The Revolving Door phenomenon, characterized by the seamless transition of personnel between regulatory agencies like the Food and Drug Administration (FDA), the Centers for Disease Control and Prevention (CDC), and the private companies they are tasked with overseeing, has been a subject of intense scrutiny. This practice, exemplified by specific cases of influential individuals who have moved between public and private sectors, raises critical questions about conflicts of interest, potential regulatory capture, and the integrity of public health institutions.
The roots of the revolving door phenomenon can be traced back to the early days of regulatory agencies. Initially modest and resource-limited, agencies like the FDA and CDC sought expertise from industry professionals as they expanded. Over time, this practice evolved into a routine exchange of personnel between public and private realms.
There are actually too numerous of examples to begin to cover in a short blog entry. To give the reader an idea of what this looks like, we will keep it to a short list of seven cases at the CDC and FDA, and a quick reminder of the trend we have now seen with NIH directors. Consider well the financial implications in a variety of other scandals and outright criminal efforts by large companies. Then, the reader should dwell on the influence of funding, regarding the manipulation of studies, the bribery of experts, and the advertising to the public. Finally, the reader ought to contemplate the concurrent shift in science toward stratified datasets instead of empirical biologic studies. It began with the tobacco industry’s efforts to rescue itself in the 1950s, but now this permeates all discussions on science to a degree wherein we forget that there are immense pitfalls to solely relying on human random controlled trials. That is, when we want to study the safety or danger of certain substances and techniques, we tend NOT to look at the cellular response inside humans anymore. Instead, we now tend to gather large datasets on people with specific reporting criteria which can be manipulated with great ease. As if taking a page directly out of the tobacco companies’ book on misdirection, many people will now sweep aside discussions of toxicology and mechanism, requiring “proof” in the format of epidemiology alone. And, as valuable as epidemiology can be to help reduce uncertainty on various investigations, it cannot prove safety, it cannot prove causation, it is not superior to empirical experiments, and it will never be the scientific gold standard or capable of eliminating the need for case studies, clinical experience, and the hard sciences.
Scott Gottlieb, a former FDA Commissioner (2017-2019), is a prominent figure in the revolving door narrative. Before leading the FDA, Gottlieb was a resident fellow at the American Enterprise Institute, a think tank with corporate ties. After his tenure at the FDA, Gottlieb joined the board of directors at Pfizer.
Andrew von Eschenbach served as the FDA Commissioner from 2006 to 2009. Following his tenure, he joined BioTime, a biotechnology company, as a member of the board of directors.
Margaret Hamburg held the position of FDA Commissioner from 2009 to 2015, overseeing critical regulatory decisions. Prior to her role at the FDA, Hamburg was on the board of directors for Henry Schein, a global distributor of healthcare products.
Julie Gerberding, the former Director of the CDC from 2002 to 2009, is another notable case. After her tenure at the CDC, she assumed the role of President of Merck's vaccine division.
Tom Frieden, former CDC Director (2009-2017), provides another illustrative case. After leaving the CDC, Frieden joined the global health initiative Resolve to Save Lives. While not a private company, this move highlights the transition from public to quasi-private sector roles. His compensation in this role was reported to be at least $300,000 annually.
Brett Giroir, who served as the Assistant Secretary for Health at the Department of Health and Human Services (HHS) and played a crucial role in COVID-19 testing efforts, joined the board of directors at Cue Health, a health technology company, shortly after leaving his position in the federal government.
Former FDA medical officer Curtis Wright, who approved Oxycontin, went to work for the very company who made the drug two years later (and it just so happened that the drug maker’s efforts to woo him before the approval are well-documented).
While not directly related to the revolving door phenomenon, it is worth noting that some members of the National Institutes of Health (NIH) have substantial net worths. Dr. Francis Collins, the former director of the NIH, is estimated to have a net worth exceeding $5 million. Dr. Anthony Fauci, the longtime director of the National Institute of Allergy and Infectious Diseases (NIAID), has an estimated net worth exceeding $11 million. These are openly disclosed valuations based on public records, which do not include ties to other assets, and certainly not any shielded or hidden wealth in international holdings, influential networks, or digital currencies.
