Publications
APS Bulletin • Volume 15, Number 1, Winter 2005
Resource Reviews
John D. Loeser, MD, Department Editor
The Truth About Drug Companies: How They Deceive Us and What to Do About It
Reviewed by John D. Loeser, MD
Marcia Angell, New York, Random House, 2004, 305 pages, $24.95 (hard cover), ISBN 0-375-50846-5. Order from amazon.com.
If you prescribe or take drugs, you need to read this book. Angell uses the American tradition of muckraking, a practice in the first decade of the twentieth century when American journalists, novelists, and critics attempted to expose the abuses of business and the corruption in politics. The Jungle, a novel about the meatpacking industry in Chicago written by Upton Sinclair in 1906, was an example of muckraking. Angell has documented carefully a series of allegations about how Big Pharma has subverted the principles and workings of American medicine. The book is timely because of the recent Vioxx fiasco and the Congressional hearings about the pharmaceutical industry and the Food and Drug Administration (FDA). There are no knights in shining armor in Angell’s tale; instead, she hopes that changes in legislation and administrative policies will reform the industry. This does not seem too likely given the close relationship between the majority party and big business.
In the first three-fourths of the book, Angell describes what has gone wrong with the drug industry. Then she gives the reader her prescription for what must be done to clean up the corruption, malfeasance, and greed that she has uncovered in her research. Not only does she expose problems, but she also tries to initiate reform. The book is thoroughly referenced, so the reader can find the source documents upon which she bases her charges.
Angell’s most devastating charge is that Big Pharma has an empty pipeline and has devoted far too much effort to making quick dollars with “me-too” drugs. This is a bad situation not only for consumers of prescription drugs but also for the companies themselves, because they will soon run out of marketable products. Angell debunks the industry allegation that research costs are responsible for the high price of drugs, citing marketing expenses that dwarf those allocated to research. Indeed, there is little evidence that Big Pharma is currently funding much basic research, as most research is funded by our taxes through governmental agencies (e.g., the National Institutes of Health [NIH], the National Science Foundation [NSF]). Often, after a small, start-up company develops and markets new drugs, Big Pharma buys the company.
Other topics Angell covers include the paucity of new drugs; how big drug companies aggressively market new drugs that have little advantage over older, less expensive ones; how marketing subverts medical education; strategies big firms take to gain additional patent protection; and lobbying activities on the part of Big Pharma. She also discusses the beginnings of public and governmental reaction to what the drug industry has wrought since legislative changes in the 1980s facilitated the rise of Big Pharma.
Angell urges the drug industry to focus its research on truly new products. She calls for a more independent, stronger, larger FDA to protect the public interest. She suggests that clinical trials should be funded by, but not supervised by, the drug industry. She would like to see a shorter period of patent and administrative protection for drugs. She thinks that drug companies should get completely out of the business of educating physicians, funding continuing medical education (CME), and buying meals for medical staff. And, like almost everyone else in America, she thinks that drug prices are too high.
Since Big Pharma has gone over the top, it is now up to the little guy to try to rein in these companies. We shall see how many of the changes that Angell calls for will occur in the coming year or so. I am not too optimistic, as I think that our government is going to have to focus upon economic and military issues; muckraking requires the time and energy to look inward. This is a well-written, easy-to-read book that is essential for anyone who wants to think about some of the current issues in American health care.
Dr. Loeser is professor of neurological surgery and anesthesiology at the University of Washington in Seattle.
Reviewer content represents the opinion of the reviewer, not APS.
Please direct your suggestions for future Resource Reviews to John D. Loeser, MD, Department Editor at jdloeser@u.washington.edu.