Here's an eye-opening book about how drug companies invent fictitious diseases, distort science and exploit consumers for the sole purpose of creating obscene profits. I couldn't finish reading this book because it got me so outraged that I had to write more articles about Big Pharma's crimes against humanity. - Mike

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Product Description

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.


From the Hardcover edition.

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Product Details

• Amazon Sales Rank: #77451 in Books
• Published on: 2005-08-09
• Released on: 2005-08-09
• Original language: English
• Number of items: 1
• Binding: Paperback
• 319 pages

Features

• ISBN13: 9780375760945
• Condition: NEW
• Notes: Brand New from Publisher. No Remainder Mark.
• Click here to view our Condition Guide and Shipping Prices

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.

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Customer Reviews

FANTASTIC READING
I should start with a disclaimer. I'm a Vice President within one of the largest drug companies in the world and I have spent close to twenty years marketing drugs. So I guess I'm not supposed to like this book. But the truth is I thought it was fantastic.

First, for those of you who are not familiar with the healthcare industry, you should know that Ms. Angell is better capable of writing this masterpiece than any other author. She used to be Editor-in-Chief of The New England Journal of Medicine, which is considered the most prestigious medical journal in the world. Don't let her credentials scare you off, though. This is easy reading and the book captures your attention like a true business thriller, only this is real life suspense.

But this volume is much more than simple entertainment. It is quite possibly one of the best analyses of the state of the U.S. drug industry today, complete with footnotes backing up every statement the author makes. You will learn not only that in 2002 the top ten drug companies made a higher profit than the other 490 businesses together on the Fortune 500 list. You will also understand how the drug industry has been able to achieve such a business success and how this success, as is often the case throughout history, will likely be their downfall.

A political tidal wave is building which will forever change both the industry and many of its infamous business practices. It is sad to note that the drug industry today is equally poorly regarded as the tobacco companies, and this is a testament not only to the shortsighted foolishness of their management, but also to the fact that you can fool some of the customer some of the time, but not all of them all the time.

So is there no hope? Well, Ms. Angell doesn't only state the problem she also presents solutions and ends her story with several thoughtful suggestions on how to change the way we discover, market and distribute new drugs. Her advice is wise and absent of quick fixes. Only time will tell if there will be a movement so strong that it can defeat ingrained business practices of the richest companies in the world.

What may help is that the drug companies are their own worst enemies. They have antagonized grannies all over the US with their work to stop reimportation of cheaper drugs into the US, a practice that has been in place for many years in Europe. And anyone in marketing or public relations can tell you that no money in the world can help you win against millions of mad grandmothers.

A Brave Exposé of Big Pharma
One of the great exposés of all time, "The Truth About the Drug Companies" punctures much of the self-generated publicity of what has come to be called "Big Pharma. Beautifully written, edited and referenced in academic style, Dr. Angell begins softly and with understatement, building logically to a shattering set of conclusions and recommendations.

Pharma's claim that high drug prices in the USA are required to support innovative research is shown with plausible data to be false. Most of the innovative drugs are actually discovered in universities, at the NIH and in small companies. Pharma's expenditures for research are shown to less than half of those for sales and marketing and lobbying. About 4/5 of research dollars spent are on "me-too" drugs that are minor variations on the original drug of each type, and thus of no value to ordinary citizens.

Dr. Angell explains how Big Pharma had patent law changed to obtain up to 23 years of protection. And how minor changes in the drug molecule have somehow become patentable in direct contravention of patent law that obvious minor changes are not patentable. Mere changes in formulation somehow became protected.

Dr. Angell confirms other reports that Big Pharma has the most powerful lobby in Washington, resulting in "...an iron grip on Congress and the White House". Big Pharma has had laws passed forbidding importation of its own drugs from outside the USA. There is no technical justification for this. Big Pharma has arranged that the Medicare Drug Benefit to become effective in a couple of years does not permit Medicare to negotiate prices. This is contrary to the ability of all other national health services in the world to negotiate prices.

Dr. Angell confirms that both the NIH and FDA are subservient to the wishes of Big Pharma. This is largely done by offering "consulting" agreements to federal employees, and to members of FDA advisory committees. The FTC and FDA crumbled to Big Pharma's wishes to advertise drugs direct to consumer, a total disaster so far, because the true benefits of many drugs, often quite minor and sometimes even negative, cannot be communicated in a TV ad.

The pervasive bribing of doctors to prescribe the latest drugs is confirmed. Big Pharma's influence on medical schools is shown, as is the control of Continuing Medical Education, required for certain certifications and hospital privileges.

"The Truth..." is truly great because a number of concrete suggestions are made to undo the damage: "Despite all its excesses, this is an important industry that should be saved - mainly from itself" (p237). Of the suggestions Dr. Angell made, the one most possible to be implemented are removing the control of clinical trials of drugs from Big Pharma and having the NIH do it. (Of course, there is the caveat that NIH employees must stop receiving compensation or gifts from Big Pharma.) Some of the scientific transgressions of Big Pharma in running and reporting on drug trials are given, such as reporting only the positive results, testing healthy adults and then allowing the drugs to be prescribed for sick adults, children and the elderly. Drugs are now tested against placebo. Dr. Angell notes that tests should also include a test group using the current best drug to see whether the "new" drug is really better. She does not address the lack of benefit of many of the best-selling drugs.

"The Truth..." is an oustanding work, in my opinion, and a short review cannot do it justice.
*****
For a similar exposé see "Prescription Games" by Jeffrey Robinson (2001). Other aspects of Big Pharma excess are given in "Heart Failure" (1989) and "Prescription for Disaster" (1998); by Thomas J. Moore; "Overdose: The Case Against the Drug Companies" by Jay S. Cohen, MD (2001). The misleading presentation of trial results is shown in "Calculated Risks" by Gerd Gigerenzer (2002) and the peer-reviewed paper: Joel M. Kauffman, Bias in Recent Papers on Diets and Drugs in Peer-Reviewed Medical Journals, J. Am. Physicians & Surgeons, 9(1), 11-14 (2004).

I have had about 14 years of experience in exploratory drug development in colleges, mostly supported by NIH grants.

What Drug Companies Fear You Will Find Out
As a pharmacist for 27 years, six of those working in sales for one of the "big pharma" companies, I was pleased to see that Dr. Angell has got it EXACTLY right. Pharmaceutical companies are now multinational corporations whose motives are the same as all mega corporations... money and profits.
I know Dr. Angells chapters on "The Hard Sell", "Marketing
Masquerading as Education", and "Marketing Masquerading as Research" are factual. I received training in all these methods
of bullying physicians into writing prescriptions for my products using many of the methods described in this book!
Dr. Angells descriptions of the pharmaceutical industries hold on politicians and the FDA is, again, completely correct.
Until politicians believe they may not be re-elected if they
continue to pander to "big pharma", it will never change.
If you are at all concerned about the outrageous price of prescriptions (and you should be), this is a must read. Better
yet, send a copy to your congressman, senators and state representatives. You can bet "big pharma" is squirming over this one!