Sickening: How Big Pharma Broke American Health Care and How We Can Repair It

by John Abramson

The inside story of how Big Pharma’s relentless pursuit of ever-higher profits corrupts medical knowledge—misleading doctors, misdirecting American health care, and harming our health. The United States spends an excess $1.5 trillion annually on health care compared to other wealthy countries—yet the amount of time that Americans live in good health ranks a lowly 68th in the world. At the heart of the problem is Big Pharma, which funds most clinical trials and therefore controls the research agenda, withholds the real data from those trials as corporate secrets, and shapes most of the information relied upon by health care professionals. In this no-holds-barred exposé, Dr. John Abramson—one of the foremost experts on the drug industry’s deceptive tactics—combines patient stories with what he learned during many years of serving as an expert in national drug litigation to reveal the tangled web of financial interests at the heart of the dysfunction in our health-care system. For example, one of pharma’s best-kept secrets is that the peer reviewers charged with ensuring the accuracy and completeness of the clinical trial reports published in medical journals do not even have access to complete data and must rely on manufacturer-influenced summaries. Likewise for the experts who write the clinical practice guidelines that define our standards of care. The result of years of research and privileged access to the inner workings of the U.S. medical-industrial complex,  Sickening  shines a light on the dark underbelly of American health care—and presents a path toward genuine reform.

Genres: Nonfiction, Health, Politics, Medicine, Science, Medical, Health Care

336 pages, Hardcover

First published February 8, 2022

Reviews

[Ell · Rating 5 out of 5]

This book is exceptional! If you read just one book in 2022, choose this one. It’s an eye-opening look into the sobering statistics and tactics used in the American healthcare system, specifically in regard to pharmaceutical companies. It is information every American should have to empower them to make better decisions regarding their health. The author of this book is a medical doctor and researcher. He has intimate knowledge about the industry he writes about. The information is presented in a very easy-to-read format, is educative, and it keeps the reader turning the pages. It is decidedly not gloom and doom. It’s an earnest dialogue of what has happened and ponderings of how to right the proverbial ship. Five stars.

[Teal Veyre · Rating 5 out of 5]

Before you read any further: I'm not anti-medication. Medication is important and necessary for many people. THAT is exactly why I'm so passionate about wanting to live in a world where patients can trust what their doctors tell them about drugs. Right now, they can not, because doctors don't even have access to all of the information about the drugs. Shouldn't we all want a world where doctors can actually look at the raw data of clinical drug trials?

This book was written by a doctor, a professor at Harvard Medical School, and an expert witness in many trials where drug companies were punished for intentionally misleading doctors about the benefits and harm of their drugs. Like this Phizer trial: https://www.justice.gov/opa/pr/justic...

I swear every time I start talking about the problems with pharma's influence over doctors, people think I'm on some facebook meme QAnon Lizard People other shit. But I am not. Dr. John Abramson is about as legit and mainstream as it gets. Hell, the federal government has called him in to serve as an expert witness against pharma corporations. Sorry, but HOW in the world can I prove my point that pharma does harm, if THIS GUY isn't mainstream and credible enough of a source?

Here is the sad truth of it: Many people can't bear to acknowledge that many medications are dangerous and harmful, because they have family members on those medications. Rather than dealing with their own icky feelings about the fact that they were a part of this, they shut their ears, choosing their own feelings over the long-term health of their family members.

But what if we lived in a world where....
1) Conflicts of interest between pharma and all medical professionals (doctors, professors in medical schools, and members of all esteemed professional organizations such as the APA) were legally prohibited by law.
2) Drug trials were conducted independently by the FDA without any funding from pharma. This would not cost taxpayers more money. It would greatly decrease the amount of people on permanent disability. So many drugs cause Akathisthia, dementia, permanent brain damage (I'm looking at you neuroleptics and anti-psychotics more broadly). Drugs would be safer and the harm more openly communicated if we could get pharma influence out of research. Therefore less people on disability and less money spent on their overall health.


This is all I want to happen in the world. If pharma didn't influence doctors and control the research, I'm so confident that we would have safer and more effective drugs, and better patient care overall.

Doesn't everyone want that?

Everyone needs to read this book. He delves deep into so many important issues.

Yes, the book is boring AF. Not everything in life is entertaining. Some things are important enough to have some discipline, buckle down, and make yourself focus.

Thank you thank you thank you to Dr. John Abramson for writing this book.

[Donna · Rating 3 out of 5]

This is Nonfiction/Health/and believe it or not...Economics. First, the title is perfectly appropriate for this one. And it definitely should promote conversation and hopefully change. The message, whether you agree with it or not, is one that needs to not only be heard but researched, debated and thought about.

Now with all of that said, I didn't enjoy this one. I'm not sure if it was the tone of the book or the tone of the narrator, but this one was a struggle to stay with. The author liked his pedestal role in this one, and his pedestal was so high it was hard to develop a positive reaction on my part. So even though it felt 1 star, the light shed on the need for change was much higher than just 1 star. So I'll settle for 3.

