The pharmaceutical companies are not in the business of curing sickness and disease. If they were they would not spend a great portion of their money on marketing and buying influence in Washington D.C. Big pharma is all about keeping people chronically sick, thus creating their own customers. If this sounds conspiratorial, read this book and learn the truth. Pharma is after one thing, and that is increased profits. If they were to provide cures, rather than maintenance drugs, they would slowly lose their customer base. Read this insidious story of an industry that plays the game as dirty as they can.

In "The Truth about the Drug Companies" Dr. Marcia Angell exposes key practices fed by drug company funds that corrupt medical care, particularly distortion of results from clinical trials and several forms of inducements for physicians to prescribe drugs. A bias soon becomes evident and carries thoughout the book: condemnation of drug companies compared with a light hand toward their physician partners.

Dr. Angell's writing is direct and clear, but the book's fact-checking and editing are sometimes sloppy. On page 9, the Hatch-Waxman act of 1984 is criticized for extending exclusive marketing rights on prescription drugs, ignoring the main purpose and effect of the law: greatly increasing the number of FDA-recognized generic drugs, mentioned in a different context on page 32. On page 22 Dr. Angell claims, "You can't just randomly test chemicals to see if one will turn up that might be helpful in treating a disease." However, that is essentially what many drug companies do. They call it "combinatorial chemistry" and will sometimes test tens of thousands of chemical compounds to find a few that might be useful.

On page 33 the book says the FDA became "the first regulatory agency in the country" in 1906. The FDA was preceded by several agencies with different areas of responsibility, such as the 1893 Office of Standard Weights and Measures and agencies regulating military supplies. On page 57 the book says NIH extramural research is "mainly done at medical schools and teaching hospitals." However, a majority of NIH research funds go to universities and research organizations (59 percent for 2007).

"The Truth about the Drug Companies" routinely uses "America" in place of "the United States." In following a pattern promoted by the AMA since the 1920s, the book tries to hijack the word "doctor," substituting it for "physician" as though there were no doctors of science, philosophy, education, letters or law.

Some of Dr. Angell's arguments can easily be stood on their heads. For example, if few significant new drugs are being introduced, how much does it matter when the new drug products enjoy somewhat longer exclusive marketing? Dr. Angell finds fault mainly with drug companies for paying physicians to participate in drug promotions (pages 30-31 and 141-143). Applying similar values, we would prosecute johns but not whores.

Dr. Angell describes chronic issues with access to vaccines and well established but low-volume medicines. They might seem to be candidates for government-sponsored supplies. However, Dr. Angell's chapter on remedies to problems is called "How to save the pharmaceutical industry" and not, for example, "How to assure safe, effective, reasonably priced and readily available medicines."

Compared to vigorous exposure of problems, Dr. Angell's proposed remedies seem timid and abstract. None of her proposed remedies would prohibit physicians from accepting payments, gifts or meals from drug companies, nor free or subsidized services, samples or "continuing education," practices that she identifies as core contributors to the corruption of medical care. No laws are proposed restricting drug company support for medical societies, hospitals, clinics, physicians, medical journals, medical schools or academic research projects. Aside from voluntary efforts, all the sources of corruption she reveals would continue unabated.

Dr. Angell's main proposed remedy would require that new drugs be compared with existing drugs and be shown to provide "something useful" (page 240). Previously Dr. Angell showed how drug companies create designs for clinical testing to achieve positive outcomes, yet she does not say how such pitfalls can be avoided. Later, on page 245, she advocates a new federal agency to "administer clinical trials of prescription drugs," with data from them to become public property. That would require an act of Congress, certain to be strongly opposed by major drug companies, but Dr. Angell provides no guidance or leadership for such a political struggle. Other approaches could be at least as effective with lower political costs, such as public education about the advantages of generic drugs, but Dr. Angell does not mention them.

"The Truth about the Drug Companies" details some of the key United States problems in prescription drug development and distribution but lacks a convincing agenda of solutions.

