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like most monday mornings you don't feel good you don't feel good about getting out of bed or getting motivated you don't have the strength to go to work like all monday mornings you're irritable anxious stressed by the overbearing start of the week a passing tiredness not necessarily get a medical you might be suffering from mmdt monday morning dysphoric trouble irritability feeling run down social withdrawal headaches monday morning dysphoric trouble is an incapacitating illness that french researchers have just discovered monday morning dysphoric trouble affects one adult out of three it can ruin your life so fight back [Music] ask your doctor for advice antiflamex 20 milligrams stop monday mornings being a nightmare there you see took less than 40 seconds to almost convince you you were sick the victim of a new recently discovered illness you were even about to go out and buy the invented medicine from the fake laboratory for a bogus illness just a joke and bad taste don't be fooled there are thousands out there who regularly swallow pills for completely fictitious illnesses invented by pharmaceutical companies oh yes it's true laboratories that seem to have one single objective to sell ever more medicine the experts describe this as illness shaping an annoying tendency the pharmaceutical industry has indulged in for more than 15 years it needs saying that between the laboratory's influence and the demands of patients the 21st century doctor is somewhat stuck in the middle especially since new illnesses have sprung up in recent years all over the place [Music] even a belly those few extra kilos around the waist are now considered serious and known as abdominal obesity luckily it can be cured this week we'll be looking at abdominal obesity which is a real name given to a well-rounded and ever-growing belly by the medical profession that was four years ago at the time abdominal obesity scientifically known as metabolic syndrome is a novelty an illness with serious consequences that affects one in four people it's a topic picked up by the media doctors have a name for all of these symptoms it's metabolic syndrome let's just consider nutritional problems which are very important two months ago sophie went on a diet and lost seven kilos yet she continues to suffer from metabolic syndrome this morning we're talking with damian about metabolic syndrome which simply means having a large belly abdominal obesity is an illness that is connected with being overweight and associated with diabetes hypertension and cholesterol he needs to be treated at once to avoid the risk of cardiovascular accidents in short a public health priority dr boris hansel is someone who seems to know and talk the most about the disease he's an endocrinologist at a major paris hospital and heads up a small unit dedicated to eradicating metabolic syndrome on tv as on the internet dr hansel seems committed to this public health drive how do i recognize metabolic syndrome [Music] do you have metabolic syndrome can't you tell just by looking at yourself belly alert everyone should measure their waistlines to fight metabolic syndrome boris hansel recommends physical exercise a balanced diet and also as an article in the parisian newspaper put it in march 2008 an accomplia pill a medicine aimed to fight obesity produced by sanofi [Music] for my part i would only prescribe this drug to people suffering from these symptoms what we also call metabolic syndrome as it endangers the life of the patient boris hansel is not the only one to promote sanofi's products in canada the same story the man who discovered the disease professor jean-louis depp the chairman of the international metabolic syndrome group also plugs a complier's active component drug ramona band this drug is the first to specifically attack the anomalies of metabolic syndrome a dose of 20 milligrams a day of ribonomat will significantly reduce the bad and harmful abdominal fat around the waist when ramona band becomes available on the market we will finally have a truly effective treatment which will attack the cause of these complications as this internal sanofi document indicates a complier seemed at the time to be one of the possible treatments for metabolic syndrome sanofi discovered the active ingredient of the medicine ramona bent in 1995. it's a new drug that shrinks the waistline and reduces metabolic risks such as diabetes high blood pressure and cholesterol it's a medicine they hope will conquer the world market and sanofi launches a powerful advertising campaign around the globe to professor philip evan the only thing missing was the archangel's trumpets every two months there was an article on how a complier would usher in remarkable progress it was like the enunciation arrival of the crib on christmas day it's coming it's coming here it is there it goes it was quite astonishing reality metabolic syndrome the danger of too fatter belly never really existed [Music] the independent doctors of the prescreer review plainly wrote back in 2006 that metabolic symbol was just a scientific block [Music] metabolic effectiveness metabolic syndrome is a series of little problems that we were made to believe could hide something far more serious in the bright sunshine of toronto in canada a scientist who studied these problems in tremendous detail agrees to be interviewed epidemiologist andrew mendte says metabolic syndrome is just a mix of high blood pressure cholesterol and diabetes and being overweight four known illnesses repackaged in a