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My friend’s oncologist did not know about my professional background in cancer research and, as far as I know, also did not know about my visit with the pathologist about Dr. Cook’s study. He simply knew that I was there to support his patient, and I tried just to listen. As far as the oncologist was concerned, the facts were simple. It was “advanced” melanoma, as confirmed by the diagnosis, and it had already metastasized to the sentinel node of the lymph gland. Therefore, the remaining lymph gland needed to be removed and treatment with interferon or its equivalent needed to begin. All of this was urgently needed, in his opinion, and his personal demeanor left no doubt what he expected her to say.

Following this recitation of the “cold, hard facts,” the doctor popped the question: “When will you be able to begin?”

My friend repeated what she had earlier said to him. “I am not going to do any of your suggested treatments.”

Visibly shocked and annoyed, the oncologist now knew that his polite demeanor during the first visit was not working. He blurted out, “If you don’t do this now, it’s going to be too late when you come back!” He clearly expected “too late” to come sooner rather than later.

This kind of pressure from a medically informed superior given to an emotionally vulnerable and uninformed patient concerned for her survival is not a level playing field. It undoubtedly leads to acceptance of the physician’s recommendation. Cancer patients intensely want to believe in their oncologist, whom they see as holding the key to their recovery.

Because of this reaction, I offered to share with him some of the literature that I had with me. Brusquely and rudely, he dismissed with a wave of his hand what he clearly considered to be nonsense. He had no interest in hearing anything but his own voice.

I can only imagine how many events like this occur in oncology offices across the country. Given the incidence of cancer in the United States, I’m guessing there are around 2,000 to 3,000 such events per day.
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In most of these visits, the patient and their friends and family are neither capable of nor interested in questioning their doctors’ opinions. I myself was taken aback by his certainty. I could not help but wonder: did I miss something? His behavior, laden with conviction and professional ignorance but also personal arrogance, was revealing—at least for me. He clearly had no interest in evidence suggesting anything other than “standard care” that favored traditional chemo treatments.

I have been told very similar experiences by dozens if not hundreds of cancer patients who are seeking information on nutrition and cancer, cases in which the research supports a nutritional approach, yet for which doctors insist on invasive, dangerous, and expensive treatments with poor success rates. However, I got much more involved in this case because the patient was my wife, Karen. And I know this melanoma case is a sample size of one and I did not professionally document it. It’s anecdotal, period. But Karen opted to do nothing aside from continuing to eat only plant-based foods, has had no side effects, and eight years later is still in excellent health, now enjoying with me our fiftieth year of marriage. In fact, I feel that Karen’s diet not only helped her after her cancer diagnosis, but in the years preceding it. The mole on her legs had been there for many years, and probably should have
been checked out earlier. It is highly likely that this mole was cancerous prior to our family’s conversion to a plant-based diet and that its progress was slowed or suspended, or perhaps even reversed, after this point. The results of the biopsy may even have showed the cancer retreating rather than spreading.

Looking back, this incident is representative of many similar stories that motivated me to write this book. Since I can’t accompany every patient to high-stakes meetings with medical professionals, I wanted to do something to level the playing field—to give vulnerable women and men a voice, and to allow them to believe they have a choice when it comes to aggressive and expensive medical treatments for serious conditions.

On one level, the interaction between Karen and her doctor is simply a story of an arrogant professional pressuring a vulnerable patient to do what he believes to be in her best interest. He knows what standard care is. She doesn’t. Period. However, when we take a step back and look at the fact that there are a few thousand of these interactions each day, we see the mark of a medical industry whose profits depend on doctors’ unquestioning belief and persuasiveness—if not their arrogance. Let’s take a minute and follow the money in this story. Where does it flow when the surgical/chemical approach is chosen over the nutritional approach, and who benefits?

