What is a conflict of interest anyway?

Whilst away on my holidays I have been watching the battle between the BMJ and Professor Sir Rory Collins. A couple of years ago I watched the battle between Professor Sir Rory Collins and the Cochrane Collaboration. A month ago I was taking part in the battle between various professors and cardiologists and Professor Sir Rory Collins.

He, as you probably know, thinks statins are wonder drugs that should be prescribed to almost everyone. Actually, that is not entirely true. He doesn’t believe they should be prescribed to almost everyone. He believes that they should be prescribed to everyone.

He thinks statins have no adverse effects at all. In fact, they actually make people feel better when they take them. He viciously attacks anyone who might dare to suggest otherwise, and has accused them of killing people by frightening them off taking these uniquely lifesaving medications. This has been the basis of his attacks over the last couple of years.

Now, he might really believe all this to be true. In fact, I think he probably does. Of course, he might not believe it to be true, but he is just saying it anyway. One of the great frustrations of life is that you can never know what another person is really thinking. You can guess all you like, but it is only ever a guess.

The problem that we have here is that Professor Sir Rory Collins runs a unit called the Clinical Trials Service Unit at Oxford. This unit has received nearly £300m ($500m) in funding from pharmaceutical companies over the years. Without this funding, his unit would be very much smaller. It probably would not exist at all.

Now, you could say that this makes Professor Sir Rory Collins utterly dependent on pharmaceutical company funding, and therefore you should not believe a single word that he has to say about anything to do with statins, and other such drugs. He is completely corrupted.

You could counter argue that this is a ridiculous stance to take. His is a highly motivated and ethical researcher who works with the industry, purely in order to develop effective medicines that will help humanity. After all he is both a Sir and a Professor.

You could say that his Knighthood and professorship are completely irrelevant, and simply ask the following question. Why does he say he has no conflicts of interest to declare. Why does he state that he receives no money from industry. Why has he never admitted to the association between himself, the CTSU, of which he is a director, and £300m in drug company funding? Why does he never disclose these financial interests? Why not, indeed?

His argument, I believe, is the following. If the pharmaceutical industry pay the CTSU, who then pay him, he is not actually being paid any money directly by the pharmaceutical industry. So he has no conflicts of interest to declare. Discuss. [Shouldn’t take long].

Whether or not you think his is conflicted (and I do), this discussion leads into a rather more complicated area. What is the purpose of declaring that you have a conflict of interest in the first place? What does it matter if you are paid money by someone else who has a vested interest in making sure that certain things are said, and done.

Now, you may think the answer is simple. If Professor Sir Rory Collins states he has a conflict of interest e.g. the unit he runs is paid £300m by the industry, we can then….. We can then…..We can then what?

Believe nothing that he says about statins. Believe everything that he says. Believe most of what he says. Believe a bit of what he says. The problem is that there are only two rational positions here.

  • Believe everything
  • Believe nothing

How can you believe most, or a bit, of what Professor Sir Rory Collins says? Which bits could you ignore, which bits could you pay attention to? How could you possibly know? The answer is that you cannot.

Which then leads onto the next question. Why do medical journals, and suchlike, demand that researchers, lecturers and authors declare their conflicts of interest? What does this achieve? If having a conflict means that the author/researcher is biased, then surely the article cannot be published – as the journal is accepting a biased piece of work. Believe me, properly done, bias is impossible to spot. It’s like hearing the dog that didn’t bark.

On the other hand, if conflicts of interests mean nothing. In that you can have financial conflicts of interest, but this makes no difference to anything you say or do – why bother demanding that the conflicts of interests are declared.

In short, I cannot see what declaring a conflict of interest achieves.

Man on the Street 1: ‘Oh, I see Professor Sir Rory Collins unit has received £300m in funding from the pharmaceutical industry. Most interesting. However, this clearly makes no difference to anything he has to say on the matter.’

Man on the Street 2: ‘Oh, I see that Professor Sir Rory Collins unit has received £300m in funding from the pharmaceutical industry. Clearly he is corrupt and biased and I shall pay no attention to any he has to say.’

Man on the Street 3: …. ‘I shall believe 82% of what he has to say.’

Man on the Street 4: …..’I shall believe 23% of what he has to say.’

Which of the men on the street has the right idea? There is no way to tell, without becoming a mind reader. At present, when it comes to conflicts of interest, we just have a gigantic fudge. So long as people declare their conflicts they are then free, it seems, to do anything they like. Carry out research, write papers, sit on guideline committees, advise the Government and NICE. Declaring the interest…what? Makes the possibility of bias disappear?

But what should really happen. My view is relatively simple. I have said it before, and will say it again. If you get paid money by the pharmaceutical industry then, fine. I have no problem with that. Good for you. Buy that luxury ski chalet in the Alps if you want. Indoor swimming pools are lovely things to have. Have both – you will certainly be able to afford it.

However, once you have taken the money, directly or indirectly, you should not be allowed to sit on guidelines committees e.g NICE. Nor should you be allowed to educate your fellow doctors on best forms of drug treatment, or act as a Government advisor on healthcare matters – or suchlike. Because you are, even if you don’t think you are – and get very angry with anyone who suggests that you might be – biased.

This nettle needs to be grasped, and it needs to be grasped soon. I am not a great believer in absolutist positions, as they tend to block the compromises that are necessary for things to work in life. However, when it comes to conflicts of interest I think that the only possible position to take is absolutist. If you are paid money by the pharmaceutical industry, you cannot be appointed to a position that allows you to influence how drugs are used. End of.

64 thoughts on “What is a conflict of interest anyway?

  1. celia

    And while we’re at it someone should make sure the BBC note conflicts of interest when interviewing Sir Rory and others in his position, which they currently don’t. This gives the impression that they are unbiased, which they clearly are not.

