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During her two decades at The New England Journal of Medicine, Dr. Marcia Angell had a front-row seat on the appalling spectacle of the pharmaceutical industry. She watched drug companies stray from their original mission of discovering and manufacturing useful drugs and instead become vast marketing machines with unprecedented control over their own fortunes. She saw them gain nearly limitless influence over medical research, education, and how doctors do their jobs. She sympathized as the American public, particularly the elderly, struggled and increasingly failed to meet spiraling prescription drug prices. Now, in this bold, hard-hitting new book, Dr. Angell exposes the shocking truth of what the pharmaceutical industry has become–and argues for essential, long-overdue change.
Currently Americans spend a staggering $200 billion each year on prescription drugs. As Dr. Angell powerfully demonstrates, claims that high drug prices are necessary to fund research and development are unfounded: The truth is that drug companies funnel the bulk of their resources into the marketing of products of dubious benefit. Meanwhile, as profits soar, the companies brazenly use their wealth and power to push their agenda through Congress, the FDA, and academic medical centers.
Zeroing in on hugely successful drugs like AZT (the first drug to treat HIV/AIDS), Taxol (the best-selling cancer drug in history), and the blockbuster allergy drug Claritin, Dr. Angell demonstrates exactly how new products are brought to market. Drug companies, she shows, routinely rely on publicly funded institutions for their basic research; they rig clinical trials to make their products look better than they are; and they use their legions of lawyers to stretch out government-granted exclusive marketing rights for years. They also flood the market with copycat drugs that cost a lot more than the drugs they mimic but are no more effective.
The American pharmaceutical industry needs to be saved, mainly from itself, and Dr. Angell proposes a program of vital reforms, which includes restoring impartiality to clinical research and severing the ties between drug companies and medical education. Written with fierce passion and substantiated with in-depth research, The Truth About the Drug Companies is a searing indictment of an industry that has spun out of control.
- Sales Rank: #141788 in Books
- Published on: 2005-08-09
- Released on: 2005-08-09
- Original language: English
- Number of items: 1
- Dimensions: 8.00" h x .70" w x 5.20" l, .56 pounds
- Binding: Paperback
- 319 pages
Amazon.com Review
Many Americans have wondered why prescription drugs have become so expensive while advertising for those drugs seems to grow exponentially. Former New England Journal of Medicine Editor Marcia Angell has some answers. The pharmaceutical industry, according to Angell, is fraught with corruption and doing a disservice to customers, the federal government, and to the medical establishment itself. In The Truth About the Drug Companies, Angell explains how a huge portion of the revenue generated by "Big Pharma" goes not into research and development but into aggressive marketing campaigns to sell their product. She describes how, even though the drug companies claim that it costs them an average of 802 million dollars per drug to develop new medicines, that figure is obscenely inflated since it factors in marketing as well as expected interest the company would have received had they invested the money in the open market. Meanwhile, Angell says, most of the R & D work is done by colleges and universities funded by the government. There are also problems with the drugs themselves, Angell indicates, since a majority are "me-too drugs", slightly modified versions of existing products which meant to address concerns of consumers most likely to spend money on pharmaceuticals. Thus, the market is filled with remarkably similar drugs to treat depression and high cholesterol while potentially life-saving medicines for diseases afflicting third-world countries are discontinued because they aren't profitable. In the books most damning passage, Angell tells of the high-priced junkets offered to doctors, ostensibly offered as educational opportunities that seem to constitute little more than bribes. The prognosis for reform is a grim one, Angell indicates, due to the massive cash reserves and lobbying efforts of "Big Pharma." Indeed, that lobby was hard at work trying to discredit her claims immediately upon the book's publication. But for anyone who's paid a pharmacy bill, The Truth About the Drug Companies is a fascinating read. --John Moe
From Publishers Weekly
In what should serve as the Fast Food Nation of the drug industry, Angell, former editor of the prestigious New England Journal of Medicine, presents a searing indictment of "big pharma" as corrupt and corrupting: of Congress, through huge campaign contributions; of the FDA, which is funded in part by the very companies it oversees; and, perhaps most shocking, of members of the medical profession and its institutions. Angell delineates how the drug giants, such as Pfizer and AstraZeneca, pay physicians to prescribe their products with gifts, junkets and marketing programs disguised as "professional education." According to Angell, the cost of marketing, both to physicians and consumers, far outweighs expenditures on research and development, though drug makers invoke R&D as the reason drug prices are so high. In fact, says Angell, with combined 2002 profits of $35.9 billion for the Fortune 500's top 10 drug companies, the drug industry is America's most profitable by far, thanks to disproportionately high prices, generous tax breaks and manipulation of patents to extend exclusive marketing rights to blockbuster drugs like Prozac and Claritin. Angell mounts a powerful case (and offers specific suggestions) for reform of this essential industry—a case worth bearing in mind as "big pharma" continues to oppose importing cheaper drugs from Canada.