First and most obvious, the more often chemotherapy and surgery and pharmaceuticals are prescribed to patients, the more money the entire industry takes in. Even if we were to assume that a chemical approach is equally as effective as a nutritional approach (though there is no proof of this), the medical industry benefits more from training and encouraging its members to choose the chemical solution. There’s a lot of money to be made in cancer treatment. That’s why drug and medical equipment companies dominate the advertising in medical journals. (That advertising explains why medical journals are loath to print results that call those industries’ practices and effectiveness into question, but we’ll look at trade journals more in
chapter fifteen
.)

Second, by passing referrals back and forth, the medical “old boys’ club” keeps its members rich and busy. Karen saw three different doctors during her diagnosis, and each new doctor meant a new co-pay for her and high costs for her insurance agency. It’s necessary to see so
many doctors when going the chemical route, because each doctor is a specialist who focuses on a specific reductionist element of cancer. But the reason for their specialization has more to do with our misguided approach to disease than the best way of treating patients. It would only take one doctor to prescribe a WFPB diet and monitor the results—were this strategy ever used.

Also, the other doctors Karen was referred to were also very likely to back up her first doctor’s point of view. They shared a paradigm, thanks to standardized educational training that does not include wholistic nutrition, and likely even shared a social circle. You can bet Karen’s oncologists weren’t playing golf with nutritionists who advocate WFPB diets!

I know that many people believe that the kind of behavior I’ve described here is symptomatic of the entire medical profession, but I would counter that. I have met many brilliant doctors who are sincerely devoted to their patients. It is not doctors who are responsible for this environment of coercion and hostility to suggestions of alternatives; it is the system in which they are trained and expected to practice. The structure of the medical industry makes it very difficult for decent and caring doctors to act contrary to the industry’s selfish, profit-seeking, defensive attitude. Those who buck the system face not just ideological pressure, but ideological pressure backed up by the subtle power of money. In some cases, even their license to practice may be challenged.

Our society embraces the sentimental notion promoted by Big Pharma that the pharmaceutical industry is a selfless group of scientists, motivated only by an intellectual hunger and desire to serve humankind, toiling away to discover the cure for cancer or diabetes or heart disease. That perception exists largely because Big Pharma is so skilled at pretending to be good while manipulating the public’s emotions. There are plenty of sincerely good people in Big Pharma, but the economic imperatives of the system override their efforts to do good.

Big Pharma is an industry, and its constituent members are businesses. Most of them are publicly traded or, in the case of the newer gene-therapy companies, privately funded by investors looking to get massive returns
as quickly as possible. Their only fiduciary responsibility to their shareholders is to turn a profit.

Okay, so, big deal. Every company is trying to turn a profit, right? If Big Pharma makes money by selling drugs that help people live longer and with less pain, why shouldn’t they? We should celebrate their profitability, because this money returns to the system to fund the research and development (R&D) that creates new drugs and refines and improves old ones. That’s just Business 101, simple enough even for a professor of nutritional biochemistry to understand. Unfortunately, Big Pharma is exempt from Business 101, because of the ingenious and insidious way they get their customers (us) to generously (and unwittingly) pay most of their research bill well before we pay for our prescriptions.

Do you pay taxes? If so, you’re contributing to the research budget of the government’s lead health research agency, the NIH, whose research priorities are heavily slanted to benefit Big Pharma. Have you ever made a donation to a private research funding agency, such as the American Heart Association, the ACS, or the American Diabetes Association? If so, you’re directly funding research that frequently creates ineffective and often harmful drugs that are sold to the American people at a huge profit. And those profits go not to us, the real investors, but to the pharmaceutical companies that patent, manufacture, and market these products. We are paying twice for stuff that often does not work at best and at worst is killing us.

