This review was written in 2004, when this book was first published. Unfortunately, not much has changed since then, though the subject matter is more relevant than ever and well worth revisiting. Author Marcia Angell is an American physician, a professor and the first woman to serve as editor-in-chief of the New England Journal of Medicine. Now in her 80’s, she is a Senior Lecturer in the Department of Global Health and Social Medicine at Harvard Medical School in Boston, Massachusetts.
This book was not a “quick read” — not because it isn’t a very well-written, fascinating exposé
of one of the most powerful industries in our country (if not the world). Rather, it was slow going because every page contained so many outrages (e.g., examples of deception, manipulation, sheer unethical behavior at the public’s expense, etc.), I had to put it down frequently to cool off.
As a former editor-in-chief of The New England Journal of Medicine, Marcia Angel M.D., experienced first hand the way pharmaceutical companies, a.k.a., “ Big Pharma,” operate and she is clearly fed-up: “Now, primarily a marketing machine to sell drugs of dubious benefit, this industry uses its wealth and power to co-opt every institution that might stand in its way including the U.S. Congress, Food and Drug Administration (FFA), academic medical centers and the medical profession itself.”
A few sample outrages:
- The “Big Lie”: Americans have been led go believe that exorbitantly high drug prices are necessary compensation for the costs and risks of research and development (R & D). Not true, Dr. Angell says. Drug prices have little relation to R & D costs and could be dramatically cut without in any way threatening quality. Prices are highest in the U.S. simply because of lack of regulation — other countries have limits on pricing!
- By far the largest portion of the industry budget goes to “marketing and administration,” including lobbying costs, perks and “education” for doctors, funding for often biased trials and hiring “experts” to promote the results, direct-to-consumer advertising (banned in all other countries except New Zealand).
- The industry is not particularly innovative. Truly “breakthough” drugs have been rare in recent years and most have come out of tax-tax-payer funded basic research at academic or government facilities, then licensed to the drug companies for final trials and marketing. Most “new” drugs are actually recycled old ones, devised by companies to extend patent rights and maintain market share. For instance, when the patent for “blockbuster” Prozac was running out, the company simply changed the color of the pills, raised the price and called it Sarafem, remarketed for PMS!
- Drug companies have by far the highest profits of all other American industries: in 2002 average 3.3% profits on sales in other industries vs. 18.5% for Pharma! The combined profits of the top 10 pharmaceutical companies on the Fortune 500 are greater than the total of all other 490 businesses on the list. Could it be, the author suggests, increasing drug prices are mostly to do with keeping stocks and executive stock options on the rise?
- Federal legislation of the last few decades has been a bonanza for Pharma, from extending patent laws and monopoly rights to allowing FDA to receive funding from Pharma exclusively for speeding new drug approvals, resulting in neglect of other areas like oversight that protects the public. Says Angel: “quick to approve; slow to remove!”
According to Dr. Angell, Americans suffer from overmedication, drug interaction problems and side effects more than the populations of other Western nations. Something, she laments, is terribly broken. How to fix a system so well-oiled by campaign contributions and the all mighty drug lobby that Congress and our so-called “watchdog” agency, FDA essentially heel to Big Pharma? Dr. Angell puts forth some excellent proposals for change, especially on the legislative level. She feels that now is a real opportunity, given increasing public awareness of lower prices in Canada, the lethal effects of some hastily-approved, heavily promoted drugs (e.g., Vioxx), etc. Ultimately, she believes, perhaps too optimistically, that votes should count more than dollars! [Editor’s 2019 Update: sadly, despite ever mounting public anger and disgust, the drug companies are flourishing. The billions they may have to pay out for fraud cases, e.g., the opioid epidemic, are just the price of doing business. Meanwhile, they continue to cash in massively, e.g., producing more and more poorly tested vaccines for which the U.S. Congress has granted Big Pharma near total liability protection.).
Try to get through this book without letting your blood pressure rise too much. (If it does, I recommend avoiding blood pressure meds in favor of a walk in the park.) Instead, let it be a call to actions for us all (who may at some time in our lives need life-saving drugs). Let your Congressional representatives know that change is needed now! You may also want to ask them if they get contributions from Big Pharma, and, if so, express your concern about where their loyalties lie. Whose interests are they protecting?
The Truth About Drug Companies: How They Deceive Us and What To Do About It by Marcia Angell, M.D.