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A very unusual business. Part 2.
Why would we get rid of an effective treatment?
Ivermectin Part 3: The People Behind the Curtain
In part one of this series, I showed that the most critical study we had on Ivermectin, a study demonstrating a 75% reduction in mortality, was influenced and weakened by an unnamed group working with Unitaid. We know this because the principal author of the study admitted it under questioning from a colleague. But… why does that even matter? Some nameless people influenced a science paper, so what?!
Let’s get into it.
Spooks changing a science paper does matter. The influence they had over this particular scientific paper had an impact on you personally. It may have extended the pandemic by a year. It may have cost thousands of lives. So why did they do it? And who are ‘they’?
Here’s the problem laid out: as early as 2020, we had excellent data screaming ‘Ivermectin will reduce hospitalisation and death in COVID patients’, thousands were dying, and advanced health systems basically did nothing. Why!?
There’s a common school of thought on these conundrums: “it must have happened that way because it’s right.” People from this school file Ivermectin away and just get on with their lives. If you’re that person, I’m asking you to stick with me and hear a decent explanation. For others, the conundrum piques their interest. They take that framework and search incredibly hard, often with amazing creativity and drive, for all the reasons that demonstrate why ‘it must have been right.’ Their view is an optimistic one, but I can find no merit in it. Why? Because it doesn’t address the elephant in the room: if everything was above board, there needn’t have been ‘invisible hands’ altering Dr Hill’s research paper.
The invisible authors would have been listed and we could check their background for conflicts of interest. We could ask them why such a conclusion was arrived at. But we don’t have listed authors, we have silent meddling and ghost-writing. We have a deliberate weakening of conclusions. Such meddling would have gone undetected if not for Dr Tess Lawrie and a recorded Zoom call. You can forgive yourself for thinking ‘this looks bad’ because it really does.
To add weight to the conundrum, consider this: the drug was cheap and available nearly everywhere. It had been successfully administered to more than 1 billion people in multiple public health campaigns before. Its safety profile had been established over the past 30 years and as such, it’s considered one of the safest drugs in the world. If health authorities rolled it out to mitigate COVID, as Lawrie put it, ‘the worst that will happen is you’ll rid the world of worms.’
Changing science papers in an underhand way is indicative of underhand motivations. So let’s not be naive and instead get into some of the reasons why a lobby would change that paper, because, like it or not, that’s what happened.
Whenever you discuss Ivermectin in the manner I’m doing now, there is a litany of ‘urban wisdoms’ that crop up. They’re usually valid questions deserving of an answer, and there’s a very common one that can help us here. It usually goes something like this: “If they [the man] owns Ivermectin, and it worked for COVID, they’d make millions from it. So it mustn’t work or they’d have rolled it out.” Answering this question will shed some light on this conundrum.
Understanding [a bit] of the business model
When a drug comes to market, the company gets a ‘patent window’: a start and end date through which the company fully owns the drug. It’s structured that way so companies can recoup the costs incurred in developing and testing drugs. When people are dying, they tend to demand medicine, and if you own it outright, you can charge whatever you want. It’s grim, but business is business.
It’s crucial to note: the patent window does end. So the pharma industry juice patent windows like lemons, squeezing out every single drop of profit before the window closes. By that time, they’ve got new patents ready to go. They can’t get the same ‘patent window’ twice, they must make their money then go cure some other disease. Or something like that.
After the window expires, the drug falls into a category known as ‘generics’. Paracetamol and aspirin are generic drugs. It means that any drug company can manufacture and market the drug. Multiple companies compete on price, and so the price rapidly declines. In theory that sounds great right? Great in theory but in practice, there are problems. It’s time to imagine a scenario.
You’re selling an excellent drug, its true excellence is known because of your excellent research studies published in excellent journals. All of this excellent data and general excellence cost your company a lot of money. Your drug is marketed for a very specific infection, and so your marketing wizards have figured out that $9000 per dose extracts the maximum profits for that particular disease. But then out of the blue, some independent researchers from a middle-income country publish a research paper. Another drug from your wonderful portfolio can also treat this very specific infection! Isn’t this good? Definitely not…
That drug is for a common disease, so your marketing wizards had set the price at $100 a dose. Your pricing strategy is now totally broken: doctors will advise patients to use the cheaper $100 drug because research shows it’s just as good and it’s $8900 less!
But it gets even worse. Imagine if researchers make these discoveries after your patent window closes. Their research shows that the drug you once owned has benefits against many conditions. The patented drugs which you plan to roll out are now threatened by cheap generic drugs that anyone can manufacture. At such low costs, these drugs will be the obvious choice for many people. This is a big problem: multiple profit verticles are under threat, your intellectual property portfolio is shrinking in value, this cannot be allowed to continue!
So let’s get back to a real example and keep that scenario in mind.
The patent window for Ivermectin ran out in 1993. In India, one of the main producers of Ivermectin is the Taj group: a titan of Indian manufacturing. This kind of manufacturing scale drives down costs. In India, Ivermectin can cost less than $3 for a course of treatment. It’s available in every single pharmacy across the country with no questions asked. Merck, a massive pharmaceutical company, once owned Ivermectin outright. They no longer do. The lemon has been juiced.
