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[videogamer]

In many ways, Dr. Marcia Angell is an unlikely muckraker. A pathologist by training, she is the former editor in chief of The New England Journal of Medicine. She is also a senior lecturer at Harvard Medical School.

But just days short of her 65th birthday and her first Social Security check, Dr. Angell is taking on the American pharmaceutical industry with a new book, "The Truth About the Drug Companies: How They Deceive Us and What to Do About It" (Random House)."I don't worry about labels," Dr. Angell said in an interview at the Hotel Monaco, where she stopped during a book tour.

In a 1996 book, she noted, she argued "that there wasn't a shred of evidence that the breast implants were causing all the disease they were said to."

"I was said to be a tool of the pharmaceutical and device companies," Dr. Angell recalled. "I call them as I see them."

Q. Why produce an investigative book on the pharmaceutical industry?

A. Because everyone knows that prescription drug prices are sky-high. Americans pay far more for our drugs than people in other countries. The drug companies say, "We need high prices to cover our staggering research and development costs, and if you do anything to squeeze our prices, it will stifle innovation." The book was written to examine that argument.

Q. The pharmaceutical companies say their prices are steep because they spend somewhere in the neighborhood of a billion dollars per drug bringing them to market. Did your research support this assertion?

A. A group of economists - mainly funded by the drug companies - came up with the widely quoted figure on this. They said that it cost $802 million to bring a drug out. They, however, were looking at the most expensive drugs to develop: new chemical compounds developed entirely in house. Most new drugs aren't that at all. Most are what people call "me too" drugs, which are slight variations of older drugs already being sold.

According to these economists, the real cost of bringing out those rare original drugs is actually around $403 million. But they doubled it by factoring in how much money the companies might have earned if they'd invested that $403 million. Moreover, the economists did not figure into their total the many generous tax breaks these companies receive for doing research and development. This is a highly inflated figure.

The fact is that for the last two decades the drug companies have been hugely profitable. Last year there was a little wiggle downward, but in 2002, the 10 biggest American drug companies had a median profit of 17 percent of sales compared to a median of 3 percent for the other Fortune 500 companies. In the 1990's, profits ran between 19 and 25 percent. Prices are high to keep profits high.

Q. Exactly what are these "me too" drugs you argue against?

A. They are minor variations of old drugs already on the market. Sometimes a company creates a "me too" drug as a way of extending a patent on an older one. For example, AstraZeneca created Nexium to replace the virtually identical Prilosec when its patent was about to expire. By putting out these me-too's, the companies can get new exclusive marketing rights on what are essentially the same old drugs.

Other companies come in with their own me-too's because markets are expandable. It's been shown that when you advertise one me-too drug, you increase the sales of all of them.

Q. Why do you have a problem with this?

A. The prevalence of the me-too's really says an awful lot about the lack of innovation within the pharmaceutical industry. If you look at the new drugs marketed over the last six years, 78 percent weren't even new chemical compounds. They were just new combinations or different formulations of old drugs. And 68 percent were classified by the F.D.A. as unlikely to be improvements over drugs already on pharmacy shelves.

At the same time, there are shortages of some important drugs that the pharmaceutical companies aren't much interested in making because they are not as profitable as the me-too's. But the companies don't have to turn out needed drugs, if they are not lucrative. And they don't.

Q. Was there anything in your life that pushed you to write this book?

A. As a journal editor, I witnessed a disturbing trend in pharmaceutical research. Twenty years ago, most drug trials were conducted at academic medical centers and the pharmaceutical companies tended to stand back during the testing period. However, in recent years, the companies have succeeded in attaching strings to research contracts, often designing the studies themselves, keeping the data in-house and deciding whether or not to publish the results. They also began to contract with private research companies for testing. Moreover, the medical schools and even individual researchers began to enter into entrepreneurial arrangements with the drug companies.

