The Truth About the Drug Companies: How They Deceive Us and What to Do About It
by Marcia Angell
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Book Summary Information
Author: Marcia AngellEdition: Hardcover
Published: 2004-08-24
ISBN: 0375508465
Number of pages: 336
Publisher: Random House
Book Reviews of The Truth About the Drug Companies: How They Deceive Us and What to Do About It
Book Review: Good diagnosis but poor therapy
Summary: 3 Stars
In "The Truth about the Drug Companies" Dr. Marcia Angell exposes key practices fed by drug company funds that corrupt medical care, particularly distortion of results from clinical trials and several forms of inducements for physicians to prescribe drugs. A bias soon becomes evident and carries thoughout the book: condemnation of drug companies compared with a light hand toward their physician partners.
Dr. Angell's writing is direct and clear, but the book's fact-checking and editing are sometimes sloppy. On page 9, the Hatch-Waxman act of 1984 is criticized for extending exclusive marketing rights on prescription drugs, ignoring the main purpose and effect of the law: greatly increasing the number of FDA-recognized generic drugs, mentioned in a different context on page 32. On page 22 Dr. Angell claims, "You can't just randomly test chemicals to see if one will turn up that might be helpful in treating a disease." However, that is essentially what many drug companies do. They call it "combinatorial chemistry" and will sometimes test tens of thousands of chemical compounds to find a few that might be useful.
On page 33 the book says the FDA became "the first regulatory agency in the country" in 1906. The FDA was preceded by several agencies with different areas of responsibility, such as the 1893 Office of Standard Weights and Measures and agencies regulating military supplies. On page 57 the book says NIH extramural research is "mainly done at medical schools and teaching hospitals." However, a majority of NIH research funds go to universities and research organizations (59 percent for 2007).
"The Truth about the Drug Companies" routinely uses "America" in place of "the United States." In following a pattern promoted by the AMA since the 1920s, the book tries to hijack the word "doctor," substituting it for "physician" as though there were no doctors of science, philosophy, education, letters or law.
Some of Dr. Angell's arguments can easily be stood on their heads. For example, if few significant new drugs are being introduced, how much does it matter when the new drug products enjoy somewhat longer exclusive marketing? Dr. Angell finds fault mainly with drug companies for paying physicians to participate in drug promotions (pages 30-31 and 141-143). Applying similar values, we would prosecute johns but not whores.
Dr. Angell describes chronic issues with access to vaccines and well established but low-volume medicines. They might seem to be candidates for government-sponsored supplies. However, Dr. Angell's chapter on remedies to problems is called "How to save the pharmaceutical industry" and not, for example, "How to assure safe, effective, reasonably priced and readily available medicines."
Compared to vigorous exposure of problems, Dr. Angell's proposed remedies seem timid and abstract. None of her proposed remedies would prohibit physicians from accepting payments, gifts or meals from drug companies, nor free or subsidized services, samples or "continuing education," practices that she identifies as core contributors to the corruption of medical care. No laws are proposed restricting drug company support for medical societies, hospitals, clinics, physicians, medical journals, medical schools or academic research projects. Aside from voluntary efforts, all the sources of corruption she reveals would continue unabated.
Dr. Angell's main proposed remedy would require that new drugs be compared with existing drugs and be shown to provide "something useful" (page 240). Previously Dr. Angell showed how drug companies create designs for clinical testing to achieve positive outcomes, yet she does not say how such pitfalls can be avoided. Later, on page 245, she advocates a new federal agency to "administer clinical trials of prescription drugs," with data from them to become public property. That would require an act of Congress, certain to be strongly opposed by major drug companies, but Dr. Angell provides no guidance or leadership for such a political struggle. Other approaches could be at least as effective with lower political costs, such as public education about the advantages of generic drugs, but Dr. Angell does not mention them.
"The Truth about the Drug Companies" details some of the key United States problems in prescription drug development and distribution but lacks a convincing agenda of solutions.
All The Truth About the Drug Companies: How They Deceive Us and What to Do About It Customer Reviews
Summary of The Truth About the Drug Companies: How They Deceive Us and What to Do About It
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 MoeDuring 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.
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