Joe Rogan Experience #1756 - John Abramson

1. 0:00 – 15:00

   (drumbeats) Joe Rogan podcast,…

   1. JAJohn Abramson0:00

      (drumbeats) Joe Rogan podcast, check it out. The Joe Rogan Experience. Train by day, Joe Rogan podcast by night, all day. (instrumental music plays)

   2. JRJoe Rogan0:12

      All right, we're, we're on. Hello, John.

   3. JAJohn Abramson0:14

      Joe.

   4. JRJoe Rogan0:15

      Thanks for doing this, man.

   5. JAJohn Abramson0:16

      Blessed to meet you.

   6. JRJoe Rogan0:16

      So, uh, this is obviously a subject, um, that, uh, in this current era is, uh, very intriguing and very important for people, um, Big Pharma. And this is, uh, the subject of your book. How, uh, Big Pharma... What, what is the, uh, the, the, the heading? How Big Pharma Broke America? Is that what it is?

   7. JAJohn Abramson0:37

      Uh, uh, it's, uh, I actually have a copy

   8. JRJoe Rogan0:38

      Broke, broke our healthcare system. a copy of it before. Oh, good, because it's not available. I tried to get it and they, uh, they sent me copies of the audiobook, but it's in these weird wave files and when the, you have to turn your screen off or it shuts off, the sound. All right.

   9. JAJohn Abramson0:52

      There you go.

   10. JRJoe Rogan0:53

       Sickening. How Big Pharma Broke American Healthcare and How We Can Repair It. Um, so how did they break American healthcare? What happened? How did it, how did we get so deep in? And how is it that we're one of only two countries on earth that allows pharmaceutical companies to advertise?

   11. JAJohn Abramson1:08

       Well, let, let's start with that question first.

   12. JRJoe Rogan1:10

       Yeah, let's do that.

   13. JAJohn Abramson1:10

       Um, so, uh, so it's, uh, the United States and New Zealand allow drug companies to advertise, but New Zealand has very active oversight of its pharmaceutical program. Active oversight of the, uh, evaluation of the efficacy of the drugs and to, whether the pricing of the drugs is reasonable. So, it turns out that even though we in New Zealand allow drug advertising, New Zealand spends the least per person amongst developed countries, and we spend the most by far.

   14. JRJoe Rogan1:39

       Hm. So, uh, uh, so is, ha- has there ever been a conversation, like, whether it's, uh, publicly or privately that you know of where they've tried to stop this? Is this one of those things that once it gets into play, once there is a, a, a law that allows pharmaceutical drug companies to sponsor or, or, or to, uh, advertise, are we doomed then? Because then the amount of money that's involved in advertising and when you see those, "Brought to you by Pfizer," those CNN commercials, and when you see the, um, whether it's for allergy medications or antidepressants, the sheer volume of money that's involved, it seems like extracting that from our system would be very difficult to manage. Because they're gonna fight tooth and claw to keep that ad.

   15. JAJohn Abramson2:30

       Absolutely. So, uh, as best I understand it, from, from the lawyers who do understand it, in, in our Constitution, the advertising of, uh, prescription drugs is, falls under the free speech, uh, mandate of our Constitution. And some things, uh, you can control the advertising of. Cigarettes and alcohol. There's no, uh, beneficial use of those. Uh, they're not a, um, they can be recreational, but there's no, uh, absolute benefit to them. But with drugs, there is a, an absolute benefit. And they, because of that, they qualify as protected under the, uh, First Amendment. However, that said, uh, the floodgates were opened, and it's clear that the drug companies are gonna spend as much advertising, however many billions of dollars, uh, they want, uh, to make as much money as they can. Uh, but there's nothing that says the drug ads need to be allowed, uh, that we need to allow them to be misleading. So, you never see in a drug ad that you have to treat, uh, 323 people with Trulicity for a year to prevent one cardiovascular event. They don't tell you that. They tell you, "Trulicity for diabetes prevents cardiovascular events in diabetics." But if they said, "You have to treat 323 people to get one better and the other three- 322 aren't gonna have a cardiovascular benefit," then you'd be delivering information that people can use. And if you said that you can't play, uh, violins or have family picnics while you're, uh, reciting all the side effects, then people would listen to the side effects.

   16. JRJoe Rogan4:15

       Hm.