Copyright © Reed Business Information, a division of Reed Elsevier Inc. All rights reserved.
From The New England Journal of Medicine
In this book, her most recent, Marcia Angell explores pharmaceutical research, deplores the rapidly expanding involvement (and distortion of truth) of Big Pharma, and implores us all (physicians, patients, politicians) to do something about it. The dust-jacket blurb asserts that Angell, "during her two decades at [the Journal] had a front-row seat on the growing corruption of the pharmaceutical industry." Perhaps, but since leaving the Journal, she's gone behind the curtains of Big Pharma, Big University, and Big Faculty. Drawing on her own work and on her thoughtful analysis of research, company financial statements, and investigative reports into drug development and marketing, Angell writes with the unambiguous and unyielding style that Journal readers came to expect and trust. By Angell's account, the current slide toward the commercialization and corruption of clinical research coincided with the election of President Ronald Reagan in 1980 and the passage of the Bayh-Dole Act, a new set of laws that permitted and encouraged universities and small businesses to patent discoveries from research sponsored by the National Institutes of Health (NIH). Research paid for by the public to serve the public instantly became a private, and salable, good, one that is producing drug sales of more than $200 billion a year. Commercialization had both specific and broad effects. Readers of this journal and others are familiar with investigations into the control that research sponsors at pharmaceutical companies exert on the design and analysis of clinical trials (including the distortion of primary outcome measures in trials) and the issue of reporting, nonreporting, and biased reporting of results. Angell reminds us of the increasingly cozy relationships between big industry and the faculties of universities. Not only are narcissistic donors renaming the medical schools; they are buying access to the best minds of their faculties. Angell's examples of the large consulting fees paid by industry to individual faculty members and to NIH scientists and directors are astounding. The broader effects are felt in the commercialization of universities, medical faculties, and our profession. In 2000, in a letter written in response to Angell's Journal editorial, "Is Academic Medicine for Sale?" a reader supplied the answer: "No. The current owner is very happy with it." The increasing intrusion of industry into medical education and the almost complete domination of continuing medical education (especially regarding drugs) by the marketing departments of large pharmaceutical companies are a scandal. The same companies also spend heavily to lobby governments. According to Angell, Pharmaceutical Research and Manufacturers of America, the pharmaceutical industry's U.S. trade association, has "the largest lobby in Washington," which in 2002 employed 675 lobbyists (including 26 former members of Congress) at a cost of more than $91 million. The result has been above-average growth in corporate profits during both Republican and Democratic administrations. The most recent and (at least to observers outside the United States) perplexing lobbying effort caused Congress explicitly to prohibit Medicare from using its huge purchasing power to get lower prices for drugs, thus opening up a dollar pipeline, in the form of higher drug prices, directly from taxpayers to corporate coffers. These changes, along with the cave-in by the Food and Drug Administration (FDA) in 1997 that permitted direct-to-consumer advertising to bypass mention in their ads of all but the most serious side effects, have further augmented profits. The overall effect has been a corruption not only of science but also of the dissemination of science. Angell documents that, contrary to what they claim, large pharmaceutical companies have "paltry output" in innovative research. In fact, as permitted by Bayh-Dole, pharmaceutical companies buy discoveries coming out of the basic-science enterprises, including universities and publicly funded granting agencies. The real costs of research on drugs by pharmaceutical companies are much less than the oft-quoted $800 million or so per new drug brought to market. Most of their research is on me-too drugs -- unoriginal, tax-deductible (and thus paid for in lost taxes by the public), and mostly unnecessary, except for corporate profits and executive bonuses. The Big Pharma companies are, in essence, manufacturing and marketing companies. Angell's concluding chapter, the least convincing one in an otherwise fascinating and penetrating book, contains the solutions, all of them predictable (and probably unattainable): control me-too drugs, re-empower the FDA, oversee Big Pharma's clinical research, curb patent length and abuse, keep Big Pharma out of medical education, make company financial statements transparent (so we can tell what the costs of research really are, as distinct from marketing), and impose price controls or guidelines. Granted, the problems are so prevalent and the corporate tentacles so entwined with our way of being that it is hard to see what else to recommend. But perhaps Angell is right. We must change the way we manage research and the development and distribution of new drugs. Not only are health and health care at risk, but so are the research enterprise and the reputations of universities and governments. The integrity of scientific research is too important to be left to the invisible hand of the marketplace. John Hoey, M.D.
Copyright © 2004 Massachusetts Medical Society. All rights reserved. The New England Journal of Medicine is a registered trademark of the MMS.
