Off the Shelf by Lynn McKeown

Big Pharma will make you sick

Marcia Angell, The Truth About the Drug Companies, Random House, 2004, $24.95.

A statement near the beginning of this very direct and revealing book jumps right out at the reader: In the year 2002, "the combined profits for the ten drug companies in the Fortune 500 ($35.9 billion) were more than the profits for all the other 490 businesses put together ($33.7 billion)." (p. 11) This is just one of the disturbing facts brought to light in The Truth About the Drug Companies, by Marcia Angell. With pharmaceutical companies much in the news lately, the book comes at an opportune time to shed light on a disturbing area of American medical care.

The huge profits of the large pharmaceutical companies – Big Pharma – are interesting in view of the often-made argument that the reason for high prescription drug prices in the U.S. is the high cost of drug research. Author Marcia Angell, a professor in the Harvard Medical School Department of Social Medicine and former editor in chief of The New England Journal of Medicine, gives the lie to this bit of industry propaganda, along with much else.

The truth about research and new drug development, says Angell, is that most of it is done by the National Institutes of Health and by large universities, along with small bio-tech companies. In other words, most drug research is done by tax-supported agencies. The drug companies charge high prices to the public, reaping huge financial benefits from research paid for by that public.

This has come about partly because of legislation allowing Big Pharma to benefit greatly if they partner with universities in drug-development. They are then allowed to patent the drugs for a certain length of time and charge high prices before they are allowed to be produced by the generic companies and sold more cheaply. But armies of lawyers employed by the pharmaceutical companies are adept at utilizing laws affecting medicines to delay for extended periods this turning over of drugs to the genetic companies.

Not only that, but because of laxness by the Federal Drug Administration, the pharmaceutical companies produce what are called "me-too drugs," drugs which vary only slightly from older drugs and may be no better, on which they obtain a new patent and make more enormous profits. (The drug trials they are required to do usually compare the new drug to a placebo rather than to similar drugs, so doctors don’t really know if the "new" drug is better.) By "education" of doctors and providing them with many free samples, the companies create a public desire for the "new" drug.

This process has been aided in recent years by the practice of mass advertising, so that the "new" drugs are then in demand by patients when they visit their doctors. Some research, according to Angell, shows that an inexpensive diuretic is just as effective as expensive new prescription drugs in curing hypertension, but a plethora of TV ads push the latest prescription marvel.

The direct-to-public advertising often involves "creating a disease" which the drug will cure. You now can get an expensive pill for the digestive distress formerly called heartburn that could be cured by an antacid tablet costing pennies. Drug companies have also found a large new market apparently for a condition they are calling "erectile dysfunction." The huge amount of TV advertising, especially in sports broadcasts, leads to one of the few moments of humor in this book. As a result of recent TV advertising (paid for by a reported $20 million deal with the National Football League) "to watch the 2004 Super Bowl was to wonder whether football causes erectile dysfunction." (p. 116, author’s italics)

It would be a mistake to see The Truth About the Drug Companies as merely an ideological attack. The author has no political ax to grind. She finds fault with the federal government as well as the companies, pointing out that the number of drug company lobbyists in Washington is huge, and politicians of both parties have benefited from their enormous campaign contributions. And both Republicans and Democrats have benefited. The book was published before the recent news about problems with the drug Vioxx, but Angell finds much fault with what she considers too-rapid and inadequate testing of new drugs, under supervision of the FDA.

After finishing The Truth About the Drug Companies, one is left angered and perplexed. How could such a situation exist? Angell finds fault in many areas. She notes that many wonderful and beneficial drugs have been developed in recent times, and the big drug companies have provided a service in making them available to the public. But she says that new procedures are necessary and new agencies may be needed, especially in the area of drug testing. She says that all the problems in the pharmaceutical industry may be creating a "perfect storm" of abuse and public indignation.

I was left, after reading the book, with a number of questions. We may need some new legislation. We may also need better, wiser procedures by doctors in the way they prescribe drugs. We may also need smarter, wiser consumers – the public who utilize prescription drugs. We tend to want to find a pill for every problem, including the inevitable problems of life and aging. If the drug companies deceive us, it may be because we’re too willing to be deceived.