While all this was occurring, I began to see bias creep into medical research. And I saw a lot of it. The most obvious example were studies comparing a new drug to a placebo. That may be enough to get a drug F.D.A. approval, but it should not be enough for The New England Journal of Medicine. Doctors don't want to know whether a drug is better than nothing. They want to know if it's better than what they are already using.

Q. The first phase - the discount card phase - of the new Medicare drug benefit is about to go into effect. Do you, as a newly minted senior, believe it will make prescription drugs more affordable?

A. It's not going to have a major effect. These discounts are very small, maybe 10 to 15 percent. At the rate of inflation of drug prices, they'll be overtaken in a very short time.

Now, the main Medicare drug benefit that goes into effect in 2006 is designed to funnel billions of dollars to the pharmaceutical industry. It's an absolute bonanza for it. The pharmaceutical industry's lobbyists made certain that the legislation contained a provision barring Medicare from negotiating drug prices.

Interestingly, the federal government negotiates drug prices for the Veterans Affairs system and gets very low prices because it is a bulk purchaser. And Medicare would have been the biggest bulk purchaser of all - so it could have negotiated very low prices. That provision allows the drug companies to continue raising their prices faster than the inflation rate, and the drug benefit will soon become unaffordable.

Q: What can individuals do to fight back?
A: One recommendation is to be aware that this industry speaks through many voices, and whenever anyone makes a pronouncement about drug prices or anything else dealing with prescription drugs, people ought to ask themselves if there is a conflict of interest. Often there is.

Patients have to become much more skeptical about claims that drugs will cure whatever ails them. There's reason to believe that some new drugs are not nearly as good as they're claimed to be, that doctors believe the claims as much as their patients do, and we have to remember that almost any drug has a risk of side effects. This isn't to say that there aren't important drugs on the market. They can be very helpful and even lifesaving.

I'm not trying to say never take a drug -- but I'm saying that people should be reluctant to take drugs unless they're pretty sure that they're needed.

I'd like to add some other points not really covered in these quotes:
1. Drug companies benefit from NIH funding: not just direct funding, but also from the basic science research that the NIH funds elsewhere.

2. "Me-too" drugs: They can be drugs that are slightly changed so that the drug company can have a brand-name prescription drug. Another kind of "me-too" drug is one that uses the same general mechanism of action. Think of all the statins and SSRI's. It doesn't cost as much to develop these drugs individually because the general mechanisms have been elucidated and oftentimes the chemical structures of the drugs are similar.

IMHO, I'm more concerned with what Dr. Angell says is their argument: "We're [the drug comapanies] the source of your miracles, of your innovative drugs, and therefore don't mess with us." I'm not quite sure about large scale changes to the system, but Dr. Angell brings up good points against the claim that the drug companies need the high drug costs because of R&D.

http://www.businessweek.com/technology/content/aug2004/tc20040818_7567_PG2_tc121.htm
http://www.nytimes.com/2004/09/14/health/policy/14conv.html

 

[fart]

as usual, it's mostly about money, and not medicine. watch this get buried as it has been for the last 15 years.

 

[duderon]

as usual, it's mostly about money, and not medicine. watch this get buried as it has been for the last 15 years.

Yup, i just recently had a doc try to push a drug on me, but i said hell no. Pretty fucking sad they don't try to help you anymore.

 

[videogamer]

Yup, i just recently had a doc try to push a drug on me, but i said hell no. Pretty fucking sad they don't try to help you anymore.

What was the drug for? Was he like a salesperson--a bit pushy?

I've never had that experience... it's usually the patients demanding some drugs just for the heck of it.

 

[fart]

if you don't trust your doctor (assuming you're talking about your GP), you may want to find a new one?

 

[duderon]

What was the drug for? Was he like a salesperson--a bit pushy?

I've never had that experience... it's usually the patients demanding some drugs just for the heck of it.

The drug was accutane, for severe acne. I would say my acne is moderate and i asked for other ways to treat it. The doctor (she) couldn't give me any other options besides accutane, which is incredibly dangerous, and some antibiotics so i just said screw it, give me some topical shit and i'll go at it alone. I was really dissapointed by this.

