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