What do you think?
Rate this book
La verdad acerca de la industria farmacéutica: Cómo nos engaña y qué hacer al respecto
Marcia Angell fue editora del New England Journal of Medicine por más de 20 años, y editor-in-chief hacia el final de ese periodo. Este libro (publicado el año 2004) es el resultado de un estudio profundo y firmemente comprometido con el propósito de entregar un reporte fidedigno y sin concesiones sobre el funcionamiento de la industria farmacéutica. Describe sus aspectos más problemáticos en el ámbito de la investigación y desarrollo de nuevos medicamentos y en lo referente a sus estrategias para influir sobre la profesión médica. Puedes leer partes de este libro pinchando la imagen
321 pages, Paperback
First published January 1, 2004
122 people are currently reading
2225 people want to read
About the author
Marcia Angell
8 books30 followersMarcia Angell is an American physician, author, and the first woman to serve as editor-in-chief of the New England Journal of Medicine. She is currently a Senior Lecturer in the Department of Global Health and Social Medicine at Harvard Medical School in Boston, Massachusetts.
Ratings & Reviews
Friends & Following
Create a free account to discover what your friends think of this book!
Community Reviews
Displaying 1 - 30 of 102 reviews
January 29, 2010
[image error]
One pill makes you larger
And one pill makes you small
And the ones that mother gives you
Don't do anything at all
It’s pretty easy to imagine the millions of dollars pharma companies spend on the advertisements we watch on television, hear on the radio, see on the Internet, in magazines, newspapers, and so forth. However, some of the advertisements, referred to as stealth ads, are harder to recognize; infomercials can fool consumers by resembling newscasts rather than commercials (Angell 117). In an even stealthier strategy, celebrities have been used to sell drugs during what appears to be an ordinary interview. Dr. Marcia Angell provides a particularly startling example in her book, The Truth about the Drug Companies:
With advertising techniques as stealthy as those evident in the Lauren Bacall example, even an alert consumer can be duped. However, what is less apparent to the general public, is the far, far greater amount of money pharma companies spend to sway doctors’ prescribing habits through gifts, drug samples, grants, trips, consultant fees, blatant drug endorsements camouflaged as medical education, and their increasing control over major medical journals. The amount of money pharma companies spend in an effort to control doctors and medical education is staggering, figures like $54 billion per year have been cited, and this estimate, made a number of years ago (Angell 122), may be far too low. Given that pharma companies are required to disclose the amount they spend on marketing, why is this figure so hard to track down? For starters, pharma companies lump “administration and marketing,” into one category. Then, pharma companies define marketing very narrowly: 1) Direct-to-consumer (DTC) advertising (mainly TV ads); 2) Sales pitches to doctors in their offices; 3) Free samples for doctors; and 4) Advertising in medical journals (Angell 121). Pharma companies thus hide billions of dollars in annual costs by categorizing many of its activities as education.
For example, detailing is “a marketing tactic that involves individual sales representatives (detailers) meeting with doctors in their offices to promote specific medications” (Horner et al 1). Typically, detailers are young and attractive. A New York Times’ study describes how many detailers are being recruited from college cheerleading squads. A detailer works in a highly competitive field where, in 2004, there were just over 100,000 drug reps for the “roughly 884,000 licensed doctors in the nation” or “at least 1 sales rep for every eight doctors” (Homer et al 8).
To learn more about the doctors they target, detailers study physicians’ prescriber reports. Prescriber reports provide a breakdown of every drug a doctor prescribes so that a detailer can “deliver a tailored marketing pitch” based on the doctor’s prescribing habits. In addition, detailers can track doctors’ weekly prescribing habits so that they know whether the particular type of sales pitch they used was effective. In the report, they can see the name of each doctor, his DEA number, and precisely what medications he/she has been prescribing. Pharmaceutical companies buy this information from pharmacy chains (Angell 129-130). Although the pharmacies do not provide the doctors’ name, the reports do contain physician identifiers which pharma companies can decode by purchasing a “comprehensive database of U.S. physicians from the American Medical Association,” which earns over 20 million dollars annually to provide this service. I have yet to talk to one doctor who knew his/her prescribing habits were available and being tracked by pharmaceutical companies. The common response I’ve received is outrage. Doctors, quite rightly, consider this an invasion of privacy and none of the pharma companies’ business. On the flipside, though, the prescriber reports, which have been studied in conjunction with drug rep visits and incentives, demonstrate that many doctors are swayed by the pharma companies’ sales techniques.
Detailers are often eager to educate doctors on the “off-label” uses of a drug. For example, the drug Neurontin has FDA approval for treating epilepsy, but as Marcia Angell has noted, there is not much money in that (158). Consequently, pharmaceutical companies work to demonstrate that a drug can be used “off-label” to treat a variety of conditions, even if the data is based on biased and inadequate research (112). The off-label uses of Neurontin are very broad and very lucrative. In addition to its FDA-approved use for epilepsy, the drug became a huge money-maker by being recommended for non-FDA-approved or “off-label” uses that included “bipolar disorder, post-traumatic stress disorder, insomnia, restless legs syndrome, hot flashes, migraines…tension headaches” (160), fibromyalgia, multiple sclerosis, and peripheral neuropathy to name just a few. Although some off-label uses of drugs may be beneficial, many are not and, again, the off-label uses can take a drug with a limited market and turn it into a multi-billion dollar success.
In addition to the off-label uses for a particular drug, pharma companies promote “Me, too” drugs to boost sales. For example, Nexium was developed when Prilosec’s patent was about to expire. Although there is no proof that Nexium works any better than Prilosec, both of which are used for acid reflux (or heartburn), AstraZeneca launched a particularly aggressive sales campaign. Nexium, the “little purple pill,” which is advertised everywhere, was developed in 2001, and by 2003, was already earning profits of 3.1 billion dollars (Angell 76-78) per year. Although Nexium is no better than Prilosec, the monthly cost for Nexium is $400 (without insurance) compared to $40 for Prilosec.
The line between pharmaceutical marketing and medical education is blurred further by the increased influence of pharma companies on established medical journals. In the January 2008 issue of The New England Journal of Medicine (NEJM), possibly the most respected medical journal in the world, there were fewer than one hundred pages of medical articles vs. 39 full-color glossies of pharmaceutical advertisements. Anyone who’s kept up with academic publishing knows that both academic presses and academic journals are in financial crisis. Medical journals receive a hefty economic boost from pharma company advertising – estimated to be as much 21% or higher of their total revenue (Sepkowitz). In addition, some medical journals publish supplements, which are “typically a one-topic, free-standing volume that shares font and layout with the present magazine—but not serious peer review” (Sepkowitz 1). More importantly, the production and publications costs are often covered generously by pharma companies. Pharma companies also provide another source of revenue. When an article is published favoring a particular drug, thousands and thousands of reprints are purchased to “sprinkle around in the good name of education” (Spitzer). Even more alarming, however, is the lack of educational rigor and the overt agenda some articles evince.
Angell, a former chief editor of the NEJM, explains how doctors are required to list all possible conflicts of interest (i.e. primarily “research” funding received by pharma companies). In one instance, while Angell was still editing the journal, all the authors’ conflicts of interest for a particular article were so extensive they could not fit in the journal and needed to be listed on a website. The article presented a study—favorable, of course—of an antidepressant agent. Clearly, the “peer-reviewed” article had been bought and paid for by a pharmaceutical company. Angell, in a trenchant footnote she appended to the article, wrote the following:
Clearly, the ubiquitous drug advertisements that dot our cultural landscape are merely a fraction of the money pharma companies spend on marketing. The implications are serious:
In short, Angell asks that the pharmeceutical industry (and those in the medical profession complicit with these practices) undergo complete reform. I agree.
One pill makes you larger
And one pill makes you small
And the ones that mother gives you
Don't do anything at all
It’s pretty easy to imagine the millions of dollars pharma companies spend on the advertisements we watch on television, hear on the radio, see on the Internet, in magazines, newspapers, and so forth. However, some of the advertisements, referred to as stealth ads, are harder to recognize; infomercials can fool consumers by resembling newscasts rather than commercials (Angell 117). In an even stealthier strategy, celebrities have been used to sell drugs during what appears to be an ordinary interview. Dr. Marcia Angell provides a particularly startling example in her book, The Truth about the Drug Companies:
Lauren Bacall, for instance, in conversation with Matt Lauer on the Today show, spoke about a friend who had become blind from macular degeneration. She urged the audience to get tested for it and mentioned the Novartis drug Visudyne. What she did not reveal is that she was being paid by Novartis. (117)
With advertising techniques as stealthy as those evident in the Lauren Bacall example, even an alert consumer can be duped. However, what is less apparent to the general public, is the far, far greater amount of money pharma companies spend to sway doctors’ prescribing habits through gifts, drug samples, grants, trips, consultant fees, blatant drug endorsements camouflaged as medical education, and their increasing control over major medical journals. The amount of money pharma companies spend in an effort to control doctors and medical education is staggering, figures like $54 billion per year have been cited, and this estimate, made a number of years ago (Angell 122), may be far too low. Given that pharma companies are required to disclose the amount they spend on marketing, why is this figure so hard to track down? For starters, pharma companies lump “administration and marketing,” into one category. Then, pharma companies define marketing very narrowly: 1) Direct-to-consumer (DTC) advertising (mainly TV ads); 2) Sales pitches to doctors in their offices; 3) Free samples for doctors; and 4) Advertising in medical journals (Angell 121). Pharma companies thus hide billions of dollars in annual costs by categorizing many of its activities as education.
For example, detailing is “a marketing tactic that involves individual sales representatives (detailers) meeting with doctors in their offices to promote specific medications” (Horner et al 1). Typically, detailers are young and attractive. A New York Times’ study describes how many detailers are being recruited from college cheerleading squads. A detailer works in a highly competitive field where, in 2004, there were just over 100,000 drug reps for the “roughly 884,000 licensed doctors in the nation” or “at least 1 sales rep for every eight doctors” (Homer et al 8).
To learn more about the doctors they target, detailers study physicians’ prescriber reports. Prescriber reports provide a breakdown of every drug a doctor prescribes so that a detailer can “deliver a tailored marketing pitch” based on the doctor’s prescribing habits. In addition, detailers can track doctors’ weekly prescribing habits so that they know whether the particular type of sales pitch they used was effective. In the report, they can see the name of each doctor, his DEA number, and precisely what medications he/she has been prescribing. Pharmaceutical companies buy this information from pharmacy chains (Angell 129-130). Although the pharmacies do not provide the doctors’ name, the reports do contain physician identifiers which pharma companies can decode by purchasing a “comprehensive database of U.S. physicians from the American Medical Association,” which earns over 20 million dollars annually to provide this service. I have yet to talk to one doctor who knew his/her prescribing habits were available and being tracked by pharmaceutical companies. The common response I’ve received is outrage. Doctors, quite rightly, consider this an invasion of privacy and none of the pharma companies’ business. On the flipside, though, the prescriber reports, which have been studied in conjunction with drug rep visits and incentives, demonstrate that many doctors are swayed by the pharma companies’ sales techniques.
Detailers are often eager to educate doctors on the “off-label” uses of a drug. For example, the drug Neurontin has FDA approval for treating epilepsy, but as Marcia Angell has noted, there is not much money in that (158). Consequently, pharmaceutical companies work to demonstrate that a drug can be used “off-label” to treat a variety of conditions, even if the data is based on biased and inadequate research (112). The off-label uses of Neurontin are very broad and very lucrative. In addition to its FDA-approved use for epilepsy, the drug became a huge money-maker by being recommended for non-FDA-approved or “off-label” uses that included “bipolar disorder, post-traumatic stress disorder, insomnia, restless legs syndrome, hot flashes, migraines…tension headaches” (160), fibromyalgia, multiple sclerosis, and peripheral neuropathy to name just a few. Although some off-label uses of drugs may be beneficial, many are not and, again, the off-label uses can take a drug with a limited market and turn it into a multi-billion dollar success.
