The Truth About the Drug Companies: How They Deceive Us and What to do about it by Marcia Angell.  Random House, 2004, 319 p

Marcia Angell’s book gives example after example of how the drug industry, known collectively as “Big Pharma,” disseminates shoddy science, corrupts regulatory safeguards and wastes money producing “me-too” drugs, or minor variations of those already on the market.  Rather than being engines of innovation, Angell argues that they are predominantly marketing machines designed to deliver enviable profits.

As a former editor-in-chief of the New England Journal of Medicine, Dr. Angell is well-qualified to comment on the industry. She describes how the marketing arms of the major pharmaceutical companies use a variety of ingenious devices to promote drugs regardless of health outcomes.  One of the saddest parts of the book was its depiction of how significant numbers of pliable medical practitioners and academics willingly dance to the industry’s tune.

Drug companies have been able to convince gullible politicians and the public that pharmaceutical costs are necessarily high because of enormous research and development (R&D) costs, and that the steady stream of innovative medicines helps lengthen life, enhances its quality, and averts more expensive medical care.  At the time the book was published, pharmaceutical companies claimed that it costs $800 million to bring a drug to market.  Angell’s analysis of this figure shows that it is inflated and that the real cost is much lower.

The other problem, in the US at least, is that drugs only have to prove that they are marginally more effective than a placebo.  This leads her to challenge the belief that new drugs must be better than older ones.  In fact, the opposite is often true, as older drugs are likely to be better understood.

One reason is that many of the drugs produced are only slightly different than their competitors, and it is a convenient myth that the pharmaceutical industry is innovative.  Most of the major breakthroughs were based on taxpayer-funded research at academic institutions, while the great majority of “new” drugs are not new at all, but merely variations of older ones already on the market.  By varying a molecule or two on the formulation of a popular drug, companies can enjoy twenty years of monopoly pricing. For example, there are six statins on the market to lower cholesterol—all are variants of Mevacor.

It is a myth, says Angell, that drug companies are primarily engaged in R&D to generate profits. Instead, they market drugs of dubious benefit, bribe doctors to prescribe those drugs and lobby politicians to protect their lucrative monopolies.

Angell makes a strong case for fundamental reform of the pharmaceutical industry. In The Truth About the Drug Companies, she proposes sensible reforms to every component of the industry. The book is a must-read for policy makers as well as the public, who are often the victims of rip-offs by Big Pharma.


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