It is a book that made me sacrifice my sleep time. I spent just a weekend to finish it. Easy to read to a laymen, with lots of examples and explanations. No wonder it is a bestseller.

The book reveals the dark side of the pharmaceutical industry. The book is filled with arguments and viewpoints, supported with facts. As such, it presents its side of the story. Though some viewpoints may be too much or too critical, and inconsistent with market economy, I still find the book as a whole convincing. I would be very interested in how the drug companies respond to the charges the book makes. It guides me to think more deeply about modern society's excesses e.g. too much focus on marketing, loopholes in patent system, imperfection of the government and the whole political system etc.

The book arouses my interest in the drug industry, and my interest in the dark sides of other industries as well. It is enlightening.

Dr. Angell seems to have a serious axe to grind in writing this book, but then again nearly everyone who writes a book has an axe to grind to some degree. She's right that the large drug companies have become heavily involved in marketing, their drugs are very highly priced in the United States, and they do produce many "me-too" drugs. To some degree, though, this is par for the course for any big company that is trying to protect its interests in a highly competitive market. It may be that the industry will behave like this indefinitely if no one intervenes, or it could be that after all of the "low hanging fruit" drugs, such as SSRIs, are created and their patents run their course, fewer big drug companies will be able to survive. We may be witnessing something like the end of the dotcom boom. In either case, Dr. Angell's book is well researched and loaded with facts and examples. It's probably good for everyone to hear her ideas. Author of Adjust Your Brain: A Practical Theory for Maximizing Mental Health.

This could be a very long review if I were to pick apart every untruth, half truth, logically twisted argument, and unsupported opinion expressed in this book. I will try to restrain myself to just a few.

First, the one good thing about this book was that Dr Angell has a tremendous talent for explaining scientific concepts to a lay audience. But that's about it.

She says that drug companies do not do much of their own research -- that universities and government-sponsored groups do. For basic research, that may be true, but drugs need to be tested extensively in patients, manufacturing methods need to be developed, and data need to be analyzed, summarized, and submitted to regulatory agencies before a drug can be marketed. Small companies and government-sponsored groups just don't have the resources to do that. So they sell their ideas to (or license to or partner with) drug companies. The smaller groups agree to terms of technology transfer. There's no piracy. Without the partnership of the drug companies, the discoveries from universities and NIH would go nowhere.

According to Dr Angell, FDA is in the pocket of the drug companies. Hardly. FDA and the other agencies around the world frequently provide input into study design -- ignore their advice at the peril of the development of your drug. FDA comes by frequently to inspect every aspect of drug development, from manufacturing to clinical research, to make sure the company is adhering to the many regulations they must follow to stay in business. The agencies thoroughly study the data and analyses submitted to them when a company wishes to market a drug. They come back with questions -- not soft ones, either -- and expect a prompt and thorough reply. The relationship is not necessarily antagonistic, but it is scientifically rigorous.

From the book: clinical studies designed by drug companies are biased: they study their drugs against placebo rather than against other drugs. Gosh, where to start on this one? First of all, as I mentioned, FDA and other agencies often weigh in on study design, especially for the larger pivotal studies. The investigators -- usually from academia -- are given an opportunity to influence study design, too. Drugs for life-threatening diseases must be tested against other therapies (she does cede this point).

She suggests that all studies should pit the experimental drug against another drug, and that the experimental drug should be better "in some way" than the control drug. This just shows a lack of understanding of basic statistical design of a clinical study. A study has a primary endpoint and several secondary ones. You can't ask the scientific question, "is this drug better 'in some way' than the other drug?" Furthermore, if you think your drug is just a little better than the other drug, you have to test it in many, many patients to show the difference statistically. This is not ethical. So instead, for example, in a cancer study, you would test your drug against another drug and show, in the primary endpoint, that it is no worse than the control drug. Then you might also be able to show some advantage in safety or in a subgroup of patients. But you have to ask one primary question.