[Emily Brown]

Big pharma employee reads book that completely roasts big pharma :)

[Barbara Clarke · Rating 2 out of 5]

I have no doubt that John Abramson meant well in writing this book about the role of BigPharma but that's about as much praise as I can muster. And here's why - this is just another book among many where docs, scholars, journalists - all competent - write about the broken healthcare system and then as their answer - well, we patients need to come together and start a movement, get congress off their butts to give two figs about our health and economic destruction from medical bills and poor and/or over treatment. The pharma industry is just one of the many members of the cabal who have a lock on both congress, political leadership, and any possibility for change.

This week, while I was skimming this book - another so what's new? reading experience - I saw Bernie Sanders on Fox News in a live debate with Lindsey Graham over healthcare, etc. Something snapped in me - how totally absurd that since maybe FDR and certainly Truman, congress doesn't think we have enough money to provide a full-on system paid for by taxes rather than making the insurance companies rich and tying people to crap jobs just for benefits. And now, we use benefits against workers forming unions - what a country!!

And now we have VCs "investing" as well. We have billions upon billions for weapons but can't actually admit that the health of constituents is of such great importance, no debate is necessary. This is the height of an absurd cruelty that not even John Abramson can admit to or call out. Instead, he has a weak to-do list like all of the other pundits, who when challenged cough up the joy of Obamacare as some kind of half-baked answer. If I were Obama, I'd ask to have my name removed.

This is all too pathetic and am going to take a break from this kind of book even though as someone who once worked in the industry. I'm always curious to see if anyone has the guts to actually do anything about what we call our world-class system. But all of the usual suspects and more every day are smelling money in the bloody water like the immoral sharks that they are. Oh, right - it would be socialism and we can' have that! Poor Lindsey - I can't wait to see you have the senate door hit you in the butt on your way out.

I reread this book and want to add that his list of why doctors "believe" drug reps made my stomach turn - and then I realized yep - they're just frail humans like the rest of us - EXCEPT - they are possibly ruining the lives, incomes, and health of patients by prescribing a drug that hasn't been really tested, that is "peer reviewed" by a corrupt process that is all about the money! Just wanted to add this to my review of June 2022. I'm working on a book and this new info will be in it.

[Christine Faunce · Rating 2 out of 5]

2 ⭐️ thank god it’s over.

Idk how you can make such an interesting topic so disappointingly bland. If you’re looking for an encyclopedia of facts with no real story telling components other than dry anecdotes, then maybe you’d like it?

If anyone has recs for books about this topic that aren’t so boring, lmk

[Kayla Tornello · Rating 3 out of 5]

The topic of this book is really important to everyone. It's sickening how much obscene profit the drug companies make while being untruthful with everyone. Americans spend more money on healthcare than other countries, yet we remain in poorer health. Things really need to change! That said, the writing itself just wasn't very compelling. I had a difficult time staying focused and interested.

I received this book from a Goodreads giveaway. Yay!

[Erin McMahon · Rating 5 out of 5]

This is the perfect book. A critical look at the pharma industry with an awareness of Social Determinants of Health, quality of care, lobbyists' interests, and NCQA quality standards. This could be another day at my client (which is infinitely better than pharma, to be clear).

I also loved the look at Humira and Aduhelm. Roast them.

[Sandra · Rating 5 out of 5]

Well, another one of those "it's worse than you think" things.

https://youtu.be/_5PLf-2FYIM?t=45

[Dennis Miller · Rating 5 out of 5]

Pharma has clearly succeeded in pulling the wool over the eyes of the public. Has Pharma succeeded in doing the same with pharmacists?

John Abramson, M.D., has been one of my heroes since 2004 when his first book “Overdosed America” was published. Unfortunately he is NOT the hero of a lot of pharmacists. As I explained in detail in my book “The Shocking Truth About Pharmacy: A Pharmacist Reveals All the Disturbing Secrets,” a very large number of pharmacists do not like people who write books critical of Pharma.

Pharmacy is different from a true science because we as pharmacists have a strong financial incentive to not question the dominant narrative in our profession--better living through chemistry. Criticizing pills is bad for business. A pharmacist who uses his position in chain drug stores as a platform to promote reform in the pharmaceutical industry is seriously jeopardizing his employment.

In my opinion, very many chain store pharmacists view pharmacy more as a business than a science. I believe you are naive if you view pharmacists as akin to skeptical scientists who have no horse in the race. We make our living by selling pills, not by encouraging people to learn how to prevent illness.

I’m now retired but I worked in chain drug stores for my entire career. Chain store pharmacists feel subtle yet powerful pressure from our corporate bosses to be positive about the pills we dispense. Besides our financial interest in downplaying adverse effects of drugs, there’s the psychological conflict (cognitive dissonance) resulting from trying to juggle the need to be positive about pills with our knowledge that many pills are a double-edge sword. Unfortunately the balance has tilted too far in the wrong direction because of a hugely powerful and corrupt pharmaceutical industry.

