August 2024

Dr. Marcia Angell is a physician trained in internal medicine and pathology. She is the former editor-in-chief of The New England Journal of Medicine, and was named by Time magazine as one of the twenty-five most influential people in America. In addition to writing "Science on Trial" in 1996, she published "The Truth About Drug Companies" in 2004.

This book takes a good look at the pharmaceutical industry from the perspective of someone who not only worked at a prestigious medical journal that published drug studies, but who also prescribed medications and treated patients. Much of the information that is discussed in this book is stuff that you won't find mentioned by the establishment media or in the ubiquitous commercials on TV. Yes this book is twenty years old, but the drug companies operate the same way now that they did back then (if anything, they are less scrupulous now). Chapter 4 poses the question, "Just how innovative is this industry?" The drug companies often complain about the hurdles they must clear in order to receive Food and Drug Administration (FDA) approval for innovative drugs that save lives, but on closer inspection these companies are not as inventive as they would have us believe. According to Dr. Angell, "At least a third of big pharma's drugs are now licensed or otherwise acquired from outside sources - including smaller companies all over the world." That doesn't sound all that innovative. On this topic, she goes on to say that, "Researchers supported by the National Institutes of Health (NIH) usually do the initial work of drug discovery. Then the drug companies keep stringing out and exploiting those discoveries."

Chapter 5 sheds some light on what are called "me-too" drugs. These are drugs that are classified by the FDA as being no better than existing drugs that are already on the market to treat the same conditions. "Me-too" drugs are often introduced just as an existing drug is scheduled to go off patent, and she gives the example of Nexium (a popular heartburn drug) and its predecessor Prilosec. This was in spite of the fact that Nexium was only a marginal improvement over Prilosec in just two of the four clinical trials that were conducted. "Me-too" drugs usually target very common and long-term conditions, such as high blood pressure, depression, and arthritis. There is more money to be made by treating the condition than by curing it with lifestyle modifications. According to the author, "Once upon a time, drug companies promoted drugs to treat diseases. Now it is often the opposite. They promote diseases to fit their drugs. Nearly everyone experiences heartburn from time to time. The remedy used to be a glass of milk or an over-the-counter antacid to relieve the symptoms. But now heartburn is called 'acid reflux disease' or 'gastroesophageal reflux disease disease (GERD)' and marketed, along with the drugs to treat it, as a harbinger of serious esophageal disease - which it usually is not."

Stretching out the length of patents is another tactic that the drug companies use to extend exclusivity and enhance their profits. Patents are usually granted for twenty years, but it can take several years for a drug to go through clinical trials and gain FDA approval. This impacts the profitability of a drug, so the drug companies will go to great lengths to extend their patents. The Hatch-Waxman Act extended drug patents for up to five years if FDA approval was delayed due to clinical testing. Additionally, the Food and Drug Modernization Act of 1997 provided an additional six months of patent protection if companies test their drugs on children. Brand-name companies may also collude with generic companies to keep prices high or delay their entry into the market. And, as I mentioned earlier, drug companies will launch virtually identical drugs with new names just as the patents are set to expire. This was the case with well known drugs such as Prilosec, Claritin, and Prozac. The fact that our federal government has created these giant loopholes for drug companies to exploit should illustrate to you that meaningful positive change to the system isn't likely to come anytime soon.

While I was disappointed that there is not more of an emphasis in this book about the importance of lifestyle modification as an alternative to taking potentially harmful medications, there is very useful advice in the afterword section. Dr. Angell provides several questions to ask your doctor if he or she wants to prescribe you a drug.

1. What is the evidence that this drug is better than an alternative drug or some other approach to treatment?

2. Has the evidence ever been published in a peer-reviewed medical journal?

3. Or are you relying on information from drug company representatives?

4. Do you have any financial ties with the company that makes this drug?

Polypharmacy is a real concern in a medical industry that simply prescribes a drug for every little malady. The author mentions the tale of a 50 year old woman who was on eighteen different medications for a variety of ailments, and as a result could barely get around, was constantly dizzy, and could hardly stand up. This is a problem! According to the author, "What she probably needed was less medication and more medical attention. Experienced specialists are familiar with this phenomenon of overmedication and often start their evaluation of a patient who is not doing well on multiple drugs by eliminating most of the medications. Frequently, the patient improves."