   17. JAJohn Abramson4:15

       So, I think the key is that the drug companies know how to use the ads very skillful to manipulate people on an emotional level, and we don't have to settle for that. We can have... You wanna advertise drugs? Okay. Let's decide what facts need to be told about this. Is this better than other therapies? Is this better than lifestyle intervention? How much does it cost? How many people do you need to treat in order for one to get better? I think if that information were included in the ads, they'd be much less, uh, the, the, the, the cost benefit of the ads would be reduced or the benefit-cost ratio would be reduced for the drug companies. And then, they wouldn't advertise so much. But right now, they can make these ads that make anything look great and make people want them and make people go to their doctor and ask for them and they make a ton of money.

   18. JRJoe Rogan5:13

       Yeah, it just doesn't seem like it should have a place. Uh, like advertising in terms of the way they're advertising, not just showing something in a print form like we, uh, you know, there is a new medication that stops, you know, the damages of high blood pressure or whatever it is. What they're doing is they have these theatrical representations of the most beautiful and wonderful life where people are dancing in wheat fields and, and, and d- delivering picnic food while everybody laughs and cheers. That should be illegal.

   19. JAJohn Abramson5:45

       Right.

   20. JRJoe Rogan5:46

       I mean, it's manipulation. It's clear, they're clearly fucking with people's heads and they're using psychology. They're, they're not doing it in a way where they're trying to objectively, coldly relate, rely facts and have people see these facts and, and recognize that this has benefit to them. No, what they're doing is they're trying to get people excited about the possibility of living a life like they're seeing. When they're relaying these facts of the, they're doing it with music, they're doing it with joyous dancing and-... it's bullshit. It's, it's really wrong because it's... Y- you're not selling a car. You know, if you, if you wanna do that to sell a car, that doesn't bother me at all. But you're doing something that you... People, uh, who have health problems are really thinking that they're gonna wind up like these people in this video. They're, they're really th- they're... You're manipulating them to the point where you're getting them to bring things up to their doctor, things about antidepressants or anti-anxiety medication, or all kinds of stuff that people could just ask for. And it's just... It seems insane that of all the countries on Earth, there's only two that allow it and, as you're saying, one that allows it pretty much unchecked.

   21. JAJohn Abramson6:58

       Right. That's, uh, that's exactly right. And, uh, I'm in total agreement with you, Joe, that... I, I don't think we're gonna get rid of drug ads, but I think we could make the drug ads... We... You could ensure that the drug ads leave people with, uh, an accurate, uh, understanding of what the benefit of the drug is gonna be.

   22. JRJoe Rogan7:20

       But don't you think if you have any ads, they're gonna... There's gonna be room for fuckery? And there's gonna be... I mean, if the... You have any ads that say, "Okay, well, no theatrical representations," they're gonna go, "Whoa. Okay." What about music? Can I have music?

   23. JAJohn Abramson7:32

       (laughs)

   24. JRJoe Rogan7:32

       Like, what about the way people talk? Like, when the... When they reli-... When they say these, uh, side effects at the end, when they list off the side effects, it's, uh, crazy the way they're talking about death and suicide. "You may have-"

   25. JAJohn Abramson7:45

       Right.

   26. JRJoe Rogan7:45

       "... suicidal thoughts." Like, oh, like, th- what? Why is it like that?

   27. JAJohn Abramson7:48

       Yeah. Right.

   28. JRJoe Rogan7:49

       Like...

   29. JAJohn Abramson7:49

       And why is the dog wagging its tail?

   30. JRJoe Rogan7:50

       Yeah.
2. 15:00 – 30:00

   Nope. …

   1. JRJoe Rogan15:00

      nothing?

   2. JAJohn Abramson15:01

      Nope.

   3. JRJoe Rogan15:01

      Nope? Wow.

   4. JAJohn Abramson15:03

      Nada.

   5. JRJoe Rogan15:03

      So, how is that possible? Was it some sort of a deal they had? They were gonna pay the amount of the fine, this enorminate- enormous, exorbitant amount, and in the deal it was that the, the actual details of it would not be divulged?

   6. JAJohn Abramson15:18

      That's correct. A- a- and it's even more serious because the drug companies own the data from those clinical trials. It's so serious, Joe. When a drug company sponsors a clinical trial and they do the analyses and they write up a manuscript and they say what happened and they send it to a medical journal and it gets peer reviewed, and doctors are trained that they should read and trust peer-reviewed articles that are well conducted and that- that's how the system works, the peer reviewers and the editors of the medical journals don't get to see the data. They have to take the word of the drug companies that they've presented the data accurately and reasonably completely. And you only get to see it in litigation, you know, five years later when, eh, when it doesn't matter because everyone's formed their opinion.

   7. JRJoe Rogan16:18

      That seems insane.