She decries me-too drugs, but ignores that people are individuals, and what works in one person might not work in another. There is also the question of improved safety. There is also the question of which drug works in which subgroup of patients. These are all very valid and ethical and scientifically robust questions being asked by clinical studies designed by evil drug companies. Doesn't sound so bad to me. It even sounds innovative.

OK, this review is getting much longer than I'd hoped. So here's the lightning round: Drug companies don't report negative results: untrue (it's often the external investigators who lose interest in negative studies once they're finished). Studies are not registered anywhere: no longer true, and interestingly enough, many medical journals are making it difficult for companies to follow the new registry guidelines. Company-sponsored medical education is just shilling: if you had to read in one sitting all the policies outlining how very prohibited this is, your eyes would cross. She makes the pharmaceutical industry sound like the Wild West when in fact it's probably the most heavily regulated industry there is.

In addition to perpetuating these and other half truths, the author takes a snide, nasty, and shrill tone that has no basis in fact. She makes these little parenthetical cheap shots that betray her already clear bias and further erode her credibility.

I always like to see both sides to an issue, so I would have welcomed a reasoned analysis of the shortcomings of the pharmaceutical industry, but this book was not it. Too bad.

The media in general and the medical industry in particular do not want you (patient) to read and be informed about what you are being prescribed and the consequences. They also are dealing with symptoms instead of causes. Prevention is not in the medical dictionary terminology. Drugs do not heal! Drugs should be a short term interrupter and not a progression from one prescription to another and another. Pharmaceutical companies are gaining more political power through Federal legislation of Congress, which results show in company coffers. Read and be informed.

This excellent book which shines a bright spotlight on the industry. This is an industry which (mostly due to its actions) is ready to implode, and I fear that it may take us physicians right along with them.

The message is clearly spelled out in the first few chapters.American consumers need to be aware of how we are being ripped off by the drug industies.This is a must read and extremely well written

At the same time people are dying from this disease, and that, Big Pharma maintains it's strangle hold on research in our Medical Schools, and the treatment of diseases. Why the Diabetes industry alone worldwide is a 4 billion dollar a day industry. Not to mention herpes, asthma, AIDS, cancer, and the like. The afore mentioned diorders are said to be incureable. Why? Well when research is geared to profit, and not a cure, one begins to understand why. No cures unless there is a profit to be made. So what if people die, it controls the population.

It has been more than 100 years or more since a real cure for a specific disease was discovered. There is more of a profit in making a crutch, than an actual cure. Because once that disease is cured there is then very little money to be made. We have diseases hanging around forever, and when they say there is no cure, they mean we have not made enough money from this disease. In short there is no profit in a cure. Profit is of main concern here. Not you or your family.

Ms. Angell has a blueprint or an inside look at the process of the how and why things are the way they are. Money, money, money. The Love of money is the root of all evil. Money before people. This book is an eye opener, and like the people who rang the bell before 9/11, if no one listens, no good can come from this book. Ms. Angell is giving us a look from the point of view of a former insider, and very well bares listening to. Read this book and become pro-active about the healthcare of you and your family.

At the same time people are dying from this disease, and that, Big Pharma maintains it's strangle hold on research in, and the treatment of diseases. Why the Diabetes industry alone worldwide is a 4 billion dollar a day industry. Not to mention herpes, asthma, AIDS, cancer, and the like. The afore mentioned diorders are said to be incureable. Why? Well when research is geared to profit, and not a cure, one begins to understand why. No cures unless there is a profit to be made. So what if people die, it controls the population.

It has been more than 100 years or more since a real cure for a specific disease was discovered. There is more of a profit in making a crutch, than an actual cure. Because once that disease is cured there is then very little money to be made. We have diseases hanging around forever, and when they say there is no cure, they mean we have not made enough money from this disease. In short there is no profit in a cure. Profit is of main concern here. Not you or your family.

Ms. Angell has a blueprint or an inside look at the process of the how and why things are the way they are. Money, money, money. The Love of money is the root of all evil. Money before people. This book is an eye opener, and like the people who rang the bell before 9/11, if no one listens, no good can come from this book. Ms. Angell is giving us a look from the point of view of a former insider, and very well bares listening to. Read this book and become pro-active about the healthcare of you and your family.

