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

Rating:
Summary: I've been cheated
Review:
This is an excellent book that details how drug companies make enormous profits. For example, Sarafem was marked as a new drug to treat premenstrual syndrome, yet it was just Prozac with a different color and a higher price. Many drugs are just not that effective. They would not sell--without the push from advertising. A review of all studies done on the 6 most widely used antidepressants (Prozac, Paxil, Zoloft, Celexa, Serzone, Effexor) found that placebos were 80% as effective. In other words, they were just a little bit better than sugar pills. The difference was only in 2 points on a 62 point depression scale. We are reminded in the book that most clinical trails last just 6 weeks. So pills may be safe for six weeks, but we do not really know what will happen after many years of use. The author is well qualified because she is an MD and an editor in chief of the New England Journal of Medicine. If you can not believe her, who can you believe.
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Rating:
Summary: Good criticisms but incomplete
Review: Dr. Angel makes a convincing case that the drug industry has mislead the public about the reason for high drug costs. In this heavily footnoted book, she outlines numerous problems in the industry, congress, and regulatory agencies as well as some steps to correct the problem.
Some of the criticisms she levels are:
The drug industry claims to just be benefiting from the free market when in fact it benefits from enormous taxpayer subsidies from research and generous tax credits for R&D making the free market arguments spurious.
The patent office awards drug patents of dubious value. This argument is much bigger than just the pharma industry, as anyone who has followed the software industry and ridiculous "business method patents" such as a method for one-click ordering on web sites knows the U.S. patent agency isn't equipped to serve its constitutional purpose on most technical patents.
Drug companies have far too much control over the clinical trials prepared for FDA approval of their drugs, biasing the results, designing studies to deliberately not find side-effects, and failing to show that new drugs out-perform old drugs.
Doctors and medical institutions are too "in bed" with their pharma reps, accepting bribes and kickbacks disguised as educational trips and consulting fees.
Congress for the last 25 years has been too friendly to the pharmas and created the legislation that spun this situation out of control.
She makes her case very well, if all of the data and sources are real and representative. I have read other reviews here criticizing her data though and have no doubt that wherever possible, she has chosen the data that while correct, contributes the most to her cause even though it may not be representative. In that respect, she may be no different than many of the one-sided research studies she blasts.
That brings me to one of my major criticisms of the book: most of the charges she levels against big-pharma could be made against any other industry. All industries report as little specific financial data as possible where she's asking for an exact accounting of R&D versus marketing expenses for every drug. All industries with the money to afford it spend ridiculous amounts lobbying politicians. Many industries have lavish trade shows that are perks for their members to attend, where they are wined and dined by someone who wants to sell them something or get their help selling something. Most competitive industries are guilty of "me-to" - when they see a competitor with something successful, they copy it within the extent of the law.
While she makes some minor points that the pharma industry should be different, she spends so much time blasting R&D versus marketing that she fails to make a clear ethical, moral, or economic case of how the pharma industry is different and should be treated differently than say competition in the auto or beer industry.
The case would have been easy to make: pharma pricing should be regulated because it already benefits from govt subsidies in the form of research (a point she makes but doesn't tie specifically to price controls), because economically there are significant barriers to entry in the industry meaning that from a free market standpoint, the govt role should be to foster competition rather than protect monopolies, and that from a moral standpoint, the human benefit from affordable drug pricing is too great to ignore and hope the free-market invisible hand will outmaneuver patents and exclusive marketing rights.
I thought she failed to place enough blame on doctors themselves and their professional societies for curbing their own greed and kicking the pharms reps and pharma subsidies out of their businesses. The lingering question of "are you prescribing x instead of y because the x rep was hot and sent you on a "educational" trip to Cancun all expenses paid" should never have to come between a patient and doctor.
I thought she failed to place enough blame on our own insatiable appetite for quick easy fixes. Why eat right and exercise to lower your cholesterol when their are a dozen statins to choose from?
I think she mentioned in one sentence the role that managed care (HMO/PPO, etc) plays in this "take the pill" attitude. Again, that's far too little emphasis. Managed case is the source of the time squeeze that forces doctors to see more patients in less time because the HMO/PPO has cut their reimbursement for doctor visits so the doc instead of counseling you to make a lifestyle change, you leave the office with a script.
I thought she failed to see the connection between our hyperlitigious society that's driving docs out of business through malpractice suits and docs covering their bases and offering a patient every possible prescription to avoid a malpractice suit if they don't get better.
Finally, I thought she failed in not considering the economic impact of the changes she's suggesting. This is not a win-win. All of the changes she's suggesting will result in massive pharma layoffs. Living in central Indiana, a region where Eli Lilly is one of the largest employers, the affects here would be devastating. We're not just talking about potential layoffs for 1000's of workers (10,000s? 100,000 throughout the industry?) we're talking about thousands more who are contractors, loss of work for the industries that provide support services for pharma, loss of a huge source of philanthropy in the case of Lilly's charitable foundation in Indy, probably a huge destabilization in real estate prices in communities that are home to big pharma headquarters, and the trickle down effects of laying off people from good paying jobs are just too numerous to list.
I'm not saying that these economic factors would outweigh the benefits of some drug price controls, I'm no where near qualified to know that. But I fault her for not acknowledging the potential downside of her proposals either through economic ignorance or again deliberately stacking the deck in her choice of facts to present.


