interesting facts:

most of the innovative drugs discovered each year are actually supported by NIH or other publicly funded research, meaning that big pharma did almost nothing in the discovery process. the price of drugs, therefore, is totally unrelated to the cost of discovery.

lots of incestuous relationships between Big Pharma + FDA, Congress, and doctors...

patent law is totally abused.

FDA, Congress, doctors, and even consumers contribute to the mess of the drug industry.

It gives us the reality of Pharma industry and how it works.

Wow, she rant... a lot about the drug company. But overall, it give you some insight about drug industry. The best chapter is the last one where she provide solutions. Do I think these solutions work? Maybe, but just don't see change will come any time soon.

Nice compilation of facts in pharmaceutical industry in the US.
1) The cost on *marketing and sales* is major (31% of profits); R&D cost is minor.
2) There aren't many new drugs developed; most useful drugs are developed not by drug companies, but, for example, by NIH.
3) Drug companies do not follow free market, but use lots of monopoly techniques.
4) New drugs "look" cool due to sales. To make them look good, drug companies can sponsor medical journals and impose more favor towards research discoveries that praises a drug, and they can also give money to physicians according to the number of patients they introduce to buy the drug (or get tested on a new drug under development).
5) The average research cost of a new drug is 100 million, but not 820 million as marketed by drug companies. The extra cost is on marketing and sales.

History: The price of prescription only medicines (POM) was acceptable before 1980, but evilly soars after 1980. Now the industry earns 200 billion dollars, ranking top 1 in the US. The root reason is that President Ronald Reagon's reforms make lucrative people respectable, so more people trade moral disciplines for profits. The social value shifts from "although I am poor, I am a gentleman" to "if you are smart, why aren't you rich?".

Key flaw in law: A new drug just needs to prove to FDA that it is effective, but *not* more effective than existing drugs.

Resources:
- Chinese version of the book

Angell seemed very knowledgeable about the pharmaceutical industry and had some valuable information to get out there; however, the book was extremely repetitive and I found myself skimming through the middle chapters when I came upon a point that she had already made multiple times.

Angell does a good job of showing what rats the pharmaceutical industry are in this book. I consider big Pharma on a level of evil close to that of big banks and big oil, big food and big chemical corporations so if this book has a fault its that she is too easy on them. Never the less she gets a lot out about some of what they are pulling.

I'm about halfway through it and it's informative. However, her rhetoric is so inflammatory and critical that it makes me doubt her credibility and political agenda. She is clearly biased against pharmaceutical companies.

Angell states that many for-profit drug companies are receiving federal research funding of some sort. Her view is that if taxpayers fund the research then private companies should not be able to profit from the resulting drugs which come to market. Her argument is that many people cannot afford the drugs that big pharma makes and therefore it is not fair that the U.S. subsidizes research with public funds.

She fails to address the argument that the economic benefits the United States derives from such research subsidies could possibly outweigh the harm done by people unable to afford the resulting drugs. She also left me wanting more analysis as to whether Medicare/Medicaid will subsidize prescription purchases for these consumers who she claims cannot afford such drugs.

Also, she claims that the FDA is not intrusive enough in their requirements for new drugs to go to market. I was under the impression that most other countries acknowledge approval by the U.S. FDA as sort of the gold standard.

Just because I had questions unresolved doesn't mean this isn't a useful read. For example, I haven't been able to find much popular literature (i.e. books available on my Kindle or on iTunes) which discuss what she claims is rampant abuses of marketing efforts by drug companies. I don't necessarily believe that gift bags full of paperweights and water bottles from pharmaceutical companies can affect an intelligent conference attendee's ethics, but I think it's useful to understand the arguments and practices in the industry.

عندما أقرأ كتبًا كهذه- لا تتوفر لها ترجمة عربية .. أتأكد أكثر بأن الطريق أمامنا نحو فهم العالم لا يزالا طويلاً!

يسلط هذا الكتاب الضوء على ممارسات شركات الأدوية غير الأخلاقية، والمدفوعة بالجشع والرغبة في مضاعفة أرباحها، في الولايات المتحدة الأمريكية. كمية المعلومات الصادمة والفاضحة في هذا الكتاب كفيلة بأن يشيب لها شعر الرأس. ورغم أن الكتاب يتاول مشكلة أمريكية خالصة، إلا أن ما يحصل هناك، لا بد وأن يكون له -بطريقة أو بأخرى- نتائج هنا!