Pharmacists seem to believe that the products we dispense are based on science when, in fact, most are based on marketing. Pharmacists are dispensing the products of an industry that routinely engages in lies, distortions, and magical thinking.

Pharmacists increasingly play the role of legitimizing Big Pharma’s products which are, in fact, quite often clouded by very serious concerns such as FDA’s becoming a captive of the drug industry, Big Pharma’s immense clout over the US Congress, and Pharma’s corrupt influence over drug research.

The public’s definition of “safe and effective” is clearly vastly different from the FDA’s definition. This leads to a reality in which commonly prescribed drugs are often linked to tumors and cancers in lab animals (read the Carcinogenesis and Mutagenesis section in the labeling). Black box warnings are too often added to the labeling years after the FDA approved a drug. Drugs are withdrawn from the market due to safety issues that were not discovered in clinical trials.

The FDA is clearly not the watchdog that the public expects and hopes. The FDA represents a clear example of “regulatory capture.” That’s a situation in which an industry that is supposed to be regulated by a governmental entity ends up controlling the regulator. The governmental entity (FDA) which is supposed to guarantee the safety and effectiveness of drugs has in reality been captured by the pharmaceutical industry.

Sixty-five percent of the FDA’s drug regulatory budget comes from Pharma through user fees. According to an official FDA publication (“FDA At A Glance,” U.S. Food & Drug Administration, Office of the Commissioner, Nov, 2020), “Human drugs regulatory activities account for 33 percent of FDA’s budget; 65 percent of these activities are paid for by industry user fees.”

The public is not told that this leads to a situation where FDA employees might feel that they work for or are beholden to Pharma rather than the American people.

In my opinion, this explains why the FDA approved the Alzheimer’s drug Aduhelm despite the fact that 10 of 11 advisory committee members voted that there was insufficient evidence to demonstrate the drug slowed cognitive decline. (The 11th panelist voted “uncertain.”) Three members of the panel resigned as a result.

In my experience, pharmacists are often far less enthusiastic about pills in private conversations with close friends and family in comparison to discussions with pharmacy customers in the drug store.

On the one hand, every day we see a drug circus on TV with Pharma’s annoying, scary, exploitative, and misleading commercials. At the same time pharmacists dispense these pharmaceuticals as if they’re entirely untainted by corrupt commercial interests and purely based on science. Pharmaceuticals are a ridiculous marketing circus on TV but somehow they immediately transform themselves into miraculous remedies in drug stores and doctors’ offices.

To what extent are pharmacists willing accomplices of Pharma’s corrupt practices? And to what extent are they unwitting dupes of Pharma? Have pharmacists been willingly led down the garden path by a nice paycheck? Should pharmacists be shouting from the rooftops that there are many drugs we dispense every day that we’d never take ourselves or recommend for a close friend or family member?

Pharmacy customers don’t know about the settlements (sometimes in the hundreds of millions of dollars) by drug companies for lying and deceptive advertising. Pharmacists seem to act like every drug we dispense is as important and effective as insulin.

Even the manufacturers of insulin, one of the true superstars in the pharmacy, have managed to cloud the halo surrounding this miraculous drug by price gouging. There are very few companies that manufacture insulin so it is ripe for price gouging.

Should pharmacists have a duty to tell customers that a drug they’re taking is currently the target of a class action lawsuit? Should pharmacists investigate and then tell customers what the yea/nay votes were from the FDA advisory panel that voted on approving the drug?

Pharmaceuticals are depicted in magazine advertisements and in TV commercials as if they are all monumental breakthroughs like insulin and penicillin. These ads portray what looks like safe and easy pill solutions for every medical problem. Then everything suddenly becomes much more complicated when information is presented regarding potential adverse effects, warnings, precautions, contraindications, drug interactions, etc.

Most pharmacists seem to be blissfully unaware of and uninterested in books that expose Pharma’s lies, distortions, myths, exaggerations, etc. When pharmacists become aware of those books, they often react with hostility.

One would think that popular pharmacy magazines like Drug Topics and Pharmacy Times would feel it is important to discuss momentous books like John Abramson’s “Sickening.” But the fact that these magazines receive most of their revenue from Pharma advertising means that pharmacists will likely not be aware of books critical of America’s pill circus.

Pharmacists sit passively at in-person continuing education seminars funded by drug companies. Pharmacists don’t ask whether the medical condition being discussed can be prevented by non-drug approaches such as dietary and lifestyle changes rather than by the sponsor’s drug. Indeed, most of the prescriptions pharmacists that fill are for preventable diseases of modern civilization. That’s one of the facts that Pharma most wants to keep hidden from you.