   8. JAJohn Abramson16:19

      It's insane. And doctors don't know this. They're taught there's this, uh, paradigm of evidence-based medicine where good doctors practice evidence-based medicine, and that's p- based on the peer-reviewed articles published in medical journals and the, and the clinical practice guidelines. And the doctors don't know that the peer reviewers didn't have access to the data and couldn't perform their independent analyses. And the clinical tri- the experts who write the clinical trials, or the, excuse me, the experts who write the clinical practice guidelines don't have access to the data.

   9. JRJoe Rogan16:53

      So, the data is only held by the pharmaceutical companies. They release their analysis of the data?

   10. JAJohn Abramson16:59

       Correct.

   11. JRJoe Rogan17:00

       And then the peer reviewers do everything based on the analysis of the data that was released by the pharmaceutical companies?

   12. JAJohn Abramson17:06

       That's correct.

   13. JRJoe Rogan17:06

       That's insane.

   14. JAJohn Abramson17:07

       That's insane. And docs don't understand it. They don't understand that they're getting manipulated, that the, that the control of the knowledge has been turned over to the drug companies. And the drug companies they pay for, I think, 86% of the clinical trials. They design them. First, they design w- they decide what they're about, and they're about the things that are gonna make money, obviously. They're not about the things that are gonna make people healthy. They're not prioritized that way.

   15. JRJoe Rogan17:34

       Right.

   16. JAJohn Abramson17:35

       But, uh, they design the studies. They figure out the doses. They figure out the conditions and exclusions of the people who are in the trials, and they do what they can to exercise their fiduciary responsibility to their shareholders, which is to make this thing come out with data that's gonna sell the drug. And then, after they've done all of that, they own the data.

   17. JRJoe Rogan18:01

       How did that ever become the way that system is set up? Like, what, what steps were not put into place to protect people from the kind of fraud that's possible when the pharmaceutical drug companies are the, the ones who are relaying the data and their interpretation of the data to the peer reviewers? Like, how, how is that ever acceptable?

   18. JAJohn Abramson18:24

       Yeah. I, I think we drifted into this situation. Um, and what made it so important, so destructive to American healthcare, is that we don't put a limit on what the drug companies can charge.... so that our prescription drugs, our brand name prescription drugs cost three and a half more- three and a half times more than prescription brand name pr- the same brand name prescription drugs in the other OECD countries, Organization of epi- economic cooperation and development. So we have a price that is making this, uh, manipulation of data, some people would say BS. Um, the price drive, it- it creates an enormous incentive. And then we don't have what's called health technology assessments. So we have no governmental or quasi-governmental oversight of, that compares the value of new drugs in terms of the therapeutic value and the economic value to old drugs, to older drugs, older- other available therapies that inform coverage decisions and inform physicians about how best to apply the new therapeutics. Um, and we also don't allow... This one is- is cr- it's just mind-boggling. We don't allow government-funded cost-effectiveness studies, and we don't allow cost-effectiveness studies to be used in government-funded health care. So we've created this situation where the prices are sky-high, where the knowledge is not being overseen, and where the cost-effectiveness is not... The- the government is not allowing cost-effectiveness to get into our dialogue in the way it should be. And we're essentially like playing a- a professional basketball game where the players are calling their own fouls.

   19. JRJoe Rogan20:22

       (laughs)

   20. JAJohn Abramson20:22

       They're paid to win and they're calling their own fouls. It- it's craziness, and that's why I wrote this book. Uh, I- I- I- I've been- I've been fortunate enough to be in this unique position as a family doctor for 20 years and then, um, as an expert in litigation, and I- I understand how this works. And- and the docs, they're trying hard. They're drowning in information and they're under more and more pressure. And th- it's just so they don't understand this.

   21. JRJoe Rogan20:52

       Were you aware of how twisted the- the system was before you started doing this litigation, before you started going over the- the peer-reviewed papers and finding out where the... Were you aware of how the system was set up?

   22. JAJohn Abramson21:06

       It came in two stages. So as I... After I finished my residency in family medicine, I did a Robert Wood Johnson Fellowship for two years. And- and that was a wonderful, uh, training in epidemiology and research design and statistics. So that- that's where I got these skills that I came back and drew on. But family medicine is very hard in an academic environment. The- the- the purpose of the fellowship was to train academics in family medicine to increase the prestige of family medicine, which seems like a good idea. But family medicine is very difficult in an academic environment because they're l- the family docs are low man on the totem pole in the hospital and all the specialists, um, specialists often don't treat them with the respect they deserve. And I decided that my calling was to go be a doctor in a smallish town, and I did that for 20 years. But I had this Robert Wood Johnson Fellowship training always in the back of my mind. And as we got through the late '90s, it became clear that the drug companies were influencing what was in the journals. And then the drug... Do you remember the drug Vioxx?