The Truth About Drug Companies (2004) by Marcia Angell describes how pharmaceutical companies manipulate science and US politics in order to make more money.
Angell was on the staff of the New England Journal of Medicine for over 20 years and became its first female editor. She has had extensive experience dealing with and observing how big pharma operates.
The accusations that Angell levels at the drug companies are that they only publish successful trials, game phase 4 trials, manipulate doctors with subsidized ‘education’ that is really a sale pitch, game the US patent system, lobby to ensure that the US government, a major purchaser of drugs doesn’t negotiate hard on price and sets the rules up to maximise profit. The book goes into detail and makes a strong case on each point. The fact that the rest of the world pays substantially less than the US does is very true and quite remarkable.
Angell doesn’t look at how the US insurance system and Medicare and Medicaid encourage people to get more expensive drugs if they are paid for by other people with little contribution from the user but the issue could be added.
The book is a solid, well researched, well reasoned and interesting look at how drug companies have manipulated the system.

You know how think you know how bad something is, but then you read something that makes you think "oh, no. It's much worse than I could have imagined"

review of
Marcia Angell, M.D.'s The Truth About the Drug Companies - How They Deceive Us and What to do About It
by tENTATIVELY, a cONVENIENCE - December 25-27, 2020

For the full review: https://www.goodreads.com/story/show/...

One of the many things that I've found annoying about the pseudo-dialog around what I call the PANDEMIC PANIC, the discussion about what's 'real' & what's a media-fabrication regarding COVID-19, has been some people's asking for "the science" that supports any position taken contrary to the mainstream narrative. This isn't because I'm opposed to science, although I do find it as potentially fallible as anything else, but because the people asking for it haven't generally, in my experience, much notion of what science is - nor wd they truly understand any science that they might encounter.

In other words, again in my personal experience, the people asking for "the science": 1. aren't scientists, 2. aren't intellectuals, 3. don't even read bks - except for, perhaps, the occasional thriller or bk relevant to some subcultural concern such as bike-riding. Nor are they people likely to've ever asked for "the science" to support much of anything else they've ever encountered in their life. Nor wd they be able to explain "the science" that backs what're hypothetically 'their own' positions on anything. The responsibility is solely on the person whose opinion they're attacking to 'prove' w/ "the science" that what they're saying is 'true'.

I, on the other hand, am a person who not only reads bks (thousands of them), but also writes bks (15 to date); who watches documentaries, & also makes documentaries (hundreds of them to date); & someone who writes & publishes criticism (something like 1,500 pieces to date). As such, I can easily demonstrate actual experience w/ critical thinking that the people asking for "the science" can't. At best, they can quote talking points from a radio program that they heard. Because they have other friends who heard the same program or something similar & because these friends can also paraphrase from these programs this parroting takes on a 'reality' to them.

W/ all this, & more, in mind, I've been accumulating bks that address medical science issues w/ the intention of actually reading them & quoting them & writing about them. Some of these bks, such as this one, are too based in commonly acccepted scientific legitimacy for most people to be able to easily dismiss them as somehow 'lunatic fringe' or 'conspiracy theorist'. Others are bks written by people so widely lambasted by what I call Fact Chokers (censors) that I'm curious about what they actually say instead of what people are being told they say in an attempt to discourage readers from finding out for themselves. I may or may not agree w/ them, I won't know until I actually read one of their bks. Finally, at least a few may say things that I find completely egregious & full of hidden agendas.

I decided to start reading these bks w/ this one b/c the title promised to support opinions & observations I already have AND b/c the author is fully credited in the area she's criticizing & is, therefore, difficult for people wanting "the science" to easily write off (w/o being told to do so by the people who tell them what 'to think' in the 1st place).

The author's bio in the back of the bk informs us of the following:

"The former editor in chief of The New England Journal of Medicine and a physician trained in both internal medicine and pathology, Marica Angell is a nationally recognized authority in the field of health care and an outspoken proponent of medical and pharmaceutical reform. Time magazine named her one of the twenty-five most influential people in America. Dr, Angell is the author of Science on Trial." - p 307

TO BEGIN: n  READ THIS BOOK, IT'S ABSOLUTELY IMPORTANTn.

"Prescription drug costs are indeed high—and rising fast. Americans now spend a staggering $200 billion a year on prescription drugs, and that figure is growing at about 12 percent per year (down from a high of 18 percent in 1999).1" - p xii

"1. There are several sources of statistics on the size and growth of the industry. One is IMS Health (www.imshealth.com), a private company that collects and sells information on the global pharmaceutical industry. See www.imshealth.com/ims/portal/front/ar... for the $200 billion figure." - p 267

It's important to inform you that everything Angell refers to is reinforced by endnotes that one can use to follow up. Alas, I DID just follow up on that one & got this message: "The page you requested was removed.". Given that this bk was published in 2004, it's no wonder that links might be broken. It's also possible that the recent spate of censorship (worse than any I've previously noted in my life) has something to do w/ it as might litigious behaviors of Big Pharma.

