Book Review: The Big Fix

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http://bmj.com/cgi/content/full/326/7400/1218

 

BMJ 2003;326:1218 (31 May)

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The Big Fix: How the Pharmaceutical Industry Rips Off American Consumers The Big

Fix opens with feisty 77 year old Melva McCuddy from Ohio struggling to find

more than $6000 a year to pay for her multiple medications. We learn that she

travels across the United States border to Canada, where her breast cancer drug,

tamoxifen, is eight times cheaper than in her local pharmacy. Then we meet her

son and grandson, both with medical troubles of their own, and discover that the

family has three generations without any insurance cover for pharmaceuticals,

and three generations forced to rely on handouts from their doctors. " The worst

thing, " Melva told the audience at the book's launch in Washington DC this

month, " is being forced to beg doctors for free samples. "

 

Katherine Greider

Public Affairs, $14, pp 189 ISBN 1 58648 185 1

Rating:

 

 

Written in a plain, clear, direct style, and with its research funded in part by

the AFL-CIO—the umbrella labour organisation in the United States—The Big Fix is

an attempt to educate working Americans about the dirty tricks of the

pharmaceutical industry. With the soaring costs of drugs and health care set to

become the biggest domestic issue in next year's US presidential election, the

book is certainly timely.

Anyone familiar with the industry's antics won't find much that's new in The Big

Fix. It is, however, a remarkably accessible round-up of the best evidence and

the sharpest analysis about key issues, including drug pricing, patent battles,

excessive profiteering, misleading marketing, disease mongering and doctor-drug

company entanglement. Author Katharine Greider has distilled much scientific

research, interviewed many key academics and activists, and made her way through

bulky reports from Congressional hearings and other investigations.

One of my favourite lines is a comment that comes originally from a drug company

marketer quoted in the magazine Pharmaceutical Executive. The marketer is

discussing the " brilliant " way in which a new condition called " erectile

dysfunction " had been " branded " to help build a market for new drugs. " We're

creating patient populations just as we're creating medicines, to make sure that

products become blockbusters. "

At times, though, The Big Fix starts to read like a grab bag of examples of Big

Pharma's nastiness, despite regular acknowledgement of the important value of

medicines. The examples and the anecdotes give life to the book, but there is no

central compelling narrative and for that reason alone The Big Fix may fail to

capture the national imagination in the way that a " good story " about the same

material just might.

 

 

Ray Moynihan, Washington DC based journalist

raymond.Moynihan

 

 

 

 

 

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