meaningless way or how to make the old appear new and what we found was that for metabolic syndrome itself the risk of a of a heart attack had an odds ratio of 2.69 so about 2.7 but if you look over here these are components of the metabolic syndrome and we found that two of the components diabetes alone or hypertension alone were equally as effective in predicting future heart attack we can simply be targeting each of these component factors and treating those factors rather than trying to diagnose people as having metabolic syndrome according to andrew mendte's study metabolic syndrome would not provoke a greater chance of heart attack than the four known risk factors which are diabetes hypertension excess weight and cholesterol but why believe him more than anyone else the interheart study was a large case control study conducted in 52 countries around the world in over over 200 centers on all five inhabited continents 27 000 people across 52 countries the canadian study is used as the yardstick the world over [Music] philippen comes to the same conclusion metabolic syndrome is just hot air [Music] treating four illnesses and calling them metabolic syndrome for someone who has just one of them and yet the ad campaign was real enough the best thing is to start worrying early because the abdominal obesity syndrome as you've called it is about having a large waistline but not necessarily associated with the little troubles that might even pass unnoticed if not looked at jointly frankly the message worked journalists thought they were educating the public about something important but again the reality appears to be quite different time to pay dr boris hansel another visit the interview is in the kitchen of his medical unit in the major paris hospital as far back as 2006 even before a complex was on the market the prescriber review which is widely read by doctors wrote that metabolic syndrome didn't exist there was a serious scientific discussion everyone agreed that metabolic syndrome did increase the risk there was consensus on how to diagnose it and what the diagnostic criteria work we know that abdominal fat provokes illnesses no one disputes that no one disputes that that's radical there was another study in the journal of the american college of cardiology carried out in 52 countries and with 27 000 patients which is in my opinion one of the largest studies ever and it states there is no more risk from metabolic syndrome than there is from diabetes cholesterol arterial pressure and abdominal fat the four factors that could have serious health effects by associating these four factors you get metabolic syndrome but it's not really more serious first of all you're right to point out that there are disagreements in the scientific studies they are serious scientific discussions but what everyone has agreed about is that metabolic syndrome causes metabolic disturbances secondly everyone is agreed that metabolic syndrome increases cardiovascular risk no yes it does yes it does wait you said it increased risks and they say exactly the opposite no no no yes yes they do it's a question of statistics do we adjust based on the known traditional factors it's important for patients to know there is no more risk it says i repeat i repeat it depends on the statistics you want to use so sanofi's a compliant drug is approved in 2007 not only for treating obesity but also for people who are overweight and suffer from hypertension diabetes and cholesterol all symptoms of metabolic syndrome the fictitious illness [Music] in fact within an 18-month period accomplia caused side effects in more than 1 000 patients in france notably serious psychiatric problems according to one french medical agency acomplia was responsible for 385 cases of depression of which 125 were serious 69 patients admitted suicidal tendencies according to the agency accomplia caused 10 deaths of which four were suicides [Music] alerted the european medicines agency in london bans the sale of accomplia a year and a half after its launch it's banned also in france soon the ban extends to the rest of the world it's a tremendous blow to sanofi the director of the laboratory is fired blown away by the enormity of the failure [Music] ruth trojan didn't wait for the drug to be taken off the market to stop taking it she felt the side effects just a few days after beginning her course of the drug in 2007 depressions she says quickly set in she agrees to talk about her traumatic descent into uh but i was terrified like an animal that's that's being hunted it could have killed me if i didn't have the presence of mind the the instinct for survival that told me stop this treatment was this the worst you'd ever felt i never felt worse never if a study published by the prestigious british scientific and medical review the lancet is to be believed sanofi knew perfectly well the dangers of the side effects from clinical tests [Music] the people who tested the medicine were two and a half times more likely to stop the testing because of depression than those who took a placebo [Music] despite the alarm signals the health authorities preferred sanofi's version of events and it was the patients who paid the price problem the problem is who should be given the benefit of the doubt tradition has been given to the medicine the company has usually claimed that it's not significant that it's the medicine then production shouldn't be stopped and it should be put on the market and eventually a decision would be made that was the usual reason [Music] in london on the 19th of june 2006 the ema the