Pharmacists don’t seem to realize the role we’re playing in legitimizing Pharma’s marketing circus. The public probably assumes pharmacists and physicians would blow the whistle if Pharma strayed too far from truth and reality. But, in my opinion, the fact that the prescribing and dispensing of pharmaceuticals facilitate a nice standard of living for health professionals guarantees that most of them will not bite the hand that feeds them.

Pharma refuses to acknowledge how miraculous, wondrous and magical Homo sapiens is, or, for that matter, all living things and all life forms. Pharma will never admit that humans are part of the natural world. Pharma promotes the idea that the human body can be completely understood in terms of chemistry and that people, therefore, need chemical solutions for everything.

We should all laugh at that self-serving and simplistic view of health. We should also laugh at modern medicine’s completely mechanistic and reductionist view of the human body. Modern medicine is, in reality, the monetization of the maladaptation of Homo sapiens in modern society.

The activity of filling proscriptions is mind-numbingly boring and monotonous. It primarily consists of transferring pills from big bottles to little bottles. But the job is extremely stressful in dangerously understaffed chain drug stores because of the potential for making a serious mistake (such as dispensing the wrong drug, typing the wrong directions on the label, overlooking a serious drug interaction or contraindication, etc.), and thereby harming someone.

For many chain store pharmacists, the only nice thing about their job is the salary. In my experience, pharmacists’ top two concerns are their salary and having enough technician assistance on hand. Concerns about the safety and effectiveness of pharmaceuticals are far down the list of pharmacists’ concerns.

Many pharmacists rationalize to themselves that the prestige of modern medicine proves that concerns about drug safety and effectiveness are exaggerated. Pharmacists seem to view their salary in comparison to that of, say, dietitians and nutritionists, as proof that pharmacy is a more important field than nutrition.

Because capitalism rewards pharmacists more than dietitians, pharmacy must therefore be more important than nutrition and more valuable to society. But clearly capitalism wants profits far more than health. Our medical system is about profits, not health.

I hope every pharmacist reads John Abramson’s “Sickening,” but I think that most pharmacists are simply not interested in a critique of the pill business, as long as the status quo provides a nice paycheck.

It is extremely uncomfortable for pharmacists to entertain the possibility that very many of the drugs we dispense are not nearly as “safe and effective” as the FDA claims. Therefore there’s not much hope that pharmacists will be critical of Pharma. “Sickening” provides an extremely important perspective that most pharmacists are not eager to consider or talk about.

Pharmacy would be a much more fulfilling profession if the importance of John Abramson’s perspective were widely acknowledged and practiced. John Abramson is one of my heroes for speaking the truth. I wish he were also the hero of very many pharmacists. Pharmacy would then be a much more honest and gratifying profession.

Dennis Miller, R.Ph., is the author of “The Shocking Truth About Pharmacy: A Pharmacist Reveals All the Disturbing Secrets.”

[sharara]

oh yeah ebm and critical appraisal is so important

[Joe E · Rating 5 out of 5]

“The illusion of American medical exceptionalism must yield to the basic principles of good science.” The primary thesis of this book is that while the USA spends the most on healthcare (by a wide margin) we also rank last among rich countries for measures of health. I liked how Dr. Abramson started each chapter with a different pharmaceutical failure. By supplementing the statistics with individual stories he really drove his points home.

Overall, I would definitely recommend this book. It completely changed my view on the issue (even if I think he might have let the insurance companies off scot free.) It also gives a path forward in tackling repugnant corporate greed and a lack of transparency in the pharmaceutical world.

One of my favorite quotes from the chapter on statins:
“The real harm is the false reassurance of protection from cardiovascular disease the guidelines provide, distracting both doctors and patients from the harder but more effective work of adopting healthy lifestyle habits.”

[Lindsay · Rating 4 out of 5]

This was an intriguing look into a physicians perception of how the pharmaceutical industry lies and misleads physicians into prescribing unnecessary medications.

[Nicole Savage · Rating 4 out of 5]

Lots more reasons to be anxious about being a physician and angry about capitalism!!! But information is power I guess and this book was nothing if not informative.

[Dennis Miller · Rating 5 out of 5]

Pharma has clearly succeeded in pulling the wool over the eyes of the public. Has Pharma succeeded in doing the same with pharmacists?

John Abramson, M.D., has been one of my heroes since 2004 when his first book “Overdosed America” was published. Unfortunately he is NOT the hero of a lot of pharmacists. As I explained in detail in my book “The Shocking Truth About Pharmacy: A Pharmacist Reveals All the Disturbing Secrets,” a very large number of pharmacists do not like people who write books critical of Pharma.

Pharmacy is different from a true science because we as pharmacists have a strong financial incentive to not question the dominant narrative in our profession--better living through chemistry. Criticizing pills is bad for business. A pharmacist who uses his position in chain drug stores as a platform to promote reform in the pharmaceutical industry is seriously jeopardizing his employment.