    Reply
    1. Katie

      The BBC is not the trustworthy Broadcasting Corporation we are led to believe. There is a longstanding miscarriage of injustice, relating to certain ill health, being meted out to women / children in the UK. The BBC have been given incontrovertible evidence of this shocking state of affairs. Far from doing what was the Corporations duty to do,
      they warned the individual, verbally , by phone, and by letter, not to contact them again (on this subject) This continued over a number of years. As a matter of grave public concern, the BBC must answer this allegation.

      Reply
  2. Ron Hall

    I would say that this statement of yours Dr. Kendrick should be forwarded to Mr Cameron our Prime Minister. After all Statins are costing NHS billions of pounds, if the whole of the country take them then I can see bankrupcy on the Horizon for it.(NHS)

    Reply
  3. Antonio Reis, Portugal

    Completely agree with MK. Although Sir and Professor, Rory Collins seems to be a person who would feel great as a new Great-Inquisitor with powers to ban heretical writings. Fortunately the Inquisition ended three centuries ago, and the BMJ rejected the request of Collins to censor the articles.

    Reply
  4. mikecawdery

    Dr Kendrick

    Re Stains, cholesterol and medical clinical drug research
    Following the recent controversy on SARs in the BMJ Prof Collins argues the investigation was not independent and came to the wrong conclusion.
    (BMJ ‘right’ in statins claims row. By James Gallagher Health editor, BBC News website )
    http://www.bbc.co.uk/news/health-28602155

    “He told the BBC: “It is not surprising the BMJ investigates itself and exonerates itself.
    “The BMJ published misinformation and they’ve withdrawn one major error, but have not corrected several other major errors.
    “My concern is that as before, patients and their doctors are misinformed by those papers and the BMJ’s failure to correct them.”

    “their doctors are misinformed by those papers”

    Really! and what about his own study, the HPS[1] report where there are hidden data, inaccurate reporting, etc. and massive misinformation about the value of statins? As shown by de Lorgeril,in his expose of skullduggery in clinical research on cholesterol and statins (see: de Lorgeril, Michel (2014-03-05). Cholesterol and statins: Sham science and bad medicine Kindle edition[2]) HPS at the Ultimate in Clinical Research: the Heart Protection Study Section) shows that misinformation and other flaws are present in Collins’ own research and by extrapolation all medical clinical research on Big Pharma drugs.

    The problems is now “What and who does anyone believe!” The flaws in statin research are such that it brings disrepute on the whole medical profession, the vast majority of whom are genuine hard-working docs doing their best for their patients but are being tainted by Big Pharma and their complicit medical researchers, the medical establishment and Governments with their DIRECTIVES (aka guidelines).

    Reminds me of a 150 year-old quote

    “Not only are men who are overconfident in their theories or ideas unlikely to discover anything, they are also very poor observers. Indeed, their observation will necessarily be influenced by their preconceived convictions and, when they are the instigator of an experiment, they are most likely to focus on those results that support their theory. Thus, because they do not point in the desired direction, certain essential facts are often neglected.
    Claude Bernard: Introduction à la médecine expérimentale 1865

    M. J. Hope CAWDERY

    References:
    1. THE LANCET • Vol 360 • July 6, 2002 • http://www.thelancet.com

    2. Michel de Lorgeril (2014-03-05). Cholesterol and statins: Sham science and bad medicine. Kindle edition

    The above also sent to Rapid Response BMJ

    I have just been re-reading some of the published reports on the HPS/BHF studies. As Dr de Lorgeril points out there are many flaws, hidden data and unanswered questions.

    Also the issue of salaries is interesting. If Oxford University is paying him, not Big Pharma, then as the main funder of the university, the tax-payer, as “owner” of the data is entitled to examine ALL the raw data. If the data is owned by Big Pharma then confidentiality is valid but then Sir Rory IS PAID BY BIG PHARMA and there is a serious conflict of interest. He cannot have it both ways.

    Reply
    1. Professor Göran Sjöberg

      mikecawdery

      Your quote:

      “Not only are men who are overconfident in their theories or ideas unlikely to discover anything, they are also very poor observers. Indeed, their observation will necessarily be influenced by their preconceived convictions and, when they are the instigator of an experiment, they are most likely to focus on those results that support their theory. Thus, because they do not point in the desired direction, certain essential facts are often neglected.
      Claude Bernard: Introduction à la médecine expérimentale 1865

      is to me a very appropriate quote since Claude Bernard is one of our greatest physiologist all time. His “Introduction à la médecine expérimentale” is also one of the best thing I have ever read about a scientific attitude in research.

      Although being a researcher in metallurgy I have still encouraged my students to read part of this book of physiology for a proper experimental approach to a reality we are trying to analyse. (Unfortunately we are today moving further away from the pure experimental approach of finding real causes instead of associations by statistical means.)

      To quote Schopenhauer in his “On the Fourfold Root of the Principle of Sufficient Reason”:

      …. where calculating begins, understanding ends; for whoever is occupied with numbers is, while calculating, a complete stranger to the causal connexion …

      As far as I have understood all this Statin business it is exactly through the advanced “calculating” (statistical manipulation) together with experimental negligence people like Professor Collins can get away with their scams.

      Reply
      1. mikecawdery

        Thank you Professor. Dr de Lorgeril used this quote and your description of its history is particularly interesting and its relevance to other disciplines is vitally important.

        It is clear that there is nothing new in the world of human actions.

    2. mikecawdery

      From my comment above

      “I have just been re-reading some of the published reports on the HPS/BHF studies. As Dr de Lorgeril points out there are many flaws, hidden data and unanswered questions.”

      As an example of the flaws, this study was designed as a 2×2 factorial with two hypotheses; a) the comparison of statins versus placebo (two groups of ~5,000 statistical units – ie patients) and b) the comparison of anti-oxidants versus placebo. The result of the analysis of this design was never published; the straight comparison between statins only and placebo was never published nor was the straight comparison between ant-oxidants and placebo. All that was stated was that “the anti-oxidants were safe”. Just what were the results?

