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Derek Lowe The 2002 Model

Dbl%20new%20portrait%20B%26W.png After 10 years of blogging. . .

Derek Lowe, an Arkansan by birth, got his BA from Hendrix College and his PhD in organic chemistry from Duke before spending time in Germany on a Humboldt Fellowship on his post-doc. He's worked for several major pharmaceutical companies since 1989 on drug discovery projects against schizophrenia, Alzheimer's, diabetes, osteoporosis and other diseases. To contact Derek email him directly: Twitter: Dereklowe

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December 11, 2006

Torcetrapib: The Foil-Lined Hat Perspective

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Posted by Derek

Since I've been getting some more less-than-friendly email from Kevin Trudeau fans recently, I thought I'd take a minute to point out something that may not have been generally appreciated. What does the complete failure of a drug like Pfizer's torcetrapib say about the evil-pharma conspiracy theories that Trudeau and his type like to spin?

I mean, think it through: Pfizer spends hundreds of millions of dollars, only to find that their drug has unexpected toxicity. Not the horrible, chemical-weapon toxicity that the conspiracy mongers talk about, mind you: 11 deaths per thousand versus 6 deaths per thousand. But development stops immediately, as it should, the very day that Pfizer's executives get the news. Two days after trumpeting the compound as the biggest thing in their pipeline, they pull it and walk away from the billions of dollars that could have been.

How, exactly, does this fit the Evil Conspiracy worldview? Isn't this, according to Trudeau, exactly the same as all the other drugs already on the market? Why would a company walk away from all that cash just because of a measly little figure like 5 excess patient deaths per thousand? If you believe Kevin Trudeau, everyone who takes anything is being poisoned already.

I know I'm going to regret making this offer, but here goes: I'd be interested in hearing a Trudeau-ite explain this one to me. If you buy into his story, why any drug ever fails in the clinic must be a real head-scratcher, since you'd think that the Evil Pharma Overlords would be able to hocus the data enough to make any sort of toxic junk look good. And this one must seem especially weird.

So tell me, you folks who are convinced that I and all my colleagues in the drug industry are poisoning the world: why did torcetrapib fail? Ground rules: you have to know what torcetrapib is, and you have to have some basic understanding of what it was (in theory) supposed to do. ("Improve cholesterol to try to prevent heart attacks" is enough of an answer for that one - there's a free one for you). And you have to be able to spell Pfizer, and to have read at least one news story about the drug's demise. Have at it in the comments section.

Comments (55) + TrackBacks (0) | Category: Cardiovascular Disease | Clinical Trials | Snake Oil


1. Torcetrapib on December 11, 2006 6:35 PM writes...

Well, I believe that the drug companies don't deliberately do 'evil' or 'good'. Their goal is to please stockholders. Period. If that entails doing 'evil', then they would usually not hesitate to go ahead and do it. It should be remembered that keeping a drug on the market or removing it is nothing more than a business decision, and not particularly a moral one. Let's say they know that the drug kills 5 instead of 4 people. Even after having this knowledge, they would withdraw the drug from the market if and only if the loss incurred in doing it is actually less than the loss they would incur if they were to go ahead and market it anyway. If their calculations indicate that the profit from the drug would more than compensate for the loss they would face if they had to withdraw the drug from the market after some stipulated time, then marketing the drug anyway is nothing more than a business decision for them. The profit might be projected to even compensate for the dozens of lawsuits that they might potentially lose.
It's like companies choosing to pollute the environment because of the realization that the money they would have to pay in fines would still be less than the money it would cost them to comply with environmental laws.
So I think that Pfizer withdrawing the drug should not be viewed as a particualrly benevolent act (that doesn't mean at all that I agree with Kein Trudeau), but only a business decision, neither 'good' nor 'evil'. In case of pharma, reputation also is a big thing, and if that's going to suffer, then it could be enough of a weight to turn the scales to one side or the other. The factoring is obsviously complex.
The bottom line is, in general, I don't think any corporation is 'evil' or 'good'. It simply aims to maximize profits and please stockholders. Any evil or good is defined by outsiders, and is collateral.

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2. Derek Lowe on December 11, 2006 9:12 PM writes...

You're absolutely right about the business part. The thing is, you want a system set up so that the moral hazards aren't easy to come across - that is, where the temptation to market a deadly but profitable drug just isn't an issue.

But the Trudeau types don't buy that - their view is that "deadly but profitable" describes just about everything on the market.

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3. eugene on December 11, 2006 9:16 PM writes...