This is just the tip of the iceberg. British medical doctor, Richard Smith, chief editor at the British Medical Journal for 25 years, Fellow of the Academy of Medical Sciences, warned us that scientific journals themselves are merely extensions of the marketing arm of pharmaceutical companies:
And we must add to that awareness the fact that at least 70% of published peer-review research cannot be replicated:
Moreover, it is the wrong and worst research which is cited most often:
Consensus scientific opinions are predominantly based on the preponderance of papers and those most-cited. Thus, we can see that in addition to the revolving door, we have the added disappointment that journals themselves are a marketing apparatus, that most of the research is not very good, and that specifically dubious research is what is often guiding the beliefs even among experts.
And then that state of affairs leads us to tribalist arguments out among the citizenry, when instead we all need to be working together collectively to put the screws to every authoritative organization and human health directive in existence.
These are not isolated affairs. Professionally, I have been combatting anti-science from authoritative health organizations for two decades. Years ago, I had to contend with provably wrong diabetes recommendations by the American Diabetes Association and The Academy of Nutrition and Dietetics. Both recommended styles of eating which will give you diabetes. The food pyramid appears to have been crafted with the intent of giving most of the populace metabolic and cardiovascular diseases. Eventually, I just resorted to cold hard experimentalist science instead of arguments. I had diabetic clients test pre and postprandial (after eating) glucoses with different food selections to see for themselves which types of eating reduced blood sugar volatility. Unsurprisingly and totally predictably, they could see for themselves that their doctors and dietitians were not even close to correct. Obviously, low carb and higher dietary fat works the best. I’ve said it before, and I’ll say it again: don’t believe me; don’t believe your expert; DO THE EXPERIMENT YOURSELF. Empiricism annihilates theories and dogma and ideology every time. In the ten to fifteen years since, both organizations walked back their policies on 130 grams of carbs per day (or more), which used to be on their websites. But neither affirm the UK research done at Newcastle University which proves that type-II diabetes is reversible. Think about that. The ADA and AND are still in the Dark Ages. Why? Well, even the funding disclosure on the ADA’s website admits to over $53.6 million from corporate donors, which reads like a veritable Who’s Who of drug makers:
And the Academy of Nutrition And Dietetics is completely captured by the food industry:
We could go on. And I have previously. I have written about the refusal of “experts” to acknowledge diabetes reversal here:
Sadly, we are only just getting started. The American Heart Association and American College of Cardiology were caught with their pants down in 2013, when they decided to recommend another 14 million Americans get on statins:
The whole situation is one of the most flagrant and worrying examples of corporate capture, as not one independent biologist or biochemist on earth agreed with the proclamation, and most researchers rebuked the guidelines. Somehow, Google results today will not even return searches for the AHA or ACC scandal. At the time, scathing criticism abounded. Today, the internet has been scrubbed. A diligent effort on search engines probably can no longer get the reader to find the very article attached above. That's really saying something, because even the Annals of Internal Medicine showed that statins DO NOT REDUCE RISK:
At the very least, the attempt to put millions of additional people on a profit-making drug for the next several decades should be a bit of an eyebrow-raiser. But I find most people don't even recall the scandal. The AHA made no apologies or revisions, and continues to receive over $30 million yearly from drug makers:
Another $690 million comes from “non-corporate” donors, which can and does include individuals who have ties to the very companies which benefit from AHA and ACC recommendations.
And these overt conflicts of interest at the AHA and ACC lead to objectively incorrect information about human health in their printed and online materials. I’ve tackled this before:
The collective memory of the public is short. And the willingness of news organizations to spend any meaningful time on these stories is nearly nonexistent. Rapidly, people forget the scandals, even big and public ones, like when the World Health Organization faked a swine flu pandemic in 2010 in order to line the pockets of vaccine manufacturers:
It is helpful to remember the cautionary tale of Barry Marshall's research on H. Pylori at this juncture. In 1980 he proved that the infection causes ulcers. However, antacids were a multi-billion dollar business; and, as hard as it is for us to imagine now, antibiotics were not a profit model for pharma companies. Drug makers were pushing ahead with antacid medications, despite concerns that they caused cancer:
And the larger scientific community rejected Marshall's work. In fact, in 1983 his peers did not allow him to present his findings. Meanwhile, with antacid treatments, peptic ulcer patients were being permanently damaged by not having access to the cure. Then something magical happened in 1985. Antibiotics became profitable thanks to their newfound widespread use in agriculture:
At last check, the antibiotic market commands about $45 billion per year, and still growing. This provided a more conducive landscape to allow the discussion of Marshall's work through the late 80s and into the 90s. We take it for granted today that ulcers are to be treated with antibiotics, especially after Marshall gained a Nobel Prize in 2005. But the profitability of antacids versus the ever-increasing difficulty in making a profit model for human antibiotic sales almost prevented the science from ever being known.