      The cocktail of anti-oxidant vitamins used is peculiar. 650 mg Vit E is about 65% of the tolerable daily intake (TDI) (http://ods.od.nih.gov/factsheets/VitaminE-HealthProfessional/). While a metanalysis in 2014 (J. Nutr. Sci. Vitaminol. 60, 194-205 2014) suggests that Vit E has, on its own, no effect on all-cause mortality, in combination with other “agents” may reduce all-cause mortality. Was this known in 2002-3.

      Vit C at 250 mg/day is basically very low; 20 mg beta-carotene is about 20 times the RDI (mg 700-900) and the TDI is 3,000 mcg RAE [(10,000 IU)3,000 mcg RAE (retinol activity equivalents)].
      (http://ods.od.nih.gov/factsheets/VitaminA-HealthProfessional/). And relates to hree diseases and disorders in which vitamin A might play a role: cancer, age-related macular degeneration (AMD), and measles. Its use in this study seems to be dubious.

      While this is better than the usual use of known ineffective RDIs in studies that show multivitamin supplements to be ineffective, are these dose rates effective in increasing the total ant-oxidant capacity of blood (TAC). I can find no evidence that the TAC was measured.

      The absence of Vit D is surprising. A recent review (Vitamin D and mortality: BMJ 2014;348:g3656 doi: 10.1136/bmj.g3656 (Published 17 June 2014) concluded that “Despite levels of 25(OH)D strongly varying with country, sex, and season, the association between 25(OH)D level and all-cause and cause-specific mortality was remarkably consistent results from a long term randomised controlled trial addressing longevity are being awaited before vitamin D supplementation can be recommended in most individuals with low 25(OH)D levels”. Thus even in 2002 Vit D supplementation would have been a better choice (http://www.vitamindcouncil.org)

      Most importantly, the absence of CoQ10 (ubiquinone) is inexplicable given the fact that Merck holds patents combining this anti-oxidant with their two statins (1990) and its known importance as an intra-cellular anti-oxidant for the protection of mitochondria from the effects of ROS. As the patents were taken out in 1990, ignorance of their existence is not acceptable. This absence in itself raises questions on integrity.

      Reply
    3. Flyinthesky

      I know it’s beyond the scope of this excellent blog but what makes people think that any other area of, so called, expertise works any differently. It doesn’t, the commonality is opportunity, empowerment and remuneration. The people who purport to be looking after us are really looking out for themselves. The missing element is choice, AKA democracy, neither of which are on offer.

      Reply
  5. Maree Bradshaw

    How about Sir Rory Collins taking the statins himself? I can almost guarantee you that he would suffer from memory loss, panic attacks , change in personality etc as did my husband when he was on them. Then your problems would be solved as he would be incapable of being a player in life let alone be involved in the statin debate.

    Reply
    1. Mary Jo

      Yes my husband was on them for short period of time and he became so symptomatic from same side effects of them that he nearly became unbearable to live with. He stopped them and thankfully was back to his normal self.

      Reply
  6. lowcarbdiabetic

    Depleted ground up uranium makes a great breakfast meal. I can state this unequivocally. The fact I have received over three hundred million pounds, from the nuclear recycling agency, has no influence on me what so ever.

    Kind regards Sir Eddie Atom

    Reply
  7. Flyinthesky

    “Its not the Matrix yet. People do think for themselves,” ?
    How can one think for oneself when one is continuously presented and programmed with distorted perspectives.
    “‘You can always rely on medicine to do the right things, after it has tried everything else.’ ”
    How many people have to die or be seriously disadvantaged before this kicks in?
    The only chance we’ll have is to be presented with the whole scenario but that’s never going to be on offer is it. Pockets have been filled and absolutes declared.
    I’m not being at all combatative, I have the greatest respect for your efforts but I reiterate: It all works the same. Choice, it’s a thinly veiled illusion.

    Reply
  8. NickM (@bokkiedog)

    Sir Professor Collins is inescapably corrupted. This is not to say that he wilfully and mendaciously manipulates facts and data, nor that he takes bribes or any other such gross malfeasance. Indeed, were he this caricature, twiddling his moustaches and cackling manically, he’d be simpler to deal with. The complexity of the truth makes it much worse to deal with.

    He is corrupted not by any venal, simple sociopathy, but via deep enculturation. And that systemic infection is much, much harder to expose and disinfect than a single bad apple in an otherwise fresh barrel. He swims in a malignant meme-pool, and it’s not surprising that his whole worldview, his perception of truth and his opinions of those who dare disagree, be discoloured by that murky meme-pool. The pool in question is filled with a number of dark, unprobed, a-priori assumptions, all of which conveniently and “coincidentally” bolster the pharmaco-industrial status quo. Some of these memes derive directly and obviously from his funding sources. After all, they expect a return on their 300 million investment. Other assumptions derive from subtler patriarchal privileges. And a more innocent remnant can be seen as a genuine, if metastasised, desire to defend Enlightenment values against barbarism and dark superstition.

    So, it’s not surprising that a man who has spent his whole life literally institutionalised should react like this to those who question him and the very bases of his institution. To try to separate the man from the institution in this instance is hopeless: it’s like asking “what is the cell – the mitochondrion or the nucleus”? So, he barks angrily not only out of anger, but incomprehension. An attack on his institution is an attack on him. And vice versa. Towered-ivory myopia is a wondrous malaise.His institution prizes a reductionist world-view, distilled into the “sell-a-pill” sine-qua-non notion of medicine. Any deviation from this word-view, to Sir Professor, is a suspicious deviation by dark-age infective agents. Furthermore, his institutions and those in its orbit prize hierarchies and status beyond mere coin. The members of those institutions are keen gatekeepers to “proper” knowledge, to status, and to their own more primal self-interests equally. And so they guard those gates as vehemently as any doberman.

