Pharmalot blogs on the Consumer's Union report that one out of six people have had a bad enough reaction from a drug that they went to the hospital.
http://www.pharmalot.com/
Which raises the question: are people and doctors taking enough responsibility for how they take their medicines? Another question: are companies doing enough to treat consumers of medicines as customers, resolving problems, addressing side effects on an individualized basis instead of behind a battalion of lawyers..

My guess is the answer is no. Therefore simply dialing up the FDA to complain about one own's sloppy behavior is no way to resolve the issue. A better way would be to get patients with similar meds, conditions and characteristics to report and share information about their experience with all drugs, OTC, prescription, supplements within a virtual community. Then that information can be scrubbed and reviewed for trends and safety signals.

Which is why CMPI is a proud sponsor of http://www.iguard.org the first patient created and patient centered source of information on how drugs are affecting people like you and me.

The Consumers Union recommendation is well intentioned but old school. The way and wave of the future is http://www.iguard.org

For those in Soros/Essential Action camp who fervently believe the way to develop drugs for global health is to have the government coordinate and run trials with IP seized from private companies, the latest HIV vaccine failures underscore the ideologically riven fecklessness of their position.

The notion that prizes to investigators plus a pittance to those who develop and manufacture medicines under a government-run clinical trial operation will yield breakthroughs is naive: the risky part, the hard part, the part requiring hundreds of billions of dollars a year, is development. That is why commercialization is critical to medical progress, as are profits.

The Soros/Essential Action model is based on hatred of capitalism not science. And in the end, it will doom the dying around the world to continued suffering. The groups will have their press clippings and accolades from the Left and those in need of breakthroughs will have nothing. Such is the perverted definition of "progress" advanced by George Soros and Essential Action

The committee voted against restricting the use of ESAs to small cell lung cancer.

Question 2--Should FDA require that product labeling be modified? Please address each of four potential approaches to mitigating risks through revised labeling separately.

a. To date, only clinical trials in small cell lung cancer have reasonably excluded an increased risk for death among patients receiving ESAs. Trials have demonstrated an increased risk of death and/or tumor promotion in head/neck, non-small cell lung cancer, breast (neoadjuvant and metastatic settings), lymphoid malignancies, and cervical cancers. Tumor types, other than those listed above, have not been adequately studied. Should the current indication be modified to restrict use only to patients with small cell lung cancer?

Vote: YES-- 6 NO-- 8

Question 2--Should FDA require that product labeling be modified? Please address the following potential approaches to mitigating risks through revised labeling.

b. Vote: The PREPARE trial demonstrated decreased relapse-free and overall survival in breast cancer patients receiving neoadjuvant chemotherapy. The risk/benefit assessment is different for patients receiving neoadjuvant and adjuvant chemotherapies than for patients with metastatic or incurable cancers. Should the current indication be modified to include a statement that ESA use is not indicated for patients receiving potentially curative treatments?

Vote: YES--11 NO--2
The current indication should be modified to say that it should not be used in the adjuvant setting.



c. Vote: Although increased tumor promotion and/or decreased survival have been demonstrated in several tumor types, adverse findings have been duplicated in two malignancies-breast cancer and head and neck cancer Should the current indication be modified to include a statement that ESA use is not indicated for patients with breast and/or head & neck cancers? (If yes, please specify breast and/or head & neck cancer).

Vote: YES--9 NO--5
Modified to say that ESA use not indicated for metastatic breast and head and neck cancers.

While Peter was trying to calm the risk communication waters..here's my suggestion about embedding reporters: Don't.

There was some important research in JAMA about how 60 percent of adolescents don't respond to the first anti-depressants they receive but respond well to the second line of meds and cognitive behavioral therapy. That jives with earlier results of cross-over studies that demonstrate about 60 percent failure rate among depressed adults and their first SSRIs.
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Of course that could explain why, in many studies, you get the zero effect vs placebo. That, and as Fred Goodwin has pointed out, the FDA refuses to allow crossover designs (adaptive trials of a sort) in neuropharm. And of course as genetic testing gets closer in antidepressants, as David Meltzer and others noted at a conference held by the ...that trial, error and miss approach to medication might be history.

But you had to search mightily for that story yesterday in the media or the blogosphere.