You are being lied to by the drug companies. They are not honest and they do not care about you. They aren't even innovative! As Dr. Angell explains, "Over the four years beginning in 2000, there were just 32 innovative drugs out of a total of 314 approved drugs." This is not the first book about the pharmaceutical industry that I have reviewed for this blog; in fact, I have reviewed several. Every book highlights something new for me, and I appreciate the perspective of someone who has both treated patients and reviewed clinical trial data for a prestigious medical journal. This book is worth reading, and I encourage you to draw your own conclusions.

I am often hesitant to tell people that I meet exactly what it is that I do for a living. That is not because I am embarrassed about my work; in fact, it is quite the opposite. I am proud of everything that we have accomplished at Total Results over the past 23 years and I believe wholeheartedly in our philosophy and everything that we stand for. The reason I say this is because discussing exercise with most people can be a tricky proposition. For one thing, many people hold their exercise ideals as tightly as they do with their views on religion and politics. Most individuals have been grossly misinformed by what they see in gyms and in the media, and as a result they have virtually no idea how proper weight training works in terms of how physical improvements are made. Talking to people about this subject and helping them to understand can be like running into a brick wall. Some people are willing to learn, and those individuals often eventually become Total Results clients. Others hold onto their preconceived notions about exercise and cannot make the intellectual leap to the next level.

"More exercise must be better." This mantra is usually touted by people who don't like to work intensely. They would much rather perform more exercises and spend more time in the gym (much of it spent socializing) then work with the requisite effort and focus that will bring optimal results. One of our clients, who has been working with us for several years, recently had a conversation with a friend of his who is a bodybuilder. Our client, who is tall and very lean, was told by his friend that if he wanted to add more muscle he just needed to "add more weight" to what he was lifting. Yes, there are people out there that still think this way. They believe that if some is good, more is better. You can see how this could develop into a slippery slope very quickly. At what point is it enough? One's safety can very easily become compromised with too heavy of a mechanical load, and overuse injury and overtraining can quickly happen with too high a volume of training as well as training too often.

"You have to train fast to be fast." This is still the foundation of the Olympic lifting crowd, and unfortunately it is still pervasive in organized team sports at the high school, college, and professional levels. These individuals mistakenly believe that in order to train the fast-twitch muscle fibers (which have the greatest capacity for power, explosiveness, and growth), you must lift weights fast. This is pure nonsense, and it is a display of ignorance because they likely have never heard of the size principle of recruitment. This means that when a mechanical load is placed on the body, muscle fibers are recruited in sequential order based on size. Slow-twitch fibers are recruited first, followed by intermediate-twitch fibers, and then fast-twitch fibers. You cannot go out of order! Fast twitch fibers are only recruited if the intensity of effort exhausts the slow-twitch and intermediate-twitch fibers first. Lifting weights in an explosive fashion only increases the risk of injury.

"Split routines are the way to go." Don't go by what you read in fitness magazines or bodybuilding forums. Most people that spend time in these forums (even in high-intensity forums) have entirely too much time on their hands, and their views are severely misguided. Split routines, in which you divide your workouts up each week based on training certain body parts, are a surefire way to grind your progress to a halt by overtraining. Your body is more than just a collection of parts. It functions as a unit, and should be trained as such; that is why we perform whole-body workouts at Total Results. If you train with the proper amount of focus and effort, one or two workouts per week consisting of five to seven exercises will stimulate optimal gains while not tapping out your body's fragile recovery ability.

"20 minutes can't possibly be enough." You are paying for results, not simply just trying to rack up as much time in the gym as possible. The human body is resistant to change; it wants to maintain the status quo as much as it can. You must give the body a very good reason to adapt, and that is where intensity of effort becomes critical. The body perceives a high-intensity weight training workout (particularly when you use a slow speed of movement and go to muscular failure) as an existential threat, so it must mobilize its resources to make physical improvements to guard against this "threat." If you are working with the proper amount of effort, a 20 minute workout is not simply something we can get away with, it becomes a necessity to keep the workout brief. Your genetics play a significant role in determining what type of visual physical improvements you make from Total Results workouts, but regardless of your genetics you can become stronger, better conditioned, more resistant to injury, and more fit if you put forth the effort on a consistent basis.

Exercise must be purposeful, not haphazard or instinctive. It's not about trends or fads, or what happens to be currently popular. Most people are not particularly sophisticated when it comes to understanding exercise. The media must carry much of the blame for this, but the individual should also bear responsibility. The correct information is out there, it just takes effort to uncover it. The Total Results exercise philosophy is built on tried and true principles that go back over a half century. Time is the most precious commodity that we have; don't waste it by pursuing ineffective mediums. Choose Total Results.