european medicines agency had been the first to authorize the sale of accomplish inside the eu [Music] was the serious nature of the side effects something that the agency had failed to notice did the scientific experts close their eyes to make a favorable decision on behalf of the laboratory in the heart of the city on the banks of the thames the ema's science boss dr eisler agrees to an interview don't you think it was one of the biggest mistake of the ema giving the authorization to that so dangerous drug i don't think it was a mistake what we need to understand is that drugs behave in one way in clinical trials and it turned out that in the clinical trials the benefit risk was positive in other words there was not a great but a helpful weight loss observed in those patients and we knew there were side effects but they were in an order of magnitude where you could conclude that some patients will benefit therefore we gave it a green light the experts at the prescreer review had expected a red light as they had serious doubts they had asked for access to the study that had led to a company of being authorized for sale [Music] the agency sent them this document which has been largely blacked out was the agency trying to hide something well that's 68 68 page of the studio so that's uh that's good but when you just watch that it's yes all in black okay it's uh no what do you think about it this was such blatant black like that this was a mistake mistake of ours yeah yeah and why why did you did it someone made a mistake within our organization if today or every place career or anybody else asks us for the full data set of clinical trials that we have in-house we would give it to them provided there is no personal data issue this mistake has been committed because dma want to hide the truth about remo level no this was the mistake of one individual that is very regrettable but why did it be that what is the answer it was probably a case of incompetence more than ema not being willing to give out data just incompetence yes the european agency agrees to provide an uncensored copy this time the 68-page document is clearly legible [Music] inside are the precise details about the side effects of accomplish from attempted suicides panic attacks delirium and in some cases aggressive behavior including sexual attacks if in london they haven't seen what depression can do then where are those who promoted the drug in the first place [Music] why didn't dr depray who took part in the clinical tests ring the alarm bells an article dating back to 2007 might provide part of the answer it's 15 million dollars that's what dr dupre the man who discovered abdominal obesity was granted by sanofi to set up a prestigious research foundation whose aim fundamentally was to highlight the syndrome an agreement the doctor prefers to forget at the beginning and it was aimed at finding out more about obesity over how many years over five years from 2005 to 2009 so not 15 million then there were several budgets there was budget for education university uh for our website and uh for the activities of the foundation 15 million dollars from sanofi accepting money from laboratories is always risky and today for the first time professor depray looks back at his involvement with a pharmaceutical company and regrets it didn't heed his warnings [Music] when we carried out the study where we tested uh we noticed the risk of depression was double what i would have liked is to have made sure any patients susceptible to depression be eliminated from the tests did you mention that or at least warn them of course everywhere in scientific podiums but i'm not the one who goes around with a briefcase trying to sell ramona bands you understand i talked about it at conferences based on what the company was saying it seems to me you were in the company's pocket and they use your studies because you are the authority on obesity and they wanted to market this product you think so too of course it is do you say to yourself i was abused by the pharmaceutical industry yes i do yes so we abused betrayed it's not clear whether the doctor regrets the 15 million dollars generously provided by sanofi to his institute dedicated to the belly [Music] syndrome doctors used by the pharmaceutical firms and who outwardly defend the interests of the companies that are pulling the strings behind the scenes [Music] the laboratory in a written statement says it took all the necessary procedures at the time yet if the company had been able to afford the services of the canadian specialist they might also have conducted other communication campaigns in france the expert on abdominal obesity is dr hansel he's the one who recommended accomplia in the parisian newspaper to patients suffering from the metabolic syndrome he also wrote a book on the subject he forgot however to mention in his book that it had been co-published with sanofi and that leads to yet more questions including whether he really did sever his links to the company i'm curious because obviously suggesting physical exercise eating better stressing less while at the same time you're in partnership with sanofi a pharmaceutical laboratory why weren't you linked with a shop that sells sports clothes or sells organic food for a better diet i was never in partnership with sanofi i don't know where you got that from [Music] well your book [Music] for statutory reasons they didn't want to distribute them so as not to give the impression they were directly involved with the book but by buying five thousand copies i imagine sanofi allowed