[Mb-civic] Health Cover-up Summary

[Linda Hassler]

FYI. This book sounds like an answer to a prayer... and the author  
offers ideas for what we can do about it.

Linda

Begin forwarded message:

Health Cover-up Summary
http://www.wanttoknow.info/060426newsarticleshttp:// 
www.wanttoknow.info/060426newsarticles

"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). 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



The below book review 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 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.

By Angell's account, 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.

But 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.

John Hoey, M.D.
john.hoey at cma.ca 

To purchase The Truth About Drug Companies from amazon.com, click here
The quote at the top is from Dr. Angell's summary of her own book on  
the New York Review of Books.

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