Most helpful customer reviews
53 of 54 people found the following review helpful.
Few other thoughts..............
By Jephy
As a physician, I guess I am one of the people who ought to be defensive about the expose' illustrated here. But I purchased the book already experiencing a good deal of abuse/shenanigans from the pharmaceutical industry, and wondering what else might be going on about which I might expand my knowledge.
From many other excellent reviews here you will know this is a must read! As one reviewer noted, it reads like a novel.....so the fiction lovers out there can delve into its details as well as those of us looking for factual marketing, political and current events reading.
Some additional notes: I'm a hospital-based anesthesiologist, and can assure readers that the tactics described herein are not limited to doctors' offices-type practices. This book does not address the techniques used by the industry to manipulate prices and costs within hospitals, but rest assured, the manipulations are there in a big way: limiting formularies, discontinuing effective and time-proven inexpensive drugs in favor of proprietary ones, marketing to non-physicians (accountants, CEO's) in a position to affect formulary decisions, etc.
There is a singular, but major criticism of this book, and that is the author's conclusion that more government involvement is one solution to reign in the excesses of the industry. This comes after the text's superior review of how government (FDA, NIH, congress-of course) has, in fact, been a major player in creating/perpetuating the problem in the first place! What a preposterous conclusion/how contradictory can one get? After recognizing, say Ted Bundy as a serial killer, would she want him chaperoning her teenage girls, using identical logic?! How much failure on the part of the criminals in congress does it take to understand that consumers (grandmothers--see earlier review), not bureaucrats, are the solution to the "fix" here?
IF YOU"RE A PHYSICIAN, this is necessarily mandatory reading. You've been hood-winked. More than that, your professional reputation and principles have been hijacked and perverted and you may very well have no clue as to the depths to which the industry has sunk to get its way at your expense. You will not practice the same after reading this book.
32 of 34 people found the following review helpful.
Read the Book
By CJ
I will try to keep my review as non-partisan as possible, but I have to say - after reading the one star reviews that have blind faith in the drug companies, they are either naive, rich enough to afford the latest greatest meds (which may or may not be that great), or have a financial stake in big pharma. Read them and laugh or grimace. Certainly, there are people who are so pro-corporate that they will keep insisting that corporations have their best interest at heart. This book is not for you.
Compared to a lot of other books in this genre (basically, pro pharma reform), this one shines. Mostly this is due to the authors front row seat experience, and her style translates well to a lay audience - a rare skill. That is why I recommend this book instead of others.
We desperately need more quality nonbiased research that does not choose to put a product in a unfairly favorable or unfavorable light due to the deep products of a sponsoring company. The public deserves better. I encourage all of you who hear about this study or that on whatever news outlet you listen to - take a look at 1 - what the study actually compared and 2 -who sponsored it. There's a lot of bias out there.
24 of 25 people found the following review helpful.
An important bit missing
By Cancer Support Inc.
I found Dr Angell's excellent book to be fairly comprehensive except for one important point: It overestimated the benefits of many drugs because it did not discuss some of the important reasons that the conclusions from many randomised controlled trials are invalid, especially for drugs for cancer and heart disease: namely the concept of 'surrogate endpoints'. These are used instead of real benefits like increased survival or reduced mortality. Instead of measuring if a drug extends life, which takes a long time and therefore costs a lot more, most chemotherapy drugs use tumour shrinkage as a surrogate end point.
Unfortunately there is little or no correlation between tumour shrinkage and increased survival - so the paradigm of what cancer is must be wrong.
As a result the FDA accepts drugs as effective based on their ability to reduce the size of tumours. It also accepts them as safe despite the fact that they are poisonous and kill thousands of people every year.
So these 'effective' drugs have no survival benefits and cause much harm.
Yet billions of dollars are spent on these drugs every year and these get included in Dr Angell's 'useful' drugs.
Another reason for the invalidity of the conclusions from many randomised controlled trials is that many trial authors publicise the fact that a drug can reduce cancer specific mortality and get it approved by the FDA yet ignore the increased deaths from other causes resulting from the drug's toxicity. There is often no overall saving of lives.
For these and many other reasons, the claim that so many drugs are useful and save lives needs to be treated with some scepticism.
The concept of surrogate endpoints is described well in Thomas Moore's excellent book Deadly Medicine where he describes how this concept was the reason for between 50,000 and 150,000 people in the US being killed by anti-arrhythmic drugs (after being approved by the FDA as being safe and effective) before its use was restricted.
Many authors have pointed out the lack of correlation between tumour shrinkage and increased survival, including Ralph Moss in his excellent book 'Questioning Chemotherapy'.
But despite this oversight Dr Angell's book provides the detail to substantiate what many of us suspected but couldn't prove.
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