In addition to the off-label uses for a particular drug, pharma companies promote “Me, too” drugs to boost sales. For example, Nexium was developed when Prilosec’s patent was about to expire. Although there is no proof that Nexium works any better than Prilosec, both of which are used for acid reflux (or heartburn), AstraZeneca launched a particularly aggressive sales campaign. Nexium, the “little purple pill,” which is advertised everywhere, was developed in 2001, and by 2003, was already earning profits of 3.1 billion dollars (Angell 76-78) per year. Although Nexium is no better than Prilosec, the monthly cost for Nexium is $400 (without insurance) compared to $40 for Prilosec.
The line between pharmaceutical marketing and medical education is blurred further by the increased influence of pharma companies on established medical journals. In the January 2008 issue of The New England Journal of Medicine (NEJM), possibly the most respected medical journal in the world, there were fewer than one hundred pages of medical articles vs. 39 full-color glossies of pharmaceutical advertisements. Anyone who’s kept up with academic publishing knows that both academic presses and academic journals are in financial crisis. Medical journals receive a hefty economic boost from pharma company advertising – estimated to be as much 21% or higher of their total revenue (Sepkowitz). In addition, some medical journals publish supplements, which are “typically a one-topic, free-standing volume that shares font and layout with the present magazine—but not serious peer review” (Sepkowitz 1). More importantly, the production and publications costs are often covered generously by pharma companies. Pharma companies also provide another source of revenue. When an article is published favoring a particular drug, thousands and thousands of reprints are purchased to “sprinkle around in the good name of education” (Spitzer). Even more alarming, however, is the lack of educational rigor and the overt agenda some articles evince.
Angell, a former chief editor of the NEJM, explains how doctors are required to list all possible conflicts of interest (i.e. primarily “research” funding received by pharma companies). In one instance, while Angell was still editing the journal, all the authors’ conflicts of interest for a particular article were so extensive they could not fit in the journal and needed to be listed on a website. The article presented a study—favorable, of course—of an antidepressant agent. Clearly, the “peer-reviewed” article had been bought and paid for by a pharmaceutical company. Angell, in a trenchant footnote she appended to the article, wrote the following:
Our policy requires authors of Original Articles to disclose all financial ties with companies that make the products under study or competing products. In this case, the large number of authors and their varied and extensive financial associations with relevant companies make a detailed listing here impractical. Readers should know, however, that all but one of the twelve principal authors have had financial associations with Bristol-Myers Squibb—which also sponsored the study—and in most cases, with many other companies producing psychoactive pharmaceutical agents. The associations include consultancies, receipt of research grants and honorariums, and participation on advisory boards.” (143)
Clearly, the ubiquitous drug advertisements that dot our cultural landscape are merely a fraction of the money pharma companies spend on marketing. The implications are serious:
* All marketing costs, whether they’ve tucked away under categories such as administration or education matter because these costs are passed on to the patients, who pay higher and higher prices (Angell, Chapter 3).
* “Me, too” drugs and “off-label” uses of drugs result in patients paying much higher prices for a new drug that offers no appreciable benefits or using a drug, for a non-FDA approved purpose, that may accomplish nothing at all (Angell, chapter 5).
* The decreased amount of rigor in some clinical trials and evident in some medical articles help to keep drugs on the market – such as Vioxx, which was shown to cause heart attacks and strokes – that are dangerous (Angell 270).
* Pharma companies often divert research money to create useless or duplicate drugs when this money could be spent finding cures for serious diseases. However, if a useless drug can bring in billions of dollars, what is the incentive for pharma companies to create drugs that provide smaller revenues?
In short, Angell asks that the pharmeceutical industry (and those in the medical profession complicit with these practices) undergo complete reform. I agree.
August 1, 2013
عندما أقرأ كتبًا كهذه- لا تتوفر لها ترجمة عربية .. أتأكد أكثر بأن الطريق أمامنا نحو فهم العالم لا يزالا طويلاً!
يسلط هذا الكتاب الضوء على ممارسات شركات الأدوية غير الأخلاقية، والمدفوعة بالجشع والرغبة في مضاعفة أرباحها، في الولايات المتحدة الأمريكية. كمية المعلومات الصادمة والفاضحة في هذا الكتاب كفيلة بأن يشيب لها شعر الرأس. ورغم أن الكتاب يتاول مشكلة أمريكية خالصة، إلا أن ما يحصل هناك، لا بد وأن يكون له -بطريقة أو بأخرى- نتائج هنا!
يسلط هذا الكتاب الضوء على ممارسات شركات الأدوية غير الأخلاقية، والمدفوعة بالجشع والرغبة في مضاعفة أرباحها، في الولايات المتحدة الأمريكية. كمية المعلومات الصادمة والفاضحة في هذا الكتاب كفيلة بأن يشيب لها شعر الرأس. ورغم أن الكتاب يتاول مشكلة أمريكية خالصة، إلا أن ما يحصل هناك، لا بد وأن يكون له -بطريقة أو بأخرى- نتائج هنا!
August 12, 2007
This book is indispensable. Exposes the lies that the big pharmaceutical companies hide behind and use to justify the ridiculously overpriced drugs they are selling and gouging consumers. The best aspect of this book is that it dispels the myth that drugs are so expensive because of the costly R&D associated with creating brand new lifesaving drugs. The truth is that the most expensive and speculative research is done at the university level, which you've already paid for with your tax dollars going to grants. By the time the drug companies come along most of the initial research has been laid, including whether the drug will be useable (and thus profitable) or not. Fact is the drug companies are way more concerned with coming out with 5 new versions of Prilosec and Claritin, a pathetically miniscule number of the new drugs that come to market each year are truly new, innovative and lifesaving. The author also does a great job of suggesting ways to get our government to crack down on these crooks.
December 3, 2022
This is one fantastically credible book. Written by the former editor in chief of the New England Journal of Medicine, it exposes the Drug Companies for the greedy companies they really are. Written almost 20 years ago you can see that things are worst now by watching the medical TV ads today - which are sickening. They show nice pictures of happy people while listing off all the side effects of taking those drugs. "Markets can be created as well as enlarged...Once upon a time, drug companies promoted drug to treat diseases. Now it is often the opposite. They promote diseases to fit their drugs." Heartburn remedy used to be a glass of milk or an over-the-counter antacid. "But now heartburn is called acid reflux disease." In other words, they invent diseases to fit their drugs.
They make HUGH profits. Spending for Marketing their drugs is at least 3 times what is spent on Research and Development. Bogus drug trials are conducted, sometimes negative results are buried. Billions of dollars of expense are disguised as administration and medical education and these millions are actually profit. Their control over the government and the laws being passed is HUGH. Imagine passing a bill saying that Medicare cannot negotiate drug prices. How sick is that.
Drug companies develop very few new effective drugs. They take the results of developments from hospital and government research and market them.
If you are concerned about health care and rising prices you must read this book.
They make HUGH profits. Spending for Marketing their drugs is at least 3 times what is spent on Research and Development. Bogus drug trials are conducted, sometimes negative results are buried. Billions of dollars of expense are disguised as administration and medical education and these millions are actually profit. Their control over the government and the laws being passed is HUGH. Imagine passing a bill saying that Medicare cannot negotiate drug prices. How sick is that.
Drug companies develop very few new effective drugs. They take the results of developments from hospital and government research and market them.
If you are concerned about health care and rising prices you must read this book.
This entire review has been hidden because of spoilers.
July 23, 2020
Nice compilation of facts in pharmaceutical industry in the US.
1) The cost on *marketing and sales* is major (31% of profits); R&D cost is minor.
2) There aren't many new drugs developed; most useful drugs are developed not by drug companies, but, for example, by NIH.
3) Drug companies do not follow free market, but use lots of monopoly techniques.
4) New drugs "look" cool due to sales. To make them look good, drug companies can sponsor medical journals and impose more favor towards research discoveries that praises a drug, and they can also give money to physicians according to the number of patients they introduce to buy the drug (or get tested on a new drug under development).
5) The average research cost of a new drug is 100 million, but not 820 million as marketed by drug companies. The extra cost is on marketing and sales.
History: The price of prescription only medicines (POM) was acceptable before 1980, but evilly soars after 1980. Now the industry earns 200 billion dollars, ranking top 1 in the US. The root reason is that President Ronald Reagon's reforms make lucrative people respectable, so more people trade moral disciplines for profits. The social value shifts from "although I am poor, I am a gentleman" to "if you are smart, why aren't you rich?".
Key flaw in law: A new drug just needs to prove to FDA that it is effective, but *not* more effective than existing drugs.
Resources:
- Chinese version of the book
1) The cost on *marketing and sales* is major (31% of profits); R&D cost is minor.
2) There aren't many new drugs developed; most useful drugs are developed not by drug companies, but, for example, by NIH.
3) Drug companies do not follow free market, but use lots of monopoly techniques.
4) New drugs "look" cool due to sales. To make them look good, drug companies can sponsor medical journals and impose more favor towards research discoveries that praises a drug, and they can also give money to physicians according to the number of patients they introduce to buy the drug (or get tested on a new drug under development).
5) The average research cost of a new drug is 100 million, but not 820 million as marketed by drug companies. The extra cost is on marketing and sales.
History: The price of prescription only medicines (POM) was acceptable before 1980, but evilly soars after 1980. Now the industry earns 200 billion dollars, ranking top 1 in the US. The root reason is that President Ronald Reagon's reforms make lucrative people respectable, so more people trade moral disciplines for profits. The social value shifts from "although I am poor, I am a gentleman" to "if you are smart, why aren't you rich?".
Key flaw in law: A new drug just needs to prove to FDA that it is effective, but *not* more effective than existing drugs.
Resources:
- Chinese version of the book
September 12, 2011
Dr. Angell is angry at the big pharmaceutical companies, or at least was when she wrote this in 2004. As such, she perhaps overreaches at times during the course of this indictment against big pharma and the American way of dealing with prescription medicines. You come across the word "reportedly," meaning, "I haven't been able to confirm this, but other people say it's true." And, "I strongly suspect," meaning, "I have every reason to believe this is true, but I can't prove it, and it probably wouldn't stand up in court. (It's understandable that not all of her suspicions can be proven; the drug companies aren't exactly forthcoming.)
Still, there is enough substance here to make one wary of pharmaceutical companies (if one wasn't already). I strongly suspect that after reading this book you'll wonder whether to accept it at face value the next time your doctor prescribes a drug.
Because of that, the best part of the book is the "Afterword," in which Angell tells you what questions you should ask your doctor, and what questions you should ask politicians.
This book made me feel blessed to have the doctor that I have (and his office), because he's not quick to write out prescriptions for every complaint, and his office seems to strive to find the least expensive alternative for me when a prescription is necessary.
My doctor even once talked me out of a medicine I wanted him to prescribe. Yes, I admit it. I'd seen it advertised on TV.
Still, there is enough substance here to make one wary of pharmaceutical companies (if one wasn't already). I strongly suspect that after reading this book you'll wonder whether to accept it at face value the next time your doctor prescribes a drug.
Because of that, the best part of the book is the "Afterword," in which Angell tells you what questions you should ask your doctor, and what questions you should ask politicians.
This book made me feel blessed to have the doctor that I have (and his office), because he's not quick to write out prescriptions for every complaint, and his office seems to strive to find the least expensive alternative for me when a prescription is necessary.
