make this plan work," Money
Maker replied confidently.
There was silence again in the great hall as President Money Lover stared at the
face of his vice president, Money Maker. Then he began in a soft voice, a kind
of voice which powerful men of powerful corporations use during the defining
moments in the history of their corporations.
"Vice President Money Maker, I know you are a man of money," he began. "I know
that my name is Money Lover, but you were the one born to love money. For money,
you will do all things, even something which I wouldn't. Sometimes I think you
emerged from your mother's uterus only to love money, to make money, to grow
money. And, God knows, we have all witnessed how you turn and twist things to
maximize the Corporation's revenues. But this time, I think you are going
astray. I do not see how you can pull that off, I mean, I don't understand how
you can make people pay billions of dollars to take our ulcer drug when they do
not have stomach ulcers," President Money Lover's voice deepened with concern.
"Sir, the Corporation has a plan, a plan to do exactly that," Vice President
Money Maker was unyielding.
A plan! Mr. Money Maker has a plan for selling the Corporation's ulcer drug to
people who do not have stomach ulcers! I was mesmerized. Then my mind drifted to
Kerry's plan for Iraq, then to Edwards's plan for Palestine, then to Bush's
master plan for democratizing Arabs. During the last election, I was frustrated
because I couldn't understand any of those plans. I wondered if it were going to
be the same with Money Maker's plan. No, I didn't want to hear another plan that
I wouldn't understand.
"Go on, Money Maker," Money Lover urged his vice president. "Tell us how the
Corporation will make billions by selling its ulcer drug to persons who do not
have stomach ulcers."
"Simply stated, sir, in this plan the Corporation will sell its ulcer drug to
prevent heart attacks and strokes," Money Maker spoke like a cat that swallowed
a canary.
"But there is no evidence that our ulcer drug prevents heart attacks, is there?"
The president's ruddy face tightened.
"No sir. The Corporation's ulcer drug does not prevent heart attacks and
strokes, that's true. But the Corporation has a workable plan to get people to
take the drug for that purpose anyway."
"Can the Corporation really do that?" Money Lover's curiosity was clearly piqued
now.
"We will get New Enron drug doctors to prescribe our ulcer drug to prevent heart
attacks and stroke."
"Will people actually do that?" the president asked, increasingly puzzled. "Do
people of New Enron trust their doctors that much?"
"No, sir! People of New Enron do not trust their doctors. Not at all. But, they
take the drug prescribed by their doctors."
"But, how would you get the drug doctors to prescribe an ulcer drug for persons
who do not have stomach ulcers?" President Money Lover persisted.
"The Corporation will get The New Enron Journal of Medicine to do that."
The New Enron Journal of Medicine! Did I hear that right?! Does New Enron
country have a journal called The New Enron Journal of Medicine? Why not?, I
asked myself. Of course! The New Enron Journal of Medicine for the country of
New Enron! What could be more logical? But did Money Maker say that the
Corporation will get that journal to teach New Enron docs to prescribe an ulcer
drug to people who do not have stomach ulcers? Wow! That's something! I tried to
remember if I had ever heard anything like that in my forty-six years in
medicine. And how would The New Enron Journal of Medicine convince New Enron
docs to do just that?, I couldn't help but ask.
"How would you get The New Enron Journal of Medicine to do that?," I heard
President Money Lover ask the question that was in my mind.
"First, we will get The New Enron Journal of Medicine to publish the results of
a blinded clinical trial showing the value of the Corporation's ulcer drug for
the prevention of heart disease. The New Enron drug doctors love blinded
clinical trials."
"They do?," the president asked. "Why do they want to be kept in the blind?"
"That's the thing, sir!," Money Maker chuckled. "The New Enron drug docs love to
be kept in the blind about what really happens during the blinded clinical
trials. The Corporation has never understood why that is so, but it does know
that to be true."
"I should have known that," President Money Lover laughed as he spoke.
"No surprise there, sir. We do that all the time. We will give a couple thousand
dollars to some drug doctors and they will conduct the trial exactly the way we
want. Then we will give a couple million dollars to The New Enron Journal of
Medicine and the journal will publish exactly what we want published."
"Aha!" the president chuckled.
"And that's not all, sir," Money Maker went on exuberantly. "We will also get a
Corporation attorney to write an editorial and get it published in the Journal."
"What? Will The New Enron Journal of Medicine agree to that? Will it actually
publish an article written by a Corporation attorney as its editorial? I didn't
know the journal is so accommodating." President Money Lover was visibly pleased
with what he had just learned.