Instead, it was a sloppy meta-analysis (meta, as in sort of, analysis as in let the computer do it) of lots of placebo controlled trials of varying quality, design, exclusivity criteria that seemed to suggest what anyone who has taken an antidepressant knows is crap: they don't work. And of course while the media and the blogosphere sneer at the source research funding they are willfully blind to the incredibly poor study design of the meta-analysis in question as well as the limits of meta-analysis in general. Here's one of many hard sci bloggers piling on the silly stew of studies that was passed off as science.

"Way too loose of p-values for false positives in studies, in medicine (and social sciences) compared to natural sciences, is one reason to not read too much into any individual study that claims antidepressants are ineffective, like the Public Library of Science meta-analysis of individual studies did.

P-values of the same looseness as in medicine/social sciences have been used to claim intercessory prayer actually works on sick people (http://www.religioustolerance.org/medical6.htm), for example, or here (http://skepdic.com/refuge/bunk21.html)


"I’m not saying that the results of a meta-analysis are no stronger than the weakest study in its umbrella. I am saying that, with p values as loose as they are in health/medicine (and social sciences), is that no massive amount of individual research studies being included under one meta-analysis will make the meta-analysis’ results anything more than a little bit stronger than the best individual study.

In other words, in medicine, and in social sciences, meta-analysis adds a very modest bump, nothing more. The problem is, most people believe it does much more than that when it doesn’t.

Or, to put it another way, meta-analysis is no better than the material it’s analyzing."
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And here's another question: if they don't work, then why do they have such horrible but rare side effects? Is it really possible that drug companies just pumped drugs that were completely worthless except for the fact that they caused kids to commit suicide?

But that's precisely the mindset of the media and to even more greater extent http://www.pharmalot.com and http://www.fiercepharma.com. Both sites totally ignored the JAMA study and focused on the meta-analysis. The JAMA study was a randomized controlled trial and the meta-analysis...well what can I say except what my high school English teach used to say regarding the difference between Cliff Notes and a novel: that meta-analysis is to real research what masturbation is to sex. Does anyone do any analysis of related analysis anymore or are journalist and bloggers just posting the facts that fit their pre-conceived notions. Does it tell you anything that the meta-analyses are easy to churn out and rush into print just before, say, the next FDA meeting of import?

Such perspectives only encourage people not to take medicines or encourage them to stop taking them because they "don't work." It's irresponsible.

Oh yeah... Here's the study that made antidepressants worthless....
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Here's Bart Stupak, head of the Health subcommittee on Energy Commerce, who is running the series of show trials on the FDA and the pharmaceutical industry (only anti-industry and FDA malcontents need testify) on the "link" between SSRIs and suicide:

"SSRI’s have not been proven effective in treating adolescent
depression. To the contrary their use may actually increase the suicide rate of its young
patients. In response to these reports of increased suicide rates with SSRI use, FDA
officials suppressed their own post marketing surveillance, prohibited FDA employees
from discussing the report, and launched an investigation to find the person who leaked information to the press. Today, SSRI remain on the market without a clear medical benefit to the patient."

Setting aside the recent tragedy in Northern Illinois where the gunmen went off his meds, went on a shooting spree and killed himself. ...Stupak's statement is not only scientifically incorrect, it is downright misleading and dangerous. There should be a black box warning around everything Stupak says regarding medicines, particularly SSRIs which have been shown to benefit patients and are associated with a decline in suicides. And again, there is no link to SSRIs and in increase in suicides, rather some unclear evidence based on an unvalidated measure called suicidality that includes just talking about self harm in general.

Stupak held several fear-drenched hearing about antidepressants in 2003-2004. He is partially responsible for the decline in SSRI prescription use and the corresponding increase in adolescent suicide. So the question is:

And this guy is head of the Health subcommittee? Why is he being taken seriously? Why isn't he being held accountable?

Here's Bart Stupak on the "link" between SSRI's and suicide

I find the hypocrisy on the Victoria Hampshire case amusing, predictable and disgusting. But it's just symptomatic of a larger trend fueled largely by hypocrisy.

Let's grant that Dr. Hampshire did find a serious problem with Pro-Heart and that Wyeth responded not by addressing the facts of the matter instead challenged Dr. Hampshire because she received $160 for prescribing a competitor's products through a website that gave her a cut of the drug sales.

Once the supposed "conflict" was identified, all the alarms went off at the FDA. Senator Grassley and the media depicted this as some sort of intimidation of a whistleblower.