    Unfortunately for Sir Professor, the Internet and the ability of independent researchers competently to partake in scientific analysis beyond those gates, despite the best intents of the gate keepers, means that he’s suffering the impudent little barbarians – like you and I and everyone else here – who snap at his heels and defy his haughty edicts, no matter how loudly he barks back. It must be very confusing for him, suddenly to have his citation-circle intruded upon by such “unwelcome externalities”.

    It almost makes you feel sorry for the old dog. Until you remember, again, the 300 mil or so his organisation pockets from organised crime*

    * Before Sir Professor should sue in outrage at my painting his paymasters thus, he should note that I’m merely quoting nobel laureate Peter Gøtzsche here!

    Reply
  9. Maureen Berry

    This is just so obvious – just so obvious – why does it need to be re-stated, again and again and again? You must feel, Dr K, like banging your head against a brick wall, again and again. Please find the strength to keep up your battle, the rest of us depend on you.

    Reply
  10. Sue Richardson

    What you say here Dr K is so utterly logical you would wonder how anyone could argue against it. Is it possible that a few extra thousand or so pounds in the bank and a ski chalet here or there, can remove the power of logical thought? Doesn’t take a Great Brain to figure.

    Reply
  11. Professor Göran Sjöberg

    I love the way you are now elaborating around the conflicts of interest!

    In fact, I was myself driven into the philosophy of science some years ago when I realised that I had been so fooled by the medical establishment. As a researcher in the natural sciences I started wondering why I had been so easily fooled.

    And, probably not by coincidence, one of my favourite philosophers then turned out to be Schopenhauer who was vigorously fighting the philosophical establishment during the first half of the nineteenth century. His favourite subject of scorn was the philosopher Hegel who he considered to be the greatest scam philosopher of all times. Hegel had been given the professorship in Berlin and in return was to be a keen advocate of the authoritarian Prussian state besides producing a totally incomprehensible philosophy which probably was a part of the game.

    The similarities between Professor Hegel and Professor Sir Rory Collins are striking to me.

    Reply
  12. Mark Johnson

    What makes the current situation worse (and totally and utterly unacceptable) is the fact that even if anyone wanted to check what Sir Prof Collins says about the efficacy, adverse effects etc of the statins he extols, they can’t. His unit holds the data and won’t release it. How in our allegedly evidence based world of medicine is this allowed to happen? It’s beyond any comprehension.

    Sir Prof Collins gets paid millions, does the research and holds the data but won’t share it, and expects everyone to believe his interpretation of that data. But that’s all OK because he’s a good lad and totally incorruptible and unbiased.

    If you don’t have memory related issues from taking statins 😉 maybe you can remember the song from which the following lyrics come:

    Ask me no questions
    And I will tell you no lies
    If you could read my heart I would not deny
    But I pretend

    Reply
  13. Mary Jo

    I strongly agree that they should declare their interests but having worked for the health service for 40 plus years !!!!
    I found there are a lotta people in it whose own self belief and arrogance knows no boundaries and he is just another one of them. They think most of us are fools and they know way better than most of us ‘little people ‘whilst these more Superior Beings …lol ……. ‘ live the lifestyle’ laughing all the way to the bank !

    Reply
  14. Jean Humphreys

    Rory Collins DOES take statins – he said so, while being interviewed on the subject by Michael Moseley, shown on television.
    Could explain some things.

    Reply
    1. Dr. Malcolm Kendrick Post author

      One advserse effect of statins is anger/irritability. I have seen it many times – but you have to ask about it, as it is not something that patients will ever spontaneously report. So, yes, if he does take statins this could be an explanation for his outbursts. I must say I have found his recent behaviour to be…. I am not sure what the word is. Perhaps displaying irrational anger, and a distinct lack of judgement.

      Reply
      1. Mary Adair

        Yes, that is one of many side effects. It is no wonder to me if you look back at history in the U.S. that people are so sickly. I have heard it said by you, Dr Kendrick, that it was not until 1953 when many young or “youngish” men were dropping dead of heart attack heart disease really became noticeable. That was just two decades shy of this country’s great depression and WWII. For the first time in our country’s history, during the depression, people were given food rations that were primarily made of “sugar”. Never in our country’s history was there so much consumption of sugar either before or since. Enter WWII and just look at what our soldiers were given…again foods high in carbohydrate (and therefore sugar) and were rationing out of all things…cigarettes. No wonder they were dropping dead, as if the stress of the previous two decades were not enough!!!
        And now, they want to blame cholesterol for the nation’s health problems? And, they are destroying people all over the world by blaming our poor liver’s production of cholesterol. Yes, it is enough to drive anyone crazy. We as a nation here in the U.S. and the world really are simply dying of nutritional deficits. Apparently with the mass production of foods to feed the hungry in the 30’s and then the soldiers (Thanks again, Dr. Keys) who were also malnourished and stressed, we now have more idiots killing us by blocking the one organ that can sustain us during even famine…our livers. It is enough to make people crazy and it has.

      1. Jean Humphreys

        He also said something along the lines of “the side effects are negligable,: I don’t have any” Hmm. How scientific is that?
        I know all my experience of statins counts as no more than anecdotal, but it was and remains real to me, however unprovable it is,

  15. Neil Chanter

    As you have so well described, we live in a world seething with bias and conflicted interest. Unfortunately, through most of life, the luxury of absolutism is quite unobtainable. Only by knowing as much as possible about conflicts of interest can we make our own personal judgement as to how to negotiate the bias of others that could affect our own decisions. With this in mind, as a uk medic, could you please elaborate on the kinds of payments a uk GP might receive that could affect his/her advice to patients? I am a retired scientist and now mainly a patient and so would greatly appreciate an insider’s understanding.

    By the way, I totally agree with your proposed absolutism solution to NICE. Data evaluation is as susceptible to independent analysis as the data is open and complete.

    I strongly support your strivings for clear thinking.

