Payments to America's Physicians - A Potential Conflict of Interest

A recent Research Letter published in The Journal of the American Medical Association or JAMA provides us with insight regarding the functioning of the American medical system, particularly, the relationship between physicians and Big Pharma.  In the article, the authors examined data from the federal government's Open Payment platform which records payments to physicians from the health care industry, focusing on physicians in specialty practices.  Open Payments was established under the Physician Payments Sunshine Act in August 2013 in an effort to ensure that patients would have the ability to discern whether financial conflicts of interest may influence physicans' prescribing histories.  Data for physicians are available in a searchable database by either physician name or hospital and, over the past two years includes payments to physician assistants, nurse practitioners, clinical nurse specialists, certified registered nurse anesthetists, anesthesiologist assistants and certified nurse midwives. Payments include but are not limited to research, meals, speaking fees, travel, entertainment, education, grants, charitable donations, honoraria and gifts noting that there is an absence of data on certain types of payments like free drug samples..  

  

For 2022 alone (the latest year for which data is available), industry made 14.11 million payments totalling $12.58 billion US to physicians as shown here:

 

Going back to the study as a whole, the authors found that between 2013 and 2022, 85,087,744 payments were made by industry to 826,313 of 1,445,944 eligible physicians across 39 specialties with the median payment of $48 per physician.  The highest annual total value was $1.60 billion in 2019 and the lowest was $863.93 million in 2020.  Let's look at some details:

 

1.) Highest sum of payments by specialty:

 

- orthopaedic surgeons - $1.36 billion (31,620 recipients)

 

- neurologists/psychiatrists - $1.32 billion (58,688 recipients)

 

- cardiologists - $1.29 billion (33,074 recipients)

 

- hematologists/oncologists - $825.8 million (17,025 recipients)

 

- general internal medicine - $588.2 million (97,542 recipients) 

 

Payments were highly skewed with the payments to median physicians ranging from $0 to $2339 compared to $194,933 for the top 0.1 percent of hospitalists and $4,826,944 for the top 0.1 percent of orthopaedic surgeons.

 

2.) Highest sum of payments by drug:

 

- Zarelto - $176.34 million

 

- Elequis - $102.62 million

 

- Humira - $100.17 million

 

Other drugs associated with high payments include Invokana, Jardiance, Farxiga, Dupixent, Botox and Keytruda. 

 

3.) Highest sum of payments by medical device:

 

- da Vinci Surgical System - $307.52 million

 

- Mako SmartRobotics - $50.13 million

 

- CoreValve Evolut - $44.79 million

 

Other devices with high payments include Natrelle Implants, Impella, Sapien 3 and Arthrex Devices.

  

During the pandemic, it became quite obvious that many physicians had very close relationships with the medical industry, in particular, the pharmaceutical arm of the business.    It is quite apparent that the health care industry directs payments of various types to physicians to influence their practices and preferences; by directing payments to physicians and other medical professionals, the health care industry is anticipating greater profits.  After all, they aren't making billions of dollars of payments to their customers without expecting a significant return on their "investments".  Unfortunately, these investments have the potential to create conflicts of interest with some physicians potentially making life and death decisions for their patients based on the influence of their benefactors.

Measles - Natural Immunity and Adult Vaccination

Public health officials (yes, the same ones that promoted COVID-19 vaccines) are now on to their next viral "boogeyman", measles.  As background, like many people particularly baby boomers, when I was younger, I had both red/hard measles also known as rubeola and German measles also known as rubella.  Given the recent advice being offered by public health officials that ALL people should be vaccinated against measles, I wondered if there were any studies that compared vaccine-induced immunity to measles to natural immunity among the vast community of adults who have already had one or both types of measles.

 

Let's start with this announcement from Canada's  Chief Public Health Officer, Teresa Tam:

 

 

Note the following recommendations:

 

1.) I strongly advise everyone in Canada to be vaccinated with two doses of a measles vaccine, especially before travelling.

 

2.) Adults should ensure they have received two doses of a measles-containing vaccine if they were born in 1970 or later, and one dose of a measles-containing vaccine if born before 1970.

 

Notice that Canada's Chief Public Health Officer states absolutely nothing about natural immunity conferring protection from measles, particularly for adults born prior to 1970.