My doctor even once talked me out of a medicine I wanted him to prescribe. Yes, I admit it. I'd seen it advertised on TV.
December 2, 2012
The Truth About Drug Companies (2004) by Marcia Angell describes how pharmaceutical companies manipulate science and US politics in order to make more money.
Angell was on the staff of the New England Journal of Medicine for over 20 years and became its first female editor. She has had extensive experience dealing with and observing how big pharma operates.
The accusations that Angell levels at the drug companies are that they only publish successful trials, game phase 4 trials, manipulate doctors with subsidized ‘education’ that is really a sale pitch, game the US patent system, lobby to ensure that the US government, a major purchaser of drugs doesn’t negotiate hard on price and sets the rules up to maximise profit. The book goes into detail and makes a strong case on each point. The fact that the rest of the world pays substantially less than the US does is very true and quite remarkable.
Angell doesn’t look at how the US insurance system and Medicare and Medicaid encourage people to get more expensive drugs if they are paid for by other people with little contribution from the user but the issue could be added.
The book is a solid, well researched, well reasoned and interesting look at how drug companies have manipulated the system.
Angell was on the staff of the New England Journal of Medicine for over 20 years and became its first female editor. She has had extensive experience dealing with and observing how big pharma operates.
The accusations that Angell levels at the drug companies are that they only publish successful trials, game phase 4 trials, manipulate doctors with subsidized ‘education’ that is really a sale pitch, game the US patent system, lobby to ensure that the US government, a major purchaser of drugs doesn’t negotiate hard on price and sets the rules up to maximise profit. The book goes into detail and makes a strong case on each point. The fact that the rest of the world pays substantially less than the US does is very true and quite remarkable.
Angell doesn’t look at how the US insurance system and Medicare and Medicaid encourage people to get more expensive drugs if they are paid for by other people with little contribution from the user but the issue could be added.
The book is a solid, well researched, well reasoned and interesting look at how drug companies have manipulated the system.
This entire review has been hidden because of spoilers.
June 27, 2025
A mixed offering. I’m sympathetic to many of her arguments, the core issue with this kind of book is that it demands insider-level understanding to properly evaluate its claims. Something only those employed in drug development and the pharmaceutical industry can truly bring. I can only partially speak from that vantage point, but even so, it’s clear her case is uneven. Some arguments are valid and important, especially those exposing systemic problems that extend beyond pharma itself. But others are far less convincing, rooted in oversimplification or selective framing. The result is a book that occasionally strikes a nerve, but just as often overreaches.
To start, several of her claims have well-established counterarguments. Take her assertion that drug prices are not commensurate with costs of producing the drug - this is true but misleading. Drug development isn’t just expensive; it’s defined by an extraordinarily high failure rate, with about 9 out of 10 drugs failing before approval. Pricing must therefore reflect not only the cost of producing a successful drug, but also the sunk costs of failed candidates, since investors back the entire pipeline, not individual assets. So her claim that prices should be based solely on a drug’s value to the patient ignores the financial reality of R&D investment. That said, I do share her broader concern about the affordability of drugs in the U.S. system. The lack of transparency around how much is spent on research versus marketing only compounds the difficulty of assessing whether current pricing is justifiable. I would not at all be surprised if drug companies hide those costs for mercenary motives.
This also ties in with her criticism of "opportunity cost." Of course, investors fund the vast majority of drug development, and to justify those investments, they must be convinced their capital could not earn better returns elsewhere. This "cost of capital" is unique to the drug industry, I believe.
I wish she had included more data and statistics to ground her arguments. For instance, her critique of "me-too" drugs ignores the fact that they can foster price competition and sometimes improve efficacy. I haven't looked at data at hand, but the fact that she hasn't examined how competition might drive down pricing strikes me as strange. Peter Kolchinsky has written about this and may have useful counterpoints.
She also tackles the issue of drug price negotiations. Again, can't say I agree with her setup here - her belief is that the US should negotiate drug prices (keeping in mind these don't actually constitute negotiations, since the drug companies can't afford to leave the table if they don't like the terms). She then argues that negotiating would make drugs more affordable, and wouldn't completely destroy innovation.
But this is a classic strawman argument. Of course, drugs would still get made - the more nuanced reality is that lower expected returns may reduce investment, leading to fewer—not zero—new drugs.. A lot of the most talented minds in the world are working on producing more addictive smart phones and artificial intelligence - I don't think curiosity is what drives them, but high salaries. Maximizing this attractiveness, I believe, is essential. We should not try to be culling the profitability of drugs as much as we should have a system that ensures everyone benefits from its innovations.
That said, I agree with her on some key points. Namely, she raises important concerns about industry conflicts of interest, such as grassroots organizations being quietly funded by pharmaceutical companies (e.g., in the case of Hepatitis C advocacy). These relationships should absolutely be made more transparent. She notes that some pharmaceutical companies own pharmacy benefit managers (PBMs), like Merck once owning Merck Medco. This kind of vertical integration deserves a lot of scrutiny. I think any critiques of hypercommercialized capitalism and corruption can be made of the pharmaceutical industry, no question.
As a concluding note, her argument that the pharmaceutical industry should simply "sell affordable drugs" overlooks the fundamental realities of drug development—namely, its high cost, high failure rate. More importantly, it misrepresents the industry’s role: pharmaceutical companies don't exist to sell affordable drugs, they exist to generate profit by developing and selling drugs. Innovation is risky, and the cost of failure is both real and substantial. Angell’s sweeping indictment of the industry fails to account for these core economic facts, I believe.
To start, several of her claims have well-established counterarguments. Take her assertion that drug prices are not commensurate with costs of producing the drug - this is true but misleading. Drug development isn’t just expensive; it’s defined by an extraordinarily high failure rate, with about 9 out of 10 drugs failing before approval. Pricing must therefore reflect not only the cost of producing a successful drug, but also the sunk costs of failed candidates, since investors back the entire pipeline, not individual assets. So her claim that prices should be based solely on a drug’s value to the patient ignores the financial reality of R&D investment. That said, I do share her broader concern about the affordability of drugs in the U.S. system. The lack of transparency around how much is spent on research versus marketing only compounds the difficulty of assessing whether current pricing is justifiable. I would not at all be surprised if drug companies hide those costs for mercenary motives.
This also ties in with her criticism of "opportunity cost." Of course, investors fund the vast majority of drug development, and to justify those investments, they must be convinced their capital could not earn better returns elsewhere. This "cost of capital" is unique to the drug industry, I believe.
I wish she had included more data and statistics to ground her arguments. For instance, her critique of "me-too" drugs ignores the fact that they can foster price competition and sometimes improve efficacy. I haven't looked at data at hand, but the fact that she hasn't examined how competition might drive down pricing strikes me as strange. Peter Kolchinsky has written about this and may have useful counterpoints.
She also tackles the issue of drug price negotiations. Again, can't say I agree with her setup here - her belief is that the US should negotiate drug prices (keeping in mind these don't actually constitute negotiations, since the drug companies can't afford to leave the table if they don't like the terms). She then argues that negotiating would make drugs more affordable, and wouldn't completely destroy innovation.
But this is a classic strawman argument. Of course, drugs would still get made - the more nuanced reality is that lower expected returns may reduce investment, leading to fewer—not zero—new drugs.. A lot of the most talented minds in the world are working on producing more addictive smart phones and artificial intelligence - I don't think curiosity is what drives them, but high salaries. Maximizing this attractiveness, I believe, is essential. We should not try to be culling the profitability of drugs as much as we should have a system that ensures everyone benefits from its innovations.
That said, I agree with her on some key points. Namely, she raises important concerns about industry conflicts of interest, such as grassroots organizations being quietly funded by pharmaceutical companies (e.g., in the case of Hepatitis C advocacy). These relationships should absolutely be made more transparent. She notes that some pharmaceutical companies own pharmacy benefit managers (PBMs), like Merck once owning Merck Medco. This kind of vertical integration deserves a lot of scrutiny. I think any critiques of hypercommercialized capitalism and corruption can be made of the pharmaceutical industry, no question.
As a concluding note, her argument that the pharmaceutical industry should simply "sell affordable drugs" overlooks the fundamental realities of drug development—namely, its high cost, high failure rate. More importantly, it misrepresents the industry’s role: pharmaceutical companies don't exist to sell affordable drugs, they exist to generate profit by developing and selling drugs. Innovation is risky, and the cost of failure is both real and substantial. Angell’s sweeping indictment of the industry fails to account for these core economic facts, I believe.
March 3, 2011
An indispensable book for anyone interested in healthcare reform. Everyone complains about affordable health insurance, but no one asks why health costs are so high in the first place. After 20+ years on the editorial staff of the New England Journal of Medicine, Marcia Angell became fed up with the obvious unethical practices of Big Pharma. She presents a well-researched and extremely thorough look at how Big Pharma is draining Americans dry. Although the book does get a bit repetitive, it was definitely worth finishing. I think most informed Americans are aware of at least some of the realities presented in this book, but it still has a lot to offer and solid evidence to back up each claim.
Read
February 5, 2009Big Pharma "is taking us for a ride," Angell contends. "And there will be no real reform without an aroused and determined public to make it happen." This expose may arouse readers, but will it help the larger cause? Critics agree that Angell's passionate, well-researched indictment of the industry's practice raises important questions. The lack of new insight doesn't diminish its power, but some critics who applaud Angell's suggested reforms also see them as unrealistic. Only Dr. Miller of The Wall Street Journal
October 17, 2016
I found this book fascinating, written by a very credible author who has had decades of experience with the industry. I have the entire book paperclipped to mark pages to refer to for later reference. This book is incredibly eye-opening, and in places, jaw dropping about how corrupt big pharma is and the lengths they go to to use the mass population as their guinea pigs. i would recommend this book to anyone concerned about what is going on in the medical field or with the pharmaceutical industry.
July 5, 2021
This book details at what length drug companies go to in order to make an obscene amount of profit, even if it puts people health at risk. The best thing we as consumers can do is to stay in good health so we don’t need to take medications as we get older or if that becomes necessary, then do our research before deciding to go on a medication regimen.
December 27, 2020
review of
Marcia Angell, M.D.'s The Truth About the Drug Companies - How They Deceive Us and What to do About It
by tENTATIVELY, a cONVENIENCE - December 25-27, 2020
For the full review: https://www.goodreads.com/story/show/...
One of the many things that I've found annoying about the pseudo-dialog around what I call the PANDEMIC PANIC, the discussion about what's 'real' & what's a media-fabrication regarding COVID-19, has been some people's asking for "the science" that supports any position taken contrary to the mainstream narrative. This isn't because I'm opposed to science, although I do find it as potentially fallible as anything else, but because the people asking for it haven't generally, in my experience, much notion of what science is - nor wd they truly understand any science that they might encounter.
In other words, again in my personal experience, the people asking for "the science": 1. aren't scientists, 2. aren't intellectuals, 3. don't even read bks - except for, perhaps, the occasional thriller or bk relevant to some subcultural concern such as bike-riding. Nor are they people likely to've ever asked for "the science" to support much of anything else they've ever encountered in their life. Nor wd they be able to explain "the science" that backs what're hypothetically 'their own' positions on anything. The responsibility is solely on the person whose opinion they're attacking to 'prove' w/ "the science" that what they're saying is 'true'.
I, on the other hand, am a person who not only reads bks (thousands of them), but also writes bks (15 to date); who watches documentaries, & also makes documentaries (hundreds of them to date); & someone who writes & publishes criticism (something like 1,500 pieces to date). As such, I can easily demonstrate actual experience w/ critical thinking that the people asking for "the science" can't. At best, they can quote talking points from a radio program that they heard. Because they have other friends who heard the same program or something similar & because these friends can also paraphrase from these programs this parroting takes on a 'reality' to them.