    Reply
    1. Dr. Malcolm Kendrick Post author

      GPs, nowadays, get very little in the way of payment from pharmaceutical companies. However, you do get paid for managing and treating various conditions through the Quality Outcome Framework (QoF). So, if you do not use statins (in some patients), you will lose payment. The total QoF payment system is worth many thousands of pounds a year, per GP.

      Reply
      1. V

        That, and the fact that official guidelines in oh-so-many countries are actually forcing GP’s to prescribe statins even when not needed at all. It’s as if you don’t do it for the money, you have to do it in order to be able to practice medicine…
        A rather sad state.

  16. Bryan Hemming

    Having taken statins for almost a year I can personally assure Professor Sir Rory Collins.the side effects are not worth it. Muscle pains, penis shrinkage, penis pain, disturbed sleeping patterns, disturbing dreams, and flatulence, just to mention a few that spring to mind immediately. Oh, and then there were the suicidal thoughts, episodes of depression and almost uncontrollable anger. But I´m sure the professor has heard of all of these and that´s why a hunk of the research findings were allowed to be withheld.

    Most symptoms ceased as soon as I stopped taking them, others took a few months.

    The idea that people should be prescribed statins even if they show no signs of cardiovascular disease, or have normal cholesterol counts, from the age of forty, is so horrible it sounds like the professor should be used as a guinea pig for drugs to prevent psychopathy.

    This man poses a very real and serious danger to the health and well-being of the British public, not to mention the economy.

    Reply
  17. Tyrannocaster

    I certainly agree with the thrust of your post here, but I also note that you yourself have a disclosure statement on the site. (The link is up at the top, on the right.) I assumed you did this because you were trying to be as clear about possible motivations as possible, and to pre-emptively disarm any critics who chose to criticize you on this issue. I have no problem with that. The problem arises, as you have noted, when people fail to mention something like this, as Rory Collins has done. (I am an American and I don’t feel at all bound by the British tradition of using honorifics automatically; I feel they should be earned, so to me, he’s just Rory Collins.)

    Your tactic of pointing out how much funding Collins’ organization has received from the industry is a good one, but I think you should add one detail; if I were you I would try to find out how much Collins himself has been paid by these intermediaries, since he seems to have made sure there is no direct link to them. For instance, how much money does he make as the director – whoever pays it? Does he receive nothing, perhaps just a tribute speech at the annual board of directors’ dinner? Why do I doubt that?

    Reply
    1. Dr. Malcolm Kendrick Post author

      people have tried to find out Rory Collins renumeration….and failed. Tis secret. Perhaps the example of Richard Doll is salutory. Having gained fame for proving that smoking causes lung cancer, he was than paid by Monsanto, and acted on behalf of Monstanto at various hearings. It is estmated he earned nearly £15m ($20m) over the years doing this, and never disclosed a penny to anyone.

      Sir Richard Doll was another Oxford Professor, and thus considered beyond reproach during his lifetime.

      Reply
      1. Ronnie H

        The tiniest of points: you say Richard Doll ‘earned £15m….’ Can we make a point of replacing ‘earned’ in this context by something more appropriate like ‘was paid’?

  18. LaurieLM

    Bryan H.- risk for suicide- and this from as early as 1992. They say below there has been ‘no adequate explanation’. But patients should be advised to stop taking statins, even if the MECHANISM of the anger, violence and suicide induction hasn’t been fleshed out yet. The correlation between suicide attempts and success, is (has been) well known.

    “Lancet. 1992 Mar 21;339(8795):727-9.
    Low serum cholesterol and suicide.
    Engelberg H.
    Abstract

    Primary prevention trials which have shown that the lowering of serum cholesterol concentrations in middle-aged subjects by diet, drugs, or both leads to a decrease in coronary heart disease have also reported an increase in deaths due to suicide or violence. There has been no adequate explanation for this association.”

    Hmmm. Since 1996 Pfizer has made $130 BILLION on Lipitor. That’s $130,000,000,000.

    “Lipitor is the best-selling prescription drug of all time, racking up global sales of more than $130 billion since it went on the market in 1996.”

    I think it would be superhuman, if you are the beneficiary of even a fraction of this money, NOT to be conflicted.

    Reply
  19. LaurieLM

    Oops. I meant to write that the correlation between low serum cholesterol and violence is (has been) well known. And Lipitor………lowers serum cholesterol.
    As a matter of fact, when Lipitor was first introduced, it would have been reasonable to have hypothesized that suicide and violence would increase.

    Reply
  20. Hans

    Within the last month I accompanied my father (he in his 90’s) to an assessment of his condition by a specialist. It was pointed out to us – and indeed had been known and understood by us since a previous assessment a few years earlier – that my father had “severe calcification” in the arteries going to the legs. Walking becomes quickly tiring for him, legs don’t get blood, so they give out. He has closed up arteries around the heart too, but no pains or any heart problems. He’s never had a cardiac “event” of any sort. His mind and personality, memory and rate of speech are still the same as when he was in his prime.

    Anyway, when the “severe calcification” was pointed out, I made known my (mock) disbelief (gentle polite sarcasm with a point): “How could he have any calcification? He’s been on statins for over 25 years.”

    Our specialist knew what I driving at (it was clear) but wasn’t about to abandon the current doctrine. Or let my doubts hang there in the room unchallenged. He replied “Well, you have to consider what worse condition he’d be in had he not taken them all those years.”

    (Recall now what Dr. Kendrick notes about not really knowing what another person is actually thinking.)

    But this reply got me thinking: If the medical establishment actually believes taking statins (and beating down your cholesterol) on a regular basis for decades left my dad with several arteries all but closed shut, and statins are harmless do-gooders whose only function is to help humanity and human bodies then clearly my father’s prescribed dosage was massively inadequate. He should’ve been taking 10 or 20 times the amount of statins all those years, right? They do good… They *only* do good… So logically if arteries became “90% closed” on a given dosage of these harmless statins, then a tenfold increase should’ve really been prescribed for my dad? And also for anyone nowadays being considered for statins, of course.