Rating:
Summary: The Pots Calling the Kettle Black
Review: Dr. Angell doesn't overload this book with footnotes, but she's got this substantially right. Her arguments are consistent with my conclusions derived from reading over 50 books on the drug industry and psychopharmacology.

I'm struck by the venom of the negative reviewers. Given the drug industry's track record, some of them may well be paid by the drug companies to discredit Dr. Angell. This would not be the first time - check out what happened to Dr. David Healy, the world's leading authority on the history of psychopharmacology, when he dared to speak out about SSRI's and suicide. (See "Let them Eat Prozac," by Healy, 2004).

More on venom: some reviewers refer to Dr. Angell as "Ms. Angell." this is an M.D., a Harvard professor, and former editor in chief of the world's most prestigious medical journal. I can't help wondering what motivates these reviewers.

So now to moral outrage: critics who aren't too troubled by the drug industry's gouging of American consumers (and its shamelessly self-serving spin on science) seem hugely offended that Dr. Angell might receive money for writing this book.

More on outrage: critics accuse Dr. Angell of not telling the whole story, of engaging in half-truths and distortion. Yet all medical science, government, and particularly psychiatry, offers up is deafening silence in response to drug company lies and distortion.

For example, you've probably seen Zoloft's TV and print ads, with the sad little blob that becomes happy via Zoloft. I have never seen any objection from the psychiatric, medical or government establishments to the one lie and several ad-biz claims that somehow come off as established science in this ad:

1) "Only your doctor can diagnose depression." A blatant lie. Thousands of non-MD's can do this, including licensed PhD psychologists, and, in my state, licensed clinical social workers. The only apparent reason for this lie is to steer consumers to MD's, who will then prescribe Zoloft.

2) Ad-biz semi-science: The ad states, "While the cause is unknow, Zoloft can help. It works to correct a chemical imbalance in the brain which may be related to these symptoms."

First, they are correct that they don't know the cause of depression, and they should have left it at that. But then comes the "chemical imbalance, which MAY be RELATED..." First, no chemical imbalance has ever been established in depression. If the imbalance is not established, it's hard to see how Zoloft can CORRECT it, despite the ad's little diagram showing how this is done. Also note the studied vagueness of "may be related," carefully avoiding the fact that even if they show an imbalance, they're a long way from demonstrating that an imbalance CAUSES depression.

Some negative reviewers seem perfectly content to let Big Pharma push this kind of ad copy as science, yet they jump all over Dr. Angell. Does the heat of their reaction reflect the magnitude of the drug industry's covert distortion of medical science? When, as here, so many people attack an author with such relish, it suggests to me that author may be on to something big.

I urge readers not to be put off by the negative reviews. Pursue it further: try Healy's "Let Them Eat Prozac," for an example of how ferociously Big Pharma defends its economic interests. Read "The $800 Million Pill: The Truth Behind the Cost of New Drugs," by Merrill Goozner (2004), debunking Big Pharma's stated reason for high drug prices (they claim the average new drug costs $800 million to develop - Goozner figures it's $100 to $200 million). This book, by a former Chicago Tribune business writer, answers critical reviewers who accuse Dr. Angell of not knowing or caring about economic reality.

Rating:
Summary: Overkill of the uninformed
Review: I generally applaud critical works that bring out questionable practices of particular industries and help keep them honest in the process. But while this book does some of that it falls far short of being credible. It is filled with economic ignorance often making the reader think that the pharmaceutical industry is supposed to be a non-profit organization. To suggest that most of the "research" happens in academia is an insult to the reader, who the author seems to presume has nothing more than a high school science education. Early basic research happens in our great universities, but the research necessary to take that discovery of a target or early stage molecule is but a fraction of that needed to bring a drug to market. I would like to see the research grant to a college professor giving him $100 million from the NIH to run a Phase III clinical trial. Or even taking things back to basic research, show me the university tech transfer office that will fit the bill for sufficient patent filings to go to market, support development research to commencement of clinical trials even.

What could have been an eyeopening view to clear suspect practices, such as "some" marketing activities, was written with such poor understanding of basic economics and understanding of "for profit" financial theory, and further misleading and uninformed diatribe regarding research, that the entire message is completely suspect and rings of an overkill Moore movie.

Rating:
Summary: The truth from one who knows!
Review: If half of what Dr. Angell book is true then the average American should be outraged!

Rating:
Summary: a few interesting bits from hypocritical author
Review: My job requires me to keep up with new drugs. I have seen how large drug companies make money and exert their influences over doctors, patients and pharmacists. The author presents some of the facts about this. I am sure that this book, although not original in any way because books like this were published before, will do well because of recent drug scandals. I must question her motive. Drug companies exert heavy influence over drug researches. They control what should be published and what should not be published. Also they finance a large part of professional journals like JAMA and New England Journal of Medicine which the author was the editor. Now that she is not the editor, she exposes all the dirty bits and turned them into this book to make money. I don't know about you, but this sounds hypocratical of her since she is just as reponsible for being a part of the system commanded by the drug companies. After all, wasn't she reponsible for the articles being published in her journal?

