The Truth about Drug Companies by Marcia Angell, MD

Book Review
By Carmen Nge

How much are you paying for your prescription medicine? Too much, according to Marcia Angell, currently Senior Lecturer at Harvard Medical School’s Department of Social Medicine and formerly Editor-in-Chief of the New England Journal of Medicine, one of the most respected medical journals in the world.

Perhaps it would not be too much if the money you spent went directly into R&D (research and development) for newer, more innovative drugs for critical illnesses. But the travesty, Angell tells us in her new book, is that what you pay for is the cost of heavy marketing, billions of dollars in legal fees (for when pharmaceuticals fight for their right to extend patents in order to monopolize profit) and dubious ethical practices such as paying off doctors to promote a particular company’s drugs.

The Truth about Drug Companies reveals the corrupt machinations of an industry that rakes in US$400 billion in profits worldwide every year. Half of that sum comes from US drug spending alone and it does not even include drugs sold to hospitals and doctors. Is it any surprise that this industry has consistently been rated the most profitable in the US since the 1980s, and only recently ranked third after crude oil production and commercial banking.

Malaysian readers will wonder what the American drug industry has to do with us but the reality is that American drug companies and their European counterparts control a multi-billion dollar global industry that supplies medicines for the rest of the world. GlaxoSmithKline and Astra Zeneca are British companies; Pfizer, Merck, Johnson & Johnson, Bristol-Myers Squibb and Wyeth are American.

Last month, the BBC reported that American drug companies, through the arm of the WTO, have pressured developing countries to buy American manufactured drugs for the treatment of AIDS instead of allowing the former to produce their own generic versions of the drugs. According to Médecins Sans Frontières, generics are usually around 70 to 90% cheaper than branded equivalents; sometimes they can even be 200 to 300% cheaper! Buying locally produced generic drugs to treat critical illnesses like AIDS not only enables governments of developing nations to save millions of dollars a year on drug spending but it also ensures some measure of financial and political independence from Western (and specifically American) influence.

Earlier in February this year, Médecins Sans Frontières reported that India, the largest producer of generic medicine in the world, will now bow down to WTO Trade-Related Aspects of Intellectual Property Rights (TRIPS) Agreement. What this means is that India, who used to be able to produce and sell generic drugs at a fraction of the cost, will no longer be able to do so. In deference to international patent laws that favour big pharmaceutical companies’ ever expanding profit margin, the Indian people as well as those of us here in Asia who import generics from India, will pay through our noses for drugs that used to cost significantly less. Public access, in developing countries, to affordable, life-saving drugs has clearly taken a backseat to profits. What is troubling is that the WTO has become complicit with big pharmaceuticals in denying the poor a right to a longer and healthier life.

In addition to lambasting profit mongering in the drug industry, Angell also criticizes its lack of innovation. Contrary to popular belief, R&D efforts have not resulted in brand new drugs; if anything, the production of truly innovative drugs—what the U.S. Food and Drug Administration calls “new molecular entities” (NMEs)—has been declining. Angell states that so-called new drugs that hit the market are merely variations of old drugs.

Most NMEs are not considered priority review—meaning drugs that likely offer a “significant improvement compared to [existing] marketed products”. In 2005, only eight priority review NMEs were approved, compared to 16 in 1998. Basically, Angell argues that drug companies spend most of their R&D developing modified versions of old drugs instead of creating new drugs that are needed by the public. Why do they do this? Because it is a quick and easy way to reap more profits.

Writing in clear, accessible language, Angell exposes the industry for what it is: a profit-mongering colossus that does not care who it tramples. With over 20 years of editorial experience in medical reporting, she manages to explain a complicated industry to the layperson without any trouble. Her book is a veritable page-turner, offering one insight after another that builds into a fitting climax: practical steps to take to protect our rights as vulnerable consumers.

Apart from arming ourselves with knowledge and asking our doctors the right questions when it comes to drugs—what is the evidence that this drug is better than an alternative one or some other approach to treatment? Are you being paid or do you receive special discounts or benefits from drug companies?—Angell also advocates a complete overhaul of the current drug industry. This would mean that countries would have to work together to ensure that big pharmaceutical companies do not continue to exert political and economic influence on global health care.

Ultimately, public medical welfare cannot and should not kowtow to the interests of capital. Drug makers have to understand that saving a life cannot be synonymous with making a profit. Sadly, the very fact that the drug industry has become a multi-billion dollar business indicates that drug companies and those who profit from them no longer care about people or ethics.