   23. JRJoe Rogan22:14

       Yes.

   24. JAJohn Abramson22:14

       It was an arthritis drug.

   25. JRJoe Rogan22:15

       I have a friend who had a stroke after taking Vioxx.

   26. JAJohn Abramson22:19

       Yeah. So it... Yeah. I- I got a letter fr- from a mother whose child died, 14- 17-year-old child died from taking Vioxx, eight samples of Vioxx. Um, but Vioxx came along and there was an article in the New England Journal that Merck had sponsored and it said it was safe and w- uh, was advantageous, not because it was any more effective, but because it reduced the risk of serious GI problems. And then there was another article in the New England Journal of Medicine that fessed up to cardiovascular problems, but the review article said this may be due to the play of chance because there were only 70 events, and such a small number of events is, uh, subject to statistical variation. And I knew that that was crazy because there were only 53 serious GI events, which was the whole reason for selling this $2 billion a year drug, was that it was safer on the GI tract and there were only 53 events.

   27. JRJoe Rogan23:29

       It was an anti-inflammatory, right? It was like-

   28. JAJohn Abramson23:31

       Mm-hmm. Yeah, exactly.

   29. JRJoe Rogan23:32

       So the- the idea was that that was better than non-steroidal anti-inflammatories?

   30. JAJohn Abramson23:36

       Exactly. Because it- because it didn't, uh, upset the stomach the same way. And this... The science was elegant and it might have worked, but it didn't. Um, and in changing that balance, it made the blood more likely to form clots.
3. 30:00 – 45:00

   And so you can't…

   1. JAJohn Abramson30:00

      by all the people who were dying from GI bleeds, and we had to switch those people from ordinary non-steroidals to Vioxx and Bextra and, and drugs like that.

   2. JRJoe Rogan30:11

      And so you can't tell us exactly what Pfizer did with Bextra, but it was enough to ... was it ... it was $23 billion?

   3. JAJohn Abramson30:21

      No, no. Um, 1.195 billion.

   4. JRJoe Rogan30:25

      Oh, okay.

   5. JAJohn Abramson30:26

      Fine, fine.

   6. JRJoe Rogan30:26

      So that was the largest fine ever?

   7. JAJohn Abramson30:28

      At that time.

   8. JRJoe Rogan30:30

      And this was, uh, d- was there deaths involved with Bextra as well?

   9. JAJohn Abramson30:41

      You know, I'd have to refresh my memory, and I might not be able to tell you even if I did.

   10. JRJoe Rogan30:46

       Okay. Um, so-

   11. JAJohn Abramson30:48

       But with Vioxx, we have the data on Vioxx because it did go to litigation in open court. Um-And it's clear that they removed three heart attacks that were critical, that flipped the statistics, and that's how they sold $12 billion worth of a drug that, um, more than doubled the risk of heart attacks, strokes, and blood clots.

   12. JRJoe Rogan31:12

       And these companies are obviously... They, they don't get disbanded, they don't get dissolved. They're still in business. And the same people are still running them in many cases, and no one goes to jail.

   13. JAJohn Abramson31:25

       Correct. It's very rare for somebody to go to jail. And even when they plead guilty to a felony, it's often a s- the, the... I don't know why this happens, but the Department of Justice allows a subsidiary of the parent company to take the hit, so that if there's another flagrant foul, the subsidiary gets... It's called disbarred, but, uh, uh, prohibited, uh, or excluded from the Medicare program. Um, the, the parent company doesn't even take the hit, the legal, um... Doesn't get the, like the legal foul counted against them.

   14. JRJoe Rogan32:02

       And so this has obviously all been set up by the pharmaceutical companies. They've a- arranged this somehow or another with the, the Justice Department or whoever's prosecuting them, or-

   15. JAJohn Abramson32:12

       No, that's going too far. That's going too far.

   16. JRJoe Rogan32:14

       No, but I mean in far... As far as, like, these regulations. Like, how is it possible that they would allow them to have such egregious violations where people die, and they also have all these safety nets in play to make sure that people don't go to jail, and make sure the parent company doesn't get hit with a fi-... I mean, that doesn't seem like it's not negotiated. It's going too far to assume or to assert? Like, what's, what's going too far?

   17. JAJohn Abramson32:42

       Um...

   18. JRJoe Rogan32:45

       It didn't happen that way organically. It didn't, like, "This seems like the best way to do it. This is gonna protect the American people the best. We're gonna make it so that, you know, you don't get in trouble."