 

According to the Centers for Disease Control and Prevention, the following  vaccination recommendation applies for adults:

 

"People who are born during or after 1957 who do not have evidence of immunity against measles should get at least one dose of MMR vaccine."

 

Evidence of immunity is defined as follows:

 

"Acceptable presumptive evidence of immunity against measles includes at least one of the following:

 

1.) written documentation of adequate vaccination

 

a.) one or more doses of a measles-containing vaccine administered on or after the first birthday for preschool-age children and adults not at high risk

 

b.) two doses of measles-containing vaccine for school-age children and adults at high risk, including college students, healthcare personnel, and international traveler

 

2.) laboratory evidence of immunity

 

3.) laboratory confirmation of measles

 

4.) birth before 1957"

 

Note that the CDC is using a 1957 birth year and that Canada's CPHO is using a 1970 birth year.  It is also interesting to observe that, unlike Canada's Chief Public Health Officer who advises that all Canadians should be vaccinated,  the CDC has an extensive list of people who should NOT get the MMR vaccine:

If adults who were born during or after 1957 plan to travel internationally, these are the CDC's recommendations:

 

"Teenagers and adults born during or after 1957 without evidence of immunity against measles should have documentation of two doses of MMR vaccine, with the second dose administered no earlier than 28 days after the first dose."

 

Here's another quote from the CDC in a March 2024 update:

 

"Measles is so contagious that if one person has it, up to 90% of the people close to them can also become infected if they are not protected by vaccination (or, less commonly, prior infection)."

 

Here is a listing of MMR and MMRV (measles, mumps, rubella and varicella) vaccines used in the United States from the CDC:

 

1.) M-M-R II® is a combination measles, mumps, and rubella (MMR) vaccine manufactured by Merck & Co, Inc.

2.) PRIORIX® is a combination measles, mumps, and rubella (MMR) vaccine manufactured by GlaxoSmithKline Biologicals (GSK).

3.) ProQuad® is a combination measles, mumps, rubella, and varicella (MMRV) vaccine manufactured by Merck & Co, Inc.

The CDC states that both serologic and epidemiologic evidence indicate that vaccine-induced measles immunity appears to be long-term and probably lifelong in most persons.  Studies indicate that one dose of vaccine confers long-term, probably lifelong, protection against rubella.

 

Now, let's look at a study which compares long-term immunogenicity after measles vaccine versus infection with the measles virus which appears on the National Institutes for Health National Library of Medicine website:

 

The authors of the Italian study used 611 subjects, both students and residents of the Medical School of the University of Bari and tested their immunogenicity (IgG) to measles, dividing them into two groups; those vaccinated with two doses of an anti-MMR vaccine (measles, mumps and rubella) and those who had a self-reported history of measles infection.  In Italy, the measles vaccine protocol was introduced in the 1970s with two doses of MMR live virus vaccine being recommended in 2003 with the first dose at 12 to 15 months of age and the second at 5 to 6 years of age.

 

For each subject, a 5 mL serum sample was collected to assess the immunity and susceptibility status.  Vaccinated individuals who had a non-protective immunogenicity (IgG) titre received an MMR vaccine with a second blood test being performed 20 to 25 days later to measure the IgG titre.  If the value did not exceed the cutoff, the individual was classified as non-seroconverted and a second vaccine dose was administered 28 days after the first booster.

 

The authors observed the following with my bolds:

 

1.) Although the immune responses induced by the vaccine are qualitatively similar to those induced by infection, antibody levels are lower after vaccination. Vaccination at a young age enhances the quality and quantity of the antibody response but has a minor effect on T cell responses. However, over time, virus-specific antibodies and vaccine-induced CD4 + T cells decrease, accounting for the secondary vaccine failure rate of 5% 10–15 years after immunization.

 

2.) The authors assessed each subject's protective antibody survival or PAS which is defined as the time elapsed from the second dose of routine MMR vaccine to the evaluation of antibody titer (years) or the time elapsed between natural measles infection to the evaluation of antibody titer (years).  They found the following:

 

"The group that had been infected by the wild virus have far longer protective antibody survival to measles than those who receive the measles vaccine."

Here is a graphic which shows the results of their analysis:

3.) "While further research is needed, our study clearly showed that natural immunity is both more robust and longer-lasting than vaccine immunity. However, this finding should not lead to a questioning of the role of measles vaccination."