How is Wyeth's behavior and the hell that Dr. Hampshire went through any different than when the roles reversed on any well meaning physician or researcher who follows the data but then is undercut by the COI canard? Is it only a COI when a drug company is involved?

How about this...recently the Josiah Macy Foundation released a report demanding that industry funded CME must end and that any academic who receives industry funding should be barred from participating in CME events because of this COI stuff.

Turns out that the report, was prepared as thecarlatblog.com notes by the brightest minds in medicine "The report was the product of a conference attended by many of the brightest minds in medicine", including Catherine DeAngelis, editor-in-chief of JAMA, David Blumenthal of Mass General and head of the Soros funded Institute on Medicine as a Profession which is leading the purge of academics who deign to work with industry; Harvey Fineberg, president of the Institute of Medicine, and David Leach, recent executive director of the Accreditation Council for Graduate Medical Education. Dan Duffy a senior adviser to the ABIM Foundation is a spin-off of the American Board of Internal Medicine, which profits from compulsory certification by internists and internal medicine subspecialists. As of 2005, the ABIM Foundation had over $60 million in its reserves, and its leadership has declared “professionalism,” as it defines it, as its mission.It was chaired by Suzanne Fletcher, emeritus primary care professor at Harvard Medical School

The conference was held in lovely Bermuda not in downtown Baltimore.



Next month, the IOM is holding a meeting on the issue of COI in CME as part of a study funded in part by...the Josiah Macy Foundation and the ABIM Foundation.

Last year the IOM held a meeting, also paid for, in part, by Macy and ABIM. Here were some of the participants:

Suzanne Fletcher
Dan Duffy
David Korn, VP for Research, AAMC and colleague of David A. Davis
Eric Campbell, Phd who works under David Blumenthal at the Massachusetts General Hospital -- and is also associated with the Soros funded IMAP -- where he regularly compiles based on surveys what physicians have what financial connections with industry. These surveys are also paid for by IMAP. High profile medical journals publish the data. The New England Journal of Medicine appropriately prevents him from interpreting the results, but in response to press inquiries he clearly imparts that these relationships are dangerous and was quoted comparing company gifts to physicians to baseball umpires being wined and dined by team management. The JAMA let him conclude that

“financial relationships are prevalent and therefore must be disclosed and managed.”

Who is on the IOM Conflict of Interest Committee?

Eric Campbell for one.

Here is the sampling of the orientation of others on this supposedly objective panel:

Bernard Lo, MD, Chair. He is an ethicist from UCSF who participated in the 1990s Clinton health plan. He has not published extensively on FCOI, although he published a survey of FCOI policies in The New England Journal of Medicine in 2000 (“Conflict of interest policies for investigators in clinical trials” volume 343, pp 1617-1620). In that publication he states:

“We suggest that university-based investigators and research staff be prohibited from holding stock, stock options, or decision-making positions in a company that may reasonably appear to be affected by the results of their clinical research.”

Robert P Kelch, MD, Executive VP, University of Michigan Health System whose last publication listed on Pub Med is entitled: “Maintaining the public trust in clinical research,” a summary in the New England Journal of Medicine in 2002 of the AAMC COI guidelines. Its conclusion states:

“One cannot work simultaneously as an inventor-entrepreneur and a physician or other health care provider and maintain the trust of patients and the public.”

And my favorite:

George Lowenstein, PhD, Professor of psychology at Carnegie Mellon University and in the vanguard of the “social science research” that concludes physicians, contrary to their beliefs, do not know when they are being manipulated by sales techniques. At the AAMC symposium on “The scientific basis of influence and reciprocity” Loewenstein “stressed the following conclusions (pp. 23-24):”

“Conflicts of interest will inevitably bias physician behavior, however honorable and well-intentioned specific physicians may be. Bias may distort their choices, or they may look for and unconsciously emphasize data that support their personal interests.

The only viable remedy is to eliminate COIs whenever possible – e.g. eliminate gifts from pharmaceutical companies to physicians. This should include gifts of any size, because even small gifts can result in unconscious bias."

So perhaps Dr. Hampshire was likewise suffering from unconscious bias or false consciousness. Or more generally, does that transcendent property only adhere to cash from drug firms and not trips to Bermuda from the same Foundation that is underwriting both the study designed to influence the IOM study and the IOM study itself?

