Customer Reviews

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

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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.

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.

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!

I will try to keep my review as non-partisan as possible, but I have to say - after reading the one star reviews that have blind faith in the drug companies, they are either naive, rich enough to afford the latest greatest meds (which may or may not be that great), or have a financial stake in big pharma. Read them and laugh or grimace. Certainly, there are people who are so pro-corporate that they will keep insisting that corporations have their best interest at heart. This book is not for you.

Compared to a lot of other books in this genre (basically, pro pharma reform), this one shines. Mostly this is due to the authors front row seat experience, and her style translates well to a lay audience - a rare skill. That is why I recommend this book instead of others.

We desperately need more quality nonbiased research that does not choose to put a product in a unfairly favorable or unfavorable light due to the deep products of a sponsoring company. The public deserves better. I encourage all of you who hear about this study or that on whatever news outlet you listen to - take a look at 1 - what the study actually compared and 2 -who sponsored it. There's a lot of bias out there.

As a physician, I guess I am one of the people who ought to be defensive about the expose' illustrated here. But I purchased the book already experiencing a good deal of abuse/shenanigans from the pharmaceutical industry, and wondering what else might be going on about which I might expand my knowledge.

From many other excellent reviews here you will know this is a must read! As one reviewer noted, it reads like a novel.....so the fiction lovers out there can delve into its details as well as those of us looking for factual marketing, political and current events reading.

Some additional notes: I'm a hospital-based anesthesiologist, and can assure readers that the tactics described herein are not limited to doctors' offices-type practices. This book does not address the techniques used by the industry to manipulate prices and costs within hospitals, but rest assured, the manipulations are there in a big way: limiting formularies, discontinuing effective and time-proven inexpensive drugs in favor of proprietary ones, marketing to non-physicians (accountants, CEO's) in a position to affect formulary decisions, etc.

There is a singular, but major criticism of this book, and that is the author's conclusion that more government involvement is one solution to reign in the excesses of the industry. This comes after the text's superior review of how government (FDA, NIH, congress-of course) has, in fact, been a major player in creating/perpetuating the problem in the first place! What a preposterous conclusion/how contradictory can one get? After recognizing, say Ted Bundy as a serial killer, would she want him chaperoning her teenage girls, using identical logic?! How much failure on the part of the criminals in congress does it take to understand that consumers (grandmothers--see earlier review), not bureaucrats, are the solution to the "fix" here?

IF YOU"RE A PHYSICIAN, this is necessarily mandatory reading. You've been hood-winked. More than that, your professional reputation and principles have been hijacked and perverted and you may very well have no clue as to the depths to which the industry has sunk to get its way at your expense. You will not practice the same after reading this book.

I found Dr Angell's excellent book to be fairly comprehensive except for one important point: It overestimated the benefits of many drugs because it did not discuss some of the important reasons that the conclusions from many randomised controlled trials are invalid, especially for drugs for cancer and heart disease: namely the concept of 'surrogate endpoints'. These are used instead of real benefits like increased survival or reduced mortality. Instead of measuring if a drug extends life, which takes a long time and therefore costs a lot more, most chemotherapy drugs use tumour shrinkage as a surrogate end point.

Unfortunately there is little or no correlation between tumour shrinkage and increased survival - so the paradigm of what cancer is must be wrong.

As a result the FDA accepts drugs as effective based on their ability to reduce the size of tumours. It also accepts them as safe despite the fact that they are poisonous and kill thousands of people every year.

So these 'effective' drugs have no survival benefits and cause much harm.

Yet billions of dollars are spent on these drugs every year and these get included in Dr Angell's 'useful' drugs.

Another reason for the invalidity of the conclusions from many randomised controlled trials is that many trial authors publicise the fact that a drug can reduce cancer specific mortality and get it approved by the FDA yet ignore the increased deaths from other causes resulting from the drug's toxicity. There is often no overall saving of lives.

For these and many other reasons, the claim that so many drugs are useful and save lives needs to be treated with some scepticism.

The concept of surrogate endpoints is described well in Thomas Moore's excellent book Deadly Medicine where he describes how this concept was the reason for between 50,000 and 150,000 people in the US being killed by anti-arrhythmic drugs (after being approved by the FDA as being safe and effective) before its use was restricted.

Many authors have pointed out the lack of correlation between tumour shrinkage and increased survival, including Ralph Moss in his excellent book 'Questioning Chemotherapy'.

But despite this oversight Dr Angell's book provides the detail to substantiate what many of us suspected but couldn't prove.

