The Truth About Drug Companies: How They Deceive Us and What to Do About It - National Health Federation

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The Truth About Drug Companies: How They Deceive Us and What to Do About It
By Andrew W. Saul
July 15, 2005

The Truth About Drug Companies: How They Deceive Us and What to Do About It By Marcia Angell, M.D. (2004 NY: Random House, 266 pages, $24.95). "Is there some way (drug) companies can rig clinical trials to make their drugs look better than they are? Unfortunately, the answer is yes. Trials can be rigged in a dozen ways, and it happens all the time."

Typically, any author making such an uncompromising statement would, just for starters, be denounced for unjustified hostility to pharmaceutical medicine. For the coup de grâce, the writer would be dismissed as an unqualified quack. Not this time. This is the stentorian voice of Dr. Marcia Angell, former Editor-In-Chief of the New England Journal of Medicine. A highly respected and established medical insider (twenty years with NEJM), she does not shrink from employing the alternative health movement's most derogatory epithet, "big pharma," to attack an industry that, she says, "will do almost anything to protect exclusive marketing rights." Dr. Angell fairly rips into her discussion of patent-prolonging, profit-piling, non-innovative "me-too" drugs, which she reveals as the true bread-and-butter of the modern pharmaceutical industry.

And as for the few truly-new blockbuster drugs, Dr. Angell shows that clinical trials are often rigged. This disgrace goes way beyond mere bias; it is blatant dishonesty. One "way to load the dice," she writes, "is to enroll only young subjects in trials, even if the drugs being tested are meant to be used mainly in older people. Because young people generally experience fewer side effects, drugs will look safer." Another of the "common ways to bias trials is to present only part of the data - the part that makes the product look good - and ignore the rest." She adds, "The most dramatic form of bias is out-and-out suppression of negative results."

Several dollars per pill is a lot of money, most especially for the uninsured. Incredibly, people without health insurance pay the highest drug prices, says Dr. Angell. And those prices are high not because of R&D, but because of S&P (sales and promotion). Pharmaceutical companies, she says, "do whatever they can to obscure the fact that in 2001 consumers paid something like a 30 percent markup for sales promotion." Drug companies' research and development expenses, the most common industry excuse for high prices, are "dwarfed by their vast expenditures for marketing," which amounts to at least $19 billion annually.

A chapter with the somewhat less-than-subtle title of "The Hard Sell: Lures, Bribes and Kickbacks" describes a pharmaceutical industry that deploys an army of 88,000 energetic sales representatives such that some physicians "may be visited by a dozen in one day." Dr. Angell says that sales reps "often announce their arrival by distributing goodies to everyone. . . as well as the inevitable sack of free samples. Gifts to doctors are often lavish," and she provides plenty of embarrassing examples. Drug companies see physicians as prescription delivery devices, and they are monitored accordingly. "Prescription-tracking companies buy information from big pharmacy chains about doctors' prescribing habits and sell it to drug companies." Drug reps "know exactly what a doctor prescribes before each visit" and "they can tell whether the visit paid off by seeing what the doctor does afterward."

The pharmaceutical presence is everywhere you find a white coat and a beeper. "Drug reps are allowed to attend medical conferences, may be invited into operating and procedure rooms, and sometimes are even present when physicians examine patients in clinics or at the bedside. Patients are often allowed to assume the reps are doctors. . . Drug companies pay doctors several hundred dollars a day to allow sales reps to shadow them as they see patients." It's a way to "build business."

And what a business it is. The entire pharmaceutical industry, says Dr. Angell, is "primarily a marketing machine to sell drugs of dubious benefit." Big pharma, she says, is "taking us for a ride." And it is no mere jaunt around the park. Drug-industry worldwide sales are approaching $500 billion per year, half of which are in North America. Profit margins are typically 20 per cent, so high that "the combined profits for the ten drug companies in the Fortune 500 were more than the profits for all the other 490 businesses put together."

One way the companies try to justify their enormous profits, Dr. Angell says, is that they use "a kind of blackmail: if you want drug companies to keep turning out life-saving drugs, you will gratefully pay whatever they charge." And they charge plenty. "When it came on the market, Taxol sold for $10,000 to $20,000 for a year's treatment. . . . Novartis priced Gleevec at about $27,000 for a year's supply. . . . Genzyme charges patients on the order of $200,000 to $300,000 for a year's supply" of Cerezyme, for which "research and early development was done entirely by NIH-funded scientists." Taxol, as well as Epogen, Procrit, and Neupogen "were developed largely with public funding."

