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

Marcia Angell (Author)

Book Description

Publication Date: August 24, 2004

During her two decades at The New England Journal of Medicine, Dr. Marcia Angell had a front-row seat on the appalling spectacle of the pharmaceutical industry. She watched drug companies stray from their original mission of discovering and manufacturing useful drugs and instead become vast marketing machines with unprecedented control over their own fortunes. She saw them gain nearly limitless influence over medical research, education, and how doctors do their jobs. She sympathized as the American public, particularly the elderly, struggled and increasingly failed to meet spiraling prescription drug prices. Now, in this bold, hard-hitting new book, Dr. Angell exposes the shocking truth of what the pharmaceutical industry has become–and argues for essential, long-overdue change.

Currently Americans spend a staggering $200 billion each year on prescription drugs. As Dr. Angell powerfully demonstrates, claims that high drug prices are necessary to fund research and development are unfounded: The truth is that drug companies funnel the bulk of their resources into the marketing of products of dubious benefit. Meanwhile, as profits soar, the companies brazenly use their wealth and power to push their agenda through Congress, the FDA, and academic medical centers.

Zeroing in on hugely successful drugs like AZT (the first drug to treat HIV/AIDS), Taxol (the best-selling cancer drug in history), and the blockbuster allergy drug Claritin, Dr. Angell demonstrates exactly how new products are brought to market. Drug companies, she shows, routinely rely on publicly funded institutions for their basic research; they rig clinical trials to make their products look better than they are; and they use their legions of lawyers to stretch out government-granted exclusive marketing rights for years. They also flood the market with copycat drugs that cost a lot more than the drugs they mimic but are no more effective.

The American pharmaceutical industry needs to be saved, mainly from itself, and Dr. Angell proposes a program of vital reforms, which includes restoring impartiality to clinical research and severing the ties between drug companies and medical education. Written with fierce passion and substantiated with in-depth research, The Truth About the Drug Companies is a searing indictment of an industry that has spun out of control.

Editorial Reviews

Amazon.com Review

Many Americans have wondered why prescription drugs have become so expensive while advertising for those drugs seems to grow exponentially. Former New England Journal of Medicine Editor Marcia Angell has some answers. The pharmaceutical industry, according to Angell, is fraught with corruption and doing a disservice to customers, the federal government, and to the medical establishment itself. In The Truth About the Drug Companies, Angell explains how a huge portion of the revenue generated by "Big Pharma" goes not into research and development but into aggressive marketing campaigns to sell their product. She describes how, even though the drug companies claim that it costs them an average of 802 million dollars per drug to develop new medicines, that figure is obscenely inflated since it factors in marketing as well as expected interest the company would have received had they invested the money in the open market. Meanwhile, Angell says, most of the R & D work is done by colleges and universities funded by the government. There are also problems with the drugs themselves, Angell indicates, since a majority are "me-too drugs", slightly modified versions of existing products which meant to address concerns of consumers most likely to spend money on pharmaceuticals. Thus, the market is filled with remarkably similar drugs to treat depression and high cholesterol while potentially life-saving medicines for diseases afflicting third-world countries are discontinued because they aren't profitable. In the books most damning passage, Angell tells of the high-priced junkets offered to doctors, ostensibly offered as educational opportunities that seem to constitute little more than bribes. The prognosis for reform is a grim one, Angell indicates, due to the massive cash reserves and lobbying efforts of "Big Pharma." Indeed, that lobby was hard at work trying to discredit her claims immediately upon the book's publication. But for anyone who's paid a pharmacy bill, The Truth About the Drug Companies is a fascinating read. --John Moe