In my opinion, very many chain store pharmacists view pharmacy more as a business than a science. I believe you are naive if you view pharmacists as akin to skeptical scientists who have no horse in the race. We make our living by selling pills, not by encouraging people to learn how to prevent illness.

I’m now retired but I worked in chain drug stores for my entire career. Chain store pharmacists feel subtle yet powerful pressure from our corporate bosses to be positive about the pills we dispense. Besides our financial interest in downplaying adverse effects of drugs, there’s the psychological conflict (cognitive dissonance) resulting from trying to juggle the need to be positive about pills with our knowledge that many pills are a double-edge sword. Unfortunately the balance has tilted too far in the wrong direction because of a hugely powerful and corrupt pharmaceutical industry.

Pharmacists seem to believe that the products we dispense are based on science when, in fact, most are based on marketing. Pharmacists are dispensing the products of an industry that routinely engages in lies, distortions, and magical thinking.

Pharmacists increasingly play the role of legitimizing Big Pharma’s products which are, in fact, quite often clouded by very serious concerns such as FDA’s becoming a captive of the drug industry, Big Pharma’s immense clout over the US Congress, and Pharma’s corrupt influence over drug research.

The public’s definition of “safe and effective” is clearly vastly different from the FDA’s definition. This leads to a reality in which commonly prescribed drugs are often linked to tumors and cancers in lab animals (read the Carcinogenesis and Mutagenesis section in the labeling). Black box warnings are too often added to the labeling years after the FDA approved a drug. Drugs are withdrawn from the market due to safety issues that were not discovered in clinical trials.

The FDA is clearly not the watchdog that the public expects and hopes. The FDA represents a clear example of “regulatory capture.” That’s a situation in which an industry that is supposed to be regulated by a governmental entity ends up controlling the regulator. The governmental entity (FDA) which is supposed to guarantee the safety and effectiveness of drugs has in reality been captured by the pharmaceutical industry.

Sixty-five percent of the FDA’s drug regulatory budget comes from Pharma through user fees. According to an official FDA publication (“FDA At A Glance,” U.S. Food & Drug Administration, Office of the Commissioner, Nov, 2020), “Human drugs regulatory activities account for 33 percent of FDA’s budget; 65 percent of these activities are paid for by industry user fees.”

The public is not told that this leads to a situation where FDA employees might feel that they work for or are beholden to Pharma rather than the American people.

In my opinion, this explains why the FDA approved the Alzheimer’s drug Aduhelm despite the fact that 10 of 11 advisory committee members voted that there was insufficient evidence to demonstrate the drug slowed cognitive decline. (The 11th panelist voted “uncertain.”) Three members of the panel resigned as a result.

In my experience, pharmacists are often far less enthusiastic about pills in private conversations with close friends and family in comparison to discussions with pharmacy customers in the drug store.

On the one hand, every day we see a drug circus on TV with Pharma’s annoying, scary, exploitative, and misleading commercials. At the same time pharmacists dispense these pharmaceuticals as if they’re entirely untainted by corrupt commercial interests and purely based on science. Pharmaceuticals are a ridiculous marketing circus on TV but somehow they immediately transform themselves into miraculous remedies in drug stores and doctors’ offices.

To what extent are pharmacists willing accomplices of Pharma’s corrupt practices? And to what extent are they unwitting dupes of Pharma? Have pharmacists been willingly led down the garden path by a nice paycheck? Should pharmacists be shouting from the rooftops that there are many drugs we dispense every day that we’d never take ourselves or recommend for a close friend or family member?

Pharmacy customers don’t know about the settlements (sometimes in the hundreds of millions of dollars) by drug companies for lying and deceptive advertising. Pharmacists seem to act like every drug we dispense is as important and effective as insulin.

Even the manufacturers of insulin, one of the true superstars in the pharmacy, have managed to cloud the halo surrounding this miraculous drug by price gouging. There are very few companies that manufacture insulin so it is ripe for price gouging.

Should pharmacists have a duty to tell customers that a drug they’re taking is currently the target of a class action lawsuit? Should pharmacists investigate and then tell customers what the yea/nay votes were from the FDA advisory panel that voted on approving the drug?

Pharmaceuticals are depicted in magazine advertisements and in TV commercials as if they are all monumental breakthroughs like insulin and penicillin. These ads portray what looks like safe and easy pill solutions for every medical problem. Then everything suddenly becomes much more complicated when information is presented regarding potential adverse effects, warnings, precautions, contraindications, drug interactions, etc.

Most pharmacists seem to be blissfully unaware of and uninterested in books that expose Pharma’s lies, distortions, myths, exaggerations, etc. When pharmacists become aware of those books, they often react with hostility.

One would think that popular pharmacy magazines like Drug Topics and Pharmacy Times would feel it is important to discuss momentous books like John Abramson’s “Sickening.” But the fact that these magazines receive most of their revenue from Pharma advertising means that pharmacists will likely not be aware of books critical of America’s pill circus.