Let's close with this data from the CDC showing how measles vaccine effectiveness is quite widely variable as follows:

 

One dose - 1 dose of MMR vaccine is—

93% effective for measles (range: 39%–100%)

78% effective for mumps (range: 49%−92%)

97% effective for rubella (range: 94%–100%)

Two doses - 2 doses of MMR are—

97% effective for measles (range: 67%–100%)

88% effective for mumps (range: 32%–95%)

 

Let me be clear - I am not against vaccinating for measles given that there is a risk of severe and permanent health complications from a measles infection.  Since measles vaccines were introduced in the early 1960s and the MMR vaccines were developed in 1971, the incidence of measles has been reduced by 99.9 percent with an estimated 20 million lives being saved so there is little doubt that the measles vaccine is effective.  That said, the study quoted in this posting shows clearly that infection with the wild measles virus confers longer-lasting immunity to measles than the vaccines which suggests that vaccinating adults who have had measles is probably unnecessary and fear-mongering about requiring measles vaccines for adults by public health officials is just that, fear-mongering, about a vaccination that is not necessarily based on science and will only serve to "fill the wallets" of Big Pharma.

mRNA Technology and the Seasonal Influenza Vaccine - The Next Experiment on Humanity

Here is a recent announcement that appeared on the United States government's clinical trials website:

 

 

Anthony Fauci's former employer, the National Institute of Allergy and Infectious Diseases or NIAID is sponsoring a Phase 1 trial of a mRNA-LNP (lipid nanoparticle) vaccine for influenza.  The vaccine, currently has the catchy name H1ssF 3928 (aka VRC-FLUNPF099-00-VP) and is known as a virus quadrivalent inactivated vaccine.  The name of the vaccine is an abbreviation of H1 hemagglutinin stabilized stem ferritin which means that the vaccine uses the stem part of the influenza vaccine as its immunogen rather than the head of the virus which is the target of traditional influenza vaccines.  The vaccine consists of a modified nucleic messenger RNA (mRNA) encapsulated in lipid nanoparticles with the lipid components including polyethylene glycol (PEG), cholesterol and ionizable lipids.  As in the case of the COVID-19 mRNA vaccines, the lipid nanoparticles prevent the human body from breaking down the mRNA before it has a chance to affect immunity just as was the case for the Pfizer and Moderna COVID-19 mRNA vaccines.

  

In the trial, the vaccine will be intramuscularly administered to 50 healthy adult volunteers between the ages of 18 and 49 years inclusive.  Volunteers will be divided into five groups of ten individuals in five experimental arms.  The purpose of the trial is to assess the safety and immunogenicity (i.e. effectiveness) of one dose of H1ssF 3928 at various doses of 10mcg, 25 mpg and 50 mcg as follows:

 

 

One of the arms of the trial will be used to compare the antibody responses to H1ssF 3928 with a traditional standard dose of IIv4, a traditional quadrivalent influenza vaccine that is "effective" against four different influenza viruses (two influenza A viruses and two influenza B viruses) that many of us have received over our lifetimes.

  

Here are more details on how the trial will be conducted:

 