As I have written before, the issue of COI is largely a red herring. COI is all about the Left's discomfort with perceived corporate influence in medicine. The giveaway of course is this absurd idea that doctors don't know when a pen will corrupt them psychobabble that is the scaffolding of this purge.

The compiling of gift and speaking registries, the movement to centralize all commercial support of research and education, conduiting it through central AHC administrations instead of to individual faculty members, ban all corporate samples and gifts to physicians and prohibit company sales representatives from visiting AHC faculty are all assaults on the free exchange of information and a threat to very canons of science. This assault on the free speech of academics -- which as I will show is nothing more than a thinly veiled and funded effort by trial attorneys to make it easier to sue doctors and overturn the FDA pre-emption doctrine with respect to what is on a drug label -- will not stand.

The Academic Senate of the University of California System, recently rejected such proposals (“Proposed Guidelines Regarding Vendor Relations”), declaring them “vague, overbroad, addressing perceived rather than real concerns and in violation of academic freedom” (reported in Nature 448: 394, 2007). So to did the University of Medicine and Dentistry of NJ.

This is just the beginning of a fight to take back medicine from the ideologues and tort lawyers.

Ambrose Bierce defined hypocrisy as "prejudice with a halo." Exactly. Time to knock that halo off.

Attacking the "conflicts" and "coverups" of companies and affiliated researchers in an attempt to discredit the commercialization of medical research comes at a price: undermining confidence in the science and the use of products themselves. As with all Ad Hominem attacks, particularly circumstancial, the fact that a researcher may stand to benefit from the acceptance of their research does not affect the validity of the research itself, since scientifically established evidence can stand or fall on its own merits. The failure to challenge such research in this fashion is of course, intellectually dishonest and manipulative. The consequence and object of such manipulation is to "frame" the choice or perspective of research as a risk to be avoid and as not relying on the research and its results as a place of certainty..

Which lead us to the spike in whooping cough cases triggered by the decline in the number of kids being immunized:

"Before the development of a vaccine, whooping cough was a major public health threat, particularly from the 1920s to the '40s, when it infected as many as 265,000 Americans a year and killed as many as 9,000 a year, said Dr. Mary Healy, director of the Texas Children's cocoon-strategy program.

Since the vaccine, she said, its annual incidence dropped to around 30,000 in the 1950s and as low as about 1,000 in 1976. It began creeping up in the 1980s and 1990s."

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Parents are convinced vaccines are unsafe not because of any evidence they are dangerous but because critics claim that the people pushing vaccines like Paul Offit are "conflicted" and therefore should not be trusted. ....Ditto the decline in SSRI and rising suicide rates because of "conflicts" and "coverups". This is now the new standard for determining whether or not research or a scientist is acceptable. Truth is now function of political correctness and adherence to the view that the commercialization of medical research is inherently corrupting. Can someone say Lysenko?

Pseudoscience leads to pseudocertainty which leads to a decline in the public health.
Those who claim that it "seems that negative studies are suppressed" are substituting emotion and bias for the scientific method. So too are those who change the subject from the outcomes to the studies to the character of those who sponsored them. Or as Saul Bellow once said: "A great deal of intelligence can be invested in ignorance when the need for illusion is deep."

The New York Times "breaks" the story that the American Heart Association receives support from Schering and Merck. The implication is that the AHA came out with a statement as a result of that connection. Let's assume for argument's sake that this is correct. And let's forgive the AHA for putting Donny Osmond on their website.

Here is the gist of the AHA statement:

Because Vytorin does not appear to be unsafe, lipid-lowering therapy with simvastatin is of proven benefit, and some patients have been prescribed Vytorin because a statin alone may not have been sufficiently effective in lowering their LDL or was not appropriate for them because of other medical conditions, we do not believe patients should stop taking the drug on their own,” said Dr. Jones. “However, patients on this combination drug should check with their doctor to see if they should stay on the drug, be switched to a statin alone, or take another combination of drugs for their cholesterol.”

Does anyone have a problem with that statement. If I were a Schering or Merck handler I would not think I got my money worth.

Or maybe the critics are not thinking conspiratorially enough. AHA also gets money from Novartis, GSK, Pfizer and other companies. Maybe they used their financial clout to water down what was going to be a hearty endorsement of the drug. Or maybe the money went to the millions AHA gives out in research grants to academic medical centers for CME and other reasons. Which is it? We don't know. And of course the rest of the pontificators have rushed to judgment based on the NY Times without regard to the essence of the AHA ENHANCE statement.