Pharmacists sit passively at in-person continuing education seminars funded by drug companies. Pharmacists don’t ask whether the medical condition being discussed can be prevented by non-drug approaches such as dietary and lifestyle changes rather than by the sponsor’s drug. Indeed, most of the prescriptions pharmacists that fill are for preventable diseases of modern civilization. That’s one of the facts that Pharma most wants to keep hidden from you.

Pharmacists don’t seem to realize the role we’re playing in legitimizing Pharma’s marketing circus. The public probably assumes pharmacists and physicians would blow the whistle if Pharma strayed too far from truth and reality. But, in my opinion, the fact that the prescribing and dispensing of pharmaceuticals facilitate a nice standard of living for health professionals guarantees that most of them will not bite the hand that feeds them.

Pharma refuses to acknowledge how miraculous, wondrous and magical Homo sapiens is, or, for that matter, all living things and all life forms. Pharma will never admit that humans are part of the natural world. Pharma promotes the idea that the human body can be completely understood in terms of chemistry and that people, therefore, need chemical solutions for everything.

We should all laugh at that self-serving and simplistic view of health. We should also laugh at modern medicine’s completely mechanistic and reductionist view of the human body. Modern medicine is, in reality, the monetization of the maladaptation of Homo sapiens in modern society.

The activity of filling proscriptions is mind-numbingly boring and monotonous. It primarily consists of transferring pills from big bottles to little bottles. But the job is extremely stressful in dangerously understaffed chain drug stores because of the potential for making a serious mistake (such as dispensing the wrong drug, typing the wrong directions on the label, overlooking a serious drug interaction or contraindication, etc.), and thereby harming someone.

For many chain store pharmacists, the only nice thing about their job is the salary. In my experience, pharmacists’ top two concerns are their salary and having enough technician assistance on hand. Concerns about the safety and effectiveness of pharmaceuticals are far down the list of pharmacists’ concerns.

Many pharmacists rationalize to themselves that the prestige of modern medicine proves that concerns about drug safety and effectiveness are exaggerated. Pharmacists seem to view their salary in comparison to that of, say, dietitians and nutritionists, as proof that pharmacy is a more important field than nutrition.

Because capitalism rewards pharmacists more than dietitians, pharmacy must therefore be more important than nutrition and more valuable to society. But clearly capitalism wants profits far more than health. Our medical system is about profits, not health.

I hope every pharmacist reads John Abramson’s “Sickening,” but I think that most pharmacists are simply not interested in a critique of the pill business, as long as the status quo provides a nice paycheck.

It is extremely uncomfortable for pharmacists to entertain the possibility that very many of the drugs we dispense are not nearly as “safe and effective” as the FDA claims. Therefore there’s not much hope that pharmacists will be critical of Pharma. “Sickening” provides an extremely important perspective that most pharmacists are not eager to consider or talk about.

Pharmacy would be a much more fulfilling profession if the importance of John Abramson’s perspective were widely acknowledged and practiced. John Abramson is one of my heroes for speaking the truth. I wish he were also the hero of very many pharmacists. Pharmacy would then be a much more honest and gratifying profession.

Dennis Miller, R.Ph., is the author of “The Shocking Truth About Pharmacy: A Pharmacist Reveals All the Disturbing Secrets.”

[Jane Hoppe · Rating 4 out of 5]

Remember how we all got whiplash these past two years when Covid maskers said, “Trust the science,” and then the anti-maskers said they were trusting the science? Not knowing which science to trust, we often found ourselves operating in the dark. Well, Dr. Abramson’s exposé of Big Pharma’s inner workings might pull back the medical fog-factor curtain a bit. Although the medicines whose research and marketing he details do not include Covid-related drugs, he does show how “science” often works and why often we can’t point to a definitive answer.

Through four case studies in his book, Sickening: How Big Pharma Broke American Health Care and How We Can Repair It, John Abramson, MD, MSc, shows how Big Pharma controls the medical research agenda. Often their goal is not optimizing health; it is maximizing profits. Profits even come before patient safety. In some cases, no one is asking the right questions—questions that would lead to improved health for the appropriate group of patients.

Furthermore, Dr. Abramson points out that at least for his four chosen examples, Vioxx, Neurontin, statins, and insulin, people tasked with educating physicians and prestigious medical journals are not given access to the real data from research trials. Unknowingly then, physicians relying on clueless peer reviewers prescribe medications based on incomplete and/or misleading information.

The decades-old adage, “Follow the money,” applies here. When scientists who stand to gain financially pay for, interpret, and market “the science,” they can be tempted to manipulate the science. To counter Big Pharma’s undue influence on American medical care, Dr. Abramson encourages grassroots activism. He calls for health-care reform with multiple goals.

[Heidi Coopman · Rating 2 out of 5]

Misses a major point. Prevention of disease through proper nutrition is only lightly touched upon in this book. Focuses on how to manage health care via public cost control programs and leaves out the need for nutrition and lifestyle education.