   19. JAJohn Abramson32:55

       Yeah. Joe, I'm not an expert at what happens at the level of the Department of Justice, but I have a lot of experience about what happens in civil litigation. Same drug, same situation, but civil litigation. And, uh, a lot of times, the plaintiff's lawyers will settle. They'll make a settlement and oftentimes bury the data, agree to bury the data-

   20. JRJoe Rogan33:16

       Hmm.

   21. JAJohn Abramson33:16

       ... in civil litigation. And I've been on the inside of some of those decisions. And the plaintiffs are representing the int- The plaintiff's lawyers are representing the interests of the people who are injured, and they're trying to get the best deal for them. And it's hard to get a jury to understand this. Now, I did participate. I testified in a federal... In federal court, in a federal trial where Pfizer... I, I, I apologize to Pfizer for p- their names coming up a lot, and they're all the same.

   22. JRJoe Rogan33:49

       (laughs) Hilarious.

   23. JAJohn Abramson33:50

       Yeah, yeah, yeah. So, I, I, I'm sorry, Pfizer.

   24. JRJoe Rogan33:53

       Sorry, Pfizer.

   25. JAJohn Abramson33:54

       Sorry, Pfizer. Yeah.

   26. JRJoe Rogan33:55

       You do make boner pills.

   27. JAJohn Abramson33:57

       (laughs) Do they work?

   28. JRJoe Rogan33:59

       Yeah, they're great.

   29. JAJohn Abramson34:00

       (laughs)

   30. JRJoe Rogan34:00

       They, they make other stuff too, right?
4. 45:00 – 1:00:00

   Right. But why would…

   1. JAJohn Abramson45:00

      break our healthcare system, because they only work when you treat people early in their disease. You can't wait until people get sick enough to need a 700 or $3,000 ... a, a $700 or $3,000 drug. You've gotta treat everybody who gets sick in order to have the benefit.

   2. JRJoe Rogan45:16

      Right. But why would they stop monoclonal antibodies from being distributed?

   3. JAJohn Abramson45:21

      I- um-

   4. JRJoe Rogan45:22

      It seems like they could make money with those, too, right?

   5. JAJohn Abramson45:25

      They can. Maybe there's more money elsewhere? I, I don't know. I, I don't know what's going on in that black box.

   6. JRJoe Rogan45:29

      The only thing that makes sense to me is that monoclonal antibodies, it doesn't seem to matter whether or not you've been vaccinated. Like, if you, if you're sick and you get those, for a lot of people, that seems to do the trick, and you get better. Maybe that's the problem.

   7. JAJohn Abramson45:46

      No. No. I don't think-

   8. JRJoe Rogan45:47

      You don't think that's the problem?

   9. JAJohn Abramson45:47

      ... I, I don't ... I think it's a problem if you can't get good therapeutics to people.

   10. JRJoe Rogan45:52

       No, that's not what I mean. I mean, the problem they have with that, with monoclonal antibodies, in that it doesn't, you don't have to necessarily be vaccinated for them to be effective. The, the whole idea, the binary approach has been, everyone needs to get vaccinated.

   11. JAJohn Abramson46:06

       Yes.

   12. JRJoe Rogan46:06

       They keep saying it over and over again. Even in light of Omicron, where it shows that it's a vaccine escape variant, or it, the vaccines are effective with it, even though it's mild.

   13. JAJohn Abramson46:16

       Um, I don't think you can say that yet. I, I, it-

   14. JRJoe Rogan46:18

       They have been saying it.

   15. JAJohn Abramson46:20

       No. It looks like people who are boosted have significant protection against Omicron, from s- from severe illness, not, not-

   16. JRJoe Rogan46:26

       But no one's getting severe illness from Omicron. There's not, there hasn't been a single death in the United States that's attributed to it.

   17. JAJohn Abramson46:33

       Uh, we're early.

   18. JRJoe Rogan46:34

       Well, there was ... Well, yeah, we're a month in. But there was one death in Texas that they initially had attributed to it, but they backed down from that. The, the person had some pretty significant comorbidities.

   19. JAJohn Abramson46:44

       Mm-hmm. We're still early on that. I, I would stay tuned. I wouldn't make that judgment yet.

   20. JRJoe Rogan46:49

       But it's a month in?

   21. JAJohn Abramson46:51

       It's a month in, but the, the number of cases has been-

   22. JRJoe Rogan46:53

       Right.

   23. JAJohn Abramson46:53

       ... going up logarithmically.