The severe conflicts of interest in these and other health-related organizations place us all in difficult terrain. We have reached a tipping point, wherein, as much as any of us would like to trust some of the declarations of the FDA, CDC, WHO, NIH, ADA, AND, AHA, ACC, NAS, and on and on the list goes, we simply cannot. We cannot trust these modern day priests and churches any more than any of us could trust the medieval authorities. They are too wrong too often. They are too tied to plutocratic control. And we have no major counteroffensive or safeguard other than intense, unrelenting distrust. The stakes for their mistakes and misdirection are too high. Gone is our former hope that the press would provide a bulwark against the strategically misleading efforts of major profiteers. Deep pockets influence the very stories and ideas we are even allowed to see. The US is the only country on earth that allows widespread direct-to-patient drug advertising. By 2016, pharmaceutical companies allocated $6.4 BILLION to advertise drugs:
Keep in mind that these are the known and direct marketing numbers. This does not include those “non-corporate” individual influential dollars we covered previously. This does not include the revolving door. This does not include all of the funding for that non-replicable research that comprises 70% or more of the papers in science. Really think about this. Think about the astronomical figures we are talking, just to influence purchase. Think about the implications. Think about what this must mean in terms of which candidates, and experts, and messages the media outlets are even allowed to air for us.
It leaves a pretty dystopian landscape, since there is no clear way out. Every time We the People might band together to combat corruption, we end up fighting each other instead, while handing over more power to the corruption we should fight. The political fissure in America is illustrative of how everyone ends up supporting the same bedrock problem at one point or another. Conservative groups empowered wealthy corporate messaging in 2010, hidden within the guise of free speech (#citizensunited). Liberal groups empowered wealthy corporate messaging in 2020, hidden within the guise of science (#trustthescience). And around the circle goes. Political and ideological tribes keep empowering the same exact wealthy corporate messages, all while thinking they are making an appeal to some higher values.
I am still a bit astonished at the willingness of so-called conservatives to defend corporate profiteering, and even more astonished at the willingness of so-called liberals to defend corporate profiteers. The former is not CONSERVing a free market. The latter is not LIBERAting the general public from misinformation and control. Republicans and democrats are running around going to bat for the exact same wealthy powerhouses. How is any defense of a giant multi-national corporation in line with support for a Republic or a Democracy? Pfizer is not the good guy simply by being involved in a form of capitalism. Pfizer is not the good guy simply by being involved in a form of science. Pfizer, or any of these giant organizations whose only interest is in power for itself, is not the good guy. Ever. Not today. Not yesterday. Not tomorrow. Not almost. Not by a long shot. Not that anyone should need a reminder, but the companies who own the messaging of our would-be regulatory agencies are by and large criminals. Literally. Pfizer was ordered to pay $2.4 BILLION for healthcare fraud in 2009:
Pfizer lied in marketing of drugs:
Pfizer illegally bribed overseas businesses for years:
And, of course, it is not Pfizer alone. Merck was caught in one of the largest fraud schemes in history:
Purdue and Sackler are still in negotiations over their $6 billion settlement regarding the bribery of the FDA and knowingly creating the opioid epidemic:
The big 3 were settling on a combined $26 billion for their parts in the opioid epidemic which is already responsible for half a million American deaths:
Johnson & Johnson was ordered to pay $2.2 billion for having bribed doctors and pharmacists:
Hopefully, you get the idea. But if you don’t, feel free to search every single drug manufacturer and “fraud,” “lies,” “bribery,” “kickback,” and related phrases. There are thousands of cases. Here’s a short list of some settlements regarding false claims, Medicare fraud, and bribery:
However, all of a sudden, when the pharmaceutical industry appeared to have found itself on the “correct” side of political debate during the pandemic, many people who would normally pride themselves on distrust of pharmaceutical industry, ironically, vehemently defended the pharmaceutical industry. More than that, defenders of the corporate profiteers vilified their own countrymen who dared to ask if we should be so trusting of pharmaceutical interests.