[Danielle Murphy · Rating 1 out of 5]

DNF. Could not stand this misinformation phoney bologna.

[Ty Langford · Rating 5 out of 5]

Fascinating and terrifying. If the evidence in evidence based medicine can’t be trusted, then what can? As one of the chief medical specialists dragged into the Vioxx case, (a drug theoretically better than traditional NSAIDS because it didn’t cause GI problems) he saw that the Vioxx data was hampered with so there would be no statistically significant increase in strokes in the clinical trial. This proceeded to mean thousands of deaths before it was finally pulled from the market and nobody went to jail. This is just one of extremely many and the first that Dr. Abramson saw. He mentions Neurontin to treat off-label, unstudied conditions because of their clever marketing. Insulin’s newer, “better” varieties that doctors prescribe due to proclaimed benefit but really cause more harm with the steep price tag. OxyContin essentially beginning the Opioid epidemic and the pharma companies knew it would be addictive. Aduhelm for Alzheimer’s where nobody on the FDAs advisory committee voted that it should be approved, but the FDA did anyways. These are just some of the many more examples he mentions about how corrupt and unregulated Big Pharma has become and how it is leading to the U.S. being the least healthy, worst healthcare system of all the top wealthy nations.

Big pharma has such a strong financial, political, and psychological grasp on the American healthcare system that there are drugs they almost exclusively sell in America because they know it won’t be approved elsewhere and because they know Americans are willing to pay. This isn’t to fault the doctors because they simply don’t know better. They go based on the most available and up to date data and have no idea if it’s wrong or they’re being mislead.

The fundamental purpose of clinical research must be to provide optimal care, but right now Big Pharma’s purpose is to serve the financial interests of its investors. With that being said, here are the points where we can improve and dig ourselves out of this grave:

1. Create price ceilings for drugs and care based on the price in other wealthy nations and by creating efficient markets through true competition. (Healthcare for all cannot be achieved until this occurs because otherwise too expensive. Vermont tried without the first step and failed).
2. Test new drugs against current ones to determine its true efficacy. As of now only 1 in 8 drugs that are released are effective.
3. Create an independent review board that cannot be influenced monetarily. This can be a government entity that creates a standard review process. Included in this is that all authors, reviewers, etc. get access to all data because right now they don’t (which is absolutely crazy).
4. Harsher punishments for those who break rules or falsify/hide data, especially if it leads to deaths. Jail time for CEOs would definitely have them be more cautious. That and it would be just given the 16,000 deaths Vioxx caused for example.
5. Spend more on lifestyle changing “therapies” like giving people money for a gym membership or simply teaching the importance of diet and exercise in schools or to parents. Healthcare only makes up 20% of our health in wealthy countries while socioeconomic status (40%) and lifestyle (30%) have more of the pie.

Unification of doctors, hospitals, common people, and the wealthy alike need to come together to finally tackle this problem. It impacts every one of us, so why not unite and give Big Pharma the finger?




That was long winded, but the American healthcare system is fractured and poor. Occasionally this book can become a little humdrum but as you can see it’s informative. Was originally going to give it a 4 star, but while writing the review I realized how much I got out of it.

[Danny Lee · Rating 4 out of 5]

What a read! As a future pharmacist, it sickens me to learn the details of how exactly having an unmatched level of pharma influence on the healthcare system is detrimental. In one sentence, unchecked financial incentive of pharma has led to corrosion of good science, leading to mediocre new treatments that may not serve the most dire health needs of Americans. The author's credibility as an expert witness for litigations against pharma shows in the book with detailed examples. His logic was sound overall and it's refreshing to see some fingers pointed at pharma because we certainly don't learn about this at school. My one comment against it would be that a lot of the content is repetitive. It was nice for me because I felt like the knowledge was being reinforced but it's not the most skillful writing.

As this issue with pharma has been in the works for decades, I think it will be very difficult to unwind all the issues such lack of regulation has resulted in. But basic steps (not so basic in depth) like making individual patient data available for clinical studies and allowing cost to be part of the formulary decision making for Medicare, etc would be a huge step, as mentioned in the book. Through this book, I've learned to not take everything at face value and I hope that my general animosity towards pharma doesn't make me blind to truly life-changing drugs that they put out once in every while. I hope that from what I learned in this book, I can take a more informed stance without just labeling them as "evil". I've also learned that many healthcare systems have room to go wrong so I want to delve further into that. It seems like America's system is particularly screwed by pharma influence but I wonder what kind of issues that other countries face and the roots of those issues. This is one of the more recent healthcare related nonfics I've decided to finish and it feels like there are many more to come!