"Eligible participants will be sequentially enrolled into dosing groups (10 mcg, 25 mcg, and 50 mcg, selected optimal dose) to receive the H1ssF 3928 mRNA Vaccine at the specified dose. A separate group of 10 participants will receive licensed quadrivalent influenza vaccine (IIV4). Subjects receiving IIV4 will be followed for safety but only their immune responses will be compared to those of participants receiving H1ssF 3928 mRNA Vaccine. Dosing of H1ssF 3928 mRNA Vaccine will commence at the lowest dose (10 mcg) and only escalate to the next highest dose if safety concerns are not identified. For each VRC H1ssF 3928 mRNA-LNP (Lipid Nanoparticle) dosing group, the first two subjects enrolled will be considered the sentinel subgroup. After the two subjects in the Low Dose sentinel subgroup are enrolled and given their vaccination, enrollment will then be stopped pending a review of the reactogenicity and safety data collected through Day 3 for both subjects. Approval by the reviewing group will allow for continued enrollment of the remaining Low Dose Group subjects to complete enrollment of 10 participants. After Low Dose Group enrollment is completed, enrollment will be stopped pending an Safety Review Committee (SRC) review of the reactogenicity and adverse event (AE) information through Day 7 and clinical laboratory results through Day 8 for all Low Dose Group subjects. Approval will allow dose escalation and initiation of enrollment of the Medium Dose Group sentinel subgroup. After the two subjects in the Medium Dose sentinel subgroup are enrolled and given their vaccination, enrollment will then be stopped pending a safety review of the sentinel subgroup as specified for the Low Dose Group. Approval will allow for continued enrollment of Medium Dose Group subjects to complete enrollment of 10 participants. After the Medium Dose Group enrollment is completed, enrollment will be stopped pending an SRC review of the reactogenicity and adverse event information through Day 7 and clinical laboratory results through Day 8 for all Medium Dose Group subjects. Approval will allow dose escalation and initiation of enrollment of the High Dose Group sentinel subgroup. After the two subjects in the High Dose sentinel subgroup are enrolled and given their vaccination, enrollment will then be stopped pending a safety review of the sentinel subgroup as specified for the Low and Medium Dose Groups. Approval will allow for continued enrollment of High Dose Group subjects to complete enrollment of 10 participants. After the High Dose Group enrollment is completed, enrollment will be stopped pending an SRC review of the reactogenicity and adverse event information through Day 7 visit and clinical laboratory results through Day 8 for all High Dose Group subjects. Reactogenicity and AE information through Day 7 and clinical laboratory results through Day 8 from the first three dosing groups will guide the selection of an optimal dose group to include an additional 10 subjects who will receive the optimal dose of mRNA-LNP. The primary objective of this study is to assess the safety of a single dose of VRC H1ssF 3928 mRNA-LNP vaccine administered IM in healthy adults, 18-49 yrs, at doses of 10 mcg, 25 mcg, and 50 mcg. The secondary objective of this study is to assess serum antibody responses to a single dose of VRC H1ssF 3928 mRNA-LNP vaccine administered IM in healthy adults at doses of 10 mcg, 25 mcg, and 50 mcg in comparison to a standard dose of IIV4."

  

Here are the primary outcome measures:

 

1.) Occurrence of any adverse events of special interest (AESIs) with VRC H1ssF_3928 mRNA-LNP vaccine. [ Time Frame: Day 1 through Day 366 ]

2.) Occurrence of any influenza-like illnesses (ILIs) with VRC H1ssF_3928 mRNA-LNP vaccine. [ Time Frame: Day 1 through Day 366 ]

3.) Occurrence of any medically attended adverse events (MAAEs) with VRC H1ssF_3928 mRNA-LNP vaccine. [ Time Frame: Day 1 through Day 366 ]

4.) Occurrence of any new-onset chronic medical conditions (NOCMCs) with VRC H1ssF_3928 mRNA-LNP vaccine. [ Time Frame: Day 1 through Day 366 ]

5.) Occurrence of any serious adverse events (SAEs) with VRC H1ssF_3928 mRNA-LNP vaccine. [ Time Frame: Day 1 through Day 366 ]

6.) Occurrence of any unsolicited adverse events (AEs) with VRC H1ssF_3928 mRNA-LNP vaccine. [ Time Frame: Day 1 through Day 28 ]

7.) Occurrence of clinical laboratory adverse events (AEs) with VRC H1ssF_3928 mRNA-LNP vaccine. [ Time Frame: Day 1 through Day 57 ]

8.) Occurrence of solicited reactogenicity adverse events (AEs) with VRC H1ssF_3928 mRNA-LNP vaccine. [ Time Frame: Day 1 through Day 14 ]

Both local and systemic adverse events will be assessed

 

The study had an estimated starting date of May 12, 2023 although the website claims that recruitment has not begun and a final data completion date of March 15, 2024 for the primary outcome measure.

 

Better line up folks.  Apparently, despite the fact that the technology has yet to be proven to be safe and effective over the medium- and long-term, humanity simply cannot get enough mRNA technology injected into our bodies.

Monica Bertagnolli - The Links Between the Nominee for Director of the NIH and Big Pharma

Joe Biden's newly nominated candidate for Director of the National Institutes for Health (NIH), Monica Marie Bertagnolli:

 

...has a very cozy relationship with one of America's largest pharmaceutical companies and a strong connection to the President as you will soon see.

  

As background, Dr. Bertagnolli was also appointed as Director of the National Cancer Institute (NCI) by the Biden Administration on October 3, 2022, one of 20 Institutes that make up the National Institutes of Health as shown here:

 

 

NCI is the federal government's principal agency for cancer research as part of the National Institutes of Health.

