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The Truth About Drug Companies:
Archive
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“How They Deceive Us And What We Can Do About
It,’’
by Dr. Marcia Angell
(Random House 305 pps., $24.95)
Pharmaceutical companies will need a new miracle pain reliever
after the whipping they receive from Dr. Marcia Angell in her book
“The Truth About Drug Companies: How They Deceive Us and What
We Can Do About It.’’
Angell’s relentless, take-no-prisoners indictment of the
industry could not come at a worse time for “big
pharma.’’ The companies are trying to fend off
profit-busting political movements that would allow the importation
of cheaper Canadian drugs and authorize state and federal
governments to negotiate wholesale prices for Medicare and Medicaid
drugs.
The core of the book slams the drug companies’ central
argument in current policy debates — that high drug prices are
necessary to support research and development of innovative new
treatments.
Furthermore, she writes, drug companies owe their exorbitant
profits to favorable tax breaks and regulatory decisions, and they
control almost every aspect of the drug approval process. The
industry also faces little scrutiny from a compliant U.S. Food and
Drug Administration, Congress and White House — all are
beneficiaries of industry largess.
Drug companies do have huge expenses, Angell says. They spend tens
of billions of dollars on what are essentially kickbacks to doctors
for prescribing their drugs, as well as supporting hundreds of
lobbyists who protect their interests in Washington, D.C., and
lawyers who work to extend patent rights that keep drug prices
high. Consumers, she said, pick up the costs.
Ouch.
Angell’s reform list is politically unpalatable, but it
serves as a starting point for serious discussion. She strongly
urges that drugs be awarded patents only if they are proved to be
better than existing therapies — not just better than placebos,
which is the current benchmark. There might be other ways to spur
innovation, rather than simply to cut off marginal improvements in
drug development. Angell argues that the average cost of developing
most drugs on the market is closer to $100 million than industry
estimates of $800 million.
She does concede that truly innovative drugs are very expensive to
produce — perhaps $400 million a year or more by her own estimate.
So-called “me too’’ drugs do help industries keep
the bottom line in the black. So perhaps the government can
preserve the most favorable patent and pricing protection for drug
companies that truly fill unmet medical needs. Patients desperately
need truly innovative drugs, such as the cancer-fighting
breakthrough Gleevac. But does the world really need a seventh or
eighth cholesterol-lowering statin?
Some steps would not have huge economic consequences. There is
compelling evidence that the work of academic researchers who
accept drug company dollars tend to favor drug company products.
But industry cash has leveraged taxpayer-funded research and, in
turn, increased the odds of truly innovative biomedical research
having a favorable impact for consumers. Scientists — and journal
editors like Angell — should continue making voluntary steps in
rooting out bias in research they review and publish.
After reading this book, there still will be arguments among
readers on the best path to take. But there will be few Bush, Kerry
or Nader supporters who advocate the status quo in how we regulate
the pharmaceutical industry. Angell raises important issues that
should be addressed by presidential candidates.
Reviewed by William Hathaway
The Hartford Courant