Rating:
Summary: A better way
Review: The drug companies want you to think there is no other way to treat problems other than their drugs. But this is so not true! For example, Reishi mushroom (Ganoderma lucida) will not only cure insomnia, reduce dermatitis swelling immediately, lower high blood presssure, but it will also reverse incurable cancer. Yes, you read that right. Look up the scientific research on it. (www.hiddenriverfarm.com has research articles.) People sent home to die of cancer started using reishi extract and their tumors disappeared. This is why the drug companies lobby to keep herbs and vitamins under control. Someday more people will realize the true value of Chinese tonic herbs and not need the expensive, dubious drugs of big Pharma.

Rating:
Summary: Eye-opening, disturbing account of pharmaceuticals
Review: This book shines a light on the truth behind the myths of the pharmaceutical industry. In a well-written and simple expose, Dr. Angell writes quite an indictment against some of the larger drug companies who are deceiving the public, bilking the taxpayers and buying favorable legislation while offering very little in the form of innovative and helpful products.

Dr. Angell devotes chapters to the myth of research and development costs cited as reasons why drugs cost Americans so much. She shows that most innovative research takes place at taxpayers expense and then profits the drug companies. She shows how drug companies deceive consumers with bait and switch practices, deceptive advertising, and high prices. A chapter focuses on the shady ways that drug companies "pay" doctors and hospitals to prescribe their drugs over better and cheaper alternatives. Of course, much is devoted to exposing the cozy relationship with between pharmaceuticals and Washington that leads to legislation favoring drug companies and sticking it to taxpayers.

I think the information in this book should be known by everyone who is consistently taking prescribed medication or visiting doctors who treat patients by prescribing the latest product. According to the author, about all doctors are influenced by the marketing and gifts of the drug companies, and that influence effects the treatment patients receive--for better or worse. Readers will also learn how drug companies get drugs approved with relatively little solid testing of the drugs efficacy and safety.

Dr. Angell does not cite many successes in patient care or positive attributes of the pharmaceutical industry (I assume there are some). She focuses on the negative practices that are hurting consumers.

We are influenced in one way or another by the propaganda of the drug companies. It is important to hear the other side of the issue by someone as informed as Dr. Angell. This book is a tool to equip yourself for better health and advocacy.

Rating:
Summary: Failing Angell
Review: Unlike some of the other critical reviewers I enjoyed the polemic. It made the book more fun to read.

But Ms. Angell is an economic illiterate.

Her basic argument is that (1) the drug companies are very profitable and (2) they would consequently not be hurt by a dose of government price controls, but such controls would benefit the consumer.

(1) is misleading. According to Fortune's "Fortune 500" issue the pharmaceutical industry did well in 2003 in terms of some measures of profitablity, but its performance was less than spectacular when "total return to shareholders" (TRTS) is considered. In 2003 it ranked #43 out of 46 industries considered. Over a five year period it ranked #38 on a TRTS basis and over a 10-year period it ranked #12.

This suggests that over the last decade the pharmaceutical industry has become a less profitable investment (when capital gains and dividends are taken into consideration), compared to other economic sectors. One reason for this is that there seem to be fewer blockbuster drugs around, a trend that lots of people expect to continue.

Price controls a la Angell would mean even lower profits and less investment in pharma, unless the industry itself invested less in R&D (which would make new drug discovery even less likely) or in marketing/admin costs. This second option would make Ms. Angell a happy camper apparently because she believes that marketing is a waste of money. She never quite says why, although many of her opinions seem to of the knee-jerk anti-business variety. Her incipient (or do I mean insipid) socialism is all too apparent in her whining about how people just wanted to do good before President Reagan came into office.

I await Ms. Angell's next book on how to sell drugs without marketing with baited breath. Actually, she writes nicely and could could have written a pleasant little introduction to the pharma industry, but it wouldn't have sold as well as I'm sure this one is. (I'm sure all those good folks in blue states are lapping her words up.)

So on second thoughts maybe her next book should be "The Truth about Publishers."



Rating:
Summary: from a sales rep's perspective, I must say, you are real!!
Review: You go girl! The neurontin case is a good summary of how it gets done. I've been there, seen it and are still seeing it! from the inside, I may add. I know you could have made a lot more money by going along with the industry given your past experiences, but you stand up for the public in the book, for that, even the ceo of large pharmas can take his hat for you even they might want to question your creditaility in a public review.

The biggest fake of this industry is that all the bribes to the doctors are not suppposed to influence the doctors to prescribe per the industry's own guideline.

your book is a good wake up call to them to straight it out. But no one wants to be the first one to scale down marketing. so the big lie continues..

Can't wait to buy your follow up book. Thanks.