This a an attck on big pharma and a well rounded one at that. In the end Angell proposes a plan to lessen the power of the pharma companies.

Everyone should read this book to help understand the unethical Big Pharma criminals that are robbing Americans with deceit and creed.
Read it and pass it on to your Physician and request a response .
Contact your Congressman and tell him/her that the American Public takes time to educate , but the Healthcare Crisis rests with Big Pharma , "Managed Care" Insurance Companies , and their Lobbies.

Everyone should read this book to help understand the unethical Big Pharma criminals that are robbing Americans with deceit and creed.
Read it and pass it on to your Physician and request a response .
Contact your Congressman and tell him/her that the American Public takes time to educate , but the Healthcare Crisis rests with Big Pharma , "Managed Care" Insurance Companies , and their Lobbies.

Big Pharma: Antibiotics, antiplatelet therapy, anti hypertensives, thrombolytics, NSAIDs, Diabetes medications, statins, SSRI's, Proton Pump Inhibitors, Beta Blockers, Calcium Channel blockers, ACE Inhibitors, anti seizure drugs, alpha blockers, 5 ARI's, anti rejection medications, cancer medications, anti nausea drugs, pressors, thyroid medication, erectile dysfunction, Anti Parkinsonian drugs, Alzheimers meds, anti psychotics, macular degeneration, rheumatoid arthritis, asthma, COPD.

Big Tobacco: Lights, Menthols, 100's, Mediums, Filters, Non Filters, Ultra Lights

Am I missing anything?

It will change how you feel about taking drugs and the pharmaceutical industry.

This book by Marcia Angell, former editor of the New England Journal of Medicine, considered the top medical journal in the country, is a scathing and accurate description of how Big Pharma is ripping off individuals and the entire health care system by overcharging for drugs during their monopoly period. They claim they must do this to pay for research and development but in fact Angell shows that they spend much more on marketing and advertising than on R&D. She has many suggestions for improving the system and lowering the costs of prescription medicine in the U.S., which are the highest in the world. People should read this book if they are concerned about drug prices and then contact Congress to urge them to reform the pharmaceutical industry.

I found Dr Angell's excellent book to be fairly comprehensive except for one important point: It overestimated the benefits of many drugs because it did not discuss some of the important reasons that the conclusions from many randomised controlled trials are invalid, especially for drugs for cancer and heart disease: namely the concept of 'surrogate endpoints'. These are used instead of real benefits like increased survival or reduced mortality. Instead of measuring if a drug extends life, which takes a long time and therefore costs a lot more, most chemotherapy drugs use tumour shrinkage as a surrogate end point.

Unfortunately there is little or no correlation between tumour shrinkage and increased survival - so the paradigm of what cancer is must be wrong.

As a result the FDA accepts drugs as effective based on their ability to reduce the size of tumours. It also accepts them as safe despite the fact that they are poisonous and kill thousands of people every year.

So these 'effective' drugs have no survival benefits and cause much harm.

Yet billions of dollars are spent on these drugs every year and these get included in Dr Angell's 'useful' drugs.

Another reason for the invalidity of the conclusions from many randomised controlled trials is that many trial authors publicise the fact that a drug can reduce cancer specific mortality and get it approved by the FDA yet ignore the increased deaths from other causes resulting from the drug's toxicity. There is often no overall saving of lives.

For these and many other reasons, the claim that so many drugs are useful and save lives needs to be treated with some scepticism.

The concept of surrogate endpoints is described well in Thomas Moore's excellent book Deadly Medicine where he describes how this concept was the reason for between 50,000 and 150,000 people in the US being killed by anti-arrhythmic drugs (after being approved by the FDA as being safe and effective) before its use was restricted.

Many authors have pointed out the lack of correlation between tumour shrinkage and increased survival, including Ralph Moss in his excellent book 'Questioning Chemotherapy'.

