Name: How Overdiagnosis Turns Healthy People Into Patients | Alan Cassels
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Description: “We get a lot of inappropriate over-prescribing for almost everything,” says drug policy researcher and journalist Alan Cassels. Cassels is the co-author of “Selling Sickness: How the World’s Biggest Pharmaceutical Companies Are Turning Us All Into Patients.” For Cassels, it was one disease in particular—osteoporosis—that changed his entire view of medicine.

Jan Jekielek is a senior editor with The Epoch Times, host of the show “American Thought Leaders” and co-host of “FALLOUT” with Dr. Robert Malone and “Kash’s Corner” with Kash Patel. Jan’s career has spanned academia, international human rights work, and now for almost two decades, media. He has interviewed nearly a thousand thought leaders on camera, and specializes in long-form discussions challenging the grand narratives of our time. He’s also an award-winning documentary filmmaker, producing “The Unseen Crisis: Vaccine Stories You Were Never Told,” “DeSantis: Florida vs. Lockdowns,” and “Finding Manny.”

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[RUSH TRANSCRIPT BELOW] “We get a lot of inappropriate over-prescribing for almost everything,” says drug policy researcher and journalist Alan Cassels.

Cassels is the co-author of “Selling Sickness: How the World’s Biggest Pharmaceutical Companies Are Turning Us All Into Patients.”

For Cassels, it was one disease in particular—osteoporosis—that changed his entire view of medicine.

Based on changing definitions of the disease, large swaths of Americans could suddenly be declared sick and in urgent need of drug treatment.

They “medicalized normal aging of basically the entire female population. Overnight,” he says.

In our interview, we discuss the influence of the pharmaceutical industry on overdiagnoses and prescriptions, and how the criteria for many diseases can be expanded arbitrarily.

“When you look closely at the quality of prescribing, a lot of times, the decision-making is not really driven by evidence. It’s driven mostly by … marketing, biases, influence from thought leaders, and influence from guidelines, medical guidelines themselves, which are often appallingly biased,” he says.

Many doctors, Cassels says, know little about the adverse effects of the many drugs they prescribe to their patients.

We also dive into the connection between psychiatric drug prescriptions and violence, how psychiatry labels normal behaviors as abnormal, and how exaggerated statistics are used to sell theories of disease and drug treatments.

Views expressed in this video are opinions of the host and the guest, and do not necessarily reflect the views of NTD.

RUSH TRANSCRIPT
Jan Jekielek:

Alan Cassels, such a pleasure to have you on American Thought Leaders.

It’s great to be here.

So what’s the answer to the question: Are we looking in the right place for answers to violent attacks?

So when you think about violent attacks, you think of people who have psychiatric problems, for example, and oftentimes when they investigate it, they look at the kind of psychiatric care a person might be under. What they’re not questioning, though, is the quality of the prescribing that goes into a lot of psychiatric care. And in fact, we know that one of the main adverse effects related to psychiatric drugs—I’m speaking broadly here, but specifically say antipsychotics or antidepressants—is violent behavior, suicide, homicide. These are all known dangers of these drugs. Oftentimes, when these violent attacks happen, such as we had in Canada where a person drove a vehicle into a group of people having a street festival, when they examine this, nobody is sitting down and asking what kind of drugs the person was taking and what kind of prescription they were experiencing.

And I think that’s probably the first place you should look, and oftentimes it gets overlooked altogether because people will assume that whatever psychiatric care they’re under must be sort of guideline care and approved, but really we have to step back and say, look, we’re probably causing a lot of the psychiatric outbursts by the kinds of prescribing that we do.

Now, is this because of rare effects that maybe even some of the doctors might not be aware of, or is that the reason?

Well, doctors’ lack of cognition around adverse effects related to drugs is well known. I mean, this has been well studied. Physicians don’t learn about the adverse effects of drugs largely because they’re not exposed to that through a lot of the marketing that they get. And of course, a lot of the information that physicians get around drugs comes from the hands of the pharmaceutical companies.

And they’re not exactly promoting the adverse effects of their drugs. Is there some way to quantify how big a problem this is? Like how often the drugs might have been responsible or partially responsible in situations where that hasn’t been looked at?

That’s a good question. I don’t think it’s been adequately studied, but I think if you talk to the experts that are, you know, well-versed in sort of the adverse effects of psychiatric drugs, they would say most of the time you can draw conclusions by looking at the drugs that the person is being prescribed.

