Bests & Worsts Reviews from Amazon

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.