   24. JRJoe Rogan46:54

       But if it was the month of Delta, we would have some pretty significant deaths. You, you can pretty m- you can kind of assume that this is less, and this is what's been s- widely reported-

   25. JAJohn Abramson47:04

       Yeah.

   26. JRJoe Rogan47:04

       ... that it's less virulent or r- less, less damaging than Delta.

   27. JAJohn Abramson47:11

       Y- yes. And it's gonna take two to four weeks in before you know, um, what the real damage is. S- so that it may be that the extremely high volume, and we broke the record of, uh, cases in a day yesterday-

   28. JRJoe Rogan47:26

       Right.

   29. JAJohn Abramson47:27

       ... um, it may be that it's ... It certainly looks like it's less, uh, virulent.

   30. JRJoe Rogan47:32

       Yes.
5. 1:00:00 – 1:15:00

   Now, what is the…

   1. JAJohn Abramson1:00:00

      spending 7% more of our GDP on healthcare than the other wealthy countries are. And 7% times a GDP of $22 trillion is a h-... $1.5 trillion a year. So, whatever you think of President Biden's Build Back Better plan, and, and... I'm not getting into politics here, but it's $1.5 trillion, $1.7 trillion that... over 10 years that he's arguing for, and this is 10 times that much money that we're pissing away each year while Americans health rank 68th in the world. This is a disaster. It's ruining our country. We can't go on like this.

   2. JRJoe Rogan1:00:43

      Now, what is the best country when it, uh, comes to healthcare?

   3. JAJohn Abramson1:00:47

      Um, France is good. It, uh... The best changes a little bit. But, uh, there's France. The UK is good. Um, Japan does well. Switzerland does well.

   4. JRJoe Rogan1:00:58

      And what do they do different than what we do, other than, uh, the... some of them have socialized medicine?

   5. JAJohn Abramson1:01:04

      (clears throat) Well, l- l- m- let's take that apart a little bit.

   6. JRJoe Rogan1:01:07

      Okay.

   7. JAJohn Abramson1:01:08

      But what they do differently is what I'm writing about in, in Sickening.What they do is they oversee the integrity of the medical knowledge that reaches doctors. They can't control the journals, they can't control that problem with peer reviewers not having the data, but they can do, uh, governmental or quasi-governmental, it's called health technology assessment, where they determine the medical value of new drugs and the e- economic value of new drugs and make recommendations about covering new drugs. Um, and they also control the price of drugs because w- with our allowing drugs to be three and a half... brand name drugs to be three and a half times more expensive, uh, than in the other, uh, developed countries, we're creating such an incentive to distort the medical knowledge. So we've got a Wild West situation where the drug companies pay PR people and the lobbyists to create this illusion that their innovation is our only hope for a long and healthy life when that's rarely true. One out of, um... in terms of new drugs, new molecular entities that are approved, about one out of four is actually an improvement over a previous drug. But in the United States, we don't know that because there's no oversight. In the other countries, they're evaluating it. So when, for example, insulin analogs come along and replace human recombinant insulin and they start to jack up the price and there's no evidence that it's better for type two diabetics who use 80% of the insulin in the United States, there's no evidence that it's better, doctors are bombarded with marketing materials that say, "You gotta give your type two diabetics insulin analogs because it's more physiologic and it reproduces, uh, natural insulin function." And in the other countries that have health technology assessment, they're saying there's no evidence that it's superior to recombinant human insulin, so use that first. If your patient fails on recombinant hum- human insulin, if they have idiosyncratic problems with low blood sugar or anything else, you can use it as a second-line drug, but not a first-line drug. But we're essentially playing this game without... it's like professional athletes not having umpires.

   8. JRJoe Rogan1:03:36

      Now, when you said... y- you said 68th, United States ranked 68th?

   9. JAJohn Abramson1:03:40

      Sixty-eighth.

   10. JRJoe Rogan1:03:42

       And that is for overall health?

   11. JAJohn Abramson1:03:45

       Yeah, yeah, healthy life expectancy is probably the best single, uh, measure of the overall health. It's how many years you live in good health. So if you live to be 86 and you had kidney disease for the last six years that compromised the quality of your life for 50%, then your healthy life expectancy would be 83. So it integrates longevity with, uh, the time you spend in good health.

   12. JRJoe Rogan1:04:09

       And do they calculate the factors involved in that? Like how- how many... how much of the factors is... how many of the factors are calculated? Is it obesity? Is it, uh, drugs, like recreational drugs, nicotine, alcohol? Like what- what are the factors that lead us to be so poorly represented there?