"I witnessed firsthand the influence of the industry on medical research during my two decades at The New England Journal of Medicine. The staple of the journal is research about causes of and treatments for disease. Increasingly, this work is sponsored by drug companies. I saw companies begin to exercise a level of control over the way research is done that was unheard of when I first came to the journal, and the aim was clearly to load the dice to make sure their drugs looked good. As an example, companies would require researchers to compare a new drug with a placebo (sugar pill) instead of with an older drug. That way the new drug would look good even though it might actually be worse than the older one." - p xviii

It's also important to emphasize that this bk is very solid in its presentation of the objectionable practices of Big Pharma. There are, in fact, so many issues brought to light & explained so clearly that this review can only hint at a few that I found most compelling. Again, I encourage the reader of this review to read the entire bk from front-to-back in order to thoroughly understand its well-developed points.

It might help the reader to understand my position here to explain that I don't take medicine except under truly extreme circumstances. I've taken many illegal drugs, esp important being consciousness-expansion drugs (a term I prefer to "psychedelics"). I'm particularly in favor of LSD & mushrooms — but I don't recommend them for everyone & I don't recommend using them frivolously. I also essentially stopped using those decades ago. Otherwise, I don't even take aspirin. I also rarely get headaches, & the worst headaches I've ever gotten have been from stupid excessive use of alcohol (I strongly warn people against hangovers where it hurts to think or move!). It used to be a joke of mine that all drugs that keep politicians alive shd be illegal. That upset some people b/c the implication was that I think medicines shd be illegal & many people I know are very dependent on them.. or at least think they are. Given my objection to a medicated society it was very welcome to me to read Angell's critique of the drug industry. Heroin is definitely a problem (& we can 'thank' Bayer for the early days of that) but pharmaceutical pushers are at least as bad — & they're legal!

"From 1960 to 1980, prescription drug sales were fairly static as a percent of U.S. gross domestic product, but from 1980 to 2000, they tripled. They now stand at more than $200 billion a year.1" - p 3

"1. These figures come from the U.S. Centers for Medicare & Medicaid Services, Office of the Actuary, National Health Statistics Group, Baltimore, Maryland. They were summarized in Cynthia Smith, "Retail Prescription Drug Spending in the National Health Accounts," Health Affairs, January-February 2004, 160." - p 268

That probably wdn't've been online as of the writing of the bk but there's some sort of gateway to it online now: https://www.healthaffairs.org/doi/abs... .

Angell starts off w/ some historical philosophizing about how the Reagan presidency inaugurated much of the unrestrained greed of Big Pharma as we know it today. She doesn't however, blame the problem entirely on Republicans, she's quite frank in her look at similarly acting Democrats.

"You could choose to do well or you could choose to do good, but most people who had any choice in the matter thought it difficult to do both. That belief was particularly strong among scientists and other intellectuals. They could choose to live a comfortable but not luxurious life in academia, hoping to do exciting cutting-edge research, or they could "sell out" to industry and do less important but more remunerative work. Starting in the Reagan years and continuing through the 1990s, Americans changed their tune. It became not only reputable to be wealthy, but something close to virtuous. There were "winners" and there were "losers," and the winners were rich and deserved to be." - p 6

Of course, the author is referring to her own professional class here; simultaneously there were punks & anarchists & other 'lunatic fringe' types whose priorities were definitely not w/ getting rich but were instead w/ Truth, Justice, & the Unamerican Way. I was solidly in that camp. How many of us were following legal developments such as what Angell details next I don't know, I certainly wasn't. But the Reagan administration in general was definitely high on the shit list.

"The most important of these laws is known as the Bayh-Dole Act, after its chief sponsors, Senator Birch Bayh (D-Ind.) and Senator Robert Dole (R-Kans). Bayh-Dole enabled universities and small businesses to patent discoveries emanating from research sponsored by the National Institutes of Health (NIH), the major distributor of tax dollars for medical research, and then to grant exclusive licenses to drug companies. Until then, taxpayer-financed discoveries were in the public domain, available to any company that wanted to use them." - p 7

Hhmm.. Taxpayer money pays for research, results enter Public Domain. That seems reasonable to me. But it also seems reasonable for researchers to benefit from their hard work above & beyond just salaries. Surely, a compromise solution cd be reached in wch the research stays in the public domain but the researchers are still rewarded for their exceptional accomplishment. At any rate, the Reagan admin was about benefitting big business, not the public. & the following is still from his January 20, 1981 – January 20, 1989 reign.