W/ all this, & more, in mind, I've been accumulating bks that address medical science issues w/ the intention of actually reading them & quoting them & writing about them. Some of these bks, such as this one, are too based in commonly acccepted scientific legitimacy for most people to be able to easily dismiss them as somehow 'lunatic fringe' or 'conspiracy theorist'. Others are bks written by people so widely lambasted by what I call Fact Chokers (censors) that I'm curious about what they actually say instead of what people are being told they say in an attempt to discourage readers from finding out for themselves. I may or may not agree w/ them, I won't know until I actually read one of their bks. Finally, at least a few may say things that I find completely egregious & full of hidden agendas.
I decided to start reading these bks w/ this one b/c the title promised to support opinions & observations I already have AND b/c the author is fully credited in the area she's criticizing & is, therefore, difficult for people wanting "the science" to easily write off (w/o being told to do so by the people who tell them what 'to think' in the 1st place).
The author's bio in the back of the bk informs us of the following:
"The former editor in chief of The New England Journal of Medicine and a physician trained in both internal medicine and pathology, Marica Angell is a nationally recognized authority in the field of health care and an outspoken proponent of medical and pharmaceutical reform. Time magazine named her one of the twenty-five most influential people in America. Dr, Angell is the author of Science on Trial." - p 307
TO BEGIN: READ THIS BOOK, IT'S ABSOLUTELY IMPORTANT .
"Prescription drug costs are indeed high—and rising fast. Americans now spend a staggering $200 billion a year on prescription drugs, and that figure is growing at about 12 percent per year (down from a high of 18 percent in 1999).1" - p xii
"1. There are several sources of statistics on the size and growth of the industry. One is IMS Health (www.imshealth.com), a private company that collects and sells information on the global pharmaceutical industry. See www.imshealth.com/ims/portal/front/ar... for the $200 billion figure." - p 267
It's important to inform you that everything Angell refers to is reinforced by endnotes that one can use to follow up. Alas, I DID just follow up on that one & got this message: "The page you requested was removed.". Given that this bk was published in 2004, it's no wonder that links might be broken. It's also possible that the recent spate of censorship (worse than any I've previously noted in my life) has something to do w/ it as might litigious behaviors of Big Pharma.
"I witnessed firsthand the influence of the industry on medical research during my two decades at The New England Journal of Medicine. The staple of the journal is research about causes of and treatments for disease. Increasingly, this work is sponsored by drug companies. I saw companies begin to exercise a level of control over the way research is done that was unheard of when I first came to the journal, and the aim was clearly to load the dice to make sure their drugs looked good. As an example, companies would require researchers to compare a new drug with a placebo (sugar pill) instead of with an older drug. That way the new drug would look good even though it might actually be worse than the older one." - p xviii
It's also important to emphasize that this bk is very solid in its presentation of the objectionable practices of Big Pharma. There are, in fact, so many issues brought to light & explained so clearly that this review can only hint at a few that I found most compelling. Again, I encourage the reader of this review to read the entire bk from front-to-back in order to thoroughly understand its well-developed points.
It might help the reader to understand my position here to explain that I don't take medicine except under truly extreme circumstances. I've taken many illegal drugs, esp important being consciousness-expansion drugs (a term I prefer to "psychedelics"). I'm particularly in favor of LSD & mushrooms — but I don't recommend them for everyone & I don't recommend using them frivolously. I also essentially stopped using those decades ago. Otherwise, I don't even take aspirin. I also rarely get headaches, & the worst headaches I've ever gotten have been from stupid excessive use of alcohol (I strongly warn people against hangovers where it hurts to think or move!). It used to be a joke of mine that all drugs that keep politicians alive shd be illegal. That upset some people b/c the implication was that I think medicines shd be illegal & many people I know are very dependent on them.. or at least think they are. Given my objection to a medicated society it was very welcome to me to read Angell's critique of the drug industry. Heroin is definitely a problem (& we can 'thank' Bayer for the early days of that) but pharmaceutical pushers are at least as bad — & they're legal!
"From 1960 to 1980, prescription drug sales were fairly static as a percent of U.S. gross domestic product, but from 1980 to 2000, they tripled. They now stand at more than $200 billion a year.1" - p 3
"1. These figures come from the U.S. Centers for Medicare & Medicaid Services, Office of the Actuary, National Health Statistics Group, Baltimore, Maryland. They were summarized in Cynthia Smith, "Retail Prescription Drug Spending in the National Health Accounts," Health Affairs, January-February 2004, 160." - p 268
That probably wdn't've been online as of the writing of the bk but there's some sort of gateway to it online now: https://www.healthaffairs.org/doi/abs... .
Angell starts off w/ some historical philosophizing about how the Reagan presidency inaugurated much of the unrestrained greed of Big Pharma as we know it today. She doesn't however, blame the problem entirely on Republicans, she's quite frank in her look at similarly acting Democrats.
"You could choose to do well or you could choose to do good, but most people who had any choice in the matter thought it difficult to do both. That belief was particularly strong among scientists and other intellectuals. They could choose to live a comfortable but not luxurious life in academia, hoping to do exciting cutting-edge research, or they could "sell out" to industry and do less important but more remunerative work. Starting in the Reagan years and continuing through the 1990s, Americans changed their tune. It became not only reputable to be wealthy, but something close to virtuous. There were "winners" and there were "losers," and the winners were rich and deserved to be." - p 6
Of course, the author is referring to her own professional class here; simultaneously there were punks & anarchists & other 'lunatic fringe' types whose priorities were definitely not w/ getting rich but were instead w/ Truth, Justice, & the Unamerican Way. I was solidly in that camp. How many of us were following legal developments such as what Angell details next I don't know, I certainly wasn't. But the Reagan administration in general was definitely high on the shit list.
"The most important of these laws is known as the Bayh-Dole Act, after its chief sponsors, Senator Birch Bayh (D-Ind.) and Senator Robert Dole (R-Kans). Bayh-Dole enabled universities and small businesses to patent discoveries emanating from research sponsored by the National Institutes of Health (NIH), the major distributor of tax dollars for medical research, and then to grant exclusive licenses to drug companies. Until then, taxpayer-financed discoveries were in the public domain, available to any company that wanted to use them." - p 7
Hhmm.. Taxpayer money pays for research, results enter Public Domain. That seems reasonable to me. But it also seems reasonable for researchers to benefit from their hard work above & beyond just salaries. Surely, a compromise solution cd be reached in wch the research stays in the public domain but the researchers are still rewarded for their exceptional accomplishment. At any rate, the Reagan admin was about benefitting big business, not the public. & the following is still from his January 20, 1981 – January 20, 1989 reign.
"Starting in 1984, with legislation known as the Hatch-Waxman Act, Congress passed another series of laws that were just as big a bonanza for the pharmaceutical industry. These laws extended monopoly rights for brand-name drugs. Exclusivity is the lifeblood of the industry because it means that no other company may sell the same drug for a set period. After exclusive marketing rights expire, copies (called generic drugs) enter the market, and the price usually falls to as little as 20 percent of what it was." - p 9
A justification for the original drug's high price is basically that the drug company had to spend a fortune on R&D (Research & Development). A significant part of this bk is spent debunking that as a PR myth.
"By 1990, the industry had assumed its present contours as a business with unprecedented control over its own fortunes. For example, if it didn't like something about the FDA, the federal agency that's supposed to regulate the industry, it could change it through direct pressure or through its friends in Congress." - p 10
Bypass democratic process anyone? The good ole 'merican way being pay-offs-every-wch-way. Profits before People, eh?
"The fact that Americans pay much more for prescription drugs than Europeans and Canadians is now widely known. As estimated 1 to 2 million Americans buy their medicines from Canadian drugstores over the Internet, despite the fact that in 1987, in response to heavy industry lobbying, a compliant Congress had made it illegal for anyone other than manufacturers to import prescription drugs from other countries." - p 15
I'm reminded of my friend Vermin Supreme ( https://archive.org/details/VerminSup... ), a perpetual candidate for just about any political office that he might be had by, & his proposed Health Plan shd he get into power: a bus ticket to Canada. Yes, for some reason, the Canadian medical system doesn't seem hell-bent on sucking every last asset out of its patients before drugging & starving them to death in a hospice.
Every once in a while, one of these greedy big companies gets caught committing a crime in pursuit of the Great American Dream (getting rich as fuck & not giving a damn about who gets hurt by it) & has to pay the piper - but like all big corporations busted in similar manner they've made so much profit off their crime that the fines, enormous tho they may be, just come out of the profits as an unfortunate expense.
"TAP Pharmaceuticals, for instance, paid $875 million to settle civil and criminal charges of Medicaid and Medicare fraud in the marketing of its prostate cancer drug, Lupron." - p 19
But there're all sorts of shenanigans going on that you're probably not aware of. Have you ever been unwittingly used by a dr in a study w/o realizing that you're a cash cow?
"To get human subjects, drug companies or contract research organizations routinely offer doctors large bonuses (averaging about $7000 per patient in 2001) and sometimes bonuses for rapid enrollment. For example, according to a 2000 Department of Health and Human Services inspector general's report, physicians in one trial were paid $12,000 for each patient enrolled, plus another $30,000 on the enrollment of the sixth patient. One risk of this bounty and bonus system is that it can induce doctors to enroll patients who are not really eligible. For instance, if it means an extra $30,000 to you to enroll a patient in an asthma study, you might very well be tempted to decide your next patient has asthma, whether he does or not ("Sounds like a little wheeze you have there. . . ."). Obviously, if the wrong patients are enrolled, the results of a trial are unreliable, and that is probably often the case." - pp 30-31
Now you don't think that 6th patient enrolled is getting $30,000 too do you? Of course not.. & they're getting hoodwinked into thinking that they're advancing science & not being used for profiteering at the possible expense of their health.
For the full review: https://www.goodreads.com/story/show/...
Marcia Angell, M.D.'s The Truth About the Drug Companies - How They Deceive Us and What to do About It
by tENTATIVELY, a cONVENIENCE - December 25-27, 2020
For the full review: https://www.goodreads.com/story/show/...
One of the many things that I've found annoying about the pseudo-dialog around what I call the PANDEMIC PANIC, the discussion about what's 'real' & what's a media-fabrication regarding COVID-19, has been some people's asking for "the science" that supports any position taken contrary to the mainstream narrative. This isn't because I'm opposed to science, although I do find it as potentially fallible as anything else, but because the people asking for it haven't generally, in my experience, much notion of what science is - nor wd they truly understand any science that they might encounter.
In other words, again in my personal experience, the people asking for "the science": 1. aren't scientists, 2. aren't intellectuals, 3. don't even read bks - except for, perhaps, the occasional thriller or bk relevant to some subcultural concern such as bike-riding. Nor are they people likely to've ever asked for "the science" to support much of anything else they've ever encountered in their life. Nor wd they be able to explain "the science" that backs what're hypothetically 'their own' positions on anything. The responsibility is solely on the person whose opinion they're attacking to 'prove' w/ "the science" that what they're saying is 'true'.
I, on the other hand, am a person who not only reads bks (thousands of them), but also writes bks (15 to date); who watches documentaries, & also makes documentaries (hundreds of them to date); & someone who writes & publishes criticism (something like 1,500 pieces to date). As such, I can easily demonstrate actual experience w/ critical thinking that the people asking for "the science" can't. At best, they can quote talking points from a radio program that they heard. Because they have other friends who heard the same program or something similar & because these friends can also paraphrase from these programs this parroting takes on a 'reality' to them.