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This review was published in Off The Edge magazine, January 2006 issue

BROGA : Environmental Travesty in our own backyard

by Carmen Nge

BROGA. Tucked 9km away from Semenyih, it used to be just an ordinary farming village but a fledging young documentary filmmaker has now put it on the world map. Alice Lives Here is a 25-minute short film that visually narrates the disturbing story of a village soon to be the site of a RM1.5 billion incinerator waste from the Broga project will soon seep into the vicinity’s soil and water. As a water catchment and farming area, Broga, situated only 2km from the incinerator, is in danger of being hazardously polluted. What is unknown to members of the public is that residents (approximately 1.5 million people) from Bangsar, PJ, Puchong, Subang, Klang and Shah Alam are supplied water from Broga. Whether we like it or not, the incinerator project will soon have a tremendous impact on our lives.

Knowledge is power, of that there is no denying. People who had a chance to view Alice Lives Here at the recent Freedom Film Festival organized by KOMAS at the Actors Studio understood this truism. Armed with political will and information about the harmful effects of incinerators, the residents of Puchong—the original proposed site for the incinerator—successfully protested the project in their backyards. But what about the residents of Broga?

Ong Ju Lin, the 34-year old amateur filmmaker and former Star journalist, spoke to Carmen Nge about her documentary on Broga and its residents’ fight for their land and the health of their community and its future generations.


CN: Why Broga? What is it about this story or Alice that makes it so appealing for film?

JL: Actually it’s by chance because I knew I wanted to make films for a long time but at the time, I was quite demotivated. I just came back from UK and was wondering what to do. A friend, Kar Yin, gave me a camera. In fact when she gave it to me I really didn’t have the motivation to do film yet. It was like… oh! Great gift but I hope I have the motivation soon.

So I guess it feels like it was fated because a week later, we went to this CIJ [Center for Independent Journalism] talk on freedom of information. I was just sitting down and listening and Alice [Lee] spoke about Broga. She was such a powerful speaker. I had no inkling that the largest incinerator was going to be built in Broga. I had never heard of Broga before. So, it’s the combination of Alice being such a powerful speaker and the issue itself that motivated me. When I interviewed her, my first instinct was: I need to talk to this woman to find out what this Broga thing is about, what this incinerator is about. She has never been a politicized person. She’s a clerk in a furniture factory and then this thing happened. Immediately I felt that there’s such a good story to tell. In my mind I thought, Ah! This is actually the person who can carry the story. It’s partly the issue but it’s also the story that I see that is so tell-able.

CN: It’s a story about Alice but in a way, it is her politicization that interests you.

JL: Yes. In the beginning we were wondering how to carry that story because here is this person, a very interesting character, but the issue was even bigger—this incinerator that nobody knew about, the media blackout, the impact of it on our environment and health. It was so big. In fact, our first instinct was: let’s just do this documentary about this incinerator. And then, upon sitting back and talking to people, I realized it could even be a more powerful story if we focused on a central character and who better else to carry this story than Alice, who we were so inspired by.

CN: The way you talk about your central character makes you sound less like a documentary filmmaker and more like a feature filmmaker. What attracts people to feature films are the protagonist and a compelling story whereas documentaries mostly revolve around issues. Have you thought about this?

JL: Yes. When I chose to do that [focus on Alice] it’s because being a journalist and a feature writer, we have always been told to write personalized stories because this is one way that people can get into other people’s lives and how they can empathize with another person. They can imagine—if I were in her shoes, this is what I would do.

I feel that my job as a writer or journalist or as a story-teller is to widen the imagination of people, to let them know why oppressed or marginalized groups or people fight against big powers, government and corporations—why do they do that? Do you think that they just want to rebel for no apparent reason? Just to be anti-government? No! It’s because they are desperate. They need to struggle. I always feel that my role is as a messenger, to try to widen that imagination. And I have used my writing to do that. I have used my photography to do that. And now I want to use film—moving visuals and audio—to impart that which I feel is very powerful.

CN: So, do you think that as Malaysians, we suffer from a dearth of imagination?

JL: (laughs) I think that with the environment we’ve been put in, being so fearful of expressing ourselves because there is such a culture of fear that we are just quite comfortable with thinking within our own world. It’s more comfortable if you don’t have that imagination to imagine yourself in another place. I don’t think we are lacking in imagination cells, that capacity or capability to imagine. But we’ve been put into an environment where in school we just listened to the teacher: don’t speak, don’t express. Then when you are an adult, the ISA, the Printing and Publications Act, all these laws and the type of TV we are fed. That is definitely restricting our imagination.

CN: In your documentary, you used Alice as a starting point but then brought us to the larger community of Broga. Do you think we have a difficulty imagining what we can do as a collective, that it is easier to imagine what we can do as individuals?