Had Ivermectin been approved globally, drug manufacturers would have caused prices to race to the bottom. ‘Other’ companies would carve out a small profit on the scale of Ivermectin sales. Sure, some money would have been made, but it’s small fry for an industry with its eyes on billion-dollar profits. To put it into perspective, it’s estimated that 1kg of Ivermectin can cost as little as $150 to manufacture, enough for 7,000 courses of treatment. At costs that low, you could treat everyone in the UK for $1,400,000. Great news for you and me, terrible for the pharmaceutical companies. There’s no juice left and so there’s no business case in allowing Ivermectin to eat into the profits from the ‘biggest disease opportunity in a generation.’
What does this all mean in practice? It sounds almost crazy to say it: human costs are not factored into profit decisions. See the oil, weapon and tobacco industries for details. It means that to protect profits, pharmaceutical companies have to protect their markets. It is absolutely critical.
They have to nudge things in their favour. They have to isolate competitors. In some cases, they have to crush competitors. They must control the process by which drugs come to market. They must spend billions on marketing. They must get as much leverage over their industry as possible. They must disempower people asking questions. They must make talking heads feel righteous about their research data. Where possible, they must gain control of the regulations to get favourable decisions. If they can’t do all of this, it’s very possible their entire industry evaporates. Breakthrough curative effects found in generic drugs can sink their business. Businesses don’t let their industry evaporate. They set up a lobby.
It’s a lot to imagine. I suspect you think I’m stretching things. Maybe you’re still seething at me personally for daring to suggest that Ivermectin works at all. There’s a kind of nervous energy that builds in your stomach as you consider the possibility. Part of that power is rooted in how we have all suffered. In how much we have invested in our understanding of the pandemic. If we had a potential treatment all along, our understanding shatters. And yet, the data sits there: invisible authors meddled in the conclusions of a key research paper and the treatment disappeared. You could perhaps find refuge in a reality where the industry lobby meddled in the research and the research didn’t support the effect either. Does that keep reality intact? The nervous energy rises in your stomach. They wouldn’t get rid of an effective therapy just to increase profits? It’s much easier to believe such a thing isn’t possible. A lobby of such power is surely a conspiracy theory.
I’m afraid not.
In 2005, spooked by the growing influence of big pharma, the UK Government wanted answers. How much influence do these companies really have over our healthcare? After an extensive year-long study involving a non-partisan committee, fifty witnesses, extensive expert testimony and hundreds of pages of documentation, The Lancet summarised the Government’s findings: “the influence of the pharmaceutical industry is enormous and out of control.” Government reports are rarely explosive, but with this one, it’s hard to overstate the strength of its findings. Here’s a snippet from the report itself.
The consequences of lax oversight is that the industry’s influence has expanded and a number of practices have developed which act against the public interest. The industry affects every level of healthcare provision, from the drugs that are initially discovered and developed through clinical trials, to the promotion of drugs to the prescriber and the patient groups, to the prescription of medicines and the compilation of clinical guidelines. We heard allegations that clinical trials were not adequately designed – that they could be designed to show the new drug in the best light – and sometimes fail to indicate the true effects of a medicine on health outcomes relevant to the patient. We were informed of several high-profile cases of suppression of trial results. We also heard of selective publication strategies and ghost-writing. The suppression of negative clinical trial findings leads to a body of evidence that does not reflect the true risk:benefit profile of the medicine.
How can we imagine such power? When we imagine ‘lobbyists’ we probably think of suits rubbing shoulders in Washington and asking for tax breaks. The real power is yielded in a complex network of NGOs, research grants, policy wonks and science publishing. Real influence is yielded by operating quietly in the background. Real influence is a dark art.
Did you notice anything in that quote? ‘Practices which act against the public interest’ and ‘ghost-writing’. That’s exactly what we have here isn’t it? Ghost-writing away an effective medication to ensure profits can continue to be made. Nudging key research papers to come to profitable conclusions. This is the bread and butter of lobbying. It certainly was not in the public interest to torpedo Ivermectin at a time when thousands were dying. Doing so required shady ghost-writers to weaken the paper’s impact.
So how can this be?
We are living through a moment where all ‘mainstream’ observers of modern life remain oblivious to this reality. Rather than acknowledge the data showing a pharmaceutical lobby committed scientific fraud, our ‘fourth estate’ instead echo a total inversion of reality. They do so with glee, jubilant that they’ve protected you and me from the perils of misinformation. It’s not the well documented pharmaceutical lobby, exposed on camera, shattering a drug’s prospects in pursuit of profits, it’s actually the independent research teams from all over the world conspiring to fraudulently demonstrate that Ivermectin creates positive outcomes for COVID patients. What they gain from this supposed fraud we are left only to imagine. Whether knowingly or not, those commentators have been sucked into the informal network that makes up the pharmaceutical lobby.
What about the invisible people?! The nameless people that work to pollute our knowledge base in their favour? “I’m not going to start naming names,” Hill said, in the conversation from part one. ‘Just… the people there…’
We have to look at this no matter how uncomfortable it makes us. So that’s what I did. I examined this case carefully, where no mainstream publication bothered to.
A forensic analysis of the pre-print paper, by a science communication expert, revealed there were multiple ‘voices’ within the paper. For at least one of those voices, English is a second language. Lobbies cannot cover their tracks entirely. There are artefacts that should have been removed and breadcrumbs that leave a trail. All of it can paint a picture of how this lobbying works, and who was likely to be involved. It reveals how all of this works.
How has our medical industry been corrupted by the interests of the pharmaceutical industry? All will be revealed in Part 3.
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Ivermectin Part 2: A Very Unusual Business <— you are here
Ivermectin Part 3: The People Behind the Curtain