W/ all this, & more, in mind, I've been accumulating bks that address medical science issues w/ the intention of actually reading them & quoting them & writing about them. Some of these bks, such as this one, are too based in commonly acccepted scientific legitimacy for most people to be able to easily dismiss them as somehow 'lunatic fringe' or 'conspiracy theorist'. Others are bks written by people so widely lambasted by what I call Fact Chokers (censors) that I'm curious about what they actually say instead of what people are being told they say in an attempt to discourage readers from finding out for themselves. I may or may not agree w/ them, I won't know until I actually read one of their bks. Finally, at least a few may say things that I find completely egregious & full of hidden agendas.
I decided to start reading these bks w/ this one b/c the title promised to support opinions & observations I already have AND b/c the author is fully credited in the area she's criticizing & is, therefore, difficult for people wanting "the science" to easily write off (w/o being told to do so by the people who tell them what 'to think' in the 1st place).
The author's bio in the back of the bk informs us of the following:
"The former editor in chief of The New England Journal of Medicine and a physician trained in both internal medicine and pathology, Marica Angell is a nationally recognized authority in the field of health care and an outspoken proponent of medical and pharmaceutical reform. Time magazine named her one of the twenty-five most influential people in America. Dr, Angell is the author of Science on Trial." - p 307
TO BEGIN: READ THIS BOOK, IT'S ABSOLUTELY IMPORTANT .
"Prescription drug costs are indeed high—and rising fast. Americans now spend a staggering $200 billion a year on prescription drugs, and that figure is growing at about 12 percent per year (down from a high of 18 percent in 1999).1" - p xii
"1. There are several sources of statistics on the size and growth of the industry. One is IMS Health (www.imshealth.com), a private company that collects and sells information on the global pharmaceutical industry. See www.imshealth.com/ims/portal/front/ar... for the $200 billion figure." - p 267
It's important to inform you that everything Angell refers to is reinforced by endnotes that one can use to follow up. Alas, I DID just follow up on that one & got this message: "The page you requested was removed.". Given that this bk was published in 2004, it's no wonder that links might be broken. It's also possible that the recent spate of censorship (worse than any I've previously noted in my life) has something to do w/ it as might litigious behaviors of Big Pharma.
"I witnessed firsthand the influence of the industry on medical research during my two decades at The New England Journal of Medicine. The staple of the journal is research about causes of and treatments for disease. Increasingly, this work is sponsored by drug companies. I saw companies begin to exercise a level of control over the way research is done that was unheard of when I first came to the journal, and the aim was clearly to load the dice to make sure their drugs looked good. As an example, companies would require researchers to compare a new drug with a placebo (sugar pill) instead of with an older drug. That way the new drug would look good even though it might actually be worse than the older one." - p xviii
It's also important to emphasize that this bk is very solid in its presentation of the objectionable practices of Big Pharma. There are, in fact, so many issues brought to light & explained so clearly that this review can only hint at a few that I found most compelling. Again, I encourage the reader of this review to read the entire bk from front-to-back in order to thoroughly understand its well-developed points.
It might help the reader to understand my position here to explain that I don't take medicine except under truly extreme circumstances. I've taken many illegal drugs, esp important being consciousness-expansion drugs (a term I prefer to "psychedelics"). I'm particularly in favor of LSD & mushrooms — but I don't recommend them for everyone & I don't recommend using them frivolously. I also essentially stopped using those decades ago. Otherwise, I don't even take aspirin. I also rarely get headaches, & the worst headaches I've ever gotten have been from stupid excessive use of alcohol (I strongly warn people against hangovers where it hurts to think or move!). It used to be a joke of mine that all drugs that keep politicians alive shd be illegal. That upset some people b/c the implication was that I think medicines shd be illegal & many people I know are very dependent on them.. or at least think they are. Given my objection to a medicated society it was very welcome to me to read Angell's critique of the drug industry. Heroin is definitely a problem (& we can 'thank' Bayer for the early days of that) but pharmaceutical pushers are at least as bad — & they're legal!
"From 1960 to 1980, prescription drug sales were fairly static as a percent of U.S. gross domestic product, but from 1980 to 2000, they tripled. They now stand at more than $200 billion a year.1" - p 3
"1. These figures come from the U.S. Centers for Medicare & Medicaid Services, Office of the Actuary, National Health Statistics Group, Baltimore, Maryland. They were summarized in Cynthia Smith, "Retail Prescription Drug Spending in the National Health Accounts," Health Affairs, January-February 2004, 160." - p 268
That probably wdn't've been online as of the writing of the bk but there's some sort of gateway to it online now: https://www.healthaffairs.org/doi/abs... .
Angell starts off w/ some historical philosophizing about how the Reagan presidency inaugurated much of the unrestrained greed of Big Pharma as we know it today. She doesn't however, blame the problem entirely on Republicans, she's quite frank in her look at similarly acting Democrats.
"You could choose to do well or you could choose to do good, but most people who had any choice in the matter thought it difficult to do both. That belief was particularly strong among scientists and other intellectuals. They could choose to live a comfortable but not luxurious life in academia, hoping to do exciting cutting-edge research, or they could "sell out" to industry and do less important but more remunerative work. Starting in the Reagan years and continuing through the 1990s, Americans changed their tune. It became not only reputable to be wealthy, but something close to virtuous. There were "winners" and there were "losers," and the winners were rich and deserved to be." - p 6
Of course, the author is referring to her own professional class here; simultaneously there were punks & anarchists & other 'lunatic fringe' types whose priorities were definitely not w/ getting rich but were instead w/ Truth, Justice, & the Unamerican Way. I was solidly in that camp. How many of us were following legal developments such as what Angell details next I don't know, I certainly wasn't. But the Reagan administration in general was definitely high on the shit list.
"The most important of these laws is known as the Bayh-Dole Act, after its chief sponsors, Senator Birch Bayh (D-Ind.) and Senator Robert Dole (R-Kans). Bayh-Dole enabled universities and small businesses to patent discoveries emanating from research sponsored by the National Institutes of Health (NIH), the major distributor of tax dollars for medical research, and then to grant exclusive licenses to drug companies. Until then, taxpayer-financed discoveries were in the public domain, available to any company that wanted to use them." - p 7
Hhmm.. Taxpayer money pays for research, results enter Public Domain. That seems reasonable to me. But it also seems reasonable for researchers to benefit from their hard work above & beyond just salaries. Surely, a compromise solution cd be reached in wch the research stays in the public domain but the researchers are still rewarded for their exceptional accomplishment. At any rate, the Reagan admin was about benefitting big business, not the public. & the following is still from his January 20, 1981 – January 20, 1989 reign.
"Starting in 1984, with legislation known as the Hatch-Waxman Act, Congress passed another series of laws that were just as big a bonanza for the pharmaceutical industry. These laws extended monopoly rights for brand-name drugs. Exclusivity is the lifeblood of the industry because it means that no other company may sell the same drug for a set period. After exclusive marketing rights expire, copies (called generic drugs) enter the market, and the price usually falls to as little as 20 percent of what it was." - p 9
A justification for the original drug's high price is basically that the drug company had to spend a fortune on R&D (Research & Development). A significant part of this bk is spent debunking that as a PR myth.
"By 1990, the industry had assumed its present contours as a business with unprecedented control over its own fortunes. For example, if it didn't like something about the FDA, the federal agency that's supposed to regulate the industry, it could change it through direct pressure or through its friends in Congress." - p 10
Bypass democratic process anyone? The good ole 'merican way being pay-offs-every-wch-way. Profits before People, eh?
"The fact that Americans pay much more for prescription drugs than Europeans and Canadians is now widely known. As estimated 1 to 2 million Americans buy their medicines from Canadian drugstores over the Internet, despite the fact that in 1987, in response to heavy industry lobbying, a compliant Congress had made it illegal for anyone other than manufacturers to import prescription drugs from other countries." - p 15
I'm reminded of my friend Vermin Supreme ( https://archive.org/details/VerminSup... ), a perpetual candidate for just about any political office that he might be had by, & his proposed Health Plan shd he get into power: a bus ticket to Canada. Yes, for some reason, the Canadian medical system doesn't seem hell-bent on sucking every last asset out of its patients before drugging & starving them to death in a hospice.
Every once in a while, one of these greedy big companies gets caught committing a crime in pursuit of the Great American Dream (getting rich as fuck & not giving a damn about who gets hurt by it) & has to pay the piper - but like all big corporations busted in similar manner they've made so much profit off their crime that the fines, enormous tho they may be, just come out of the profits as an unfortunate expense.
"TAP Pharmaceuticals, for instance, paid $875 million to settle civil and criminal charges of Medicaid and Medicare fraud in the marketing of its prostate cancer drug, Lupron." - p 19
But there're all sorts of shenanigans going on that you're probably not aware of. Have you ever been unwittingly used by a dr in a study w/o realizing that you're a cash cow?
"To get human subjects, drug companies or contract research organizations routinely offer doctors large bonuses (averaging about $7000 per patient in 2001) and sometimes bonuses for rapid enrollment. For example, according to a 2000 Department of Health and Human Services inspector general's report, physicians in one trial were paid $12,000 for each patient enrolled, plus another $30,000 on the enrollment of the sixth patient. One risk of this bounty and bonus system is that it can induce doctors to enroll patients who are not really eligible. For instance, if it means an extra $30,000 to you to enroll a patient in an asthma study, you might very well be tempted to decide your next patient has asthma, whether he does or not ("Sounds like a little wheeze you have there. . . ."). Obviously, if the wrong patients are enrolled, the results of a trial are unreliable, and that is probably often the case." - pp 30-31
Now you don't think that 6th patient enrolled is getting $30,000 too do you? Of course not.. & they're getting hoodwinked into thinking that they're advancing science & not being used for profiteering at the possible expense of their health.
For the full review: https://www.goodreads.com/story/show/...
May 11, 2025
DNF (did not finish) - Borrowed from library and had to return. Don't care enough to renew because the macroscopic lens doesn't behold my attention. This book is from the early 2000s, so as one with medical industrial corruption as a special interest, it was interesting reading an MD's perspective from that time. I note that the corruptions documented, which may have been groundbreaking at the time, are so commonplace now that they're passively accepted by all. Apparently, this book didn't do much to encourage medical society and fellow doctors into the world of the ethical and noncorrupt.
November 5, 2025
Reading a 20+ year old book on this topic was interesting. You see the bad patterns are still there and even worse. We are heading toward times where it’s very hard to trust any medical advice. It would be great to read an updated version of this book.
July 3, 2024
Drug prices are infernally high in America because big pharmaceutical companies deceive consumers, doctors, and regulatory agencies to prop up profits, according Marcia Angell, MD, a longtime editor of the New England Journal of Medicine.
The Truth About the Drug Companies: How They Deceive Us and What to Do About It, her book, is a damning expose of the false claims, bad faith, payoffs, backscratching, dodgy legal maneuvers, and borderline fraud the world's giant drug companies practice and get away with every day of the week.
Pharmaceutical companies regularly rank high on lists of the most profitable Fortune 500 companies, and selling drugs is one of the most profitable businesses in America.
Dr. Angell spent 20 years editing the New England Journal of Medicine and her well-documented book explains how the industry she understood so well keeps prices sky-high by pulling the wool over the eyes of American consumers, politicians, and doctors morning, noon, and night.
Although her book was published two decades ago, Dr. Angell's book remains one of the best and most extensive exposes of the shady practices of large drug companies who habitually rig the system to enrich themselves.
Medicine is a noble profession, she believes, and new, more effective drugs to treat various medical problems are sorely needed. However, Dr. Angell observes, for-profit drug companies are less focused less on creating useful new drugs than on raking in enormous profits, often on drugs which aren't any better than existing drugs.