From Publishers Weekly

In what should serve as the Fast Food Nation of the drug industry, Angell, former editor of the prestigious New England Journal of Medicine, presents a searing indictment of "big pharma" as corrupt and corrupting: of Congress, through huge campaign contributions; of the FDA, which is funded in part by the very companies it oversees; and, perhaps most shocking, of members of the medical profession and its institutions. Angell delineates how the drug giants, such as Pfizer and AstraZeneca, pay physicians to prescribe their products with gifts, junkets and marketing programs disguised as "professional education." According to Angell, the cost of marketing, both to physicians and consumers, far outweighs expenditures on research and development, though drug makers invoke R&D as the reason drug prices are so high. In fact, says Angell, with combined 2002 profits of $35.9 billion for the Fortune 500's top 10 drug companies, the drug industry is America's most profitable by far, thanks to disproportionately high prices, generous tax breaks and manipulation of patents to extend exclusive marketing rights to blockbuster drugs like Prozac and Claritin. Angell mounts a powerful case (and offers specific suggestions) for reform of this essential industry—a case worth bearing in mind as "big pharma" continues to oppose importing cheaper drugs from Canada.
Copyright © Reed Business Information, a division of Reed Elsevier Inc. All rights reserved.

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Product Details

• Hardcover: 336 pages
• Publisher: Random House; 1 edition (August 24, 2004)
• Language: English
• ISBN-10: 0375508465
• ISBN-13: 978-0375508462
• Product Dimensions: 9.3 x 6.5 x 1.2 inches
• Shipping Weight: 1.2 pounds
• Average Customer Review: 3.9 out of 5 stars  See all reviews (99 customer reviews)
• Amazon Best Sellers Rank: #152,511 in Books (See Top 100 in Books)

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Most Helpful Customer Reviews

417 of 444 people found the following review helpful:

5.0 out of 5 stars FANTASTIC READING, August 25, 2004

By 

Peter Rost (Short Hills, NJ United States) - See all my reviews
(REAL NAME)   

This review is from: The Truth About the Drug Companies: How They Deceive Us and What to Do About It (Hardcover)

I should start with a disclaimer. I'm a Vice President within one of the largest drug companies in the world and I have spent close to twenty years marketing drugs. So I guess I'm not supposed to like this book. But the truth is I thought it was fantastic.

First, for those of you who are not familiar with the healthcare industry, you should know that Ms. Angell is better capable of writing this masterpiece than any other author. She used to be Editor-in-Chief of The New England Journal of Medicine, which is considered the most prestigious medical journal in the world. Don't let her credentials scare you off, though. This is easy reading and the book captures your attention like a true business thriller, only this is real life suspense.

But this volume is much more than simple entertainment. It is quite possibly one of the best analyses of the state of the U.S. drug industry today, complete with footnotes backing up every statement the author makes. You will learn not only that in 2002 the top ten drug companies made a higher profit than the other 490 businesses together on the Fortune 500 list. You will also understand how the drug industry has been able to achieve such a business success and how this success, as is often the case throughout history, will likely be their downfall.

A political tidal wave is building which will forever change both the industry and many of its infamous business practices. It is sad to note that the drug industry today is equally poorly regarded as the tobacco companies, and this is a testament not only to the shortsighted foolishness of their management, but also to the fact that you can fool some of the customer some of the time, but not all of them all the time.

So is there no hope? Well, Ms. Angell doesn't only state the problem she also presents solutions and ends her story with several thoughtful suggestions on how to change the way we discover, market and distribute new drugs. Her advice is wise and absent of quick fixes. Only time will tell if there will be a movement so strong that it can defeat ingrained business practices of the richest companies in the world.

What may help is that the drug companies are their own worst enemies. They have antagonized grannies all over the US with their work to stop reimportation of cheaper drugs into the US, a practice that has been in place for many years in Europe. And anyone in marketing or public relations can tell you that no money in the world can help you win against millions of mad grandmothers.

173 of 185 people found the following review helpful:

5.0 out of 5 stars A Brave Exposé of Big Pharma, September 23, 2004

By 

Joel M. Kauffman (Berwyn, PA United States) - See all my reviews
(REAL NAME)   

This review is from: The Truth About the Drug Companies: How They Deceive Us and What to Do About It (Hardcover)

One of the great exposés of all time, "The Truth About the Drug Companies" punctures much of the self-generated publicity of what has come to be called "Big Pharma. Beautifully written, edited and referenced in academic style, Dr. Angell begins softly and with understatement, building logically to a shattering set of conclusions and recommendations.

Pharma's claim that high drug prices in the USA are required to support innovative research is shown with plausible data to be false. Most of the innovative drugs are actually discovered in universities, at the NIH and in small companies. Pharma's expenditures for research are shown to less than half of those for sales and marketing and lobbying. About 4/5 of research dollars spent are on "me-too" drugs that are minor variations on the original drug of each type, and thus of no value to ordinary citizens.