This book hits the drug companies where they live, and it gives us the ammunition we need to bring about change. The changes needed are to almost every aspect of the way pharmaceutical companies work, from the discovery of new drugs through the clinical trials, the FDA approval process, the marketing, the education, the patenting process, the effects on generic drug manufacturers, and of course what typical American consumers pay for drugs.

While Angell's book is comprehensive in its descriptions of the problems and its proposed solutions, it is not a long book and it is easy to read. There is an extensive bibliography and index, allowing us to look up individual sources and evaluate them ourselves. The chapters are organized in a comprehensible fashion, and Angell repeats information that might have been forgotten so that a reader can easily make connections and understand situations without having to backtrack and reread sections.

The book hits the high spots but does not delve into specific areas with a great deal of detail. Angell provides case studies to illustrate points but does not dwell. I found myself at times wanting more in some areas, but on balance I believe the format and information provided is a good length and with sufficient detail to tell the story.

Most importantly, this book offers concrete suggestions, not just those that can be made by congress (much of what's wrong can be corrected there) but also what we as individuals can do for ourselves. I expect to see attacks on this book, backed by the pharmaceutical industry (but probably not under its name), but anyone who will take the little time to read it will be able to put those attacks in their place. An important book about an industry that affects all of us.

I read the book, then this past Friday listened to Dr. Angell and the CEO of the pharmaceutical industry lobbying group interviewed on NPR's Science Friday." Dr. Angell's point in a nutshell is that the drug companies have been engaging in predatory practices while dressing themselves up as Good Citizens. The perspective of the CEO was that the drug companies are Good Citizens.

This is the first time I have heard an NPR host get so agigated that he turned on one of the guests (the CEO). In one instance the host asked what what the merits of marketing erectile dysfunction drugs to healthy young adults as profiled in the ads. The CEO, whose sense of humor quotient seems pretty low, tried to explain that the ads were serving a positive public health role if getting people to see their doctor and perhaps discover health problems that would otherwise be undiagnosed. I think this response simply infuriated the host even more.

What the book is missing is an indepth narrative of the development of a drug, or perhaps several drugs, with the perspective of the drug company taken into account (woithout necessarily agreeing with it). Angell does have a number of stories including the outrageous behavior of Parke-Davis in its promotion og Neurontin.

Marcia Angell's background (physician; former editor of the New England Journal of Medicine) make her uniquely qualified to write this book.

Among her key points are that 1)most of the expenditures for developing new drugs are funded by the government, 2)most of the drugs are "me-too" variations with little or no benefit vs. those currently on the market (a fact concealed by comparing them vs. a placebo instead of existing drugs, or by testing a new drug vs. an inappropriate dosage of something else), 3)companies spend more on marketing than research, 4)considerable extra profits derive from minor tweaking of existing drugs to all extending their patent protection, 5)that in 2002 the top ten drug companies made greater profits than the other 490 businesses on Fortune's Top 500 list, 6)how pharmaceutical companies' consulting agreements" with government officials at the FDA and NIH distort regulation, 6)that drug companies only publish and report positive results from tests, and 7)the strong hold drug companies have on Congress through their political donations.

This book cries out for change!

I loved the book, some of it seemed a bit fragmented, but understood, tis a complex issue. As referenced, it does not suprise me in the least that drug companies account for more than the profits of the top 5 fortune companies. I have met the "wonderful" drug reps, scurrying around with the luggage on wheels and bags of goodies (pens, pads of paper, other gizmos) and "drug lunches". They corner you in the break room, when you are lucky to get a break, before you even sit down, you are forced to sign in and listen to their well practiced lectures in their expensive suits. I would appreciate less of the "goodies" and more research funded by those other than the drug companies themselves or others associated with those companies as discussed in her book. Anther topic I found to be interesting was how R&D is less than advertised and much of the expense is d/t advertising. From my own experience, the fact that a few Zofran cost $400, so you don't vomit is ridiculous! It's interesting to me now to have an idea where this money is going according to this publication. I also enjoyed the section on new medical conditions arising now that were unheard of in the past, PMMD for example. I also found it frightening that, according to the book, drug complanies are promoting to doctors the use of medications for unapproved uses by the FDA, so they will prescribe more of the medication. I thought the discussion in her book regarding cutting off the last leg of unfavorable research findings to publish a fantastic looking study was disgusting (Celebrex anyone?). She talks about why HIV/AIDS meds are so expensive and the impact on people desperate for medications and could die if they don't get them. Again, thank you for writing this- I think that those who idolize drug companies and even those who work for them who are unaware may benefit from your lengthy research on the topic.