    Or maybe a machine is needed to suck all the evil cholesterol entirely out of the body as soon as it is made…

    Reply
    1. Antonio Reis, Portugal

      Very good point! I could also tell the story of my mother who despite 84 years is still in good health …. if not for the fact that she has a peripheral neuropathy as a result of taking statins for over 20 years. There are five years she left statins and partially recovered movement.

      Your quote “Well, you have to consider what worse condition he’d be in had he not taken them all those years.” reminds me of an anecdote that reflects the same kind of thinking:
      “Two people were picnicking in the middle of the road, despite a very large tree was right on the edge of the road.. Suddenly appears a car at high speed. The driver seeing the two friends on the road, deviated from his course, hit the tree, and got very hurt. A friend says to the other: Imagine if we were eating under the tree !!!

      Reply
  21. LaurieLM

    More FYI, from 2002: violence lonk to low total serum cholesterol….. Clearly, if the low TC comes about honestly (maybe from low-fat, high grain {cholesterolly foods displacing}) diets, or from taking statins…….not good either way. Emphasis mine:

    “The violent offenders having lower than median TC levels were eight times more likely to die of unnatural causes. ”

    “Eur Arch Psychiatry Clin Neurosci. 2002 Feb;252(1):8-11.
    Total serum cholesterol level, violent criminal offences, suicidal behavior, mortality and the appearance of conduct disorder in Finnish male criminal offenders with antisocial personality disorder.
    Repo-Tiihonen E1, Halonen P, Tiihonen J, Virkkunen M.

    Abstract

    Associations between low total serum cholesterol (TC) levels and antisocial personality disorder (ASPD), violent and suicidal behavior have been found. We investigated the associations between TC levels, violent and suicidal behavior, age of onset of the conduct disorder (CD) and the age of death among 250 Finnish male criminal offenders with ASPD. The CD had begun before the age of 10 two times more often in non-violent criminal offenders who had lower than median TC levels. The violent criminal offenders having lower than median TC levels were seven times more likely to die before the median age of death in the study material. The violent offenders having lower than median TC levels were eight times more likely to die of unnatural causes. The mean TC level of these male offenders with ASPD was lower than that of the general Finnish male population. Low TC levels are associated with childhood onset type of the CD, and premature and unnatural mortality among male offenders with ASPD. The TC level seems to be a peripheral marker with prognostic value among boys with conduct disorder and antisocial male offenders.”

    Reply
    1. David Bailey

      LaurieM,

      I am not clear if you are observing correlation or causation in these studies. Do you think the low serum cholesterol actually causes anti-social behaviour, or could it be that naturally low cholesterol is associated with other abnormalities that cause the anti-social behaviour?

      Those of us who are old enough to be given statins, don’t usually engage in anti-social behaviour, so I am guessing that most of the people you are studying must have naturally low cholesterol. As Dr Kendrick has pointed out, even eating a diet that is low in fat and cholesterol, doesn’t lower a person’s cholesterol level greatly.

      Alternatively is there evidence that statins do sometimes produce anti-social behaviour (as opposed to memory loss)?

      Reply
      1. Dr. Malcolm Kendrick Post author

        David, At one point, before statins came along (when other drugs were being used to lower cholesterol) it was noted that in all the studies on cholesterol lowering drugs the rate of violent deaths went up. This was a consistent finding, so much so, that it was being considered a reason not to use drugs to lower cholesterol. Then, along came statins, and all concerns went out of the window. Along with multi, multi-billion dollar profits.

      2. David Bailey

        Dr, Kendrick,

        That sounds intriguing – but was it possible to break down what “violent deaths” actually meant? I mean, surely there were not many of us over 60’s going out on armed robberies!

        Would it include deaths caused by inattention – such as road accidents – or suicide – conceivably caused by the discomfort and sense of the body giving way resulting from statin poisoning?

        Or could it be that people on statins become irritable and end up in fights?

        David

      3. Dr. Malcolm Kendrick Post author

        The deaths were of things like accidents, suicide, violence (non-specific), car crashes. Becuase no-one could explain these effect, they were were virtually written off as ‘coincidence.’

  22. LaurieLM

    High-fat food for thought.

    We in the US are told we have the ‘best’ health care in the world; especially for those who can afford to access it.

    It’s certainly the most expensive. I’ve been in contact with Stephanie Seneff. (She’s at MIT; has published many papers on nutrition and health, and I’m the 4th author on 2 of her articles!…… believe me, a great honor).

    We are agreed that the suicide of Robin Williams is probably an illustration of a few, debilitating, depression-inducing things.

    In his own words (interviews) he describes being depressed, addicted and bipolar. All, sadly, no surprise to us as they are hallmarks (Stephanie’s hypothesis) of LOW serum cholesterol and low levels of cholesterol-sulfate. We have no inside info, but deep suspicion, and resignation that it was the case with RW that he must not have had enough fat and cholesterol in his marvelous, funny brain. He had money and access to U.S. Health care- the ‘best’ on the planet. His early death must be devastating for his 3 children. It might have been avoided.

    The causes of low cholesterol-sulfate are cholesterol hysteria and heavily promoted diets low in animal fats and cholesterol, low in animal protein (sulfur) and high in cholesterol-displacing sugars, and other carbohydrates and high in (further cholesterol-displacing) grains. Adding serious insult (to possibly Williams too) are the cholesterol-lowering statins that are now the ‘standard of care’. And the guidelines are being set (by financially interested committee) to ever decreasing cholesterol concentration targets. The guidelines dictate what is a low-enough- serum cholesterol level, and also continue to decrease the age at which this drug is to be instantiated. Vested interests, therefore, dramatically increase the numbers of ‘patients’ and decrease the age of ‘patients’ prescribed statins – for life.

    On a personal note, both Stephanie and I took each of our husbands (with their permissions) off the statins they had been, as ‘standard of care’, prescribed. (Apologies to Stephanie for writing this private info.).