hachette to go to go ahead with a book it probably covered all the expenses yours and assets and allowed the book to be published well what's true is that at the time so if you wanted to develop the medicine and present it as a cure for abdominal obesity exactly that's what we're interested in so they were happy that metabolic syndrome was being talked about do you ever feel that you were being used by sanofi for example if you gave you an award for your internet site on belly syndrome as well as 23 000 euros for the research you'd conducted into stress and metabolic syndrome the impression is that sanofi wanted are also aware i always follow so it's not just the book that links the doctor in sanofi to recap for his work on belly syndrome dr hansel received 23 000 euros from sanofi he also received an award for his educational website also from sanofi last january his theories were sponsored by sanofi the list gets longer yet the professor insists that sanofi's support was disinterested [Music] so how will he react to the now infamous presentation in 2007 that recommends a complier to treat metabolic syndrome be honest sanofi made the link between belly syndrome and accomplia every time it had a chance to deal with doctors in this regard yes they did do that but i can assure you i know nothing about it it's abnormal because i'm not familiar with that presentation let's take a look here it is look a compliant metabolic syndrome i haven't seen this ever you've never seen this document that i've never seen it your name's mentioned i spoke about metabolic syndrome if they then sold more of the medicine that's not my doing i might have benefited indirectly without thinking of it if they rushed in and mentioned what i wanted you say they took advantage of me to talk about what they wanted yes you're right that's how i see it with serious side effects too in france 9 out of 10 people say they trust their doctors the family doctor the one we've known since we were small and is worthy of our trust or at least usually but can we still trust their diagnosis [Music] martial angel can answer that one the former publisher of the new england journal of medicine the bible of the independent medical press and today a professor at harvard she says trust is no longer possible [Music] if a drug company wants as big a market as possible the company will promote conditions that affect almost everyone there's much more money in doing that than in making drugs to treat serious medical conditions that affect a relatively small number of people and if you look at these these diseases that they're marketing they're diseases that are fairly ill-defined and they're diseases that affect mainly fairly normal people and they can convince people that that a lot of people have this disease then their market gets bigger and sometimes they create medical conditions sometimes they just expand the boundaries of existing conditions but either way their market gets bigger extending the perimeter of an illness what was uncovered during this documentary is surprising laboratories that continue to push the limits and lower the very thresholds of diagnosis their aim is to treat as many patients as possible and for as long as possible a study carried out in the united states shows how just by changing a comma or a digit the number of patients can increase significantly take diabetes which before was diagnosed if one had 140 milligrams or more of blood sugar per deciliter of blood then in 1997 a who committee lowered the threshold to 126 milligrams and in one fell swoop 1.7 million more americans suddenly became diabetic the same is true of cholesterol in 1998 the threshold went from 240 to 200 and 442.6 million people in the usa alone and an 86 increase in clients for the pharmaceutical companies [Music] it seems now that there are only two kinds of people in the world those who have medical conditions and those who don't know it yet and and that's what the drug companies are working on in geneva these people may not know they are ill osteoporosis is a well-known disease that weakens bones and today its world osteoporosis day to alert measure and detect the disease the organizer of this event has broken the piggy bank the woman looking for information is giselle val in no time at all the volunteer worker will ask her to complete a lengthy questionnaire what kind of questions did you ask madame um well with the frank's test you can calculate the risk over the next 10 years of bone fractures no time to think it's off to the bone inside a sacred object the bone denser meter a machine that's worth several tens of thousands of euros that takes x-rays of bones the objective is to measure bone density in the fight against osteoporosis this exam is decisive careful though if the machine says your bones are weak then you are at risk that's uh from what i see the column from top to bottom then the exam is just to see whether you've had any fractures of the vertebrae in your life not that you know of but i think you may have done these vertebrae this one is lower in the front than in the back as if it's been squashed the test's great advantage is that it helps determine the kind of treatment that's needed to help rebuild the bone it's an important test as it helps decide whether the patient needs medicine and effectively the pharmaceutical industry is never far behind on the track are the companies that are helping finance a campaign it's almost like a major sports event the same sponsors one finds in almost any brochure aimed at the general public and in the midst of this