But despite this oversight Dr Angell's book provides the detail to substantiate what many of us suspected but couldn't prove.

If you want, or need to know what the modern drug industry is all about from a regulatory, or financial standpoint, this book is REQUIRED READING. If you are a security analyst for a Wall Street firm, and you cover the drug industry, and you haven't read this book, I have three words for you - Shame On You.

If you are in Wall Street, and you read this book, don't tell anyone because the drug companies will cut you out of any investment banking business you may want to do. They don't want you to have this information.

A professional who cuts through all the jargon wrote this book. She gives you the reader what you need to know, to have a comprehensive understanding of the growth of the drug industry in the United States and the world. Dr. Angell has instant creditability as the former editor in chief of the New England Journal of Medicine (NEJM). As you might be aware, this periodical along with England's Lancet are the two most prestigious medical journals in the world, and that's saying something.

What the author has to say about Big Pharma is saying something else. Her comprehensive understanding, and willingness to tell the truth is nothing less than a gift to all of us, who seek the truth about the way things work. This book is a GIFT to the American people. It is a book that the major drug companies would have paid NOT to have been published, and you need to know that.

There are some serious problems that our drug industry is facing. There are other problems that are systemic to our country that the drug industry is responsible for, where the bad in fact may outweigh the good. The author PULLS NO PUNCHES in going through them with you.

Let's just go through a couple of issues, and you'll see why you need to read, study, and act on what the author is saying. As a player in this industry, I know that Dr. Angell knows what she's talking about. She also has my complete admiration and respect. In writing this book she is BURNING BRIDGES, and you have to respect someone who is willing to hurt herself financially, to do the right thing. This is a woman that could easily serve on two or three Boards at a $100 grand or more apiece, but not after writing this book.

· You will learn how the drug companies outright lie about how much money really is spent on Research and Development. The companies are using this catchall phrase as a basket into which they dump other expenses to build this number up as much as they can to use it for their own advertising advantage.

· You will learn how the drug companies really pour the vast bulk of their financial resources into marketing the products they sell, rather than creating them.

· You will be shocked to learn that the vast number of new, and important drugs is not produced in the laboratories of the major drug companies at all. They are produced in federally funded university settings, or smaller biotechnology firms.

· You will be blown away to know that several Federal laws have virtually mandated that these discoveries than be licensed to the major drug firms for marketing and distribution.

· You will see how the so-called military-industrial complex that President Eisenhower warned us about in his farewell speech to America (Goggle it), applies to the drug industry as well. There is a government-drug interlocking process that is basically adverse to the democracy that we live in.

· Dr. Angell shows you how this process works directly against the financial interests of every living American. It results in each of our citizens paying far more for American made drugs than people outside the United States pay for our own drugs.

· The reasons for the outrageous excess cost of the Senior Citizen Drug Plan implemented under President Bush will be obvious to you after you read this book.

When it comes right down to it, this is the finest book on this topic on the market today. The drug companies if they could, should buy every copy, and burn it. They don't want you knowing this information, which is information you need to know. BUY THIS BOOK.

Richard Stoyeck

Spot on! I have been practising medicine for 15 years and the ways drug companies make their profit are becoming more and more annoying. Fake studies, employed "experts", creating new diseases, broadening disease definitions....

Thanks to the writer for this excellent book, 2 thumbs up!

The well-laid out facts speak for themselves. Drug companies are crooks -- plain and simple. Anyone who gave this book less than 4 stars either can't read, can't understand facts or has a hidden agenda.

Read it. Get pissed. Stop taking medications. Watch 'Big Pharma' crash and burn.
Wishful thinking? Maybe. Maybe not.