    “Eur Arch Psychiatry Clin Neurosci. 2002 Feb;252(1):8-11.
    Total serum cholesterol level, TC, violent criminal offenses, suicidal behavior, mortality and the appearance of conduct disorder in Finnish male criminal offenders with antisocial personality disorder.
    Repo-Tiihonen E1, Halonen P, Tiihonen J, Virkkunen M. ”

    “Lancet. 1992 Mar 21;339(8795):727-9.
    Low serum cholesterol and suicide.
    Engelberg H. “

    Reply
    1. mikecawdery

      LaurielM

      I too am a great fan of Dr Senneff and her colleagues’ work – makes a lot of sense. I envy you being able to work with her.

      My first reaction when I heard of Robin Williams death – statins the US being paranoid about cholesterol.

      Many thanks for the refeerences – always useful.

      Reply
    2. Mary Adair

      Laurie M.
      Thanks for commenting on our beloved Robin Williams. It was always my thought that he had to have been bi-polar because of that wild and oh so funny brain of his. My first thought when I heard of his suicide…he had to have been on statins as he had open heart surgery years before and certainly had the best “standard of care” the U.S. has to offer. He was not one to have been in and out of rehab his whole life. Actually, I only noted he admitted to one stint in rehab. He used cocaine (although I can’t imagine his being any more manic) early on in his life, but again, said he quit on his own. That does not sound like a man who was a tortured soul. I have to wonder just what could have been so bad. He had so many projects in the making and he was just a regular guy who walked down the streets of his own neighborhood, popped up unannounced at comedy clubs, and gave to others. Socially, he reached out a lot and felt a strong connection to others. Not everyone who is bi-polar is suicidal. We loved him…and he loved us too. May he finally rest in peace. Thanks again.

      Reply
  23. Carol Jewell

    Dear Malcolm,

    The heading on one of your latest blogs comes across as, confused, flimsy, glib and in its context ambiguous.

    “What is conflict of interest anyway” you state.

    II don’t do “blog” ( Why would anyone practising doctor wish to ?) but I would like to say there are a vast numbers of patients who know exactly what a conflict of interest is…………….! The same system denies them what is their right, to be physically healthy. This means carrying out a proper clinical assessment which detects what is causing their symptoms, and responds accordingly .…………………………

    Why have so many GP’s lost such a skill ?!

    Think……………………………………… “Conflict of interest”

    Carol Jewell (Mrs)

    +

    Reply
    1. Christopher Palmer

      Dear Carol,

      “The heading on one of your latest blogs comes across as, confused, flimsy, glib and in its context ambiguous.”

      A conflict of interest can be compared to beauty. Interpretation rests with the perception (eye) of the beholder, Hence conflict of interest is ambiguous in itself because parties of alternate persuasion have alternate takes on one given circumstance. Conflict of interests can never be deabted with outright finality.

      “Why would any[one] practising doctor wish to” .. blog?

      Because the said doctor wishes to share insights with other practising doctors and patients might not otherwise have easy access to such insights. Ease of access to the truth is denied because adherents of dogma shout down and drown out their better informed critics. The truth in these affairs do not generally get a fair hearing. The blog and comment forum that Dr Kendrick hosts is one of the ways to counter the injustice the truth suffers.

      We do agree with you, at least I know I do. .. ..

      Many doctors have become quite robotic in their approaches to certain aspects of clinical assessment. But they are guided to such an approach by all pervasive influences and bias that shapes what they learned in medical school and how they approach general practice. The great influences are social conditions, not enough regard for ’cause’ in illness, not enough regard for, or ambition to, deliver ’cause’ related interventions, the Quality Outcomes Framework (QOF) which offers financial reward for target driven incentives, and guidelines on lipid modification issued by NICE that represent total nonsense. In the main, where CVD, general practice, and primary prevention, is concerned NICE are firmly part of the problem and not the solution.

      Hosting the blog is exceedingly generous spirited on the part of the host. But the blog and comment aspect adds value. Threads always develop. People raise objections to points raised and often objections are often further explained or explained away in instructive and revealing ways. Readers of the blog get to learn something from the host, readers get to learn from other readers, and at times followers present the host with promising new lines of inquiry. It’s highly transparent and informal crowd-sourcing.

      * * *

      Mine is an extreme example, I do concede. I have read several cholesterol sceptic authors several times over and with truly forensic intent to identify the very roots of the cholesterol myth. I have been interested in why people trend away from wellness for six years and have been reading into cholesterol and cholesterol history for four of those. Thousands of hours have passed with me reading, thinking, or writing. I owe a lot of what I have learned to certain blog and comment forums. The biggest lesson I ever learned was hard-won and slow in installation. What I have leaned is that what I have learned is a mere fraction of that which exists to be learned. However much I know, or allow myself to think I know. I now know there is a very real prospect that something of importance (to do with almost anything) residing in matters I do not know, and I do not even know I do not know, could alter my understanding for the better, if only I knew.

      The great problem with Professsor Sir Rory Collins, (and with Dr Ancel Keys who gave us the cholesterol myth in the first instance) is that they all too easily cherish(ed) that which they think (thought) they know (knew) while not reserving enough regard for those unknown unknowns that might actually have great pertinence. Rory Collins simply accepts that cholesterol is proven to be a dose dependent atherogen, an impression that Keys promoted in the 1950s, but for more than three decades it has been clear that cholesterol is not a dose dependent atherogen at all. Evidence gleaned from experimental research indicates certain oxides of cholesterol are dose dependent atherogens, while cholesterol itself is not all atherogenic.

      Mary Adair, below, is quite correct, that cholesterols’ contribution to physiology is overwhelmingly positive, and only a false impression distracts us from that perception. The same is true where lipoproteins are concerned.

      If you really want GPs to be less robotic in the way they approach diagnosis and treatment in certain of their affairs you have to challenge the stubborn and wilful persistence of the easily adopted notion that cholesterol is a dose dependent atherogen, not just in GPs, but within and throughout the fatheaded folks at NICE, and the key opinion leaders that influence them.