awareness campaign a woman in dark glasses who seems to be avoiding the limelight are you part of the organization no i'm the sponsor who is the sponsor amgen it's a pharmaceutical company it's a new treatment so it's a little early to tell is this sponsorship an important financial investment or is it just a few thousand euros and nothing special well we don't comment about that confidential no comment probably because in this business there's so much at stake the financial risks are considerable but what is osteoporosis exactly the much talked about illness is when bones deteriorate the older we get the weaker they become the result is the compression of vertebrae and the risk of spontaneous fractures look at this osteoporosis informational film broadcast along the lines of a scary movie [Music] one woman in three will suffer from osteoporosis leading to fractures that could prove fatal if you know there's a danger that threatens you wouldn't you do something to stop it one woman out of three fatal danger numbers and words and music meant to scare you the fear of illness a sentiment that laboratories exploit to the full these days and to ray moynihan this systematic practice must be stopped disease-mongering is something the australian journalist is very familiar with he's been monitoring it and the pharmaceutical companies for 15 years he's noticed that the best sales occur when the companies instill fear in fact it's the key to their strategy sadly i think the marketing of fear has become central to much drug company marketing that the fear of getting old the fear of having a sexual difficulty the the fear of having a fracture the fear of having a heart attack the fear of of being your children being suicidal the fear of your children not succeeding at school and and these these fears are used in order to turn healthy people into patients osteoporosis becomes a bigger and bigger global health problem osteoporosis is a silent disease that could affect 3.3 million women according to a french think tank it's quite an epidemic and yet some doubt whether it's real disease is that what you're asking osteoporosis is the aging of bones it's the aging of skin the answer tends to be no everyone gets wrinkles fairly quickly and everyone's bones get weaker as they get older osteoporosis the thinning of the bones is a risk factor for future disease it's a risk factor for future fracture but it has been sold to the world as a silent killer disease that we must address and we must treat with drugs to define osteoporosis and treat it more effectively the health authorities arbitrarily decided the reference should be the bone density of a 30 year old woman not 60 not 40 but 30. the bones of a young woman were taken as being normal and that instantly classified large numbers of older women as being abnormal so every older woman or every woman older than 30 is going to show some loss of a bone mass after a certain age if you have a condition that everyone has then it's a mistake to treat it like an illness to take a drug for it this is a classic example of disease mongering of turning ordinary life into medical conditions and of turning ordinary people into potential patients a healthy woman whose doctor told her she was sick that's what happened to shirley bowles [Music] united states district court southern district of new york master file on the 8th of august 2011 in florida shirley bowles records her last will and testament a moment captured on video by her lawyer seriously ill she attacks merck the pharmaceutical company shirley bowles takes the oath and she enters the fight of her life for eight years the 73 year old american had been taking fosmax a drug meant to fight osteoporosis it's produced by merck and sold throughout the world shirley suffered from necrosis of the jaw a serious side effect of fosmax as her health worsens her lawyer decides to record her will on camera these are the last pictures of shirley bowles [Music] what was your understanding of why he prescribed fosa max to you it was to strengthen your bones did you follow dr mill's advice on this medication yes yes ma'am can you describe for us what pain you feel from these jaw problems it's like a sometimes it'll start off like a terrible toothache just really and then it would begin with would go like halfway and then you know it's go back the other way how often are you in pain man from your jaw every minute i'm bored the physical agony that consumes shirley is therefore due to phosmax the anti-osteoporosis drug which was sold beginning in 1995 by merck laboratories since then an estimated 225 million people like shirley bowles have taken the drug it's a successful medicine and one that brings in as much as three billion dollars a year her family provided these pictures of shirley bowles in 1997 shirley is 59. her doctor diagnosis she's at risk from osteoporosis and prescribes fosomax and she takes the drug for eight years [Music] but the medicine never took care of shirley instead it ate away at her jaw little by little what does the word fistula mean to you it means an opening oh sore do you have any yes i do mr videographer you could kind of zoom in on mrs bowles face and chin can you point to your fistulas for the jury please ma'am okay the very first one was underneath here the second or they sort of went in right a serious infection of the jawbone for an illness she never had during trial some compromising emails were produced in court in them employees of merck suggested tampering with studies that showed a link between fosomax and the case of necrosis of