 

[videogamer]

The drug was accutane, for severe acne. I would say my acne is moderate and i asked for other ways to treat it. The doctor (she) couldn't give me any other options besides accutane, which is incredibly dangerous, and some antibiotics so i just said screw it, give me some topical shit and i'll go at it alone. I was really dissapointed by this.

What's wrong with the antibiotics? There are some antibiotics that are combined with benzoyl peroxide, and I find them to be pretty effective. imho, it's a lot better than just benzoyl peroxide alone.

Really, you should see what some other doctors do to acne. I once shadowed a doctor who injected something (I don't remember) into all the pimples so that they would deflate faster.

 

[duderon]

What's wrong with the antibiotics? There are some antibiotics that are combined with benzoyl peroxide, and I find them to be pretty effective. imho, it's a lot better than just benzoyl peroxide alone.

Really, you should see what some other doctors do to acne. I once shadowed a doctor who injected something (I don't remember) into all the pimples so that they would deflate faster.

The problem with antibiotics is that i don't want to take them for x amount of years. I was on minocycline/tetracycline for at least a year with okay results. No studies have been done on how antibiotics affect you over a long period of time, and i don't want to find out what they will do to me. If i were to take an antibiotic for a long period of time, say for like 2+ years, and i have some other sort of infection that the same antibiotic was to be used to treat it i'd be screwed.

For an example, the other antibiotic the doc wanted me to try was bactrim. If you look bactrim up on google you'll see that it doesn't say to take for acne. I just don't want to take that chance, where the antibiotic could affect another part of my body.

Anyway, i've looked at some other options and i'll be fine

 

[Fresh Prince]

Wasn't their an article a few moths ago that said some % of drugs were ineffective?

Also I thought their was a push away from antibiotics. I think they found people weren't finishing their presriptions and were creating 'super-bugs' that became tolerant to antibiotics.
Scary stuff.

 

[videogamer]

The problem with antibiotics is that i don't want to take them for x amount of years. I was on minocycline/tetracycline for at least a year with okay results. No studies have been done on how antibiotics affect you over a long period of time, and i don't want to find out what they will do to me. If i were to take an antibiotic for a long period of time, say for like 2+ years, and i have some other sort of infection that the same antibiotic was to be used to treat it i'd be screwed.

For an example, the other antibiotic the doc wanted me to try was bactrim. If you look bactrim up on google you'll see that it doesn't say to take for acne. I just don't want to take that chance, where the antibiotic could affect another part of my body.

Anyway, i've looked at some other options and i'll be fine

It's times like these I wish I studied harder in micro. So what do you use nowadays for your acne?

 

[duderon]

Benzoyl Peroxide 8% topical cream twice a day now. Going to get Retin-A Micro in a couple days. When i get to the university in a few days i'm going to order some Primrose Evening Oil. It's an Omega 3 fatty acid and it's supposed to deplete the sebum glands that cause inflammation and acne in the first place.

Even though it's contrary to popular opinion and almost all dermatoligists will say diet doesn't affect acne, i've tried to cut out all grains from my diet. If you want to learn more go to www.mercola.com I like what mercola says, although he does push his items (what doctor wouldn't though).

Yeah that's about it, unconvensional but i'd rather attempt this than going on drugs.

 

[tree fiddy]

A while ago when I went to the doctor about being depressed, she said I was a prime candidate for SSRI's. Boy, was she fucking wrong. They made me worse and it really sucked weening off the last type(effexor). I refuse to touch any more anti-depressants again.