JL: Actually we wanted to show more of the collective effort because even Alice told us that it was impossible for her to do it alone. In fact, she wasn’t actually the first person to start the whole thing. She was part of a committee and we found out that she actually broke away from the committee to take matters into her own hands to sue the government. So, it’s definitely a collective project but I find that in film you can’t tell so much of that.

In order to make it powerful, you have to really tell some partial truths in a way. Or one side of it. It’s true that Alice really took it upon herself to do all that but you really have a choice of including how much she actually put in or how much the people around her put in. That’s what people say is artistic license and you really have a lot of power to tell the story the way you want to tell it. So it’s a challenge to that person who’s doing film to find the angle that is attractive to people, appealing and gets the message across. And there’s the ethics of how much of that can you do, whether it’s how aware are you of the ethics of showing that side of things.

CN: What has been audience feedback thus far? Have you asked what people think of your film?

JL: Yes, we always ask people for feedback. Some of the comments we’ve gotten back… Beth Yahp said that we romanticized it too much, the whole issue and Alice. That we talk about Alice like some super duper human being. There is too much emphasis on her. Otehrs want to see more of the issue. Some of them are not convinced that the incinerator is bad. They want more of the issue, statistics and stuff. A friend, Jacklyn, felt that the issue could be balanced out better to equally cover all parts of the issue—Alice, the media blackout and the community struggle. It is hard because it’s our first effort. We also made a concerted attempt to make it not more than half an hour. We could have made it longer but we didn’t want to bore people.

People can criticize it for not being an objective piece but it is not our intention to do that. It was our intention to show how the Broga people and Alice struggled against the project. We didn’t intend to make a conventional documentary where we have experts speaking and pro and anti incinerator people speaking about this and that. We wanted a personal story of Alice and she is the conduit that opens up to this issue and why they were fighting so hard.

CN: So this is not a story about Broga in a true journalistic sense. Would you say then that your documentary is part of a new genre people are calling film activism—about creating a kind of awareness that brings people to an active state of wanting to do something, to make a change?

JL: Yes. Because it moved people to want to know. If I were to do a conventional documentary, people would just watch and go back and sleep. I am so angry with how things are reported in this country that I want to do things my way, how I see it and I want to show that part of it. You can actually blame me—that I am doing the same thing like the oppressors who use the media as a propaganda to advance their own agenda instead of being objective. Why shouldn’t I? (laughs) If I have that power to use it and I know I am fighting on behalf of people who have been so oppressed for so long, why shouldn’t I use that same weapon, to use film to move people to do something?

The Q&A session after the screening was very telling because people were moved and that was what I wanted to happen. And it did! You can criticize me for not being objective but people were moved and they decided to do something about it. They started asking all these questions: How come we don’t know about this? The factual things can come later, when the interest is already there. My documentary didn’t have to do all of that because that may have actually spoilt it. People would have to sit through all these facts and lose interest. The first thing that moves people is the heart and then the head would come next. It moved them enough to want to find out more.

CN: Did Alice and Broga residents agree to cooperate with you because they hoped the film would do some good for their cause?

JL: They were very skeptical though. (laughs) It’s so funny. Yin San (the producer) just told me that Alice’s sister said “Aiya, you think with that small camera they can come up with anything!” They did not believe that we were serious. But Alice feels that if anybody wants to help then she is going to help them help her. So she was open to the filming. But they were actually very surprised when it came out. Not only did it come out but it won a prize. Not only did it win a prize but it was featured on NTV7 and so many papers covered us, Sun and NST. So they were very happy that the issue was brought up because they couldn’t get the media to cover them. They are such a marginalized and oppressed group; they really didn’t have a voice.

CN: So what is the status of Broga now?

JL: Well, not good. Their interim stop work order has expired. So, it looks like the project has been revived. We went to film on August 10th and they are starting work—digging the soil and all of that. The hearing [of the main suit] scheduled for August 26 has been adjourned to October. Now they are debating whether Alice has the right to represent the people of Broga and the only reason why they are saying that is because she is not a landowner there. But she is a resident there and her mother is a landowner but the legal debates continue. The court may be the last resort they have.

CN: What is next on the horizon for your film?

JL: We want to make a more professional cut which we hope we can show to a wider audience. Alice has the conviction and innocence that if the government and more people understand where she is coming from, they would support her cause. I feel she is a lot like me because I feel that if people can know what it feels like to be in another person’s shoes facing that, they would understand, they wouldn’t fight them.


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This interview was published in Off The Edge magazine, October 2005 issue.