The Truth About the Drug Companies
How they deceive us and what to do about itby
Marcia Angell, MD
reviewed by Mira de Vries
Marcia Angell was (chief) editor of the renowned New England Journal of Medicine for two decades. As stated on the back of the 2005 paperback edition of her book, she “had a front-row seat on the growing corruption of the pharmaceutical industry.”
She fleetingly mentions possible negative effects to health by drugs, although she is not skeptical, for instance, of the need to medicate when high blood pressure, high cholesterol levels, or HIV are diagnosed. She has faith that in some distant future, genetic research will lead to new and helpful drugs. Naturally, she does not mention forced medical treatment, nor the effects of the massive amounts of drugs we collectively excrete on the earth we all share.
Angell’s main beef is that the drug companies are too profitable. She correctly identifies that they are not a free-market success story. They live off industry-friendly laws and regulation, publicly funded research, monopoly rights, protectionism, and tax breaks. Their best client, the biggest single purchaser of prescription drugs, is government.
The pharmaceutical industry uses its wealth and power to manipulate congress, federal and state legislators, the Food and Drug Administration, and the courts. “[It] has essentially hired government to do its bidding." It has by far the largest lobby in Washington. Drug companies even hire family members of congressmen to lobby them. And they "donate" copiously to political campaigns. “Legislators are now so beholden to the pharmaceutical industry that it will be exceedingly difficult to break its lock on them.”
Meanwhile, some of the public is growing more skeptical of the pharmaceutical industry, as evidenced, among other ways, by the many books criticizing it that have recently come on the market. In the preface to the paperback edition of The Truth About the Drug Companies Angell lists four titles that appeared around the same time as her own. Blech’s book is not included, nor is that by Medawar & Hardon.
The industry is responding by increasingly disguising its propaganda as education. It hides behind supposedly grass-roots patient groups, which are in fact funded and often founded by drug companies. It advocates its products using paid anecdotal testimony, preferably by celebrities. Industry domination of medical schools and journals ensures that physicians are trained to reach for a prescription pad, and learn no other way of dealing with their patients’ complaints.
Most of the new drugs coming on the market are me-too drugs. (Some other authors call them copy-cat drugs.) Drugs that are not proven to be better than existing drugs should not be allowed onto the market, Angell contends. But how does she expect the benefit of a drug to be proven, while she acknowledges that the research that delivers such evidence is subject to wide-spread manipulation and fraud?
In my opinion the most shocking revelation Angell makes in her book is about research on children. As an incentive to include children in drug testing, which Angell endorses, the US government grants a six-months’ extension of a drug’s patent rights. (This same legislation is now being pushed through the EU.) When the drug is a good seller, this proposition is immensely lucrative, so drug companies test drugs for conditions such as heartburn and “premenstrual dysphoric disorder” on children, even though these conditions never affect children. At the same time, the government’s goal is defeated, because less lucrative drugs for rarer conditions that do affect children remain untested on them.
Except for her call to repeal parts of the Bayh-Dole act, and to repeal the extension of exclusive marketing rights for testing drugs in children, the solution Angell proposes is more regulation. With this she joins the ranks of the large majority of the population that continues to believe that regulation protects the individual citizen, even though it has never accomplished this in the past. She admits that every regulatory law legislated, no matter how well-intentioned, winds up benefiting the industry. Yet she proposes even more of those laws. This is the same logic by which some people think that if their appliance doesn’t start to work when they kick it, they must have to kick it harder.
Who "except for libertarian extremists and The Wall Street Journal" could possibly want legal restrictions on pharmaceutical marketing removed, Angell rhetorically ponders. Yet she does not address arguments in favor of removing restrictions, except by the epithet “extremist” and by positing that before regulation, all sorts of “worthless and dangerous patent medicines” were peddled to a gullible public. The latter is true, but after a whole century of regulation, we have more of such worthless medicines than ever, and precisely the ones that are covered by prescription laws and regulation are the most dangerous.
When Angell mentions law suits brought by individuals or consumer groups, she suddenly seems to switch sides. She rallies to the defense of the drug companies, calling the charged offenses “alleged,” a word she never uses to describe her own hefty accusations, and claiming that many of these charges are frivolous.
Angell has done a fine job of diagnosing the pharmaceutical industry's disorders, but most of the medicines she prescribes will do more harm than good. The one remedy she apparently finds unfathomable is leaving the individual citizen free to be responsible for his own health care.