the jaw in another email the director of the clinic flatly refuses to pursue a study on the side effect shirley bowles lawyer is visibly angered by the correspondence when he cross-examines a merck executive he writes to you how about if we a keep on the lookout for msgs with potential in this area b pass them on to the type of intra merck onj organization monjo right that you outline below for vetting c tweak out something that looks good and d search out the money did i read that correctly uh you read that correctly is this how it works at mark is this how it works that you guys got a monjo hit squad that looks for potential studies and then tweaks them out so they look good to merck is that how it works dr kimmel made several proposals those are his proposals i mean that's all i can be for sure of in terms of what he meant by that statement [Music] tim o'brien is shirley boles's lawyer and for the first time he implicates the pharmaceutical giant merck as the fosomex drug is accused of being responsible for the side effects merck knew for years that it had to study this and here we are years later and it has still not conducted one study one single study to systematically address the relationship between phosmax and osteonecrosis of the jaw it's too great a risk and it's precisely what the jury in new york decides in the shirley bowls case merck has fined 1.5 million dollars in damages [Music] and this for an illness she contracted while treating an illness that she never had but money can't cure everything on the 4th of september 2011 shirley bowles dies due to complications of necrosis of the jaw [Music] [Music] despite the verdict merck continues to insist its drug is effective and brings genuine benefits to the patient [Music] it reduces the risk of fractures by a half it says this merck laboratory document has the same claim that the medicine reduces by 51 percent the chances of a broken hip to check merck's claims afsapps the french agency for the safety of health products was approached and their findings were clear-cut on its own website the agency stated it came to the same result namely that there was a 51 reduction in the risk of a broken hip the aim is to reduce the risk of fractures by 50 percent and it matches the figures we have for the drug that limit bone mass loss two different sources one message which is reassuring other than the fact that after the inquiry we discovered the source for the french agency's information [Music] was merck the french agency was basing its results purely on the laboratory studies of the company that produced the medicine yet even more serious was a report commissioned by the fda the american food and drugs administration which revealed a dirty tricks campaign it states the risk of fractures is reduced by half due to the drug but if the report is studied carefully then it can be seen the natural risk is minimal just two percent as against one percent with fosomax an effectiveness that is purely relative to be clear if you take two people who have osteoporosis fosomax prevents one of them from suffering fractures but stepping back a little the reality is that only two people in 100 who have osteoporosis will have a fracture anyway a very small number but not a fact the laboratory wants to advertise of the two people out of 100 at risk fosomax will only save one isn't somebody making fools out of us [Music] i think a lot of the marketing of the osteoporosis drugs has really oversold the benefits for example the world was told that fosomax can cut the risk of fracture in half it can cut your risk of hip fracture let's say by 50 percent now that technically may be true but in actual fact if your risk is just two percent to start with then it cuts it from two percent to one percent and according to the same fda report the medicine becomes dangerous after being administered for more than three years something else the drug company is reluctant to talk about fortunately though there's afsaaps [Music] don't you feel misled by the figures being touted by the drugs companies that give the impression they reduce the risk of fractures by a half when the risk is really very small anyway i don't know the numbers so i can't tell you it does seem small though why it's their opinion yes i understand but it seems small i guess you have to see it also in perspective how's it possible you don't know the numbers no no the other important information it appears that after a certain time the medicine does more harm than good what do you think of those findings it's still in the fda report i can't judge i don't know it [Music] well it's fairly clear that asaps won't be much of a source for treatment of osteoporosis in the meantime the pharmaceutical companies can rejoice and make themselves at home in all our drug stores and maybe not for that much longer there are currently an estimated 1700 lawsuits filed against merck in the united states for necrosis of the jaw [Music] this document issued by the american dentists associations the risk of osteonecrosis of the jawbone is 1 in 23 a little more than 4 percent that's six thousand times higher than mercs official figures which was once again picked up by [Music] afsceps [Music] [Laughter] no one at merck was available for interviews so instead there's a conference in which they're participating in downtown paris merck like other drug companies has a stand to show off its products during a scientific symposium on osteoporosis among the urdurv and champagne is one of the company's salesmen hello are you in charge of the merc stand yes is there someone