So maybe dig into that a little because what you’re describing is not something that’s obvious.

Yes, it’s not obvious, but I mean, let’s put it this way: we assume, as consumers and as patients, that when we’re presented to a physician with a particular disease, the decision-making around your condition and how to treat it—in terms of some kind of therapy or drug that you might get—is evidence-based. It’s based on a physician’s careful assessment of the science and an assessment of your disease. Though when you look closely at the quality of prescribing, a lot of times that decision-making is not really driven by evidence; it’s driven mostly by, sometimes, marketing, biases, influence from thought leaders, and influence from medical guidelines themselves, which are often appallingly biased.

I’ll give you an example: someone who presents with high blood sugar, you know, might be a precursor to prediabetes or diabetes. A physician will assume that, because of the guidelines, this is the level at which you should start taking some kind of treatment to alter your blood sugars, without knowing that the people who wrote the guidelines are heavily funded by pharmaceutical companies.

In fact, the Canadian guidelines’ conflicts of interest of the authors fill up 15 or 20 pages. So what’s clear to us who independently look at this kind of thing is that the pharmaceutical companies are very good at putting their own people on guideline committees. And that’s why we end up in a situation where we get a lot of inappropriate and overprescribing for almost everything.

Now, with that particular scenario, I recall some instance—and maybe it was a different drug—but where the level of blood sugar was moved to something lower, right?

You would not believe how often they move the goalposts. To give you an example, probably the best example of blood sugar is blood pressure. Okay, so 20 years ago, if you came in and your doctor said your blood pressure is 150/90, they would say it’s a little on the high side, no problem; you know, maybe you should exercise some more and reduce the salt in your diet. Today, now, over time, that 150/90 has been lowered to 140, to 130, and now it’s around 120.

When you lower the level at which you start treating someone or telling someone that they’re ill or potentially ill from high blood pressure, you expand the massive pool of people that become patients. And this is one of the key things behind disease mongering: when you change the definitions of what the disease is, you expand the pool. They never change the definitions that reduce the size of the pool because, again, the pharmaceutical companies are very, very involved in the writing of the guidelines, but we document that in selling sickness how, by just lowering, say, the level at which we would consider high cholesterol to be a condition, overnight they would expand the number of Americans who would be treated for cholesterol-lowering drugs by 25 million people, just by changing the definition.

So, I mean, you’re describing, I think, a very powerful incentive structure to do precisely that.

Exactly. The incentives are all in the direction of the pharmaceutical companies and for those who are funded by the pharmaceutical companies, including the patient groups and specialty societies and so on, absolutely. But what’s missing from this situation is that you don’t have enough people, perhaps like me, who are critiquing this and saying, just hang on a second, you just moved the goalpost. You’re not actually expanding the number of people who are going to be considered well; you’re expanding the group of people who are considered sick.

So you’re actually creating illness. You’re creating a sense of ill-ease amongst the population when you start telling people your blood pressure needs to be at this level; otherwise, you’re unhealthy. And this idea that telling people that they’re not healthy when they otherwise are is really the essence of disease mongering. This is something that I’ve written quite a bit about.

This is your term, I think. You coined the term disease mongering.

I wrote the book, yes. So I wrote a funny little book called The ABCs of Disease Mongering because I wanted to describe in 26 letters how we see this kind of creation and marketing of illness from cradle to grave, from babies to people who are at the end of their lives, where normal human changes in physiology and your life as you age become another reason for which another drug might be prescribed. So, you’re right. There’s definitely a campaign, shall we say, to get more and more of us to become ill.

So one thing comes to mind. In the U.S., there’s been a lot of discussion about autism rates growing in a way that’s frankly shocking when you look at these graphs. Now, what’s very curious about this is that I think it’s actually kind of the industry that’s saying this is a function of precisely what we’ve just been describing of the goalposts being moved. So now we’re just overdiagnosing autism a lot more.

Absolutely. It used to be, for example.

But this is a curious situation because I think it’s the industry that’s saying that, whereas it’s the people who are like yourself, like activists, who are saying the opposite, no, that this is actually a real shift.

On this point around autism, same with attention deficit disorder, I would agree with that, where they have changed the goalposts on what used to be considered autistic behavior, or say on the spectrum, 15 or 20 years ago. There might be, say, 15 to 20 different symptoms. And of this checklist of symptoms, if the child exhibits 10 of them, for example, they might be considered to have autism.