      It a shame, 2014 presented opportunities for cholesterol and statin sceptics to get it on record that cholesterol is not a dose dependent atherogen, but the argument did not come to the fore. I worked frantically to try to place my knowledge of this upon a firm, well argued, and evidence-backed, basis complete with all citations. Time and eventualities beat me. I think I must be the only one at it. I ain’t finished yet.

      If it can be said plainly that cholesterol is not a dose dependent atherogen then every facet of the fat/cholesterol hypothesis will have been revealed as an untruth. This is the case, it is just a tricky thing to argue it is the case.

      The fat/cholesterol hypothesis grew from an entire absence of evidence, and runs counter to the real evidence that has been assimilated over time. This rather undermines the case for lipid modification in any setting, but especially so in the case of primary prevention, which is the case that has an estimate 7 million people in the UK taking cholesterol lowering drugs called statins and all arising from the guidelines NICE issue upon ‘lipid modification’. The number may rise under newly implemented and revised guidelines to an estimated 10 million or more. All this eventuality has to back it is mythical notoriety of cholesterol for being a dose dependent atherogen, which it is not. Discussion of conflicts of interest is not impertinent, but I believe the topic is less pertinent than others.

      Stains are not magic bullets, they are ‘friendly fire’ dispensed by even the most friendly and well intentioned of family doctors, that risk damaging the delicate physiology of 100% of takers.

      Changes are needed and soon. Dr Kendricks blog backs such propositions. That’s why Dr Kendrick and his blog represent forces for ‘good’, and why neither should be scoffed at.

      Reply
      1. Professor Göran Sjöberg

        Christopher Palmer

        I think your comment here is one with the deepest insight about the unveiling process.

        “I owe a lot of what I have learned to certain blog and comment forums. The biggest lesson I ever learned was hard-won and slow in installation. What I have leaned is that what I have learned is a mere fraction of that which exists to be learned.”

        My lesson learned is almost identical.

    2. David Bailey

      All over the internet, the most interesting and useful blogs come from people who know something about their subject! Using that criterion, surely a practicing doctor (who also does research) is exactly the right person to write a blog!

      Having said that, I often think that those who write blogs may forget that new readers obviously don’t know all the context to which the headline blog article relates. This can be confusing, and I wonder if the heading of every blog article should contain some sort of reminder of that context, for example:

      “More about conflicts of interest in relation to the prescribing of statins. – What is a conflict of interest anyway?”

      Reply
  24. Mary Adair

    Dr. Kendrick, I recall friends in the states in the early 80’s who began talking about processed sugars and those bad carbs being at the root of many illnesses relatively new to the U.S. I myself gained weight 15 years ago due to a broken foot which prevented me from exercising. I went on the high fat, low carb diet. I stayed away from the “bad” carbs. I had energy to burn. I never felt better, lost 50 lbs. which was more than I needed to lose and maintained that lifestyle for many years until I was put on statins. At that time, I was sick and tired and tired of being sick. I won’t go into that. One issue I don’t understand is if our livers who produce cholesterol in order to serve functions such as repair, cell turnover, and well just about every thing you can think of in our bodies, how could they have changed so drastically since the 50’s and 60’s to this date? It just makes no sense strictly from an anthropological point of view. It is damn near impossible. And what do you think Dr. Kendrick about Scottish Independence and its effect on the National Institutes of Health for the Scottish people?

    Reply
  25. Mich

    My mom was put on Crestor over a yr ago, and her health has taken a steep decline, stomach pains, chronic diarrhea, memory probs., and extreme anger. The “reason” the doc. prescribed them, is because her LDL was insanely low, and HDL was extremely high (like 15 times higher than avg). Have you heard of any statin or any doc. prescribing statins to lower HDL? None of the info. I read said anything of the kind.

    As for my dad, he’s been on Lipitor for about a decade, has the muscle pain, back pain, memory is the sh!ts, loses temper all the time. I really want to get out of this situation but jobs are scarce and don’t pay well, so I’m stuck still at home.

    And this is in Canada. I’ve wondered if contacting a lawyer or writing to the doc (he thinks he’s God though) will help. I’ve just reported the Crestor adverse reaction to Health Canada. I did a search too, from 1987, and from 2003 on there are almost daily reportings on the MedEffect site. One was about a 22 yr old man who took Crestor and had a heart attack and died. Shocking!!!

    Reply
    1. David Bailey

      I’m not a medical doctor, but you won’t get official medical advice on the internet anyway. Nevertheless, if your parents are wiling, and they haven’t suffered heart attacks or strokes, I’d suggest they do what I did – stop the statin and see what happens. My symptoms were noticeably less intense after 1 week, but it took me 9 months to get completely back to normal – just to give you an idea of the possible timescales.

      Reply
    2. karinska2

      That’s awful Mitch, can you not persuade your parents to stop taking the drugs? Do not allow anyone to bully you or shut you up, easier said than done sometimes but take as much info from this blog as you can and don’t give up.

      Reply
  26. pmw7070

    Not sure how this conflict of interest concept is any different in any field of research. You propose a thesis to a funding agency, and the mechanism to “prove” it. By definition you have a vested professional and economic interest in the outcome. If you believe the thesis, you tend to disbelieve, discredit, or rationalize results that do not support your thesis. You tend to disbelieve, discredit, or rationalize the results of others with alternative theories that do not support your thesis. If you manage to get to be an “expert in the field,” maybe if the research area is new enough and/or the field is small enough, you have weight with the applicable funding agencies and journals, you can influence the direction enough that research by others is dismissed or discredited; research in the area is incestuous and not honestly independent. You say “Statins,” I say “global warming.”

    The only alternative I can imagine would be two different researchers, one to propose and one to independently perform the experiment, not communicating directly with the original proposer.

    Reply

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