 

[Loki]

The pharmaceutical industry in this country is incredibly corrupt, though it would take much too long to speak to in any depth. Suffice it to say that we're getting gouged-- big time. Couple that with the prevalence of direct-to-consumer marketing strategies and you have a gluttonous and largely self-perpetuating industry. The issue of physicians needlessly pushing drugs on patients is a related one; while there is no excuse for it, realize that most primary care doctors have seen their incomes decline precipitously over the last decade due to shrinking insurance reimbursements and rising overhead (staffing, supplies, malpractice insurance etc.), and use such relationships with the pharm companies to supplement their income-- and these deals are often quite lucrative. Is it wrong? Obviously. Is it illegal? I'm actually not sure, to be honest-- you'd think it would be, but this sort of thing is so common that I wouldn't understand how it still goes on if it was truly illegal. I guess maybe because such collusion is hard to prove? Who knows-- it's totally wrong, though.


Now, if it was a dermatologist who was shilling for the drug companies (as in deadlifter's case), well, that's just terrible. They still make $300K+ for < 40 hours/week of work with no off-hour call. Sounds especially greedy in that case.


Another common argument cited by pharmaceutical reps is the fact that we subsidize the majority of the world's drugs. The vast majority of popular drugs have been developed in the US with US funds (either NIH grants or sales revenue, which is disproportionately garnered in the US market); the only reason all these socialist bastions in Europe like Scandinavia, Denmark, Switzerland, and even the UK (to say nothing of Canada ) can have their drugs at affordable prices is because we're largely subsidizing them, believe it or not. I'm not really sure as to the answer for such a situation, but a redistribution of subsidies given to these multinational drug companies would certainly seem to be in order-- perhaps one based on consumption patterns. If France purchases, say, 6% of the worldwide sales volume of a particular new drug, perhaps it should be asked to pony up 6% of the total amount of subsidies being given to the company for R&D? I dunno-- I haven't really thought about the particulars, and the above might not even be fair if given a second thought....I was just throwing it out there.


I think a big problem is that these companies are publicly traded, and are thus beholden to the same "market forces" that "economists" like to tout in every other discussion of industry. Now, these market forces are somewhat mitigated by the government funding they receive, but they're (market forces) still supposedly "overwhelming". So who really knows what the answer is? I do know that a 17%+ profit margin is just insane as compared to other sectors, and that perhaps regulation should be put into place which requires a certain percentage of those profits to be funnelled back into R&D, while still leaving a healthy profit margin of, say, 6-8% (as compared with the 3% cited for the other Fortune 500 companies). I dunno, really...


It's just all screwed up. I'm also interested in whether drug companies were publicly traded prior to, say, the mid-late 80's. If not, what were the forces which compelled them to become so?

 

[demon]

I didn't read the article because my eyes hurt too much from just waking up to stare at the screen, but the drug industry, particularly the anti-depressant/etc industry, is a real piece of shit. Companies like Eli Lilly are a good example. It is well documented that they've always known the horribly dangerous effects drugs like prozac can have on people, especially children, and they handed them out like tic-tacs anyway....even to children. My sister was one of those kids, and at 10 or 11 she was prescribed prozac and, just as had been documented about children and prozac, she became suicidal and we took her off it a week after I had to pull a butcher knife away from her throat. Supposedly there is/was some major lawsuit against (I think) the company Eli Lilly for this kind of shit and my dad was going to get in on it, but I don't think he every bothered. Fuckin idiot.

A few years ago I was prescribed a couple anti-depressants (two because the first gave me a rash), and looking back, my needing anti-depressants was total bullshit. I'm glad I took it for like half a week and then quit. They'll hand out this kind of shit for ANYTHING nowadays.

 

[speedpop]

For the record, I recently read an article about HIV and it's known "help" through medicine.

These guys had wound up using electric currents through the blood system somehow and the AIDS infected blood was somehow shut down. I can't remember the details as I skimmed through it.

Needless to say, of course there is corruption in the drug industry. Went down to the pharmacy and bought all this shit for my girlfriend due to food poisoning.. wasn't really working so her friend gave her some chinese herbal stuff that tasted awful but it worked like a charm. Woke up the next day fit as a fiddle.