The Truth About the Drug
How They Deceive Us and
What to Do About It
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 New England Journal of Medicine
had a front-row seat on the growing corruption of the pharmaceutical
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
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
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
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
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. The Big
Pharma companies are, in essence, manufacturing and marketing companies.
chapter, the least convincing in an otherwise fascinating and penetrating
book, contains the solutions, all of them predictable: 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
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.
England Journal of Medicine
http://content.nejm.org/cgi/content/full/351/15/1580 (payment required
to view article)
The Truth About Drug Companies
The quote at the top is from
Dr. Angell's summary of her own book in the New York Review of Books.
riveting 10-page summary of Dr. Angell's book,
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