Big Pharma is not satisfied with this cozy arrangement, however. In a never-ending effort to increase their profits, they seek government protection from the free market even as they exploit it for all it’s worth. Talk about having your cake and eating it too! Here’s how it works (with a nod to Professor Donald Light of the University of Medicine and Dentistry of New Jersey and Professor Rebecca Warburton of the University of Victoria, Canada, whose recent work reveals some little-known and damning facts about Big Pharma’s Big Claims about its Big Expenses).
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In an online review of their various published findings, Light and Warburton concluded the following: Big Pharma justifies its expenses and gargantuan profits by claiming very high R&D costs to bring a new drug to the market. The most commonly cited figure is a staggering $1.32 billion per drug. That’s a lot of money when, according to independent
review groups, 85 percent of new drugs are useless or no better than the drugs already available. But this $1.32 billion price tag turns out to be highly inflated by the drug companies. Light and Warburton say this is “to justify higher prices [in the marketplace and receive] more government protection from free-market competition and greater tax breaks.” An inflated estimate of costs helps them cry poverty and dupe the government into passing anticompetitive legislation and relieving them of their tax burden. After all, a financially strapped pharmaceutical industry would be a national disaster and a tragedy—imagine if the cancer breakthrough that’s just around the next corner never materialized because some drug company had to cut back on R&D.

After carefully evaluating and professionally publishing their findings, Light and Warburton say that “no one should trust any estimate” of drug development costs by Big Pharma. They found that these costs are far lower per typical drug, averaging only around $98 million for development (ranging from a low of $21 million to a high of $333 million) plus an uncertain amount for research. Research costs are almost impossible to estimate because it’s impossible to know what scientific research should be counted as leading to which drug product. And most basic research is done at government expense with “84% of the world’s funds for research [coming] from public or foundation sources,” according to a National Academy of Sciences and other official reports.

When independent and reliable sources of cost estimates are considered, Big Pharma is scamming the system—by a Big Bunch. First, they came up with this $1.32 billion figure by using only the costs of 22 percent of the most expensive drugs (new chemical entities that are developed in-house) and implying that this was an average for all drugs. Second, the costs they claim on randomized clinical trials appear excessive, with twice as many subjects per trial as the averages reported by the FDA and costs per subject that are six times higher than NIH figures; overall, Big Pharma’s trial costs are more than twelve times higher than independently reported averages. Third, their reported lengths of both trials and time it takes the FDA to review new drug applications for approval are significantly longer than those reported by the FDA.

The story gets worse! Big Pharma also inflates the interest rate they use to determine the cost of capital and ignores substantial tax savings related
to R&D and their foreign tax havens. Those lost taxes, according to Light and Warburton, “might pay for nearly all pharmaceutical R&D costs.”
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In all, the total costs industry pays for the development of a new drug (including the amount they receive from government grants) approach only $70 million—not the $1.32 billion they claim. And the extra $0.02 billion added to the $1.30 billion is silly. All that tells us is Big Pharma is using the marketing trick of false specificity to get the public to believe they have performed a mathematically accurate estimate.

Big Pharma has been telling this kind of Big Lie for decades. When President Lyndon Johnson spoke to a group of Big Pharma executives in 1969, he bluntly told them that they knew well that NIH was doing their research and, further, that the public was footing the bill.

They reinvest these profits strategically, buying air time to keep broadcasting the Big Lie. The United States is one of only two countries on earth (New Zealand is the other) where drug companies are allowed to advertise directly to the consumer instead of just to physicians.
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Under the sway of advertisers, more and more of us are “asking our doctor about Viagra” and thousands of other brand-name drugs.

Big Pharma hasn’t forgotten to “educate” our physicians as well. According to a 2008 report, Big Pharma spends, as of 2004, an average of $61,000 per year, per each and every physician in the country, to promote its products. It also organizes a massive number of promotional meetings for doctors, wining and dining them and giving away vacations and computers and other wonderful perks. In 2004, the last year for which I could find data, there were 371,000 such meetings in the United States, or more than 1,000 meetings each day of the year. That works out to an average of twenty physician-fests a day in every state of the Union.
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