The next point of course is that if the AHA is simply a paid for mouthpiece for Big Phama, it goals, views, tactics, etc by virtue of receipt of financial support, then that cause and effect relationship must apply equally to organizations and individuals who receive support from organizations. So therefore, physicians, researchers, etc who receive money from foundations such as Commonwealth, the Open Society Institute, Pew, Josiah Macy, etc to share its biases and ideology. Similarly, people from HMOs, insurance companies, CMS, Medicaid who share a cost cutting view will reflect that bias and particular view of technology.

Finally, there is the so what question? As Ezekiel Emanuel as stated regarding for-profit IRBs: "What we should really focus on then is not the ideology of profit status but these substantive outcome data."

No one has proven that the purist approach will produce better health, better drugs, safer medicines. The movement against so-called conflict of interest is all based on a revulsion towards the profit motive in health. It is more like the Taliban trying to purify the planet than a systematic effort to make medicine more patient centered based on an mechanistic undestanding of how to predict and prevent illness. The purists skip right past personalized medicine because it is not part of the grand scheme to rid medicine of the corruption.

Quite the opposite, the evidence that expelling "commercial interests" from CME (I guess that would mean Danny Carlat and Howard Brody since they make money off books and lectures), academic detailing, state formularies based on so-called evidence based medicine, conflict free FDA advisory committees, the application of the precautionary principle to the development and use of medicine (don't use any new medicine for 7 years according to Public Citizen), turn over all drug development to government and shorten patents and of course a single payer system would improve health.

Academic detailing according to CATIE and ALLHAT? One size fits all medicine? Paying doctors to prescribe generic when will have genetic tests and algorithms that indicate otherwise? The attempt to discredit researchers who have worked or have received funding from pharma is an intellectually dishonest and weak way to simply not engage in discussion or consider important, mechanistically valid research. It is the new Lysenkoism.

You wouldn't know from all the rapid pharma hating that mortality and morbidity has been declining worldwide in direct proportion to the rate of introduction of new drugs, devices and surgical techniques. Medical technology has done more to advance and enhance humanity than anything else we could have come up with. Check that, the commercialization of medical technology.

Rather, the piling on is just an expression of a hatred of capitalism. To paraphrase Aaron Wildavsky, my critics see medical technology as part of the apparatus by which corporate capitalism maintains inequalities that harm society and the public health.

The piling on is a product of a particular view of how the world works. These are angry, fearful people who have a utopian plan to take medicine back to a pristine time that never existed. The disturbance is, in fact, in their psyche and souls. Their success in enacting their plan comes at the expense of the reputation of good scientists everywhere, trust in science generally and medical progress. To make themselves right, they would destroy others and rule over the rest.

Let me respond to the latest tut-tut from Roy Poses who insist he isn’t calling physicians who work for drug companies or consult for them prostitutes but just wants transparency about their funding sources. I see a backtracking big time, much hypocrisy and huge bias. There is no doubt Poses is part of the “I hate Pharma” crowd along with many in the blogosphere. And he presumes that the only source of bias that affects the public health adversely – mostly without empirical evidence – is financial inducements from drug companies. He even uses the pejorative term “collaboration” as in drug companies are “now are the largest collective source of medical research money, they are thus under great pressure to collaborate with these companies. An academic trying to raise research money from one such company might find it hard to resist offers of consulting fees, speaker’s honoraria, advisory board positions, etc from that company. But once the academic thus starts to work part time for the company, who knows where his or her interests lie?”

So for Poses the mere receipt for pharmaceutical research dollars is like alchemy, transforming the pure, virginal scientist into someone who – along with his or her results – can be twisted into something that reflects the desire for profits, not the public health. By his standards Gertrude Elion, Louis Pasteur, Josh Lederberg, Joseph Goldstein, Phil Sharp, Nobel Laureates all, are untrustworthy tools while Poses is the trusted one because they take or took drug money or worked for drug companies while he Poses just got one Merck grant back in 1997-1999 (which he never declared on his blog).

He gives two examples

“For the final words, let me quote Dr Stefan Kertesz, who was commenting on the pervasiveness of conflicts of interest affecting the 2004 National Cholesterol Education Panel guidelines that suggested drastic lowering of cholesterol for patients with heart disease and diabetes. (Hat tip for this to DB's Medical Rants.) These controversial guidelines may be one reason physicians feel compelled to use drugs to lower cholesterol which have, like ezetimibe, no proven independent benefits for their patients.”