 

Let's look at Dr. Bertagnolli's connection to Big Pharma.  Thanks to Open Payments Data, an official website of the U.S. government, we know which companies have funded Bertagnolli's research.

  

Here's her payment summary for 2021, the latest year for which data is available:

 

 

Associated research funding is provided to research a project of study where the physician named is the principal investigator, in this case, Dr. Bertagnolli.

  

Here is a graph and table showing Dr. Bertagnolli's associated research funding back to 2015:

 

 

Here are the top companies making associated research funding to Dr. Bertagnolli in 2021:

 

 

As you can see, in 2021, Pfizer was responsible for funding 72.1 percent of research in where Dr. Bertagnolli was the lead researcher.

  

Here's the same data for 2020:

 

...and 2019:

 

 

In closing and because Joe Biden really doesn't care what the serf class thinks of his potential appointment of Dr. Bertagnolli, here's a sampling of what appeared on the White House website on May 16th, touting the views of her peers on her nomination:

This is yet another fine example of "agency capture".  While it is not corruption per se, it's pretty clear that there are close links between Dr. Bertagnolli's research and Pfizer.  One has to wonder whether she will be able to be impartial when dealing with Pfizer (and other Big Pharma companies) as director of the National Institutes for Health given that Pfizer has funded a very significant part of her research.

But, then again, if there's anything that the last three years have taught us it's that health care in America is rife with conflicts of interest and has very little to do with actually improving our health.

Moderna's Focus on mRNA Technology

With the exception of politicians, health care officials and the mainstream media who seem to have very little knowledge about the mRNA technology being used in the COVID-19 vaccines, the history of the use of mRNA in vaccines has been fraught with issues.  Nonetheless, Moderna, one of the three main players in the mRNA space is going full bore on the use of this technology for other uses.

  

Here is a brief article that looks at history of the technology as quoted from the Bloomberg School of Public Health at Johns Hopkins University:

 

Here are some quotes:

 

"Messenger RNA, or mRNA, was discovered in the early 1960s; research into how mRNA could be delivered into cells was developed in the 1970s. So, why did it take until the global COVID-19 pandemic of 2020 for the first mRNA vaccine to be brought to market? 

 

The early years of mRNA research were marked by a lot of enthusiasm for the technology but some difficult technical challenges that took a great deal of innovation to overcome. 

 

The biggest challenge was that mRNA would be taken up by the body and quickly degraded before it could “deliver” its message—the RNA transcript—and be read into proteins in the cells. 

 

The solution to this problem came from advances in nanotechnology: the development of fatty droplets (lipid nanoparticles) that wrapped the mRNA like a bubble, which allowed entry into the cells. Once inside the cell, the mRNA message could be translated into proteins, like the spike protein of SARS-CoV-2, and the immune system would then be primed to recognize the foreign protein. 

 

SO, WHAT HAPPENED ONCE THEY FIGURED OUT THIS TECHNOLOGY?

 

The first mRNA vaccines using these fatty envelopes were developed against the deadly Ebola virus, but since that virus is only found in a limited number of African countries, it had no commercial development in the U.S.

 

THEN COVID-19 HIT … WHAT HAPPENED THEN?

 

Remember, the COVID-19 pandemic spurred manufacturers to develop dozens of potential vaccines against SARS-CoV-2 and brought tremendous increases in funding. Some of those vaccines used traditional methods involving adenovirus as the spike protein delivery system—such as the Johnson & Johnson vector vaccine.

 

Thanks to decades of research and innovation, mRNA vaccine technology was ready. With COVID, this technology got its moment and has proven to be extremely safe and effective. Pfizer’s COVID-19 vaccine is the first mRNA product to achieve full FDA approval in the U.S."

 

Proven to be extremely safe and effective?  Hmmm, let's see about that.  Given the widespread government and public health approval of the mRNA technology, it is interesting to note that Moderna's mRNA-1273 vaccine trial isn't scheduled for completion until December 29, 2022 as shown here:

 

 

Nonetheless, Moderna, a company with no product sales revenue until 2020 when its COVID-19 vaccine started rolling out and massive losses attributable to common shareholders as shown here:

 

 

...is going all in for mRNA technology.  

