Sunday 14 April 2013

Book Review: The Truth About Drug Companies

Title: The truth about drug companies: how they deceive us and what to do about it (2004)
Author: Marcia Angell
Publisher: Random House, New York

Marcia Angell was an editor for a leading medical journal (the New England Journal of Medicine) from 1979 to 2000, and she is an outspoken critic of big pharma. In this book, she spells out why, and makes a compelling case for being sceptical about the medical information we receive, whether it be from journals, companies, doctors or interest groups. The extent to which that information is biased towards pharmaceutical companies (and their products) remains underestimated.

In this book, the author systematically works through all of the ways that drug companies sacrifice truth and patient benefit for profit and market share. Some of these are listed here:

Inflating the costs of research and development to justify high prices
  • Most innovative, high risk research is done by public academic groups, not industry.
  • Much industry research is on me-too drugs (cheaper).

Influence over government
  • Pharma is the largest lobby group in Washington, and it gets what it pays for, with some amazing pro-pharma government decisions.
  • Regulators (such as the FDA) are influenced by direct funding (most employees and funding in the FDA comes directly from industry) and by indirect influence (most advisors in most advisory committees for the FDA receive industry funding). Even the choice of FDA commissioner is influenced.

Overstating effectiveness / understating harm
  • Biasing the literature by withholding negative studies, and designing and controlling studies themselves, ghostwriting articles, sponsoring key decision makers.
  • Advertising new drug over equally effective generic alternatives.

Influencing patients
  • Direct to consumer advertising.
  • Indirectly via ‘grass-roots’ patient groups.

Influencing doctors
  • Indirect kickbacks (direct kickbacks are now illegal).
  • Controlling medical education by sponsoring meetings, providing educational dinners and often convening conferences themselves (pharmaceutical companies hosted 300,000 pseudo-educational events in 2000).
  • Rep visits, free samples.
  • Donations to the departments of “thought leader” physicians.
  • Funding pseudo-research to increase brand recognition.
  • Speaker fees.
  • Advisor fees.
  • Writing fees.
  • Royalties.
  • Committee memberships.

There is not much to criticise about this book. Some of the information may be out of date, and it is focussed on the USA, but most of the companies are global, their practices are similar elsewhere, and most of the problems persist today.

The bottom line
Apart from providing a thorough criticism of the pharmaceutical industry, Dr Angell also tells us of the current problems facing the industry (albeit, largely of their own doing) and gives some advice about what to do to save the patients, and to save the pharmaceutical industry from itself. A must-read for any doctor, and a good read for anyone else.

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