The industry is profitable. One company, Pfizer, enjoyed sales of an eye-popping $100 billion in 2022.
From 2000 to 2018 the median profit of drug companies expressed as a fraction of revenue was almost double that of large nonpharmaceutical companies (13.8% vs 7.7%), according to a recent study published in the Journal of the American Medical Association. That level of profit can buy a whale of a lot of influence, and it does.
In the 20 years since Dr. Angell first shined the light into the dark crannies of Big Pharma, it's safe to say that America's drug companies haven't reformed very much at all.
HIGH DRUG PRICES
American consumers do not get prescription drugs at reasonable prices. Americans pay almost twice what patients in other industrialized nations like Canada pay for the same drugs, even for drugs which are manufactured here and must be shipped to other countries.
Pharmacological drugs are not priced according to what they actually cost to make (numbers which companies take pains to conceal) but according to what the market will bear. Big Pharma claims this is because new drugs cost a lot to develop, but Dr. Angell observes that this claim is false and deceptive. These days, she notes, drug companies spend a lot more on advertising and marketing than they do on research and development to develop new drugs.
Due to changes in legislation governing the patent process, and exclusive marketing rights granted by the Food and Drug Administration or FDA, new drugs now enjoy 20-odd years of profitable exclusivity before less-expensive generic drugs can even be released to compete with them.
Even when patent protection expires for profitable drugs, Big Pharma's lawyers fight to extend the life of the patent (and the stream of profits) in myriad ways. Federal regulators can be too compromised or overwhelmed to respond, Dr. Angell writes, or they simply ignore the legal games and the underlying dodgy legal strategy, and look the other way.
An obvious example of the enormous power of Big Pharma is the Medicare prescription drug benefit, passed by Congress with some hoopla in 2003. Urged on by an army of drug company lobbyists, this legislation expressly forbade Medicare from negotiating prices with drug companies. This forced the federal agency that funds health care for older Americans to pay the absolute maximum retail price for senior's drugs.
No other government agency is forbidden from negotiating prices, Dr. Angell noted. Today, more than 20 years after the prescription drug benefit passed, Congress has finally and timidly allowed Medicare to negotiate prices for only about a dozen drugs.
DEVELOPMENT COSTS
To justify high drug prices, drug companies claim that they need their fat profits to finance the research and development necessary to develop life-saving new drugs, but this claim is untrue.
Developing good new drugs is important. In fact, it's the reason drug companies exist. Years ago, big drug companies did actually work to develop useful new drugs, according to Dr. Angell, but these days, very few truly life-saving new drugs are being developed at pharmaceutical companies.
During the Reagan years, Congress passed legislation that changed the way the industry worked, Dr. Angell says.
Since the 1980 Bayh-Dole Act and laws that followed in its wake, she notes, big drug companies develop few new cutting-edge drugs on their own. The Hatch-Waxman Act of 1984 ushered in more laws favorable to Big Pharms.
In 1992, the Prescription Drug User Fee Act gave drug companies authority to pay "user fees" to the FDA to expedite approval of new drugs. These fees soon accounted for more than half the FDA budget, making the agency more or less dependent and almost captive to the industry it is charged with regulating.
Big Pharma now typically licenses drugs after their development has been funded by the National Institutes of Health and basic research as well as first, second, and third stage clinical trials conducted by universities and small start-ups who are now legally permitted to patent and profit from their discoveries.
Most promising new drugs are developed elsewhere, and merely licensed by large drug companies. While drug companies sometimes fund Phase 4 clinical trials, the last of four phases necessary to present a new drug to the FDA for approval, Dr. Angell notes that this is a small percentage of the total cost of development.
Since drug companies can also design and pay for clinical trials of their own drugs, this gives them an opportunity to put their fingers on the scale in various ways. Drug companies might design trials in such a way that they yield favorable results, for instance, or they can bury or not publish information on trials which don't yield the results they want.
Dr. Angell cites an internal document produced by the National Institutes of Health, which was publicized by the consumer group Public Citizen. The NIH analyzed the five top-selling drugs of 1995 -- Zantac, Zovirax, Capoten, Vasotec, and Prozac. Of the 17 scientific papers leading to their discovery, 16 of 17 came from outside the industry. Even when all the relevant published research on the five drugs was examined, 55 percent came from NIH-funded laboratories and 30 percent from foreign academic institutions, with only 15 percent from the industry.
"ME TOO" DRUGS
Truly new and useful drugs represent only a small share of "new" drugs brought to market, Dr. Angell writes.
In 2002, of the 78 new drugs approved by the FDA, only 17 contained any new active ingredients at all. And only seven of those were classified by the FDA as improvements over older drugs.
Drug companies shell out much more money for direct-to-consumer television advertising than they do to develop new drugs. Most of their TV advertising budgets go to promote profitable "me too" drugs. These are not actual improvements on older drugs, but rather drugs that chemically resemble a best-selling drug, sometimes differing from the original by only a molecule or two to justify a new patent.
The drug marketed as Viagra, successfully introduced to treat erectile dysfunction, was quickly followed by competing "me-too" drugs Levitra and Cialis. Prozac, a best-selling type of antidepressant, was followed by Zoloft, Celexa, and Lexapro, "me too" drugs introduced by other pharmaceutical firms.
Schering-Plough's Clairtin, an allergy drug, was followed by the same company's "me too" drug Clarinex, a very slightly modified version of Claritin introduced and heavily marketed when the original Claritin went off patent and was available as a generic.
Many pharmacological firms employ this "bait and switch" strategy when introducing "me too" drugs to replace best-selling older drugs. Big advertising budgets for "me too" drugs with a new name, and in a new package, and in a new color, are intended to switch consumers from one drug going off patent to another patented drug and of course the advertising and marketing costs are passed along to consumers in the form of very high prices.
Clinical trials which allow new drugs to be compared with a placebo, rather than an existing drug. This allows drug companies to market new drugs which are not any better than existing drugs, according to Dr. Angell. She calls for new drugs to be tested against existing drugs in clinical trials, and to prove they are truly more effective than existing drugs before they are approved for use.
FOOD, FLATTERY, AND FRIENDSHIP
Big Pharma fields a virtual army of representatives to call on doctors, and sell and promote new drugs. This amounts to one drug company rep for every five or six physicians in the U.S., Dr. Angell observes.
Drug company representatives call on medical doctors and doctors in training and aim to persuade them with "flood, flattery, and friendship." Reps ply medical professionals not only with nice meals at expensive restaurants, but also with all-expense paid vacations, lucrative speaking engagements, and more.
Money invested in wooing doctors to use a particular drug often results in more prescriptions, and higher profit, on the back end.
One inducement is to give doctors free samples of new drugs, which their patients may ask for after seeing TV advertisements. The physician can make his patients happy by providing free samples. But when the doctor writes that patient a prescription for the new drug, the patient or health care provider pays the high retail price which includes the company's advertising and marketing costs but also a considerable bit of profit.
The work of drug company reps can involve giving doctors personal gifts, offering doctors and their spouses all-expense-paid trips to drug company-sponsored "in service" presentations in exotic locations, offers to write and place articles with the doctor's byline on new drugs in medical journals, paying doctors to enroll patients in company-sponsored research trials, filling in doctors and staff in on the latest (company-sponsored) research, and more.
Big Pharma is active in supporting and sponsoring medical trade associations and "educational" conferences of all sorts which often allow them an opportunity to promote particular drugs.
Physicians who are experts or highly-regarded in their fields frequently sit on important committees, and a good many are recipients of significant drug company largesse. It is good form and often required that doctors declare a competing financial interest, if one exists, but this is not always done.
When an expert panel recognized a new category of high blood pressure called "pre-hypertension," acceptable normal blood pressure levels were revised down from 140 over 90, to 120 over 80. While lifestyle changes are often recommended first, changes in diet and exercise patterns are difficult to achieve for many, and the upshot is doctors write million more prescriptions for blood pressure-lowering drugs and that increases the profits for Big Pharma.
Similarly, Dr. Angell observes, expert panels have recommended acceptable blood cholesterol levels be revised down from below 280 (where they stood for some time) to below 240, and then to below 200. This helped make Lipitor the top-selling pharmaceutical drug in the world in 2022, since millions more Americans were being diagnosed with high cholesterol under the new guidelines.
The influence of drug companies now reaches deeply into the nation's medical schools, where the process of diagnosing and treating disease is becoming more closely linked with which drug to prescribe rather than examining all feasible treatments for a particular disease or condition.
LOBBYING
Big Pharma employs an army of well-connected lobbyists to work the halls of congress, and the state legislatures.
Lobbyists often begin their careers as regulators with agencies like the FDA or as politicians or congressional staff members, and then transition to lucrative corporate lobbying jobs. According to Dr. Angell, Big Pharma employs more lobbyists than the defense industry, or more than one lobbyist for every member of Congress.
Members of Congress need campaign contributions. Politicians that introduce industry-friendly legislation or help push it through are often beneficiaries of significant drug company largess when they run for office or retire.
Politicians who sit on important committees or oversee particular agencies can walk through the "revolving door" into high-paying drug company jobs, while drug company executives often waltz into jobs overseeing the industry from which they sprang.
Not surprisingly, some studies show that only about 41 percent of Americans now trust Big Pharma to look out after their interests.
THE FUTURE
Unless American consumers demand it, and Congress can be convinced to respond with strong, appropriate legislation, Big Pharma looks to chug right into the future reaping bigger and ever-growing profits.
Americans take a lot of prescription drugs. In 2021, more than 60 percent of Americans over the age of 18 took at least one prescription drug, according to statistics from the Centers for Disease Control. For people over 65, some 90 percent took at least one drug, and many take considerably more.
When Dr. Angell's book was published two decades ago, Big Pharma was raking in revenues of $200 billion a year on prescription drugs. This year, according to Health Care Analysis, Americans will spend more than $600 billion on prescription drugs.
In 2022, the FDA approved 37 new drugs, according to Accountable US. The same year, America's five largest drug companies reaped a whopping $80 billion in profit.
The Centers for Medicare and Medicaid Services’ (CMS) Office of the Actuary predicted that it expects national healthcare expenditures to outpace U.S. economic growth over the next several years. The CMS estimates this will result in an increase in the health spending share of our gross national product from 17.3% in 2022 to 19.7% in 2032. This analysis showed U.S. healthcare expenditures reaching $4.8 trillion this year with healthcare spending reaching $7.7 trillion by 2032.
Robert Weissman, president of Public Citizen, has stated that the coming surge in healthcare spending “has nothing to do with improving care and everything to do with price-gouging, monopolization, and wealth extraction by insurance corporations, Big Pharma, and for-profit hospitals.”
The Truth About Drug Companies, Dr. Angell's book, remains the single best explanation of why we Americans pay sky-high prices for prescription drugs.
This review was previously published on Medium.com
The Truth About the Drug Companies: How They Deceive Us and What to Do About It, her book, is a damning expose of the false claims, bad faith, payoffs, backscratching, dodgy legal maneuvers, and borderline fraud the world's giant drug companies practice and get away with every day of the week.
Pharmaceutical companies regularly rank high on lists of the most profitable Fortune 500 companies, and selling drugs is one of the most profitable businesses in America.
Dr. Angell spent 20 years editing the New England Journal of Medicine and her well-documented book explains how the industry she understood so well keeps prices sky-high by pulling the wool over the eyes of American consumers, politicians, and doctors morning, noon, and night.
Although her book was published two decades ago, Dr. Angell's book remains one of the best and most extensive exposes of the shady practices of large drug companies who habitually rig the system to enrich themselves.
