Joan-Ramon Laporte, MD: “You can’t prescribe an antidepressant over the phone” | Trends | Project

Pharmacologist Joan-Ramon Laporte arrived at the Ateneo de Madrid to present his book. Chronicle of an intoxicated society (Peninsula Editions). The volume and scope of the data included in the work, which brings together the knowledge accumulated during a career dedicated to the study of drug side effects, has not prevented the book from reaching its third edition in just a few months. After several interviews, Laporta, who hosts EL PAÍS at the Atocha station, is particularly concerned with one question: “Has the book been read?”

Chronicle of an intoxicated society It is a solid bastion that resists almost any criticism. This work, defending a provocative thesis, demands that anyone who questions it delve into its nearly 700 pages of information, with a show of rigor and a pronounced vindictiveness.

In February 2022, the Catalan pharmacist was invited to participate in the Congress of Deputies’ study committee on vaccine management. During his speech, he expressed some controversial ideas about these treatments and suggested that mass vaccination was a “global experiment”. His statements, which have been criticized in various media, are still not entirely clear to Laporte. “Well, yes, of course, it was an experiment, and at first it seemed worth doing,” he says.

After the pandemic, Laporte began writing this book. In the introduction, he acknowledges the existence of a “silent epidemic of drug side effects.” It notes that in Spain, these effects are responsible for more than half a million hospitalizations and at least 16,000 deaths each year, as well as tens of thousands of cases of various diseases such as cancer, heart disease, dementia, and Alzheimer’s. Likewise, the author acknowledges that “when they are really needed, there are many drugs that can cure the disease or alleviate its symptoms.”

Economic interests

A pharmacologist warns of a significant increase in drug consumption; in the last 20 years, this consumption has almost doubled in developed countries. “Polypharmacy is the norm,” he says. “For every two people over 70, five or more drugs have to be taken continuously.” According to the doctor, many of these prescribed drugs are unnecessary, contraindicated, unsuitable for the patient, or prescribed in too high doses.

Laporte identifies five systemic elements that contribute to this global epidemic. Most notably, each new drug is evaluated by the company that makes it, and regulatory agencies accept the results of these studies without effective verification of the reliability of the data. The results of clinical trials, he adds, are usually kept confidential. “If they are not favorable to the drug, they are not published, or a modified or even invented version is published,” he says.

The expert emphasizes that the financial priorities of sponsors have a significant impact on biological research. Since the pharmaceutical industry is the largest investor in medical research in the world, it dictates the questions and goals of this research. “This leads to interest being focused more on the drug than on the patient,” he says. According to Laporte, this approach can distract attention from the most important aspects of treatment and health care, since decisions about what to study are motivated more by potential profit than by real medical needs.

Chain of side effects

Laporte realized that society was “drunk” after decades of work and research in the field of pharmacovigilance. In 1982, he started a project, funded by the Medical Research Foundation, that asked doctors to report suspected adverse drug reactions using a “yellow card” system inspired by the British method. This system made it possible to collect the necessary data to understand and improve the safety of drug use.

Early reports included unexpected cases, such as a rash in a child who had taken paracetamol for a cold. This and other similar cases showed that many doctors did not realize that some illnesses could be caused by drugs. Instead of ruling out the problematic drug, they prescribed others, creating a harmful cycle known as iatrogenic cascades, which occur when treating a drug-induced side effect leads to prescribing more drugs, which can cause more side effects and require more courses of treatment.

Laporte notes that the debate on drug abuse does not usually appear in the media for two reasons. On the one hand, there is the secrecy surrounding drug development, and on the other, there is a general perception that the topic is too technical for the general public. “The reality is that most doctors don’t know what I’m talking about in the book,” he says. Many workers are “intoxicated” by information about new drugs controlled by pharmaceutical companies, Laporte says. “The marketing department The company selling the drug knows full well that the doctor prescribing it knows nothing about its technical properties. What’s interesting is to convey a story that’s complex enough to make you feel like there’s complex science behind it.”

The pharmacist advocates a profound rethinking of the doctor-patient relationship, promoting a more human approach and less focus on technology and drug administration. “There are many doctors who rely on cryptic and arcane language, like getting answers from a mysterious oracle,” he says. This, he says, reflects a change in modern medicine, which communicates less and less with the patient.

Laporte recalls that at the end of his career, a physical examination was essential. “If a patient came into the office with acute abdominal pain, the most important thing was a physical examination. Where does it hurt, how does it hurt? Instead, nowadays, the first step is usually to send the patient for an ultrasound. Although this is a great technical advance, it distanced the doctor from the patient,” he says. He also criticizes the lack of time doctors have for patient care. “This has introduced virtual consultations into our lives. “You can’t prescribe an antidepressant over the phone.”

While his interventions in Congress are now a thing of the past, Laporte notes that this is not the first time he has done so. He says he did not find his comments controversial. “I have always said that when a new drug comes out, we must check the statements of the manufacturer, who clearly has their own interests,” he explains. “When the vaccines were released in January 2021, I asked myself the same questions I always ask about any new drug: How long will the protection last? How will they respond to new variants? Will they be able to prevent transmission? What undisclosed side effects might they have? And within a few months, we began to get answers.”

The doctor addresses the controversial issue of being labeled as an “anti-vaxxer” and how it affects public debate. “When I am asked in interviews whether I am anti-vaxxer, I have said that I will not answer. I find it very astonishing to accuse someone of being anti-vaxxer simply for expressing doubts about the COVID vaccine,” he explains. According to him, such accusations divide society and breed hatred. He notes that it has been impossible to have a calm discussion on the topic and that neither the public administration nor the media have facilitated this type of discussion.

At 76, Laporte continues to show fighting spirit. Asked what he does when he has a cold, he replies: “If I’m really sick and my whole body hurts, I take a small dose of paracetamol or ibuprofen. “A 200mg dose of ibuprofen is as effective as a 400mg dose, but with fewer side effects, which are particularly common among older people.” He regrets that the 200mg tablets are not sold in Spain, so he buys them when he travels to France. “It would be good news if someone sold them in Spain, unless they were sold as sweets.”