Well, they’ve changed that over time, so now they only have to exhibit 6 of them or 4 of them. And so when you, again, when you do that, you’re expanding the pool of people who begin to take this label and perhaps to be accepted for treatment for it. And, as you know, there’s a whole industry around autism.

At the same time, you have to ask yourself if there are actual things in medicine or in society that might be causing neurodevelopmental problems in children, and that’s when you start looking at things like drugs or perhaps vaccines, right? Just putting that out there that those things need to be adequately studied in order to be able to determine what is actually causing this apparent rise in autism or ADHD [Attention deficit hyperactivity disorder].

So basically you’re saying that both things can be very much true; that there could be a rise in these neurodevelopmental issues, but at the same time, autism itself could be overdiagnosed because it serves the interest of people who want to provide drugs around that.

Absolutely. You hear anecdotes of parents who want a diagnosis for their child because that’s going to get them special care or extra help in school and so on. You certainly see that in the area of ADHD, where it actually comes as a relief to some parents that, oh my goodness, my son now has ADHD and therefore is eligible for some extra help in school. Explain to me, you kind of describe this almost like assistance.

I guess this disease mongering is a systemic thing. It’s something that’s almost done in every area. Give me some examples where we see that.

Again, it’s a cradle-to-grave phenomenon. I maybe start from closer to the end of people’s lives. And this is something that I became aware of 30 years ago. And when I started becoming aware of this one disease and to see to which the industry had infiltrated itself into the definition of the disease, it changed my whole view of medicine. And that was osteoporosis. And, you know, in the early 90s, a major pharmaceutical company in the U.S. created a new drug to treat this condition, osteoporosis, which at that point wasn’t very well understood.

In fact, there wasn’t really an agreed-upon definition. There was a meeting convened at the World Health Organization [WHO], and at that meeting, there were officials, endocrinologists, and others, as well as representatives from pharmaceutical companies that were making drugs to treat this condition. There, they set the definition at a certain level of bone density.

This is the density of your bones as you age; they set it at a certain level in a way that would have diagnosed something like 50 percent of the female population over 70 with having this condition. They set the definition that way and basically said overnight that this portion of the population that has bone density below this now has this condition called osteoporosis. Or if it’s close to that, they might have something that is pre-osteoporosis or known as osteopenia.

What you ended up doing is medicalizing normal aging of basically the entire female population overnight. That drug became a blockbuster drug, prescribed widely. The company that was marketing it bought bone density testing equipment and distributed it through all the clinics and hospitals throughout the U.S. and basically overnight created a condition that is a normal part of aging and really medicalized one’s bones.

That has gone on to be extremely controversial because that drug, you know, after time, when you get millions of people taking a drug, that’s when you start seeing the major problems—severe problems with swallowing, esophageal burning, over the long term. This is cruel and ironic at the same time. Those drugs are called bisphosphonates. It was found that drugs in that class actually make people’s bones more brittle, and more prone to breaking.

Admittedly, elderly people falling and breaking a hip can be quite a serious problem. Oftentimes that can lead to, you know, disability, nursing homes, and sort of the beginning of the end of a person’s life. Absolutely, you want to do what you can to reduce the sort of problems of broken bones in elderly people. But preventing falls should be the focus, not using a drug that’s going to alter the chemical composition of your bones, which ends up making your bones more brittle. Again, that was, from start to finish, I would say a pharmaceutical industry construct.

And now they’ve moved on to other classes of drugs, but still, I have friends of mine who are my age, in their 50s and 60s; they’re on a bicycle, they fall off, and they break. their wrist or they’re skiing or they’re in an accident, they get sent to their doctor. The first thing they do is send them for a bone density test, and they’ll say, oh, you have pre-osteoporosis. It drives me crazy because they are using the broken bone as a pretext for explaining to a person that they now have this disease and that they possibly could be a candidate for a drug.

I mean, this is, forgive me, I’m going to play advocate to the devil here a little bit, but some people have low bone density and probably need some kind of help, but it’s never the drug that will be helpful for this in your view?

It depends. So what is the problem that we’re trying to solve here? There is a whole range of different bone densities. A lot of people live perfectly well and quite healthily with low bone density. It’s not something that is kind of like developing gray hair and wrinkles. Eventually, your bone density will change over time, and it will become lower than it was when you were in your 30s.

