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The Truth About the Drug Companies: How They…
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The Truth About the Drug Companies: How They Deceive Us and What to Do…

by Marcia Angell

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In the five years 1998 through 2002, 415 new drugs were approved by the Food and Drug Administration, of which only 14 percent were truly innovative. A further 9 percent were old drugs that had been changed in some way that made them, in the FDA’s view, significant improvements. And the remaining 77 percent? Incredibly, they were all me-too drugs – classified by the agency as being no better than drugs already on the market to treat the same conditions. Some of these had different chemical compositions from the originals; most did not. But none were considered improvements. So there you have it. Seventy-seven percent of the pharmaceutical industry’s output consisted of leftovers.

Marcia Angell is perhaps best known for her outspoken objections to the use of placebo controls in the testing of low-dose antiretrovirals for the prevention of maternal-fetal transmission of HIV in the developing world during the 90’s. Her now infamous editorial in the New England Journal of Medicine sparked a major controversy, and ultimately resulted in Angell’s retirement from the Journal. In The Truth About the Drug Companies, Angell takes aim at big Pharma and their deceptive practices here at home.

Angell’s primary target here is the R&D myth that drug companies invest billions of dollars into the production of new, life-saving drugs, and that strong patent laws are required in order to protect the ability of Pharma to continue to produce these invaluable outputs. In fact, the largest portion of Pharma’s spending appears to go to marketing, in the form of direct-to-consumer advertising, continuing medical education, and direct-to-physician advertising (often disguised as something else) – all in support of me-too “blockbuster” drugs which offer minimal improvements over already-existing treatments. And at the other end, most of the basic research which goes into the discovery of new molecular entities is funded publicly – through the NIH and non-profit research organizations. Drug companies come in at the back end – buying copyrights to data which was generated through the use of public funds, then patenting the final product and selling drugs back to Americans at outrageous prices.

I have mixed feelings about this book. On the one hand, Angell is preaching to the choir insofar as I tend to agree with her substantive positions regarding industry influence on the medical profession, the testing and marketing of me-too drugs, the invention of new diseases and drug markets, and the unmitigated mess that has been made since the passage of the Bayh-Dole Act and the Medicare Prescription Drug Benefit. On the other hand, I found Angell’s arguments often sloppy and under-cited, with many of her factual claims undermined by her heavy rhetorical style. Much of Angell’s writing comes off as mere vitriol, which is frustrating since although my familiarity with the material helps me to know that she is right, her approach to the topic undermines her credibility – I would imagine especially with those who are inclined to disagree with her or who aren’t as familiar with this literature. There’s no need for the heavy-handed approach Angell takes: truly, the facts can speak for themselves, and her arguments would be better served if she could present them more objectively, and with less exaggeration.

The other big problem with this book (and this is no fault of Angell’s, it is just the natural course of things) is that much of the data is already obsolete. This book was first published in 2004, before we could really see the results of the prescription drug benefit pan out; before the financial collapse in 2008; and before the passage of Obamacare. Given all of the important changes which have been implemented since the writing of this book, many of the arguments bear further scrutiny, and the long-term effects of much legislation is, as of yet, unknown. Ultimately, a book worth reading, but I worry about the effect her tone has on her credibility. ( )
  philosojerk | Apr 25, 2012 |
How the medical profession and 'Big Pharma'interact.
  mdstarr | Sep 11, 2011 |
Mostly concerend with shock value, but most of us are unshockable with regard to Rx companies. ( )
  pilarflores | Dec 22, 2009 |
How the medical profession and 'Big Pharma'interact.
  muir | Nov 9, 2007 |
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Amazon.com Amazon.com Review (ISBN 0375760946, Paperback)

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

(retrieved from Amazon Mon, 30 Sep 2013 14:00:37 -0400)

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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 growing corruption 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 with and increasingly failed to keep up with spiraling prescription drug prices. Now, in this new book, Angell exposes the truth of what the pharmaceutical industry has become - and argues for essential, long-overdue change."--BOOK JACKET.… (more)

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