Is there a pill for greed?The Globe and Mail, 11 September 2004
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
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.
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
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."
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.
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.
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.
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.)
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
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
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