The author devotes considerable attention to, and succeeds in clarifying what is, at best, a complex topic: taxpayer-funded scientific research does not belong to the taxpayers. The results can be, and are, snatched up and patented by pharmaceutical corporations. And since the 1980s, it's not only legal, it's positively encouraged.

You will rarely hear academia complain. Why? Because they are aboard the gravy train. Dr. Angell writes: "Columbia University, which patented the technology used in the manufacture of Epogen and Cerezyme, collected nearly $300 million in royalties" in 17 years. "The patent was based on NIH-funded research." Harvard is in just as deep. In its own Faustian dealings with the drug companies, "a Harvard hospital has a deal that gives Novartis rights to discoveries that lead to new cancer drugs . . . Merck is building a twelve-story research facility next door to Harvard Medical School . . . In Harvard Medical School 's Dean's Report for 2003-4, the list of benefactors included about a dozen of the largest drug companies." The result? "Bias is now rampant in drug trials. . . (Pharmaceutical) industry-sponsored research was nearly four times as likely to be favorable to the company's product as NIH-sponsored research." "NIH-sponsored" means taxpayer funded. And, then, when they need to use a drug, those same taxpayers pay again, and way too much, for the drug they already paid out grant money to develop. What a sweet system for the pharmaceutical cartel.

Twin chapters ("Marketing Masquerading as Education" and "Marketing Masquerading as Research") reveal that drug companies pay nearly two-thirds of the costs of continuing medical education. This, and other even more dubious practices, makes doctors into "company shills," says the author. "By calling it education . . . but not marketing, companies needn't worry about anti-kickback laws." While the pharmaceutical industry's reach into education is bad enough, its grip on research is scandalous. For example: Drug company "publications strategies" have them "sponsor minimal research, prepare journal articles based on it, and pay academic researchers to put their names on those articles." So bad is it that Dr. Angell wrote an editorial in NEJM (1) entitled "Is Academic Medicine for Sale?" A reader wryly responded, "No. The current owner is very happy with it."

Overall, this is one grim subject. Fortunately, there is ample charm in Dr. Angell's writing style. Though she will bludgeon you with buckets of incriminating information, you will enjoy the process. Clearly, Dr. Angell was well-placed as Editor-In-Chief of NEJM. Her writing is crisp and clear, efficiently organized, tightly referenced, and still a surprisingly good read for the layman. Her discussion of the marketing of erectile-dysfunction drugs constitutes an engaging example: "Here the expectation is that you will ask your doctor to prescribe the drugs for you. For instance, GlaxoSmithKline and its co-marketer Bayer' signed a deal with the National Football League to promote their me-too drug Levitra to compete with Viagra for the huge "erectile dysfunction" market. Reportedly the deal cost the companies $20 million. In addition to exclusive league sponsorship, they made individual deals with some of the teams. The agreement with the New England Patriots, for instance, called for Levitra's burning flame logo to appear on signs ringing Gillette Stadium. Mike Ditka, former coach of the Chicago Bears, would make a thirty-second pitch on a large screen. In fact, to watch the 2004 Super Bowl was to wonder whether football causes erectile dysfunction." (p. 116)

In the "Get Our Money's Worth" chapter, Dr. Angell presents her prescription for the government to fix what presently amounts to a pharmaceutical financial free-for-all. And until that very cold day in Hades may arrive, her closing presentation is doubly important. In the Afterword, Dr. Angell provides a list of cautionary, highly-specific questions that all patients should ask their doctors whenever they are issued a prescription. These will likely be the most photocopied pages of a totally remarkable book.

It is especially satisfying to find a distinguished physician-author letting loose well-deserved, point-blank salvoes straight into the bulwarks of the pharmaceutical industry. Reading The Truth About the Drug Companies will leave some readers with the realization that the truth is just as bad as they feared. It will leave the rest of us with the realization that it is far, far worse.

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Among many other things, Andrew Saul is Contributing Editor for The Journal of Orthomolecular Medicine and is the author of the book DOCTOR YOURSELF: Natural Healing that Works (Basic Health Publications, 2003). His website is http://www.doctoryourself.com.