   13. JAJohn Abramson1:04:28

       Right. So, um, one of the issues that I'm sure you've heard of is the diseases of despair that, um, uh, Professors Deaton and Case... Professor Angus Deaton is a Nobel Prize winner, and his wife is a professor at Princeton as well, they wrote a book about diseases of despair and how non-college-educated, non-college-educated white Americans are having, um, an epidemic of drug overdoses and suicides and liver disease. Um, and it... that it has to do with the economic context that, um, that the, um, wages and quality of life are not as high, that people's expectations about how their lives are going to unfold and having families and living independently and owning a house have gone down. And that all that adds up to these diseases of despair causing, uh, 100 deaths out of 100,000 white Americans, and they chose ages between 50 and 54, but you could take any age group. (clears throat) But the important fact here, that's true and that's awful, but the increased death rate in that group is not 100 per 100,000, but 400 per 100,000, and the other 300 deaths have to do with cardiovascular disease and diabetes and all the things they die of. But those folks are exposed to the social pressures that are compromising their health. This is a long answer to your short question.

   14. JRJoe Rogan1:06:13

       No worries.

   15. JAJohn Abramson1:06:13

       Um, but, um, so my opinion, um, what I tell you as a medical fact, I stand by. My opinion on this is that since 1980, the United States has had a radical growth in economic inequality. That, um, essentially, the share of the, um, income pie has been so distorted to the wealthy that it's like the average family living at the median income level of $55,000 with 2.6 people in their household, i- if they were getting the same share of the income pie that they got in 1980 as they are now, they would have $20,000 more a year. But as it stands now, that $20,000 is transferred from people who are working hard and trying to keep their kids in clothes and pay their bills to the top 1%. So it's like the working people in America are donating $20,000 per family to the top 1%, and that's having a disastrous effect.

   16. JRJoe Rogan1:07:24

       How... Y- This is kind of an interesting, uh, d- side track, right? Because now we're talking about economics, but, uh, d- is there a way that that could be switched? Is there a way that that could be somehow or another rediverted?

   17. JAJohn Abramson1:07:40

       Absolutely.

   18. JRJoe Rogan1:07:41

       What would, what would that-

   19. JAJohn Abramson1:07:42

       A-

   20. JRJoe Rogan1:07:42

       ... way be?

   21. JAJohn Abramson1:07:42

       Absolutely. Um, if the economy is such that companies on their own are suppressing the wages of working people and they wel- uh, and transferring that money to the wealthy people, you simply do it with tax policy. If you can't do it pre-tax, you can do it with tax policy.

   22. JRJoe Rogan1:08:05

       And how would you do that? You would give them a tax break, or you would tax the rich more? What would you do?

   23. JAJohn Abramson1:08:10

       You'd pull some of that money back. And you could do it with tax credits. You could do it with tax rates. You could do it with, um, inheritance taxes. Uh-

   24. JRJoe Rogan1:08:19

       The, the problem people have with taxes, whether this is, uh, accurate or not, is that no one trusts the government to do well with that money. No one trusts the, the bureaucracy and the, the, the nonsense and red tape that's involved in our over-bloated government to the point where they're like, "Yeah, I'd be more than happy to give them extra money, because I know they're gonna do with it very good things."

   25. JAJohn Abramson1:08:42

       I agree. And what we got, we got because we don't trust the government. And how we get to some middle ground on this, uh, I hope you're smart enough to figure it out, 'cause I'm not.

   26. JRJoe Rogan1:08:54

       No.

   27. JAJohn Abramson1:08:54

       But-

   28. JRJoe Rogan1:08:54

       Definitely not.

   29. JAJohn Abramson1:08:55

       But, but we've got to get to a middle ground. The working people in the United States are getting a raw deal. S-

   30. JRJoe Rogan1:09:02

       So do we achieve, like, some sort of a, a, a better state with unions? Is it-
6. 1:15:00 – 1:30:00

   And the drug companies…

   1. JRJoe Rogan1:15:00

      that really don't have anything to look forward to, and this is what alleviates some of their horrible feeling, is just get drugged up.

   2. JAJohn Abramson1:15:10

      And the drug companies were very willing to make a buck doing it.

   3. JRJoe Rogan1:15:13

      Yeah. Have you ever seen the, um, the documentary, The OxyContin Express?

   4. JAJohn Abramson1:15:17

      No.

   5. JRJoe Rogan1:15:18

      It's a- it was on Vanguard. Um, and it was, uh, essentially, they showed that Florida had created this situation where they would have these pain management centers that were essentially just pill mills. The pain management center was connected to a pharmacy that only had pills.

   6. JAJohn Abramson1:15:37

      Yup.