That’s a problem.
And it remains a problem even when we move our focus from the Pfizers of the world to the regulatory agencies or official organizations who are supposed to be disinterested groups, because, as I painstakingly detailed above, they are NOT disinterested. They are merely arms of the marketing apparatchik of the drug manufacturers and industrial giants of the world.
My hope had been that sober and moderate minds would move increasingly back to a default position of extreme skepticism against wealthy corporations once the tribal rhetoric died down. But three-and-half years after the peak pandemic worry, well into the endemic phase, I’m not so sure. In daily conversations I find that people won’t really acknowledge the fundamental problem with choosing an ideological or political side. They like their sides, even when it means allying themselves with the pharmaceutical industry or wealthy corporations. They keep to their sides, even when confronted with irrefutable contrarian evidence.
Look no further than discussions on vaccines, and you find almost no one who can manage to place himself or herself in a third camp. People immediately stake out a “pro” or “anti” position, and this tends to be informed first by what type of virtue someone wants to signal or which political camp with which someone prefers to be associated. That’s not actually how science works. There are risks AND benefits. AND different drugs or vaccines carry different ratios of risks and benefits. Nowhere does there exist a space to be “pro” or “anti” with regard to an entire category of unrelated or variant substances, especially by tribalist pressures. Some of X may be good. Some of X may be bad. Science does not have a place to be 100% pro-X all the time. Science does not have a place to 100% anti-X all the time. Each particular individual substance must be individually evaluated; and each one will have different degrees of risk or effectiveness.
The resistance against nuance, or new or different ideas is not shocking. Over the past two decades as a health and fitness professional I have seen people refuse to budge off of clearly anti-science beliefs around the “badness” of cholesterol, or salt, or saturated fat, or red meat, or youth weightlifting, or fill-in-the-blank-here. People really like their tribes. People really want to side with wealthy corporations even while in the very act of saying they do not.
The tipping point has brought us to a place where that type of simpleton sidism simply will not do. The sides and tribalism and the ardent defense of really big pocketbooks is not advancing any of the common people. A brief look at American health statistics will show that none of the popular medical advice or popular health and fitness advice has been productive. It is the opposite of effective. It is embedded in a backdrop of ideological and political division, a ruse to keep the majority of people at each other’s throats, distracting us from the rampant corruption and corporate control of messaging. That’s just the stark health outcomes. When we expand our view to look at how wealth is distributed and how real purchase power of the middle class has evaporated since the 1970s, we can see that there is a concerted effort to consolidate all power and money in a tiny oligarchy which effortlessly pits the whims of common folk against each other.
It should come as no surprise then that empirical science is generally not even discussed. The framework for nearly every human health science debate is our interpretations of epidemiological tables, NOT experiments which could be observed and replicated and tested and verified or disproven.
That’s new. That’s engineered to fit perfectly with the revolving door, conflicts of interest in funding, advertising, and monopolistic control of messaging. That’s a problem.
The tobacco industry left an indelible mark on science, even if it ultimately failed to exonerate itself in a court of public opinion. From the 1950s to the 1970s tobacco industry interests set about swaying scientific opinion merely through funding. That is, they knew that if tobacco companies set out to fund research, it would just so happen to be increasingly LESS critical of the tobacco-cancer connection:
Categorically, what occurred in this period of time was a vehement insistence on epidemiology instead of biologic studies. If you subject human cells to smoking, asbestos and tar in a laboratory, it’s pretty clear what happens. If instead you compile enormous epidemiological reports on smokers and reported responses, stratify the results, and present interpolation, there is a lot of wiggle room to say whatever you or your benefactors want to say. If you generate desired conditions for a randomized controlled trial, you can actually prove the opposite of scientific fact WHILE claiming you abided by the gold standard. Scientific fraud and selective data presentation is significantly easier in RCTs than in finite experiments. Try to recall the Nature article above on how 70% of peer-reviewed published research cannot be replicated. Try to guess if that 70% is empirical biologic research or if it is epidemiology.
