Film Review- First Do No Pharm

Personal impressions of a film by Aseem Malhotra

Disclaimer: I began my journey in pharmacology in 1966, first with a MSc (Alberta, 1968), then PhD (BC, 1971) and Postdoc (Stanford, 1973) followed by 44+ years at Queen’s University (until 2017). During that time, I was involved in some collaborations involving pharmaceutical companies at the basic science-drug discovery level.

---

I became aware of “First Do No Pharm” through John Campbell’s channel on YouTube; see WW Vid 4 1 rev 1 hk 9 (youtube.com).

The film opens with a series of statements by former USA presidents, and then a bit of personal history by Dr. Malhotra about his family and his own commitment to use medical training for the good of the community. We are then introduced to a patient, Tony Royle, who relates his experience with a heart attack and his subsequent interactions with the medical system. Initially he was stented in his circumflex artery, then after 9 months his health declined substantially. He asked if this was due to normal pathology or could it be the medications he was prescribed? Subsequent discussions led Malhotra to attribute Royle’s declining health to the adverse effects of the statin that had been prescribed. The film used this as a segue into statin therapy and adverse effects.

Heads up. This movie contains a plethora of factual information; I had to watch it twice- during the second viewing, I stopped it frequently and made notes. The quantity of information made the objectives seem disordered. For my old mind, stating and labelling the objectives in the following order would have been helpful:

·         Drugs have more serious adverse effects than manufacturers are willing to admit and doctors are able to explain clearly to their patients.

·         Clinical trials are conducted by drug manufacturers to support drug sales not to elucidate the real risk/benefit ratios.

·         Medical journals, which are used as the foundation of evidence-based medicine, are compromised by the advertising and reprint income received from drug companies.

·         The business model used by drug manufacturers has evolved from ethical, good intentions to one of profit above all. Settling huge law suits is just part of doing business.

·         Big business has shifted conditions to its advantage by using its money to influence regulatory agencies, medical journals and professional bodies.

·         Solutions to our problems may include changing the healthcare model to emphasize health promotion, and jail time for executives of offending corporations.

---

---

Having said this, the film gives us more than enough information to make us uncomfortable about our healthcare systems and many of the major players therein. Here are a few of the highlights.

·         Tony Royle, a former prediabetic, is now thriving, physically active and eats a low carbohydrate, ketogenic diet. He states that society had normalized substandard health.

·         Royal colleges. Malhotra had written a paper on the dangers of too much medication, which was caught by mainstream media and brought to the attention of the public. And of course the royal colleges and almost certainly the manufacturers of statins. This resulted in a stern letter from the Academy of Medical Royal Colleges conveying their disapproval of his candid discussion of overly liberal prescriptions medicine. They isolated him from the profession to extent possible. The film then goes on to say that the royal colleges had received over £9 Million in marketing payments from drug and medical devices companies between 2015 to 2023. A BMJ investigation revealed that the Royal College had received over £1 Million from Pfizer, the maker of Lipitor (atorvastatin) the sales of which were $172 Billion between 1997 and 2022.

·         In 2011, Malhotra wrote an article for the Observer asking “Why are we serving junk food to my patients in hospitals?” The film goes on to question the mantra that cholesterol and saturated fats are evil, and asks about sugar being the culprit responsible for much/most of modern society’s chronic illnesses. He goes on to say that “Poor diet is responsible for more disease than physical inactivity, smoking and alcohol combined” and mentions 32 conditions that result from poor diet.

·       

 

·         Big Food and Big Pharma practices support each other in that contemporary food marketing is a significant contributor to much/most of our chronic health problems, and drug companies are more than happy to sell profitable, drug-based solutions.

·         Dr. Robert Lustig describes the problems brought on by the pharmaceutical solutions and points out lifestyle (dietary) approaches that are practical and affordable.

·         Dr. John Abramson describes how Big Pharma has assumed control of the medical publishing industry to the detriment of ordinary family doctors and citizens, and to the benefit of drug company profits.

·         The national regulators, such as FDA (USA), MHRA (UK) and HC (Canada), receive large portions of their budgets from Big Pharma, between 50% and 86%. How can this NOT influence decision making related to new drug approvals?

·         Big Pharma has paid $Billions to settle lawsuits but this has not made them more careful about drug safety; the contemporary business model includes this as a line item business expense on the way to substantial profits.

·         Pharmaceutical companies have always had a fiduciary responsibility to generate profits for their shareholders; they do not have a responsibility for patient safety- this is the role of national regulators.

·         Around 2000-2010, it became apparent that the pharmaceutical model of healthcare, “a Pill for Every Ill”, had gone too far. In 2012, the BMJ published articles on “Too Much Medicine”.

·    

 

Approaches to Addressing our Problems.

Change the priorities of Healthcare. Malhotra has been advocating lifestyle approaches to disease prevention and health maintenance for years. This should be a priority of medicine in general.

National Regulators must prioritize protection of national populations. This may mean ending their reliance on pharmaceutical company fees, i.e. their income. Clinical trials to test the efficacy and safety of novel drugs should not be under the control of drug manufacturers who profit from the approval of a new drug.

Individuals should be held accountable for decisions that adversely affect large populations of ordinary citizens. Massive fines have not made us safer. Putting some Big Pharma executives in prison is more likely to generate a change in the culture. RFK Jr has said that if he gets the opportunity, he will pursue making egregious bad actors criminally responsible for their actions against citizens. I hope he does because this might encourage some Canadian politicians to follow suit. We need more people like Kennedy, Andrew Bridgen and Derrick Sloan, neither of the latter two were re-elected. You can bet that Big Pharma and Big Food are doing their best to prevent RFK Jr from getting his opportunity to carry out this mission. It would be interesting to know what interests worked to prevent from Bridgen and Sloan’s re-elections.