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 grāce, 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.
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.
The
Truth About Drug Companies: How They Deceive Us and What to Do
About It By Marcia Angell, M.D. (2004
