Top MD Reveals Corruption in Health Care
"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) [in 2002]. Over the past two decades the pharmaceutical industry has moved very far from its original high purpose of discovering and producing useful new drugs. Now primarily a marketing machine to sell drugs of dubious benefit, this industry uses its wealth and power to co-opt every institution that might stand in its way, including the US Congress, the FDA, academic medical centers, and the medical profession itself."
-- Dr. Marcia Angell, former editor in chief of the New England Journal of Medicine on health corruption
The book review below, taken from the prestigious New England Journal of Medicine, clearly reveals just how corrupt the pharmaceutical and health care industries have become. The book's author, Marcia Angell, M.D., is a former editor in chief of the highly respected Journal. She is currently a senior lecturer in social medicine at Harvard Medical School. Her book, The Truth About the Drug Companies, provides yet another eye-opening example of how greed has taken over many facets of business and government, and offers empowering ideas on what we can do about it.
New England Journal of Medicine
Volume 351:1580-1581, October 7, 2004, Number 15
http://content.nejm.org/cgi/content/full/351/15/1580 (payment may be required to view article)
The Truth About the Drug Companies:
How They Deceive Us and What to Do About It
In this book, her most recent, Marcia Angell explores pharmaceutical research, deplores the rapidly expanding involvement (and distortion of truth) of Big Pharma, and implores us all (physicians, patients, politicians) to do something about it. The dust-jacket blurb asserts that Angell, "during her two decades at The New England Journal of Medicine had a front-row seat on the growing corruption of the pharmaceutical industry."
Since leaving the Journal, she's gone behind the curtains of Big Pharma, Big University, and Big Faculty. Drawing on her own work and on her thoughtful analysis of research, company financial statements, and investigative reports into drug development and marketing, Angell writes with the unambiguous and unyielding style that Journal readers came to expect and trust.
The current slide toward the commercialization and corruption of clinical research coincided with the election of President Ronald Reagan in 1980 and the passage of the Bayh-Dole Act, a new set of laws that permitted and encouraged universities and small businesses to patent discoveries from research sponsored by the National Institutes of Health (NIH). Research paid for by the public to serve the public instantly became a private, and salable good – one that is producing drug sales of more than $200 billion a year.
Commercialization had both specific and broad effects. Readers of this journal and others are familiar with investigations into the control that research sponsors at pharmaceutical companies exert on the design and analysis of clinical trials (including the distortion of primary outcome measures in trials) and the issue of reporting, nonreporting, and biased reporting of results.
Angell reminds us of the increasingly cozy relationships between big industry and the faculties of universities. Not only are narcissistic donors renaming the medical schools; they are buying access to the best minds of their faculties. Angell's examples of the large consulting fees paid by industry to individual faculty members and to NIH scientists and directors are astounding.
The broader effects are felt in the commercialization of universities, medical faculties, and our profession. In 2000, in a letter written in response to Angell's Journal editorial, "Is Academic Medicine for Sale?" a reader supplied the answer: "No. The current owner is very happy with it." The increasing intrusion of industry into medical education and the almost complete domination of continuing medical education (especially regarding drugs) by the marketing departments of large pharmaceutical companies are a scandal.
The same companies also spend heavily to lobby governments. According to Angell, Pharmaceutical Research and Manufacturers of America, the pharmaceutical industry's U.S. trade association has "the largest lobby in Washington," which in 2002 employed 675 lobbyists (including 26 former members of Congress) at a cost of more than $91 million. The result has been above-average growth in corporate profits during both Republican and Democratic administrations.
The most recent and perplexing lobbying effort caused Congress explicitly to prohibit Medicare from using its huge purchasing power to get lower prices for drugs, thus opening up a dollar pipeline, in the form of higher drug prices, directly from taxpayers to corporate coffers. These changes, along with the cave-in by the Food and Drug Administration (FDA) in 1997 that permitted direct-to-consumer advertising to bypass mention in their ads of all but the most serious side effects, have further augmented profits. The overall effect has been a corruption not only of science but also of the dissemination of science.
Angell documents that, contrary to what they claim, large pharmaceutical companies have "paltry output" in innovative research. In fact, as permitted by Bayh-Dole, pharmaceutical companies buy discoveries coming out of the basic-science enterprises, including universities and publicly funded granting agencies. The real costs of research on drugs by pharmaceutical companies are much less than the oft-quoted $800 million or so per new drug brought to market. Most of their research is on me-too drugs – unoriginal, tax-deductible (and thus paid for in lost taxes by the public), and mostly unnecessary. The Big Pharma companies are, in essence, manufacturing and marketing companies.
Angell's concluding chapter, the least convincing in an otherwise fascinating and penetrating book, contains the solutions, all of them predictable: control me-too drugs, re-empower the FDA, oversee Big Pharma's clinical research, curb patent length and abuse, keep Big Pharma out of medical education, make company financial statements transparent (so we can tell what the costs of research really are, as distinct from marketing), and impose price controls or guidelines. Granted, the problems are so prevalent and the corporate tentacles so entwined with our way of being that it is hard to see what else to recommend.
perhaps Angell is right. We must change the way we manage research and the development
and distribution of new drugs. Not only are health and health care at risk,
but so are the research enterprise and the reputations of universities and governments.
The integrity of scientific research is too important to be left to the invisible
hand of the marketplace.
Book review written by John Hoey, M.D., former editor-in-chief of the Canadian Medical Association Journal