"Sir, the Journal accommodates us whenever we find it necessary. Whenever there
are slack sales of the Corporation's drugs, we write the editorial and pay some
professor in one of the medical schools to lend his name to that editorial. That
way the New Enron drug docs never know that the Corporation had bought that
editorial."
"Clever! Very clever!," President Money Lover exulted.
"There is yet more to the Corporation plan, sir," Money Maker added hastily.
"Pray tell me, my vice president, what else is there for us to know before we
start counting the Corporation's billions from the sale of its ulcer drug for
the prevention of heart attacks?"
"The New Enron docs are mortified of the New Enron lawyers. To protect
themselves from those lawyer sharks, the frightened New Enron docs prescribe
drugs strictly in accordance with the drug standards established by The New
Enron Journal of Medicine. And . . ."
"And the Corporation will tell the Journal to establish a new standard, is that
it?," Money Lover interrupted Money Maker excitedly.
"Precisely, my president. Precisely. The Corporation will get The New Enron
Journal of Medicine to establish that standard." Money Maker swallowed another
canary.
"Clever stuff! Very, very clever stuff, indeed!," Money Lover enthused. "But how
did you know all that?"
"Sir, didn't you just tell everyone that I emerged from my mom's uterus for the
sheer love of money?! The Journal will publish editorials written by the
Corporation's attorneys under the name of some professor because we will pay for
that. Sir, the Corporation gives the journal millions of dollars in ad money.
Hence we have, shall we say, the proper access to the editorial room," Money
Maker swallowed his third canary.
"Excellent, my lad, excellent!" Money Lover applauded Money Maker. "But tell me,
what will the Corporation ulcer drug do to persons who do not have stomach
ulcers?"
"The drug will block the acid production in their stomachs," Money Maker replied
in a matter-of-fact way.
"What will blocking acid production in the stomach do?"
"It will prevent digestion of proteins."
"What will failed protein digestion do to those who take the drug?"
"They will have malabsorption."
"What else will it do?"
"It will also prevent killing of bugs and parasites ingested with the food."
"What will that do?"
"It will set the stage for microbial infections and parasitic infestations."
"What will those sick people do then?"
"They will have to take the Corporation's antibiotics, and our Corporation will
ring in more billions."
"Will those antibiotics have side effects?"
"They always do. Those people will get overgrowth of oxygen-hating bugs in their
guts."
"What will happen then?," Money Lover pressed on.
"Our Corporation will sell them its antifungal drugs and bring on more billions.
"Will antifungal drugs cure fungal infections?"
"They never do."
"Then what will happen to the sick people?"
"They will be told they are sick in their heads, and they will be referred to
New Enron shrinks."
"Then what?"
"Then the shrinks will prescribe the Corporation's antidepressants and other
mind-altering drugs."
"You have thought of everything, my lad, haven't you?"
"All for the glory of the Corporation, sir," Money Maker was both humble and
earnest.
"Superb! Simply superb, my boy," President Money
Lover giggled, then went on. "The Corporation will sell its drugs at every step.
Make billions at every turn! That's an ingenious scheme, if I ever saw one. I
congratulate you, Money Maker!" President Money Lover giggled again, then
surveyed the corporate minions crowded in the great hall and fell silent.
Several moments passed. Then Money Lover spoke again:
"It all sounds so very wonderful, but my son, Money Maker, are you sure there is
no fly in the ointment?"
"No fly in this ointment sir," Money Maker responded quickly. "The plan is
solid. There simply aren't any holes in it."
"But what if some quacks claim that they can prevent heart attacks by right
choices in the kitchen, nutrients, herbs, meditation, and physical exercise?,"
Money Lover asked with caution in his words. "What if the people of New Enron
believe them and refuse the Corporation's ulcer drug?"
"That cannot happen, sir," Money Maker countered.
"I foresaw that, and I have arranged for many editorials printed in The New
Enron Journal of Medicine. Those editorials will declare all natural measures
unscientific. Clinical nutrition will be dismissed as quackery, as it has been.
Clinical ecologists will be branded charlatans, as they have been. Those who
claim to have healed with spiritual work will be considered delusional, as they
have been. Truth be told, President Money Lover, The New Enron Journal of
Medicine has done extremely well in that area in the past. We can only look
forward to greater cooperation from it. All insurance companies in New Enron
country pay only for drugs. Nutrients are not covered. Reimbursement for herbs
is declined. And all that is so because of The New Enron Journal of Medicine. Of
course, the Corporation rewarded the Journal well for that."
"I wouldn't have expected anything less than that from you, my Vice President
Money Maker," Money Lover uttered and closed his eyes.