That trend continues to this day.
In toxicology and biologic studies, we find that any suspension of aluminum or mercury is unsafe to inject into the body. No matter what type of chemical bond they are in, they cross the blood brain barrier and damage neural cells:
The toxicology has no sides. This is irrefutable. It is replicable. Any research facility can conduct the experiment and falsify it. No one has.
Likewise, cholesterol cannot generate heart disease. There is no biologic evidence that it ever could. Nothing in biochemistry allows for it. Any research facility could show how cholesterol molecules are generative in cardiovascular disease. None do.
There are no sides here.
That is the hard science.
That is the only science.
Until someone comes along with soft science, to present stratified results from meticulously-crafted random controlled trials. They decide on the reporting method. They gather the data. They choose how to contrast groups. They generate the inclusion and exclusion criteria. And then they present an interpretation to create the impression there is a debate or another side. Precisely like when the tobacco companies wanted to invent the appearance of uncertainty or debate, many people today hold up epidemiological results as the superior determinant in scientific causation. In fact, you may get labelled a pejorative simply by asking about mechanism or known biology. In fact, you may find yourself joining in the labelling and tarring and feathering of anyone who asks about empirical science or biologic studies.
If we can even take the slightest step back, we can see we have willingly entered total insanity. Imagine awaiting and debating the epidemiology on asbestos and its risks today. If we had not come to a consensus about asbestos and its harm in the 1940s, that would be the case. We would have a whole group of researchers presenting dissenting opinions on the way the RCT data should be interpreted. In fact, it might be considered ignorance to discuss how the microscopic fire-resistant prismatic needles of asbestos destroy human tissue. We might find ourselves ignoring biologic and empirical science about asbestos, only to hold up whatever the industry-funded epidemiology says alone.
We have to create a new paradigm. Sadly, in health-related science, we must adopt a painful degree of disapproval, a painful degree of suspicion and distrust. The conflicts of interest run too deep to hand over our trust. If we are to err in a direction, it must be one that opposes powerful organizations. And the more painful behavior within that adoption could be working together with otherwise political or ideological adversaries. It is going to require some serious ego death and eating a lot of humble pie. Even that may be unlikely to solve our crisis, because we need to go the distance and be adamant that epidemiological datasets are not science in the strictest sense. They are tools, but ones subservient to toxicology, biologic studies, empirical experiments, clinical experience, case studies, and reproducible or verifiable facts.
There are many medical and scientific thinkers who have already sounded the alarm on the limitations of RCTs. We need to begin listening to them. We need to take up the language of Ellis' and Adams' 1997 paper in the International Journal of Clinical Practice: "The Cult of The Double-Blind Placebo-Controlled Trial." It is not a coincidence that the rise of the cult of the double-blind placebo-controlled trial runs parallel to the worsening of health outcomes. As RCTs have become a religious banner of scientific truth, health outcomes have worsened. As influential people ignore empirical biological facts and known scientific mechanism in favor of epidemiology, the public is getting exactly the wrong messages. We can no longer allow RCTs to command our unquestioning devotion. We can consider them as a very small part of the puzzle - a puzzle whose majority is comprised of biologic studies, toxicology, case studies, empirical experiments, clinical experience. But we MUST NOT keep getting fooled into forgetting the hard science while mesmerized by cherry-picked, fraudulent, or manipulated numbers.
We have hit the tipping point with conflicts of interest in human health-related science. We have to be keenly aware of the dangers, between the revolving door, the corporate funding, the interested funding, the advertising juggernaut, and the attempt to replace hard sciences with soft sciences. And we must work together to push back toward a genuine age of science and reason, a genuine democratic effort, a genuine free market. In so doing, may we reclaim common sense itself, our health, our brotherhood of mankind, and our free society.