[Hailey · Rating 2 out of 5]

2.5* stars if we are being technical but i was fully prepared to give this book like 4 stars — maybe 3.5 — until the final few chapters. worth reading still but if you DNF after section 2, you’re not missing out!

i thought the structure of parts 1 and 2 of the book worked well, and the case studies were super interesting. after that, it got repetitive, but still, the application of behavioral psychology to health policy was pretty interesting even though not a ton of novel info was revealed (big pharma is still bad!)

what really got me was that — after building an entire book around the power and influence of drug companies (particularly over the systems capable of change!) — in part 3, the best “reform” the author has to offer is vote!! like bestie you JUST spent 200 pages telling me that my politicians were paid off and i have no influence over medical journals anyway 😩

anyway, i won this book in a giveaway from goodreads / review not compensated! feeling responsible to disclose this since academics/doctors/drug companies don’t disclose their financial interests in papers and positions of power but alas!

[Anne · Rating 3 out of 5]

I gave this book 3 stars because it has some good information I have not seen elsewhere about how big pharma controls research in the US. It also explains using real data how results are manipulated by using relative percentages (rather than absolute percentage changes or Number Needed to Treat) to convey benefits but absolute percentage numbers or Number Needed to Harm to minimize side effects.

That being said, it could use a good editor. There is a lot of repetition and bloated writing. I also found the negative tone in the early chapters due to the author’s personal experiences to be distracting from the fact-based arguments he set forth.

Finally, I was tempted to subtract a star due to the extremely poor print quality of the hardback I read. It looked like it was run off on an aged copy machine in need of a new toner cartridge! Grayish smears across the entire page, every few pages.

[Katy Koivastik · Rating 5 out of 5]

An eye-opening and sad commentary on the medical profession and its complicity in endorsing drugs and implements whose testing is shrouded in secrecy by “Big Pharma”.

John Abramson, a doctor himself, was tapped as an expert witness in many trials, forcing him to drill down into the details of the claims made by drug manufacturers. The result is this important book. Abramson details how consumers and doctors are tricked into using newer and newer, and of course more expensive, drugs and medical devices where older therapies suffice.

Without beating the reader over the head, Abramson advocates healthier lifestyles as a worthy alternative. At the very least, Abramson’s message is “buyer beware”.

Well narrated by Kevin Stillwell.

[Cynthia Cordova · Rating 4 out of 5]

this book is super informative! Id suggest it to everyone! I’d say very liberal left but I learned a lot. Like at one point he makes arguments for a Friedman like market and how we aren’t doing that. And it’s like…my guy…making an argument for full “free market” to get people who aren’t anti-capitalists just kinda isn’t it? But also who knows, maybe he isn’t anti-capitalist. Idk how you write this and aren’t but wouldn’t shock me! And I think a good pairing with the other book I just read about generic drugs. The long and short: we are incredibly fucked.

Oh also! He does classic, “make sure to go vote!” Like…man come on lmao

[Kim Novak (The Reading Rx) · Rating 3 out of 5]

The author brings up a lot of good points but sometimes comes off as a bit pretentious and dramatic. I had to knock a star off due to his misrepresentation of why CF patients in Canada have previously had a 10 year longer life expectancy compared to the US. It had nothing to do with what he stated and was entirely due to an earlier quality improvement initiative involving early nutritional intervention. Later birth cohorts did not have the discrepancy. And don’t get me started about his views that Trikafta “isn’t worth the cost”… while we can certainly be riled at the pricing and debate what it should cost, to say that the these patients’ lives aren’t worth any price is frankly insulting to CF patients and their families everywhere. Just to be transparent as to why this irked me so, I’ve been a CF pharmacist for over 20 years and have seen exactly what quality care, non pharmacological interventions, and groundbreaking drugs can achieve together.

While still a recommended read, there are some cringy moments and views that lack nuance and have unrealistic applications.

[Shauna · Rating 4 out of 5]

This book was terrifying. It was an eye-opening look at the tactics used by pharmaceutical companies to sell their product (often at the expense of the health of the American public). This should be required reading for all physicians (maybe I’ll gift it to mine), so they’re at least aware of the manipulation happening with medical research. Other than universal healthcare, his final recommendations seemed spot on.

[Nick · Rating 3 out of 5]

I picked this up after Patrick Radden Keefe’s “Empire of Pain,” but it didn’t have nearly the same impact. Fascinating subject that obviously need much change, but I found the writing style to be overly simple and repetitive.

[Christy Barton · Rating 5 out of 5]

just depressing and appalling and illuminating of the worst of human nature :( each chapter is a gut punch. how greed at the expense of health and life can go this unchecked is beyond me. i hope everyone learns more about pharma in order to be informed about what is going on and then take action. jeez

[LB · Rating 4 out of 5]

okay WOW. humbling to say i had no idea what big pharma actually was before reading this book. insane stats and such a clear breakdown of the american healthcare system. feeling like such a nerd but i actually really enjoyed this book

[Katie Stein · Rating 3 out of 5]

Really great content but quite heavy at parts which made it hard to get through. Also very little comment on things we can do to make changes except for a few pages in the last chapter. Learned a lot but not much I can do with it other than educate others.