Dr. Angell explains how Big Pharma had patent law changed to obtain up to 23 years of protection. And how minor changes in the drug molecule have somehow become patentable in direct contravention of patent law that obvious minor changes are not patentable. Mere changes in formulation somehow became protected.

Dr. Angell confirms other reports that Big Pharma has the most powerful lobby in Washington, resulting in "...an iron grip on Congress and the White House". Big Pharma has had laws passed forbidding importation of its own drugs from outside the USA. There is no technical justification for this. Big Pharma has arranged that the Medicare Drug Benefit to become effective in a couple of years does not permit Medicare to negotiate prices. This is contrary to the ability of all other national health services in the world to negotiate prices.

Dr. Angell confirms that both the NIH and FDA are subservient to the wishes of Big Pharma. This is largely done by offering "consulting" agreements to federal employees, and to members of FDA advisory committees. The FTC and FDA crumbled to Big Pharma's wishes to advertise drugs direct to consumer, a total disaster so far, because the true benefits of many drugs, often quite minor and sometimes even negative, cannot be communicated in a TV ad.

The pervasive bribing of doctors to prescribe the latest drugs is confirmed. Big Pharma's influence on medical schools is shown, as is the control of Continuing Medical Education, required for certain certifications and hospital privileges.

"The Truth..." is truly great because a number of concrete suggestions are made to undo the damage: "Despite all its excesses, this is an important industry that should be saved - mainly from itself" (p237). Of the suggestions Dr. Angell made, the one most possible to be implemented are removing the control of clinical trials of drugs from Big Pharma and having the NIH do it. (Of course, there is the caveat that NIH employees must stop receiving compensation or gifts from Big Pharma.) Some of the scientific transgressions of Big Pharma in running and reporting on drug trials are given, such as reporting only the positive results, testing healthy adults and then allowing the drugs to be prescribed for sick adults, children and the elderly. Drugs are now tested against placebo. Dr. Angell notes that tests should also include a test group using the current best drug to see whether the "new" drug is really better. She does not address the lack of benefit of many of the best-selling drugs.

"The Truth..." is an oustanding work, in my opinion, and a short review cannot do it justice.
*****
For a similar exposé see "Prescription Games" by Jeffrey Robinson (2001). Other aspects of Big Pharma excess are given in "Heart Failure" (1989) and "Prescription for Disaster" (1998); by Thomas J. Moore; "Overdose: The Case Against the Drug Companies" by Jay S. Cohen, MD (2001). The misleading presentation of trial results is shown in "Calculated Risks" by Gerd Gigerenzer (2002) and the peer-reviewed paper: Joel M. Kauffman, Bias in Recent Papers on Diets and Drugs in Peer-Reviewed Medical Journals, J. Am. Physicians & Surgeons, 9(1), 11-14 (2004).

I have had about 14 years of experience in exploratory drug development in colleges, mostly supported by NIH grants.

62 of 68 people found the following review helpful:

5.0 out of 5 stars What Drug Companies Fear You Will Find Out, September 20, 2004

By 

Stuart Cameron "stu" (Seattle,WA USA) - See all my reviews

This review is from: The Truth About the Drug Companies: How They Deceive Us and What to Do About It (Hardcover)

As a pharmacist for 27 years, six of those working in sales for one of the "big pharma" companies, I was pleased to see that Dr. Angell has got it EXACTLY right. Pharmaceutical companies are now multinational corporations whose motives are the same as all mega corporations... money and profits.
I know Dr. Angells chapters on "The Hard Sell", "Marketing
Masquerading as Education", and "Marketing Masquerading as Research" are factual. I received training in all these methods
of bullying physicians into writing prescriptions for my products using many of the methods described in this book!
Dr. Angells descriptions of the pharmaceutical industries hold on politicians and the FDA is, again, completely correct.
Until politicians believe they may not be re-elected if they
continue to pander to "big pharma", it will never change.
If you are at all concerned about the outrageous price of prescriptions (and you should be), this is a must read. Better
yet, send a copy to your congressman, senators and state representatives. You can bet "big pharma" is squirming over this one!