  

Here is a table and a graphic showing Moderna's product pipeline which solely focuses on mRNA:

 

The only product which is currently commercial is its mRNA-1273 COVID-19 vaccine.  While most of its other products are in preclinical or Phase 1 trials including its influenza vaccines, the company's CMV (human cytomegalovirus) vaccine, mRNA-1647, is the second vaccine to undergo Phase 3 trials in the company's history.  With RSV being the new bogeyman in the world of health, it is interesting to note that the company's mRNA-1345 RSV vaccine is currently in Phase 3 trials with completion projected for November 30, 2024 as shown here:

 

 

One has to wonder how long it will be before the FDA approves the mRNA-1345 vaccine given the growing concern about the rapid spread of respiratory Syncytial Virus through the population in recent weeks.

 

I find it fascinating that Moderna is putting all of its "eggs" into the mRNA "basket", particularly given that the trials for its headline product, the mRNA-1273 COVID-19 vaccine, are not yet complete, meaning that it is unclear what potential health issues could be related to the widespread use of this technology over the medium- and long-term.  As well, the fact that Big Pharma is able to conduct its Phase 3 trials at the same time as the vaccines are being administered to the public plays well to shareholders since it helps profitability by reducing the high cost of trials during the development phase of new pharmaceuticals.

Payments to Physicians and Growing Public Skepticism About the Profession

Over the past three years, it has become increasingly apparent that many physicians are in the back pockets of Big Pharma.  Thanks to Open Payments, we have the data to prove this.

 

As background, Open Payments is a United States government program under the auspices of the Department of Health and Human Services.  Open Payments is:

 

"...a national disclosure program that promotes a more transparent and accountable health care system.  Open payments houses a publicly accessible database of payments that reporting entities, including drug and medical device companies, make to covered recipients like physicians."

 

Data for all of program year 2021 (January 1, 2021 to December 31, 2021) was just released in January 2023.

 

Here's how the Open Payments system works:

 

Here's a video with additional background information on the program:

 

Payments are reported across three major reporting categories:

 

1.) General Payments: Payments or other transfers of value made that are not in connection with a research agreement or research protocol.

 

2.) Research Payments: Payments or other transfers of value made in connection with a formal research agreement or research protocol.

 

3.) Physician Ownership Information: Information about the ownership or investment interests that physicians or their immediate family members have in the reporting entities.

  

Let's look at what Open Payments found for the 2021 program year.  Here is a graphic summarizing the findings for 2021:

 

 

Here is a breakdown of physician payments by state:

 

 

Big Pharma paid a total of $2.032 billion in 7,844,949 payments to physicians with the national mean payment being $3,823.36 and the national median being $142.93.  Here is a table showing the top ten states in order of total payments:

 

 

Here is a table showing the top ten states in order of mean payment amount:

 

 

For the purposes of this posting, we will focus on two companies; Pfizer and Moderna.  We will only look at one of Pfizer's subsidiaries; Pfizer Inc. out of New York, since it is responsible for the vast majority of payments:

 

1.) Pfizer:

 

 

In case you were curious, here is some background information on Peter Tontonoz who happened to be the largest single recipient of Pfizer's largesse:

 

2.) Moderna:

To put payments to physicians into context, let's quote from a paper by Dr. Misop Han entitled "Trends in Industry Payments to Physicians in the First 6 Years After Graduate Medical Training":

  

"Financial incentives and conflicts of interest have been considered important elements that may influence physician decision-making and may contribute to an increase in health care costs.  Although physicians and researchers collaborate with the pharmaceutical and medical device industry to develop products to benefit patients, increasing concerns have been raised that these relationships may affect the cost of drugs and medical devices, the quality of patient care, the integrity of scientific investigations, medical education, and clinical practice recommendations.  Substantial efforts have been made to identify, limit, and manage potential conflicts of interest in financial relationships between physicians and industry to protect the integrity of professional judgment and to preserve public trust."

  

Not surprisingly, since the pandemic began, medical doctors have seen their ethical ratings drop as shown on this graphic by Gallup:

 

 

In 2020, 77 percent of respondents rated physicians as high or very high compared to 62 percent in 2022, a very significant decrease.

 

Given the fact that many physicians proved themselves to be less than reliable and unbiased sources of information, particularly with regard to the COVID-19 vaccines, during the pandemic and the fact that Big Pharma spends billions of dollars a year to court medical doctors, it's no wonder that the public is becoming skeptical about the profession.