A silence fell upon the cavernous Corporation hall again. All eyes were fixed on
President Money Lover's closed eyes. There was yet more silence. Finally, Money
Lover opened his eyes, rose and spoke the words: "The Plan is approved! Go, my
children, go. Spread it in all parts of New Enron country. Go get 'em all, all
of those New Enron docs, and tell 'em to drug everyone! The Corporation must get
richer and richer, forever and ever!"
The great Corporation hall broke into a deafening applause. There was great
jubilation. Long live our President Money Lover! Long live Vice President Money
Maker! Long live the Corporation! Long live our beloved New Enron country. And
then someone in the crowd shouted: Long live The New Enron Journal of Medicine!
*******************
When I woke up, I recalled my dream. Amusing, all that corporate stuff. Later
that day, I went to the office and found my copy of the January 20, 2005, issue
of The New England Journal of Medicine on my desk. I opened the journal and saw
the title of an article about the use of an ulcer drug to prevent coronary heart
disease. I went straight to the "Conclusion" section of the abstract of that
article, read it, and then re-read it. A deep chill passed through my spine.
What I had seen in my dream about The New Enron Journal of Medicine came true in
a truly chilling way. The New England Journal of Medicine published the results
of a clinical trial paid by Pfizer corporation to show that its ulcer drug
Nexium is good for preventing heart attacks. Yes, yes! That's true. Hard to
believe, but it is absolutely true. Pfizer corporation paid for the trial to
show that. And this is what the Journal told its readers:
First, that fifty million Americans started taking aspirin for preventing heart
disease during the last two decades;
Second, aspirin doubles the risk of gastrointestinal bleeding; and
Third, that the Pfizer drug Nexium taken with aspirin is better than Plavix, a
drug claimed to prevent heart attacks but made by a Pfizer competitor.
I realized that Pfizer Corporation also sells Bextra, an arthritis drug. And
just as in my dream about New Enron, Pfizer Corporation has been very worried
about its arthritis drug Bextra since Vioxx, another blockbuster arthritis drug,
was withdrawn because it causes heart attacks. Many people have raised questions
about the toxicity of Pfizer's Bextra. So, the Corporation has been very
concerned about its arthritis drug. What an amazing coincidence! Astonishing how
every part of my dream about The New Enron Journal of Medicine came true on the
pages of the January 20, 2005, issue of The New England Journal of Medicine.
What a dream! What a coming true of a dream! Who would believe that? Now, I
should say something about the Corporation getting its writers to write
editorials for The New Enron Journal of Medicine of my dream.
EDITORIALS FOR SALE
Many doctors are likely to dismiss the notion of editorials of medical journals
for sale as preposterous. An editorial of The New England Journal of Medicine
for sale? Too absurd to think about, they might say testily, if they respond at
all. Some fool looking for cheap thrills, some others might snicker. I offer the
following direct quote from a 1994 issue of The New England Journal of Medicine:
The practice of buying editorials reflects the growing influence of the
pharmaceutical industry on medical care.
Hard to believe, but those words come straight out of The New England Journal of
Medicine, 1994:331;674. Now consider another quote from the same issue of The
New England Journal of Medicine:
The caller said that I would not really have to do much work on this subject. I
would discuss the matter with them, and they would then have a professional
writer compose the editorial, which I would modify as I saw fit. I would earn
$2,500 for what was estimated to be several hours of work.
For several hours of work! The writer must suffer from
chronic fatigue syndrome
and periods of brain fog if he needs several hours to read an editorial written
by corporate writers and 'modify' it as he saw fit, I remember thinking when I
read those words. Then I read the following words from the same article in The
New England Journal of Medicine:
"The editorial was to be about the potential legal liability incurred by
physicians who prescribe drugs that may have sedative side effects, such as
antihistamines."
An editorial in The New England Journal of Medicine against drugs ghostwritten
by a corporation! Why would a drug corporation pay money to have an editorial
written against drugs? It made no sense to me. I looked at the bottom of that
editorial and saw that the writer is a professor at the Harvard School of Public
Health. On the surface that made sense. Who could be more suitable for warning
doctors against the potential legal liability of drugs than a professor at the
Harvard School of Public Health? But that, of course, did not answer the
question: Why would a drug corporation pay money to have an editorial written
against drugs? I read the editorial closely and learned that the editorial in
question was being purchased by one drug corporation to discredit the drug of a
competitor drug corporation. What could be more clever? That made perfect sense.
From somewhere came the words of Walt Whitman: 'I love doctors and hate their
medicine.'
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