in charge here from merc not at the moment maybe later yes of course you can request a meeting but not at the stand no that's just me here because we've asked many times for a meeting we wrote well usually maybe not but we've been asking for three months three months and nothing listen i'll pass on your request not authorized to talk okay but you did say there'd be a merck medical director in this room just need to find her excuse me have you seen anyone from merck here someone we can talk to yes but she's a sales person and can't talk to us and we've been trying for three months to find someone who can answer our questions i'm not from merc though so we saw do you know where they are i saw some merck people this morning do you know where they're going [Music] no sign of merck on the horizon or is that there is professor christian rue a specialist on osteoporosis it's his osteoporosis research and information group the grio that is organizing this forum and welcoming drug companies with open arms [Music] and all the drugs companies are just using you as a springboard for their products i hope the doctors can put matters in perspective when it comes to all the various studies that have been presented you can see what's going on in the rooms there's a lot of networking and information sharing yes but it's a great platform for them it's a chance for them to meet doctors and share results once again stand back a critical mind christian rude doesn't seem to have stood back when it came to all the propositions made by the laboratories that produced the osteoporosis drugs among the best known are merck of course and then there's servier lily amgen novartis weth and rosh i don't want to embarrass you but i see that you once worked for merck also for servia i'll stop there it's the truth because i am closely involved in the management of osteoporosis and therefore i've had the opportunity to collaborate with industrial partners that develop the drugs in this field but that doesn't stop me from talking about the limits of these medicines their side effects and the limits of what they can actually do the many commercial ties that nevertheless don't stop the scientists from being independent but on grio's internet site there's a page titled osteoporosis in 100 questions [Music] which is financed by lilly the pharmaceutical firm 100 questions is a lot except that there's not one question on the necrosis of the jaw no question about the side effects there are lots of questions of a positive nature there are many questions on the environment and the kinds of questions that are asked during consultations about milk physical exercise and medicine nothing about the side effects of the medicines though that's kind of awkward it is awkward it's always hard to draw up a list of the side effects for the general public it could be counterproductive could scare people off i think it should be part of the unique conversation between the doctor and his patient the key is when the prescription is made out having said that you're right from the moment there's a site for the public it's useful to have all the information gathered there i'm asking you because the questionnaire has been prepared in partnership with lilly another pharmaceutical company what does such a partnership mean did they pay for the brochure so um originally the brochure was meant to be on paper and be distributed to doctors who wanted it through the intermediary of the laboratory there were several illnesses so they paid for the brochure [Music] not as long as there's editorial freedom but that's just it though isn't it what stopped you mentioning the side effects in the questionnaire if it was put together and paid for by the company as long as as long as there's freedom no i'm trusting you with your answer here look so long as there's complete editorial independence which was the case so it was your call not to mention the side effects it wasn't a brochure promoting medicine and if you look at all the questions it had to give more complete information on that particular question but osteonecrosis of the jaw is a serious side effect it is a serious side effect but it's extremely rare from one percent it's down to about one in fifty thousand what's amazing is that we have a californian study that you must know since you specialize in osteoporosis it's the study here the the study says something completely different you have it right it says the risk is 4.3 and 100. yes so hardly one in 50 000 is it it's 6 000 times higher than mercs's study which is 3 000 times more than the number you've given us and a risk of 4.3 in 100 for necrosis of the jaw is something to think about isn't it of course it's big it is big but they're the only ones with such a high rate and the number you published is one in 100 000. that's the number several scientific companies have given so i think it's been verified the numbers have been compared right but you can't tell me you who were president of griot for five years that i think it's been verified so why put out that figure and not any other it seemed to be the average figure based on the various researchers an average which suits the companies for six months no pharmaceutical company had agreed to be interviewed oh yes the one response was this short note from merck sent by registered post it said that nothing was more important for merck than the safety of its medicines and that no risk of osteonecrosis has been reported during clinical tests but there was no mention of sally bowles her case was possibly just not part of their marketing plan guys