The drug failed in phase 3 because it didn't do what Pfizer wanted. Is that simple enough? But it's not what "you" think it wanted... What Pfizer wanted was for the drug to be addictive, so that when you go off it, you start feeling worse (unless you take a natural cure to compensate). I mean, why do you think you need so many trials for drugs that Pharma makes?

To prove that they are safe for humans!? Don't be ridiculous. Then drug trials would take a year tops.

All that it did was cause a few extra deaths, which is fine, but you don't want it to cause more deaths than natural, or else the victims would notice. It's not enough to give the sheeple pills anymore, Pharma realized that they need to put stuff in there upon which the organism becomes dependant. But it's got to be subtle, because there are too many courageous people exposing their lies.

Read Kevin's book. Most cures in his book have been proven to work and have gone through real 'clinical trials'. I just don't know how the people in charge of 'clinical trials' for Pharma can sleep at night...

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4. trrll on December 11, 2006 9:16 PM writes...

There are lots of way to maximize profits and please stockholders. I don't doubt that Kevin Trudeau is maximizing profits, and if he has any stockholders, they are probably pleased. So what makes one company maximize profits by selling snake oil or cigarettes and another company maximize profits by producing drugs to relieve suffering? Perhaps some companies and stockholders actually like to feel good about themselves while they are making their money?

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5. eugene on December 11, 2006 9:17 PM writes...

Okay. How did I do? On a scale of one to ten? I always worry that I use too much colour and not enough forceful rhetoric. Oh... darn.

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6. d_orbital on December 11, 2006 9:48 PM writes...

..."but you don't want it to cause more deaths than natural, or else the victims would notice."

Would they really notice if they're dead?

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7. eugene on December 11, 2006 10:14 PM writes...

If all the victims were dead, then the drug wouldn't make any money. Pharma likes to poison you slowly. The drugs turn you into a junkie who goes out to their job like a zombie, brings back some cash and swallows their pills to get their high at night, while sending the dealers the cash. Careful though, you don't want to overdose!

You're better off smoking the real stuff this way. Pot probably will cure you instead of killing you like Vioxx or Torcetrapib.

And you d_orbital. What are you, but a potential victim?

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8. d_orbital on December 11, 2006 10:21 PM writes...

Oops, I meant would the victims (read: dead) notice if they were dead ;)

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9. SA Researcher on December 11, 2006 10:42 PM writes...

(Note: I'm not actually a Trudeau-ite, I'm just trying to think like one. It burns us, precious!)

Nobody, not even Trudeau, is ready to argue that drug companies are stupid. The trick, which they have thus far managed admirably, is to come up with drugs that sicken patients gradually, drawing them into a deepening spiral of dependence on pharmaceuticals, rather than killing them outright. As the first commenter pointed out, the principal business of a drug company is to make money. To do this, they need people to buy their drugs, and keep buying their drugs until they die. The drug companies know that nobody will buy a drug that is obviously killing people; just look at the Vioxx fiasco and you'll see why safety trials are so crucial to the drug companies.

See, on the face of it, the trials are exactly what they appear to be. The pharma conspiracy has to convince people that their poisons are safe, and in this age of increasing consumer awareness of the risks inherent in drug use, nothing less than a full-blown multi-million-dollar trial will do. But from the drug makers' perspective, the trials are something else entirely. They have to make sure their customers aren't dying off too quickly to present a stable future source of income. Dead patients don't buy drugs, but patients suffering from ill-defined problems with uncertain sources buy them by the truckload. Thus, the most successful drugs for the poison-pushers are exactly the ones that perform exactly as they're "supposed to" in trials. Ever notice how many "little" side effects all those trials show? Headache, nausea, diarrhea, fatigue... that stuff is gold for the drug companies. Sure, they sound like no big deal, but add all those things up and you've got one sick patient who will buy anything to feel better. They've got us hooked through the nose, in no small part because they use these big showy withdrawals as yet another means of convincing us that they're only working for our health, even as they slowly sap and impurify our precious bodily fluids.


Okay, I got all Dr. Strangelove there at the end, but still. E for effort?

Also, have you seen this? No real info, but at least the fools are saying *something*

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10. milkshake on December 11, 2006 11:13 PM writes...

Here are the other ground rules (not in tinfoil but in Saran wrap):

1. All pharma companies are evil; Pfitzer is the ringleader. When Pharma is not momentarily evil it has some nasty agenda.
2. Don't listen their sinister propaganda - the fact is that cheap and life-saving medicines are kept hidden from patients.
3. It is well-proven that doctors are in confederacy with pharma. Doctors don't like you to get better - they are slowly poisoning you instead.
4. If you publish these secrets they will prosecute you. They will try to assasinate you. They will lock you away and then will experiment on you

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11. eugene on December 11, 2006 11:15 PM writes...