Controversial? Most of the people who Poses and Kertesz slime by association did the original work to establish the value of statins in the 1980’s. Does Poses not prescribe statins to people with high LDL and low HDL. And for him to say he won’t prescribe Vytorin because it has not proven independent benefit is shocking. It is both wrong and demonstrates he practices political science, a science driven by his guilt by association mentality.

Poses has also remained silent about the rash of websites that have popped up urging people to sue Merck and Schering for false claims, to stop taking Vytorin and switch to “natural” cholesterol lowering products that they sell, etc. No conflict there? Is it ok for physicians to promote and consult for companies pushing this approach?

Let us go further. So obsessed is he with the fear of pharma infiltration of medicine and science that he casts a blind or biased eye towards other sources of conflict. Indeed, he ignores his own position stated in another post: “I think Anaissie et al have demonstrated the glaring need for tough regulations requiring disclosure of all financial (and probably political) conflicts of interest affecting anyone who can make decisions, for individuals or organizations, in health care. Basically similar regulations should apply not only to government agencies and academic medical institutions, but also all other health care organizations, not-for-profit and for-profit included.”

Indeed, by focusing exclusively on financial conflicts and indeed only one subset of such monetary influences – ignoring funding from foundations, government business grants such as SBIR funds, money from consulting for trial attorneys or tort settlements, -- Poses and others ignore other forms of biases that can be as or more dangerous. As John P. A. Ioannidis wrote in Why Most Published Research Findings Are False:

“Conflicts of interest and prejudice may increase bias, u. Conflicts of interest are very common in biomedical research, and typically they are inadequately and sparsely reported. Prejudice may not necessarily have financial roots. Scientists in a given field may be prejudiced purely because of their belief in a scientific theory or commitment to their own findings. Many otherwise seemingly independent, university-based studies may be conducted for no other reason than to give physicians and researchers qualifications for promotion or tenure. Such nonfinancial conflicts may also lead to distorted reported results and interpretations. Prestigious investigators may suppress via the peer review process the appearance and dissemination of findings that refute their findings, thus condemning their field to perpetuate false dogma. Empirical evidence on expert opinion shows that it is extremely unreliable].

But let us focus on other forms of bias.

For instance, the Prescription Project, which according to it’s website seek to ensure that “ industry-physician relationships are free of conflicts of interest and that physicians base their prescribing decisions on accurate and unbiased information is essential to promoting sound and cost effective health care.”

The Prescription Project has advisory committee members that consult for or work for the largest HMOs and the generic lobbying group. It obtains substantial funding from George Soros, as do many other organizations intertwined with The Prescription Project. The PP also “collaborates” with the Community Catalyst Group, another leftist organization that receives support from the Prescription Access Litigation Project. So the Prescription Project benefits indirectly from an organization that receives funding from trial lawyers.

Should Poses be suspicious about the choice of drugs made by The Prescription Project based on their source of funding? Not a peep.

In the end, Poses may be right to be cautious but the caution should be comprehensive or it is simply part of an ideological push or grab for power.

The point is, conflicts are a problem but ideological agendas and professional hubris can be deadly or truly damaging. I have not even touched the human cost of Steve Nissen’s attack on ADHD medicines, Avandia, etc. or the hype surrounding vaccines or SSRIs. I will only quote Marcia Angell who noted:

“Modern history is replete with instances of fervent beliefs or conventional wisdom being proved wrong by scientific research. Only a commitment to evidence can test the hopes, fears and biases that otherwise would have full sway. Science is sometimes messy and slow, but it’s the only method we have to answer questions about the material world and to evaluate the many health scares that recurrently sweep across the country. Like democracy, it’s better than whatever is second best, and we ignore it at our peril.”

Here are two of the qualities Leon Wieseltier in The New Republic like about about John McCain that make him a nearly ideal presidential candidate. "anxiety over the environment and contempt for pharmaceutical companies."

Contempt for pharmaceutical companies? And how does that translate into good public policy? Pushing for drug reimportation? Patent seizures?

I think there is a bit of projection on Leon's part but what prompts this hatred? What did drug company's do wrong that deserves contempt? I know this will tick off the whack jobs that equate anything that is sponsored by drug companies as a pollutant or a criminal activity, but I really would like to know.