Medicine is a noble profession, she believes, and new, more effective drugs to treat various medical problems are sorely needed. However, Dr. Angell observes, for-profit drug companies are less focused less on creating useful new drugs than on raking in enormous profits, often on drugs which aren't any better than existing drugs.
The industry is profitable. One company, Pfizer, enjoyed sales of an eye-popping $100 billion in 2022.
From 2000 to 2018 the median profit of drug companies expressed as a fraction of revenue was almost double that of large nonpharmaceutical companies (13.8% vs 7.7%), according to a recent study published in the Journal of the American Medical Association. That level of profit can buy a whale of a lot of influence, and it does.
In the 20 years since Dr. Angell first shined the light into the dark crannies of Big Pharma, it's safe to say that America's drug companies haven't reformed very much at all.
HIGH DRUG PRICES
American consumers do not get prescription drugs at reasonable prices. Americans pay almost twice what patients in other industrialized nations like Canada pay for the same drugs, even for drugs which are manufactured here and must be shipped to other countries.
Pharmacological drugs are not priced according to what they actually cost to make (numbers which companies take pains to conceal) but according to what the market will bear. Big Pharma claims this is because new drugs cost a lot to develop, but Dr. Angell observes that this claim is false and deceptive. These days, she notes, drug companies spend a lot more on advertising and marketing than they do on research and development to develop new drugs.
Due to changes in legislation governing the patent process, and exclusive marketing rights granted by the Food and Drug Administration or FDA, new drugs now enjoy 20-odd years of profitable exclusivity before less-expensive generic drugs can even be released to compete with them.
Even when patent protection expires for profitable drugs, Big Pharma's lawyers fight to extend the life of the patent (and the stream of profits) in myriad ways. Federal regulators can be too compromised or overwhelmed to respond, Dr. Angell writes, or they simply ignore the legal games and the underlying dodgy legal strategy, and look the other way.
An obvious example of the enormous power of Big Pharma is the Medicare prescription drug benefit, passed by Congress with some hoopla in 2003. Urged on by an army of drug company lobbyists, this legislation expressly forbade Medicare from negotiating prices with drug companies. This forced the federal agency that funds health care for older Americans to pay the absolute maximum retail price for senior's drugs.
No other government agency is forbidden from negotiating prices, Dr. Angell noted. Today, more than 20 years after the prescription drug benefit passed, Congress has finally and timidly allowed Medicare to negotiate prices for only about a dozen drugs.
DEVELOPMENT COSTS
To justify high drug prices, drug companies claim that they need their fat profits to finance the research and development necessary to develop life-saving new drugs, but this claim is untrue.
Developing good new drugs is important. In fact, it's the reason drug companies exist. Years ago, big drug companies did actually work to develop useful new drugs, according to Dr. Angell, but these days, very few truly life-saving new drugs are being developed at pharmaceutical companies.
During the Reagan years, Congress passed legislation that changed the way the industry worked, Dr. Angell says.
Since the 1980 Bayh-Dole Act and laws that followed in its wake, she notes, big drug companies develop few new cutting-edge drugs on their own. The Hatch-Waxman Act of 1984 ushered in more laws favorable to Big Pharms.
In 1992, the Prescription Drug User Fee Act gave drug companies authority to pay "user fees" to the FDA to expedite approval of new drugs. These fees soon accounted for more than half the FDA budget, making the agency more or less dependent and almost captive to the industry it is charged with regulating.
Big Pharma now typically licenses drugs after their development has been funded by the National Institutes of Health and basic research as well as first, second, and third stage clinical trials conducted by universities and small start-ups who are now legally permitted to patent and profit from their discoveries.
Most promising new drugs are developed elsewhere, and merely licensed by large drug companies. While drug companies sometimes fund Phase 4 clinical trials, the last of four phases necessary to present a new drug to the FDA for approval, Dr. Angell notes that this is a small percentage of the total cost of development.
Since drug companies can also design and pay for clinical trials of their own drugs, this gives them an opportunity to put their fingers on the scale in various ways. Drug companies might design trials in such a way that they yield favorable results, for instance, or they can bury or not publish information on trials which don't yield the results they want.
Dr. Angell cites an internal document produced by the National Institutes of Health, which was publicized by the consumer group Public Citizen. The NIH analyzed the five top-selling drugs of 1995 -- Zantac, Zovirax, Capoten, Vasotec, and Prozac. Of the 17 scientific papers leading to their discovery, 16 of 17 came from outside the industry. Even when all the relevant published research on the five drugs was examined, 55 percent came from NIH-funded laboratories and 30 percent from foreign academic institutions, with only 15 percent from the industry.
"ME TOO" DRUGS
Truly new and useful drugs represent only a small share of "new" drugs brought to market, Dr. Angell writes.
In 2002, of the 78 new drugs approved by the FDA, only 17 contained any new active ingredients at all. And only seven of those were classified by the FDA as improvements over older drugs.
Drug companies shell out much more money for direct-to-consumer television advertising than they do to develop new drugs. Most of their TV advertising budgets go to promote profitable "me too" drugs. These are not actual improvements on older drugs, but rather drugs that chemically resemble a best-selling drug, sometimes differing from the original by only a molecule or two to justify a new patent.
The drug marketed as Viagra, successfully introduced to treat erectile dysfunction, was quickly followed by competing "me-too" drugs Levitra and Cialis. Prozac, a best-selling type of antidepressant, was followed by Zoloft, Celexa, and Lexapro, "me too" drugs introduced by other pharmaceutical firms.
Schering-Plough's Clairtin, an allergy drug, was followed by the same company's "me too" drug Clarinex, a very slightly modified version of Claritin introduced and heavily marketed when the original Claritin went off patent and was available as a generic.
Many pharmacological firms employ this "bait and switch" strategy when introducing "me too" drugs to replace best-selling older drugs. Big advertising budgets for "me too" drugs with a new name, and in a new package, and in a new color, are intended to switch consumers from one drug going off patent to another patented drug and of course the advertising and marketing costs are passed along to consumers in the form of very high prices.
Clinical trials which allow new drugs to be compared with a placebo, rather than an existing drug. This allows drug companies to market new drugs which are not any better than existing drugs, according to Dr. Angell. She calls for new drugs to be tested against existing drugs in clinical trials, and to prove they are truly more effective than existing drugs before they are approved for use.
FOOD, FLATTERY, AND FRIENDSHIP
Big Pharma fields a virtual army of representatives to call on doctors, and sell and promote new drugs. This amounts to one drug company rep for every five or six physicians in the U.S., Dr. Angell observes.
Drug company representatives call on medical doctors and doctors in training and aim to persuade them with "flood, flattery, and friendship." Reps ply medical professionals not only with nice meals at expensive restaurants, but also with all-expense paid vacations, lucrative speaking engagements, and more.
Money invested in wooing doctors to use a particular drug often results in more prescriptions, and higher profit, on the back end.
One inducement is to give doctors free samples of new drugs, which their patients may ask for after seeing TV advertisements. The physician can make his patients happy by providing free samples. But when the doctor writes that patient a prescription for the new drug, the patient or health care provider pays the high retail price which includes the company's advertising and marketing costs but also a considerable bit of profit.
The work of drug company reps can involve giving doctors personal gifts, offering doctors and their spouses all-expense-paid trips to drug company-sponsored "in service" presentations in exotic locations, offers to write and place articles with the doctor's byline on new drugs in medical journals, paying doctors to enroll patients in company-sponsored research trials, filling in doctors and staff in on the latest (company-sponsored) research, and more.
Big Pharma is active in supporting and sponsoring medical trade associations and "educational" conferences of all sorts which often allow them an opportunity to promote particular drugs.
Physicians who are experts or highly-regarded in their fields frequently sit on important committees, and a good many are recipients of significant drug company largesse. It is good form and often required that doctors declare a competing financial interest, if one exists, but this is not always done.
When an expert panel recognized a new category of high blood pressure called "pre-hypertension," acceptable normal blood pressure levels were revised down from 140 over 90, to 120 over 80. While lifestyle changes are often recommended first, changes in diet and exercise patterns are difficult to achieve for many, and the upshot is doctors write million more prescriptions for blood pressure-lowering drugs and that increases the profits for Big Pharma.
Similarly, Dr. Angell observes, expert panels have recommended acceptable blood cholesterol levels be revised down from below 280 (where they stood for some time) to below 240, and then to below 200. This helped make Lipitor the top-selling pharmaceutical drug in the world in 2022, since millions more Americans were being diagnosed with high cholesterol under the new guidelines.
The influence of drug companies now reaches deeply into the nation's medical schools, where the process of diagnosing and treating disease is becoming more closely linked with which drug to prescribe rather than examining all feasible treatments for a particular disease or condition.
LOBBYING
Big Pharma employs an army of well-connected lobbyists to work the halls of congress, and the state legislatures.
Lobbyists often begin their careers as regulators with agencies like the FDA or as politicians or congressional staff members, and then transition to lucrative corporate lobbying jobs. According to Dr. Angell, Big Pharma employs more lobbyists than the defense industry, or more than one lobbyist for every member of Congress.
Members of Congress need campaign contributions. Politicians that introduce industry-friendly legislation or help push it through are often beneficiaries of significant drug company largess when they run for office or retire.
Politicians who sit on important committees or oversee particular agencies can walk through the "revolving door" into high-paying drug company jobs, while drug company executives often waltz into jobs overseeing the industry from which they sprang.
Not surprisingly, some studies show that only about 41 percent of Americans now trust Big Pharma to look out after their interests.
THE FUTURE
Unless American consumers demand it, and Congress can be convinced to respond with strong, appropriate legislation, Big Pharma looks to chug right into the future reaping bigger and ever-growing profits.
Americans take a lot of prescription drugs. In 2021, more than 60 percent of Americans over the age of 18 took at least one prescription drug, according to statistics from the Centers for Disease Control. For people over 65, some 90 percent took at least one drug, and many take considerably more.
When Dr. Angell's book was published two decades ago, Big Pharma was raking in revenues of $200 billion a year on prescription drugs. This year, according to Health Care Analysis, Americans will spend more than $600 billion on prescription drugs.
In 2022, the FDA approved 37 new drugs, according to Accountable US. The same year, America's five largest drug companies reaped a whopping $80 billion in profit.
The Centers for Medicare and Medicaid Services’ (CMS) Office of the Actuary predicted that it expects national healthcare expenditures to outpace U.S. economic growth over the next several years. The CMS estimates this will result in an increase in the health spending share of our gross national product from 17.3% in 2022 to 19.7% in 2032. This analysis showed U.S. healthcare expenditures reaching $4.8 trillion this year with healthcare spending reaching $7.7 trillion by 2032.
Robert Weissman, president of Public Citizen, has stated that the coming surge in healthcare spending “has nothing to do with improving care and everything to do with price-gouging, monopolization, and wealth extraction by insurance corporations, Big Pharma, and for-profit hospitals.”
The Truth About Drug Companies, Dr. Angell's book, remains the single best explanation of why we Americans pay sky-high prices for prescription drugs.
This review was previously published on Medium.com
January 28, 2012
Nobody who reads this book will want to take a pill ever again. Dr Angell exposes the modern legal drugs trade for what it is, so deeply rooted in profit lust and political corruption, it's got nothing to do with curing disease and everything to do with making truckloads of money. Drug companies cry poor, yet they charge exorbitant prices for their products, drag out their patent rights as long as possible, and prevent the medicine being distributed more cheaply in poorer countries that desperately need it - all while they make even higher record profits every year. They spend a lot of time developing nearly identical drugs for trivial conditions like colds (because they can sell a lot), but hardly ever produce treatments for rare disorders, on which they might only break even. Despite claiming that they need to charge high prices to conduct research, they do almost none, instead piggy-backing on taxpayer-funded universities and research organizations, so their research is basically free. They pay doctors with "educational" seminars in exotic locations and provide them with misinformation so the medicos choose their drugs every time and even prescribe them for illnesses for which they were not designed, and on which they have minimal effect. Although I have been wary of the drugs trade for many years, this was the book that provided me with the evidence to back up my suspicions. Read it and be informed: despite being a few years old, and American in focus, it's still applicable around the world today - you will understand much better how you get your medicine and make better choices.