"Starting in 1984, with legislation known as the Hatch-Waxman Act, Congress passed another series of laws that were just as big a bonanza for the pharmaceutical industry. These laws extended monopoly rights for brand-name drugs. Exclusivity is the lifeblood of the industry because it means that no other company may sell the same drug for a set period. After exclusive marketing rights expire, copies (called generic drugs) enter the market, and the price usually falls to as little as 20 percent of what it was." - p 9

A justification for the original drug's high price is basically that the drug company had to spend a fortune on R&D (Research & Development). A significant part of this bk is spent debunking that as a PR myth.

"By 1990, the industry had assumed its present contours as a business with unprecedented control over its own fortunes. For example, if it didn't like something about the FDA, the federal agency that's supposed to regulate the industry, it could change it through direct pressure or through its friends in Congress." - p 10

Bypass democratic process anyone? The good ole 'merican way being pay-offs-every-wch-way. Profits before People, eh?

"The fact that Americans pay much more for prescription drugs than Europeans and Canadians is now widely known. As estimated 1 to 2 million Americans buy their medicines from Canadian drugstores over the Internet, despite the fact that in 1987, in response to heavy industry lobbying, a compliant Congress had made it illegal for anyone other than manufacturers to import prescription drugs from other countries." - p 15

I'm reminded of my friend Vermin Supreme ( https://archive.org/details/VerminSup... ), a perpetual candidate for just about any political office that he might be had by, & his proposed Health Plan shd he get into power: a bus ticket to Canada. Yes, for some reason, the Canadian medical system doesn't seem hell-bent on sucking every last asset out of its patients before drugging & starving them to death in a hospice.

Every once in a while, one of these greedy big companies gets caught committing a crime in pursuit of the Great American Dream (getting rich as fuck & not giving a damn about who gets hurt by it) & has to pay the piper - but like all big corporations busted in similar manner they've made so much profit off their crime that the fines, enormous tho they may be, just come out of the profits as an unfortunate expense.

"TAP Pharmaceuticals, for instance, paid $875 million to settle civil and criminal charges of Medicaid and Medicare fraud in the marketing of its prostate cancer drug, Lupron." - p 19

But there're all sorts of shenanigans going on that you're probably not aware of. Have you ever been unwittingly used by a dr in a study w/o realizing that you're a cash cow?

"To get human subjects, drug companies or contract research organizations routinely offer doctors large bonuses (averaging about $7000 per patient in 2001) and sometimes bonuses for rapid enrollment. For example, according to a 2000 Department of Health and Human Services inspector general's report, physicians in one trial were paid $12,000 for each patient enrolled, plus another $30,000 on the enrollment of the sixth patient. One risk of this bounty and bonus system is that it can induce doctors to enroll patients who are not really eligible. For instance, if it means an extra $30,000 to you to enroll a patient in an asthma study, you might very well be tempted to decide your next patient has asthma, whether he does or not ("Sounds like a little wheeze you have there. . . ."). Obviously, if the wrong patients are enrolled, the results of a trial are unreliable, and that is probably often the case." - pp 30-31

Now you don't think that 6th patient enrolled is getting $30,000 too do you? Of course not.. & they're getting hoodwinked into thinking that they're advancing science & not being used for profiteering at the possible expense of their health.

For the full review: https://www.goodreads.com/story/show/...

This book by a doctor and former editor of the New England Journal of Medicine is a serious indictment of the pharmaceutical industry, particularly as it operates in the US. Although I was aware of much of the information, she lays it all out with detailed documentation.

While most basic research is conducted by the NIH and/or universities, drug companies continue to excuse their exorbitant price-gouging on the costs of "research and development". While their big expenditures are actually direct to consumer marketing and marketing masquerading as "education".
The other big expense is for legal fees - to seek ever-longer patent rights, and lobbying. They have the FDA, congress and all the rest of us in their pockets. In the meantime, while they tout their creativity and innovation, most of the new drugs they promote are new versions of old drugs, some with really minimal changes and no advantage. (Prozac was colored pink and given a new name for marketing as a drug for pre-menstrual tension!) Also because they have control over their drug trials, much of the data is skewed in favor of newer, more expensive ones they want to patent.

They also do not have any interest in developing drugs for diseases that affect fewer than 200,000 people or those which affect people in countries that cannot afford their gargantuan markups.
It is really sickening! The only way to beat this sickness is to use as few medications as possible, only when absolutely necessary, in generic form, and buy from Canada or overseas when possible.