Book Review: The Truth About Drug Companies

[Guest guest]

Is there a pill for greed?

 

By ALISON MOTLUK

Saturday, September 11, 2004 - Page D4

http://www.theglobeandmail.com/servlet/ArticleNews/TPStory/LAC/20040911/BKDRUG11\

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THE BOOK:

The Truth About

the Drug Companies:

How They Deceive Us

and What To Do About It

 

By Marcia Angell

Random House, 305 pages, $34.95

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When your aunt had depression 10 years ago, she took Prozac. When her son

needed treatment a few years later, he got Paxil. Not long after, your

friend was told by her doctor that Zoloft was the best pill for the job.

 

To some, this might seem evidence of the relentless march of the

pharmaceutical industry to find new and better treatments for debilitating

illnesses. But Marcia Angell, author of The Truth About the Drug Companies:

How They Deceive Us and What To Do About It, sees it differently.

 

As a doctor herself and formerly editor-in-chief of the New England Journal

of Medicine, a top U.S. medical journal, she argues that drug companies are

simply not the innovative, risk-taking, entrepreneurial and virtuous

powerhouses that they pretend to be. " This is an industry that in some ways

is like the Wizard of Oz -- still full of bluster but now being exposed as

something far different from its image, " she writes. " Instead of being an

engine of innovation, it is a vast marketing machine. Instead of being a

free-market success story, it lives off government-funded research and

monopoly rights. "

 

Those three antidepressants are a great illustration. Prozac was the first

of a whole generation of drugs known as selective serotonin reuptake

inhibitors, or SSRIs. But in 2001, its patent expired. That meant generic

companies could make the drug too, and the U.S. price fell by about 80 per

cent. So Prozac's original exclusive makers, Eli Lilly, no longer poured

money into marketing it for depression. (Instead, they were busy

repackaging it in a lavender-and-pink capsule and touting it under a new

name, Sarafem, for a brand-new illness, " premenstrual dysphoric disorder, "

under brand-new patent protection -- but that's another story.) By then,

the makers of Paxil and Zoloft were eagerly promoting their " new "

depression drugs.

 

Only, according to Angell, there wasn't very much new about them. They are

what are known in the trade as " me too " drugs, because they're just

variations on an old theme, not genuinely novel products. This is one of

the reasons, Angell says, that drug companies lavish so much creativity and

money on marketing: They need to convince you to spend several times more

for a drug still under patent when a generic version might do just as well.

 

You wouldn't be alone in believing, for instance, that Paxil is the

preferred treatment for anxiety. But the truth is that drug companies get

exclusive marketing rights simply by testing out their product against a

placebo and showing that it works better than nothing at all. (And they

often have trouble making even that meagre claim.) The danger of comparing

your new drug with drugs already on the market is that they may not be

better, and they could be worse -- as was the case in 2002, when a public

study compared blood pressure medications. It found that the older, cheaper

diuretics were better than the new, and very expensive, ACE inhibitors and

calcium channel blockers.

 

According to Angell, between 1998 and 2002, of 415 new drugs approved by

the U.S. Food and Drug Administration, only a third were both new chemical

entities and promised a " significant improvement " over available drugs.

What's more, most of those new and useful entities were developed not by

big pharma, but as a result of government funding through the U.S. National

Institutes of Health. These days, at least a third of big pharma's drugs

are purchased from the outside, Angell says.

 

Many of Angell's stories are unsettling. It made me uncomfortable to learn,

for instance, that doctors are financially induced to enlist patients in

clinical trials. Collecting data for trials does incur some costs, but she

says the average " bounty " is about $7,000 per patient; in at least one

case, physicians were paid $12,000 a head and $30,000 on the enrolment of a

sixth participant. Drug companies also pay to have their reps shadow

doctors as they go about their daily work: performing surgery, conducting

examinations, dispensing medical advice. Often, the patients are allowed to

believe company reps are medical professionals. (We know this because one

duped patient sued.)

 

Angell also describes how top media personalities accept six figures for a

day's work on what she calls " stealth ads, " which are given away to TV

stations and aired as " news breaks. " Particularly unpalatable was the

revelation that drug companies test blockbuster drugs on kids just to get

the extra patent protection for doing so, even if the drug -- say, for high

blood pressure -- has little relevance for the pediatric population.

 

Drug companies insist they couldn't do cutting-edge research if prices were

lower. But that simply doesn't square with the huge profits they've been

recording. For the past two decades, they've been the most profitable

industry in the United States every year but one. And they haven't been

squeaking into top place: In 2002, Angell says, the combined profits

($35.9-billion U.S.) of the top 10 drug companies in the Fortune 500

exceeded the profits ($33.7-billion U.S.) for all other 490 businesses

combined. Angell also does a nice job of debunking the myth that it costs

$800-million to discover each new drug; she puts the figure closer to

$100-million.

 

Angell can be forgiven for focusing so intensely on the United States,

since the situation there is uniquely awful. Despite publicly funding much

of the basic research of drug discovery, Americans pay the highest prices

in the world for prescription drugs. Prices are so high that an estimated

one in four seniors either skip doses to make the drug last longer or don't

bother to fill their prescriptions at all. Hence the much-publicized Rx

trips to Canada, and the bustling trade in Canadian mail-order pharmacies.

 

But surely even Angell's U.S. readers would like to know more about how

Canada (and every other developed country on the planet) manages to keep

drug prices under control. Angell sketches Canada's policies in just a

paragraph -- we have a review board that monitors world prices and makes

sure ours don't exceed the median -- but if it's as simple as that, why

don't Americans do the same?

 

This bare-bones approach throughout the book is the only real

disappointment. I wanted more of the story behind how things happened, more

of the complexity and nuance. Still, even as a skeletal primer, this is an

excellent and important book. I can't think of anyone, apart from the very

young and the fainthearted, who should not read it.

 

Alison Motluk is a Canadian journalist who has covered science policy for

New Scientist magazine.