   7. JRJoe Rogan1:15:37

      They only served opiates. So, you would go to this pain management center, you'd go to the doctor, and you'd say, "Doctor, my back is killing me." The doctor would say, "What you need is some OxyContin, son." And they would write you a prescription. You would literally go right next door, and they would have the pills for you. And they also did not have a digital database, so you could go to Jamie and get a prescription from Jamie, and then leave him and then go to another doctor, Mike, right down the street, and get a prescription from him. And you could do it all day long, and people were doing this, and then they were selling these pills on the OxyContin Express that drove it straight up into Kentucky and Ohio and, you know, where- wherever the highway took it. And they w- they were seeing how there was a, a direct chain of events where these people were going to these pill mills, stockpiling all these pills, and then they were selling them into these other states and making a lot of money.

   8. JAJohn Abramson1:16:30

      Right, so you see the synergy between the folks whose lives aren't working out the way they wanted to and they're miserable.

   9. JRJoe Rogan1:16:37

      Yeah.

   10. JAJohn Abramson1:16:37

       And maybe they're miserable because of back pain or maybe they're miserable because life doesn't have the meaning they hoped it did.

   11. JRJoe Rogan1:16:43

       Yeah.

   12. JAJohn Abramson1:16:43

       And you have the drug company, which is telling doctors that they've got a new product that's less addictive. It's so much less addictive that you can treat non-cancer pain and not get into trouble with it.

   13. JRJoe Rogan1:16:56

       Y- yeah.

   14. JAJohn Abramson1:16:56

       That it last 12 hours, but they know it doesn't last 12 hours, and when it wears off before 12 hours, they tell the doctors to increase the dose because that means they're not taking enough, not that their drug doesn't last 12 hours.

   15. JRJoe Rogan1:17:08

       Right.

   16. JAJohn Abramson1:17:09

       And, and that it can't be abused, and people are crushing it and putting it in a straw and shooting it up and so forth. So, you've got the drug company that's an actor, and you've got the social circumstances where people are hurting, whether it's medical hurting or spiritual hurting, or whatever you wanna call it.

   17. JRJoe Rogan1:17:27

       Yeah.

   18. JAJohn Abramson1:17:27

       Um, and it's just a recipe for disaster, and without the appropriate oversight of the drugs, we're n- w- the faucet, the spigot's turned on.

   19. JRJoe Rogan1:17:38

       And that's, uh, in this country, it's been one of the most egregious offenses by the pharmaceutical drug companies, is distorting the data on the, uh, addictive properties of opiates.

   20. JAJohn Abramson1:17:50

       Absolutely. Absolutely.

   21. JRJoe Rogan1:17:53

       It's a scary thing when you thi- you find out how many people. There was, uh, a statistic that was just re- re- revealed, uh, just released rather, that, uh, from people 18 to 49, uh, fentanyl was the number one cause of death. 100,000 people died in this country from fentanyl that are ages 18 to 49. Uh, th- extremely potent opiate.

   22. JAJohn Abramson1:18:15

       Yeah.

   23. JRJoe Rogan1:18:15

       And most of it recreational, right? Most of it is, like, from cut-

   24. JAJohn Abramson1:18:19

       A- all of it.

   25. JRJoe Rogan1:18:20

       Yeah. It's hard.

   26. JAJohn Abramson1:18:21

       But, I, I don't know if it's 100,000. I think it's 100,000 deaths total.

   27. JRJoe Rogan1:18:25

       Yes.

   28. JAJohn Abramson1:18:25

       And fentanyl's a major proportion of those 100,000 deaths.

   29. JRJoe Rogan1:18:28

       Oh, that's not what I saw. I think... I thought I saw that it was... They were literally attributing 100,000 deaths.

   30. JAJohn Abramson1:18:33

       It could be. Could be.
7. 1:30:00 – 1:30:38

   There is. I've, I've…

   1. JRJoe Rogan1:30:00

      this stuff.

   2. JAJohn Abramson1:30:01

      There is. I've, I've laid it out.

   3. JRJoe Rogan1:30:04

      (laughs)

   4. JAJohn Abramson1:30:04

      You wanna know how much fuckery there is? I know how much fuckery there is and it's in that book. And you need, you don't need to know all these facts, 577 billion and 456 billion, you don't need to know those. But what you do need to know is that the drug company is in the business of making money. And they do it very well, and they will continue to do it ever better, until they're stopped. And we might as well stop them sooner rather than later. And we need the drug companies. We need them to commercialize medical science. I'm not for socializing this.

Episode duration: 2:29:34