Customer Reviews

The Big Fix: How The Pharmaceutical Industry Rips Off American Consumers (Publicaffairs Reports)

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Did you know that when you or your insurance company plunk down big bucks for your Zocor or Zoloft or Zyrtec, you're paying nearly twice as much as the French and Italians and about a third again as much as the Swedes, Swiss, Germans and Canadians? What for? If you believe the pharmaceutical industry, the high price of your prescription is supporting research that could save your life. And so it does, but not nearly to the extent we've been led to believe. In fact, as you'll learn in this well documented new book, much of that research is done on your tax dollar by Uncle Sam, with the drug companies reaping the profits at little or no expense to themselves. Your drug dollars are also paying for 625 industry lobbyists--a contingent larger than Congress itself. You're also subsidizing anti-consumer legal battles, like the one against that Maine law designed to get competitive drug pricing for Medicaid and uninsured patients that was just upheld by the Supreme Court. And all those lawsuits to prevent or stall low-priced generics from getting onto the market after patents expire. And then there's the annual $2.6 billion in consumer advertising--a tenfold increase in just a decade, and all those free samples and other rewards to doctors. Is this how you want your hard-earned healthcare dollars spent? Do you really want the pharmaceutical industry setting America's drug policy? If not, what can you do about it? Reading this excellent book is a very good place to start.

If you've ever stood at the pharmacy counter and wondered why the prescriptions you've just picked up cost so much, this book has the answers. Big Pharma - the major drug companies - need to make big profits, and the author explains how they use the money you pay them. She does it without being sensational or shrill, instead calmly laying out the facts of direct-to-consumer advertising, pharma-sponsored conferences, pharma-sponsored research, vacations and coffee mugs and big consulting fees for doctors. I for one had no idea of the extent of their reach, and I find it shocking and enraging. Big Pharma virtually sets the health agenda, and after reading this book I have a clearer sense of how they do it. I hope our politicians pay heed, and start fixing this disaster.

Despite the inflamatory title, for which I deducted one star, this book is a compelling read. Whatever side of the drug prcing and access debate you are on, you can learn from Ms. Greider's review of the core issues. She makes the issues entirely understandable and it is actually a fascinating read.

What is clear is that the status quo will not stand. That is, the polical pressure and books like these will force the drug industry to either lower or slow down price increases. If not, then legislative action largely from states, will put a cap on prices through state pricing negotiations with drug companies. This book, despite the insulting title, should be read by all drug company executives. While I doubt it is a "big fix", I have no doubt aggressive drug marketing practices are not all pure and need some revisions soon.

Katharine Greider has given you a rare unbiased look inside the pharmaceutical industry. I know several doctors. They all get 4-6 visits a day from drug "detailers." That's where they get virtually all their prescribing information. Forget about older generics that are just as effective. Forget about the thousands of studies published everyday on natural substances which are as effective, much less expensive with no side effects. A study published in the Journal of the American Medical Association in April, 1998 showed that:

In 1994, an estimated 2,216,000 (1,721,000 to 2,711,000) hospitalized patients had serious adverse drug reactions (ADRs) and 106,000 (76,000 to 137,000) had fatal ADRs, making these reactions between the fourth and sixth leading cause of death.
Do you really think this has improved in the last 10 years?

In December, 2003, at a conference in London, Dr. Allen Roses, a senior vice president of GlaxoSmithKline candidly admitted that fully 90% of prescription drugs only work 30% to 50% of the time.

Other countries control drug prices...the same drugs from the same companies for which Americans pay exorbitant prices. Despite two laws passed by Congress since 2000, the FDA, under pressure from drug company lobbyists, still prohibits "reimportation" of drugs from Canada and other countries. States and cities are deliberately challenging the FDA to help their seniors get drugs at reasonable prices from Canada. Busloads of seniors travel from New Hampshire, New York, Michigan and Montana to get their prescriptions filled in Canada. Is this a sensible solution?

To fully understand the dynamics of this ridiculous situation, read this book. For example, there are no studies to compare the effectiveness of "new" drugs to those already available (and about to go off patent) or to generics. Does this make sense?

Most people are unaware that Costco sells the same drug as the local pharmacy at a 30-80% discount. Anyone can use the Costco pharmacy. By law, you do not have to be a Costco member. Call them for a price quote on your next prescription drug. Fight back, America!

The U.S. ranks #1 in amount of healthcare spending per person yet 37th in healthcare performance (World Health Organization). We are second-to-last of industrialized countries listed in disabled persons earning capacity (annex to Society-at-a-Glance 2002) and 17th in life expectancy (U.S. Department of Health and Human Services). Editorialist Nicholas Kristoff cites the C.I.A. World Factbook ranking the U.S. 42nd in infant mortality, a "national disgrace....that the average baby is less likely to survive in the U.S. than in Bejing or Havana" (New York Times; 1/12/05). According to Dr. Kenneth Liegner's testimony before the New York State Assembly Committee on Health (11/27/01), a 7-year-old Lyme disease patient was kept alive on expensive medication until, due to insurance company policy, "she died within one month of cessation of intravenous antibiotic treatment." Liegner adds, "Metropolitan Life Insurance Company had an important formative role in the creation of the National Institutes of Health. This raises the issue of possible ongoing undue influence of the insurance industry in setting national public health priorities".

On the other hand, although the U.S. is the only industrialized country with no pharmaceutical price cap, "The National Institutes of Health said rules designed to reduce conflicts of interest at the agency went too far. So instead of barring thousands of employees from owning stock in pharmaceutical and bio-technology companies, only about 200 senior employees will be affected...." ('NIH Revises Ethics Rule on Stock Ownership'; USA Today; 8/26/05). So it's not only insurance companies influencing public health policy.