That was good SA Researcher. A good example of plagiarism!

Except for the Dr. Strangelove bit.

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12. Scientifically challenged on December 11, 2006 11:18 PM writes...

You people are scientifically challenged. Speaks volumes about the US school system.

Trudeau is a snake oil salesman.

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13. milkshake on December 11, 2006 11:50 PM writes...

I just would like to point out and to warn everybody that people paid by pharma industry are probably following this discussion thread quite carefully and they can find out n few clicks who you are and where you live. You should not underestimate this - we may live in nominally 'free'country but you never know where your name, address, social security will end up, on what kind of watchlists. Because they have the means.

The will they have always.

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14. jim on December 12, 2006 12:24 AM writes...

#12 Dry wit or are you sarcasm-challenged? If the latter than your statement about the educational system is ... ironic.

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15. Jose on December 12, 2006 1:26 AM writes...

Apparently, 75% of adult Americans cannot put cell, molecule and atom in size order. How can you really expect to have any kind of scientific discourse with total scientific iliteracy like that?

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16. Milo on December 12, 2006 6:57 AM writes...

Jose, you are not helping the situation by actually putting them in order for us :-)

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17. daen on December 12, 2006 9:16 AM writes...

> > 75% of adult Americans cannot put cell, molecule and atom in size order

> Jose, you are not helping the situation by actually putting them in order for us :-)

Smallest first, right? ;-)

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18. bloodletting on December 12, 2006 11:00 AM writes...

Some of these comments show a complete ignorance of scientific theory. Why don't we get the ten commandments back in school, get rid of that evil sectarian evolution hocus pocus, and start teaching our kids how prayer will save them from all ailments! Oh yeah, that's how they did it during the F'n DARK Ages and when the TALIBAN was in charge. Educate yourselves people. Think for yourselves!

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19. GoBlue on December 12, 2006 11:43 AM writes...

Please explain how a "real" clinical trial would only take "a year, tops."

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20. Derek Lowe on December 12, 2006 12:30 PM writes...

I can see that I should have heeded the advice about not summoning up anything that you don't know how to send back down. . .

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21. milkshake on December 12, 2006 1:44 PM writes...

Herr, die Not ist groƟ!
Die ich rief, die Geister,
Werd ich nun nicht los.

Derek, I think you should read the book "Big Pharma - Big Lies. The Things Your Doctor Does Not Want You To Know"

In this book you would find how to re-invigorate your body, re-juvenate your cells, jumpstart your metabolism, clense your liver and digestive system, how to rid your body of toxins that cause cancer, asthma and diabetes. How to live long and healthy life by using only natural ingredients, minerals and vitamins. This research is based on the most advanced european hollistic sciences and it is proven to cure 94% of modern "diseases".

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22. Palo on December 12, 2006 2:57 PM writes...

I want to point out, to make things clear, that I think Derek is only attacking Kevin Trudeau and followers and he is not trying to lump together all criticism of Pharma-run clinical trials.

I know Derek knows there's is a decent, rational and well-intended criticism of some pharma practices, and yes, very often they include some corrupted (ethically corrupted or just plain data-corrupted) clinical trials.

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23. Harry on December 12, 2006 3:01 PM writes...

LOL, Derek, et al- you know it's hard to tell the satirical comments from the "true believer" ones!

If I wasn't familiar with the names of some of them, I'd believe that they actually supported that charlatan and huckster Trudeau.

Unfortunately, the only way to get rid of the zombified legion of Trudeauvians may be the passage of time. They tend to have short attention spans.

Merry Christmas to you all and best wishes!


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24. Derek Lowe on December 12, 2006 3:23 PM writes...

Palo, that's true - questions about "why did you do trial X this way", or "how come you didn't look for Y", or "why haven't you released that data from trial Z" - all of those I have no problem with.

But you should see some of the e-mail I get from the Trudeau-ites. They start with how they're glad I lost my job, and go on from there.

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25. Lipitor on December 12, 2006 3:29 PM writes...

I can't believe that Trudeau's book has received more than 2000 mostly favourable reviews on Amazon.

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26. kiwi on December 12, 2006 4:07 PM writes...

you could always write a book "evil pharma: the insiders view" and after a week of grabbing money from various foil-lined hat-wearers, retire to the caribbean and buy your own island. it'd be a good source of income for the ethically flexible.

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27. Hap76 on December 12, 2006 4:42 PM writes...

You all simply are deluded by the PR of the pharmaceutical industry. Don't you realize that by pulling torcetrapib from the market, Pfizer is trying to show the public that they are honest and well-intentioned, so the next time they release a drug a