November 16, 2011
This book by a doctor and former editor of the New England Journal of Medicine is a serious indictment of the pharmaceutical industry, particularly as it operates in the US. Although I was aware of much of the information, she lays it all out with detailed documentation.
While most basic research is conducted by the NIH and/or universities, drug companies continue to excuse their exorbitant price-gouging on the costs of "research and development". While their big expenditures are actually direct to consumer marketing and marketing masquerading as "education".
The other big expense is for legal fees - to seek ever-longer patent rights, and lobbying. They have the FDA, congress and all the rest of us in their pockets. In the meantime, while they tout their creativity and innovation, most of the new drugs they promote are new versions of old drugs, some with really minimal changes and no advantage. (Prozac was colored pink and given a new name for marketing as a drug for pre-menstrual tension!) Also because they have control over their drug trials, much of the data is skewed in favor of newer, more expensive ones they want to patent.
They also do not have any interest in developing drugs for diseases that affect fewer than 200,000 people or those which affect people in countries that cannot afford their gargantuan markups.
It is really sickening! The only way to beat this sickness is to use as few medications as possible, only when absolutely necessary, in generic form, and buy from Canada or overseas when possible.
While most basic research is conducted by the NIH and/or universities, drug companies continue to excuse their exorbitant price-gouging on the costs of "research and development". While their big expenditures are actually direct to consumer marketing and marketing masquerading as "education".
The other big expense is for legal fees - to seek ever-longer patent rights, and lobbying. They have the FDA, congress and all the rest of us in their pockets. In the meantime, while they tout their creativity and innovation, most of the new drugs they promote are new versions of old drugs, some with really minimal changes and no advantage. (Prozac was colored pink and given a new name for marketing as a drug for pre-menstrual tension!) Also because they have control over their drug trials, much of the data is skewed in favor of newer, more expensive ones they want to patent.
They also do not have any interest in developing drugs for diseases that affect fewer than 200,000 people or those which affect people in countries that cannot afford their gargantuan markups.
It is really sickening! The only way to beat this sickness is to use as few medications as possible, only when absolutely necessary, in generic form, and buy from Canada or overseas when possible.
June 6, 2017
This was such an upsetting book for me, as I have a PharmD degree and spent 19 years working in retail pharmacies. I agree w/ every word of it. Dr. Angel is a former editor of the "New England Journal of Medicine" so was uniquely positioned to write this book. The only problem w/ the book is that I just finished reading it, but it was written in 2004. The Medicare Part D Act had just been passed but not implemented yet, and of course, the ACA was far in the future. Both Acts just played into the hands of Big Pharma, however. Things need to change, and soon, or Americans are not going to be able to afford their necessary medicines. Ask your doctor questions about all new prescriptions, and nag your legislators about their donations from and lobbying by pharmaceutical companies. We're being raped by them, America. Wake up!!
December 4, 2021
Reaction: quick primer on the what, why, and how big pharma needs our help, regardless of what they claim they can do on their own (legally, ethically, socially, etc)
Writing Style: academic but for layperson
Argumentation: Drug companies are founded upon the maintenance of human health and well-being, but the ablest, capitalist tendencies of the structure and function of their practices misalign their goals. Thus, we all ought to play a part in improving the drug market
Commendation: many myths dispelled, great use of references across interviews, experiences, papers, and news media to dive deep
Critique: puts the doctor in a bad light, and rightly so, but also what about other healthcare providers and their roles in the prescribing/advertising of drugs
Writing Style: academic but for layperson
Argumentation: Drug companies are founded upon the maintenance of human health and well-being, but the ablest, capitalist tendencies of the structure and function of their practices misalign their goals. Thus, we all ought to play a part in improving the drug market
Commendation: many myths dispelled, great use of references across interviews, experiences, papers, and news media to dive deep
Critique: puts the doctor in a bad light, and rightly so, but also what about other healthcare providers and their roles in the prescribing/advertising of drugs
May 19, 2009
Angell writes clearly about a very difficult and multifaceted subject. Her points are well documented, and her criticism is pragmatic while her principles remain earnest. Her sardonic wit is never too far away.
I haven't read non-fiction this good in a while. I picked up the book as part of my blogging activities for background research; but now I would say this book has empowered me and given me a greater understanding on how the world works.
I haven't read non-fiction this good in a while. I picked up the book as part of my blogging activities for background research; but now I would say this book has empowered me and given me a greater understanding on how the world works.
July 14, 2010
Angell does a good job of showing what rats the pharmaceutical industry are in this book. I consider big Pharma on a level of evil close to that of big banks and big oil, big food and big chemical corporations so if this book has a fault its that she is too easy on them. Never the less she gets a lot out about some of what they are pulling.
November 1, 2015
Fascinating and disturbing the extent that people will go for money. We either need to improve our ethical maturity as a race or make changes to our government to regulate this kind of behavior (i.e. manipulating the system to take billions of dollars from people for a product that isn't substantially better than what already exists).
July 20, 2022
Marcia Angell’s painstaking account of big pharma’s shenanigans is a sobering read. Even people in the healthcare field will be surprised by the sheer extent of big pharma’s reach and the multiple means the industry employs to fatten its profits and prolong monopolies that impose huge costs on society.
April 18, 2014
Clear and cogent explanation of pharmaceutical industry and the crucial roles that industry-friendly legislation has played in creating the billion-dollar behemoth. It was updated 9 years ago, but a new addition would be helpful.
February 17, 2020
This book should be read by every person to understand how "big Pharma" is ripping them off and making their health worse, not better. Canada so far it appears to have resisted the influence but if the voting public is unaware we could end up in the same boat.
July 6, 2007
Opinionated, self-righteous polemic. I guess it's one side of the story.
September 8, 2022
It gives us the reality of Pharma industry and how it works.
May 12, 2017
I really enjoyed this book but I will be brief in my review. Not that this book doesn't deserve a lot of credit for exposing the greed and treachery of the pharmaceutical companies but this book was published in 2004. I am hopeful that much has changed in that time period and thus feel that it would be unfair to lambast the current state of the industry. Not that I'm optimistic that anything has changed. In truth, I feel that the industry has probably become more greedy and devoid of ethics. This book didn't mention anything about the release of Oxycontin and the subsequent opioid epidemic that has far surpassed a breaking point. So if that's any indicator of a decade of progress for the drug companies, I would say that things are much worse than Dr. Angell presents.
I do think this book is worth a read even if the information presented "may" be dated (I can't emphasize how much I disagree with that assertion). America is a greedy country and we have let unchecked capitalism run rampant for far too long. Just a quick breakdown of some of the interesting points in this book.
1) Big Pharma spends substantially more of marketing than they do on research and development
2) many of the breakthroughs that lead to new drugs come from universities and private bio-med companies that receive funding through the NIH which gets their money from federal tax money. So some of the drugs we rely on that cost a fortune were actually discovered by universities, who now earn a profit from them, that were funded by our tax dollars
3) America is the only country in the world that doesn't fix prices, meaning that drugs are vastly more expensive here than anywhere else in the world
4) The logical solution to the above would be to import drugs from other countries but that's illegal
5) Clinical trials aren't as rigorous as one would think and new drug releases are questionable in their safety as a consequence
6) the pharmaceutical lobby is the largest in the country and at the time of the book's writing, the top ten companies on the Fortune 500 were pharma organizations.
There is a lot more to learn in the book and it will blow one's mind. The worst part of the whole ordeal is that many of these drugs are necessary. There have been some great developments and Big Pharma isn't all bad. While it would behoove us to overhaul the industry, it's definitely going to be an uphill battle and likely a losing fight. It would be interesting to see what else is out there for follow-up. Regardless, this book would be beneficial for anyone who has ever taken any medication. The history of the industry and prescribing practices alone are worth an afternoon of reading.
I do think this book is worth a read even if the information presented "may" be dated (I can't emphasize how much I disagree with that assertion). America is a greedy country and we have let unchecked capitalism run rampant for far too long. Just a quick breakdown of some of the interesting points in this book.
1) Big Pharma spends substantially more of marketing than they do on research and development
2) many of the breakthroughs that lead to new drugs come from universities and private bio-med companies that receive funding through the NIH which gets their money from federal tax money. So some of the drugs we rely on that cost a fortune were actually discovered by universities, who now earn a profit from them, that were funded by our tax dollars
3) America is the only country in the world that doesn't fix prices, meaning that drugs are vastly more expensive here than anywhere else in the world
4) The logical solution to the above would be to import drugs from other countries but that's illegal
5) Clinical trials aren't as rigorous as one would think and new drug releases are questionable in their safety as a consequence
6) the pharmaceutical lobby is the largest in the country and at the time of the book's writing, the top ten companies on the Fortune 500 were pharma organizations.
There is a lot more to learn in the book and it will blow one's mind. The worst part of the whole ordeal is that many of these drugs are necessary. There have been some great developments and Big Pharma isn't all bad. While it would behoove us to overhaul the industry, it's definitely going to be an uphill battle and likely a losing fight. It would be interesting to see what else is out there for follow-up. Regardless, this book would be beneficial for anyone who has ever taken any medication. The history of the industry and prescribing practices alone are worth an afternoon of reading.
July 11, 2024
Great read for anyone interested in 'how we got to now', esp in light of living through seeing Rachel Walinski admit on tv that she considered the Pfizer press release as actual medical data to make public health decisions on, though she also admitted she didn't verify any of the supposed data that led Pfizer to make such a statement. It was a press release!
-facepalm moment-
I so wondered how this was all possible this huge week oiled machine that made big pharma this grand Savior to humanity yet at the same time is a criminal organization.... Welp now I see behind the curtain and understand how & why may doctors who enjoyed the benefits of big pharma 'education' were all in.
It's really important for everyone to understand - IT'S A BUSINESS this thing most of us call medicine.
Seriously this was an illuminating, easy to read, comprehensive though brief, important piece of literature.
Plus, it helps you to navigate and empower you to know what to ask your doctor in order to understand how deeply entrenched they are with big pharma or if they indeed are looking to do what's best for THE PERSON, THE PATIENT sitting in front of them.
'First, Do no harm' is an important ethical model to live by, esp for Doctor's, but sadly many in the medical field nowadays only seem to be worried about doing no harm to their currently plush financial situation from the kickbacks, incentives and consulting fees.
-facepalm moment-
I so wondered how this was all possible this huge week oiled machine that made big pharma this grand Savior to humanity yet at the same time is a criminal organization.... Welp now I see behind the curtain and understand how & why may doctors who enjoyed the benefits of big pharma 'education' were all in.
It's really important for everyone to understand - IT'S A BUSINESS this thing most of us call medicine.
Seriously this was an illuminating, easy to read, comprehensive though brief, important piece of literature.
Plus, it helps you to navigate and empower you to know what to ask your doctor in order to understand how deeply entrenched they are with big pharma or if they indeed are looking to do what's best for THE PERSON, THE PATIENT sitting in front of them.
'First, Do no harm' is an important ethical model to live by, esp for Doctor's, but sadly many in the medical field nowadays only seem to be worried about doing no harm to their currently plush financial situation from the kickbacks, incentives and consulting fees.
Displaying 1 - 30 of 102 reviews