Consider these non-profit healthcare CEO salaries buried in the 'Money' section of USA Today: Catholic Healthcare West CEO--$1 mil. + $896,000 expenses/allowances; Memorial-Sloan Kettering CEO--$2.3 mil. "with 2 surgeons making $1.6 mil. each"; Kaiser Permanente's Foundation Hospital outgoing President--$7.4 mil.; and Universal Health Services CEO--$16.2 million dollars in 2003 ('Non-profit Hospitals Top Salaries May Be Due For a Checkup'; USA Today; 9/30/2004).

Non-profit funds are procured under the guise of altruism but become organizational charity theft when used for extravagant salaries. The rationalization is that such salaries are necessary to attract leading professionals within a competitive system, and are a drop in the bucket compared to overall healthcare costs. But isn't that a most terrible commentary on America to say the economy demands we act as pigs with the charity money? Tragically, "Right-to-Life" proponents oppose universal healthcare, practicing socio-economic Darwinism in creating more American road kill.

This short book is a compilation of complaints against the US pharmaceutical industry (Big Pharma) and how it rips of American consumers and taxpayers. The points presented are as follows.
1. Big Pharma uses advertising to get consumers to buy the latest and most expensive drugs when cheap, generic ones often do the same or better job.
2. Big Pharma uses lobbyists to get lawmakers to extend patent protection for drugs about to lose patent protection.
3. Big Pharma benefits from a lot of federal research dollars, and reaps huge financial rewards from patents on ensuing drugs.
4. Big Pharma actively lobbies doctors to get them to use their drugs.
5. Big Pharma has gradually taken control of the R&D part of the industry, to the point that research data is often edited or massaged to make the drugs look good and cover up negative data.
6. Big Pharma uses all sorts of kickbacks and marketing tools to force people to buy the most expensive drugs in each class.
7. Big Pharma creates medical conditions thru advertising, in effect creating customers for their creations.

Many of these complaints are raised in other texts, but none as short and polemic as this one. The big is a quick read, and uses a lot of real life examples. Unfortunately, the book is somewhat incomplete; it should have provided tables and charts with more statistical data. There should also have been a chapter describing the entire process by which a new drug is created, tested, marketed, and finally distributed to consumers. All in all, an OK book.

Not nearly the insightful analysis that is claims to be, it presents a lot of the practices of the pharmaceutical industry that deserve scrutiny, including its promotional practices and focus on drugs that treat chronic vs. acute conditions, because that is where the profits are. But it doesn't address the issues of high healthcare costs. Pharmaceutical profits represent such a small fraction of healthcare costs that even if they were eliminated, total costs would go down perhaps a few percentage points. We would still have out-of-control healthcare costs. And the book doesn't adequately address the profit motivation that is needed to support innovation and has always been the strength of this great country, nor does it adequately address the economics that support how often drugs save many more dollars in healthcare costs vs. their costs, or the fact that many drugs especially generics are available at much lower costs in the US than elsewhere. Drug firms have their issues, reforming their cost structures including drug R&D and other practices is necessary, but many of the roots of healthcare costs go well beyond drug firms, and unless the whole system is addressed, to pick on one seemingly dysfunctional part will do little.

Patients themselves contribute to the high-cost of healthcare by expecting free healthcare and not doing anything to take care of themselves preventively. How telling is it that many people take better care of their cars than than themselves (is this because no one else will fix our cars for free if we abuse them)? What I look at my personal experience, and how much better pharmaceuticals have made my life when I needed them, and how inexpensive they were, lifesaver is what I think, not rip-off.

Bottomline, if you want some insight into some practices that could be improved without enough context to the overall structural issues in healthcare, read on. But for a more balanced debate around what really has to be done to fix healthcare costs, dig deeper.

This book made it much clearer to me how the pharmaceutical companies operate. Everyone should read this who takes prescription medications. A must read for all!!

In 30 yrs. of working as a retail pharmacist I have heard my fair share of "bitching" about drug prices as the Denver Two Step refers to. People don't take care of themselves and many have at themselves to blame, in part, for the high prices they pay for drugs. This hardly leaves the pharmaceutical manufacturers off the hook, though. While they do spend many millions developing a new drug that makes it to the marketplace, they spend three times that amount in promotions and advertising for each such drug. Even foreign manufacturers set up plants in the U.S. because this is where the money for pharmaceuticals is made. Why do American drug companies charge American pharmacies much more for drugs than they do foreign pharmacies? Why do Americans travel to Mexico and Canada for drugs? You really can't blame a company in America for making profits; that's what capitalism is about. But it seems that 30 years ago, ethics was almost as important as profit, even in the drug industry. Drug companies have in part taken advantage of the pendulum swing from the days when the doctor "knew all" and the patient nothing to the current direct to consumer drug advertising that seems to maximize drug benefit and minimize drug adverse reactions to a public that is too willing to take a pill rather than do the things Ms. Denver points out which requires effort and behavioral change. Change by both the consumer (lose weight, exercise, decrease drug demand etc) and the drug companies would seem desirable. Drug company influence in Washinton is disproportionate to the 8% of medical costs they account for and with the Leapfrog and other "influential" groups behind them, they peddle way too much influence with an extremely large number of influential lobbyists. American consumers are getting "ripped" but they are complicit in the process too often. Blame is easier than change.

This is my personal response to anyone else throwing darts at this book by Katherine Greider. Let it be from now on that you eiether agree with Mrs. Greider on this issue, or you side with the Big Pharma terrorists.
As her father, the great muckraker William Greider demystified the U.S. Federal Reserve, K. Greider demystifies the big drug companies with their claims that they must have their way with public policy.
It would seem that a President who purports to be "pro-life" would waste no time pushing some PRICE CONTROLS so people could afford the prescription drugs they need.