That was the other problem with the bone density measurement: they were comparing women in their 70s to women in their 30s, and then they were pointing at them and saying, well, they have low bone density. Well, they have a lower bone density than they did when they were young, active, and probably in the prime of their life.

So yes, is there a problem with people having low bone density? If people are repeatedly falling and breaking bones, yes, that can be a problem, but I could be wrong; I don’t believe there’s any drug in the world that’s going to prevent someone from breaking a bone if they fall.

So the idea that this drug will somehow prevent breaks when people fall, that is untrue?

It’s totally untrue. I’ll give you an example of how crazy this was. They marketed this drug called Fosamax; the generic name is alendronate. They marketed it as reducing hip fractures by 50 percent, and I know because I’ve used the ads that the company ran in major medical journals. I’ve used these ads in presentations that I’ve done on this very topic, and they show a person, an elderly woman bent over, and it’s like a 50 percent reduction in hip fractures.

My question is, when somebody gives you a number like that, well, how many hip fractures were there in the placebo group? I mean, the women in the group—there were more than 3,000 women in this trial that had low bone density defined them as having osteoporosis. They had had previous fractures, they have low bone density, so they’re at high risk. How many of these high-risk women, in the course of four years, would have a hip fracture? Well, the answer was about two percent—two out of a hundred. How many had a hip fracture if they took the drug? Well, it was 1 out of 100.

So when you go from 2 out of 100 down to 1 out of 100, that’s a 50 percent drop. And so the 50 percent was marketed to patients, to doctors, to specialists. People went away thinking this drug is miraculous. It’s going to reduce our rate of hip fracture by 50 percent. This is kind of what turned me into an activist when I saw the misuse of those numbers and how misleading that would be for my mother or my grandmother, thinking that they’re going to have a massive effect when there’s a one percent difference.

Well, and it’s also probably not statistically significant at all.

It’s not clinically significant. I mean, statistics is a whole other game, but they would have determined that it was perhaps statistically significant that you had fewer hip fractures in the bisphosphonate group, but at the same time, is that meaningful to have a one percent difference? How does that compare to the rate of adverse effects?

And we know that the rate of adverse effects is much greater than one percent, right? So you’re promoting this drug on the basis of a misleading reduction, and this happens all the time. We saw this, we still see this today. You remember the 95 percent during COVID. It’s the same sort of thing.

It’s the difference between relative risk and absolute risk, absolutely. Yeah, it’s just shocking. I mean, this is a very widely prescribed drug or was; I don’t know what the status is, but I know because I discussed it with my mom at one point. These are very commonly used. How many situations like this are there?

In my book about disease, we’re going to have 26 examples. But yes, this kind of using exaggerated statistics to sell theories of disease and drug treatments is ubiquitous. It’s everywhere.

Before we continue, tell me a little bit about what you were doing when you said you became radicalized, you became an activist. How did you get into all this?

I went back to university. I was a naval officer. I went through military college and served in the Navy for 12 years. Then I went back to university and started studying a master’s program in public administration. I got asked at the time if I would be interested. in working on a project studying pharmaceutical policy in British Columbia. And it sounded really interesting, so I signed up for that. Even though I was headed for the Foreign Service, I ended up becoming a drug policy researcher and never went into the Foreign Service.

But one of the first studies that I was asked to work on was developing a guide for consumers around osteoporosis. And that’s when I started to read and understand what a massive amount of misleading information was out there. And then I took that and I said, well, does this happen in other areas?

And then I started looking and started working with people that were experts in hypertension, which is high blood pressure. It’s very similar kinds of things in terms of the manipulation and the use of statistics in order to increase the sort of appeal of drug therapy, the appeal of it. And even discovering the degree to which doctors are misled by the marketing materials that they are exposed to.

And this really kind of shocked me because I thought, like most people, that the decisions made about the drugs that we get every day are mostly science-based and are based on a good understanding of the potential benefits and the potential harms. And I discovered over time that that kind of paradigm doesn’t exist in the real world. The paradigm that does exist is that there are many decisions that go into making prescribing decisions, and the marketing of both the disease and the treatment are a major part of it. There are other things. We can’t discount the idea of patient demand, where people are exposed to information from their neighbors, from advertising.

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