It is very good to know about the truth, mainly when you have to deal everyday with prescription drugs, whether being a doctor or a patient. It is very sad to know that marketing is above research and that medications could be much more affordable. I am a physician and I got really astonished with these reports, made by Dr Marcia Angell, who used to work in the edition of the New England Journal of Medicine, one of the most important in the medicine world. Profits are the aim, not the cure or the constant serch for the cure. The power of this industry is enormous and something has to be done to inhibit its powerful lobby around the globe. We are paying for the industry marketing, not for the drug itself. Physicians are seduced by drug companies since they are in Medical School with gifts,meals, congress refunds, etc in order not to realize this scenery. We should all open our eyes - physicians and patients and try to join forces and demand new politics or laws for this issue. Dr Marcia should be congratulated for her courage in publishing a delicate subject like this, standing in her position as a physycian and an ex-editor of the NEJM.

I always thought we were getting ripped off by the drug companies.Marcia Angell has the facts and figures to prove it.
Your book was reccomended by the manager of a GNC store. I thought maybe he was promoting sales of supplements but the book proves he knew what he was talking about. I agree with the author that the politicians in Washington won't do anything to curtail the rip offs because that is where they get huge finacial help from the drug barons. One day, the American people will wake up and use the ballot to change things.

Dr. Angel excoriates me too drugs but one of them saved my life. I tried Prozc, Luvox, Zoloft, Xanex, Miltown, and many other drugs but none of them helped me get over OCD.
I didn't get better till I discovered Paxil. Aside from this one point I enjoyed her book very much.

I'm not surprised that the reviews of this book are polarized.

One the one side are those who are shocked to discover that the primary motivator of Big Pharma is not to develop chemicals that improve the health of patients, but merely to aggressively market products to make a profit. On the other side are those who respond with indignation at such an allegation. However Angell's expose, while somewhat biased, is 100% accurate.

The arguments against her seem to take the flavor that in big business profit is king and any means to make a profit within the boundaries of the law is acceptable. This would be a valid argument if the products in question were basic consumer goods, not treatments for medical conditions. This is compouned by the fact that many of these products prove to be dangerous, and many are no better than current therapies used for the conditions they are marketed to treat.

For those who are still under the illusion that drug companies are there purely to develop treatments to make us all healthier, this is required reading. Guess what? There is a good chance that your physician and local pharmacist shares this illusion.

For more information on how physicians are duped on a regular basis, I recommend the website nofreelunch.org

i had no problems with getting the book and it looks great. thanks!

Ethics in research involving humans and disclosing conflits of interest are important chapters inside academy. But its consequences are living in all society. Marcia Angell, former editor of the most influent medical journal, made a disclosure of the rhetoric discourse of the regulations and clinical research inside drug companies. Interests, marketing, costs and research were deeply analysed with an easy language (either for non-specialists). This book is of great interest for researchers, bioethicists and internal review board members.

This is the question to be asked - are the pharmaceutical companies current priorities humanitarian or financial? I am a recent cancer survivor and very thankful for the meds I received via chemo/radiation therapy and those I continue to take for further protection. On the other hand, the cost for such is astronomical and one can't help but wonder about those afflicted who haven't a great insurance plan to cover those costs. Furthermore, no one need go any further than Enron to see how easily money can take precedence for some at the detriment to others. We all seek better health care at an affordable cost. Why shouldn't questions be asked and accountability be expected from this industry who holds a big chunk of our lives in their hands by not only what they distribute [and this has questionable issues also], but also how much they charge for such.To not ask questions and hold this industry accountable would be foolish. Making money is one thing and how you spend it is another. One reviewer commented on the wasteful spending at a casino by those who complain about medical cost and yet he/she seems to see nothing wrong with wasteful spending on promotions to give us more of what we don't need and less of what we do. I would like to know that ALL of us will be protected from an avian flu epidemic and that there IS a cure for cancer and for them to know we DO NOT need another or improved cold remedy, sleep aid or erectile dysfuntion product on the market!! Once the "heart" of the industry stops pumping, it's over. I think it's time to defibulate the industry and think this book can initiate the shock.

Marcia Angell's background (physician; former editor of the New England Journal of Medicine) make her uniquely qualified to write this book.

Among her key points are that 1)most of the expenditures for developing new drugs are funded by the government, 2)most of the drugs are "me-too" variations with little or no benefit vs. those currently on the market (a fact concealed by comparing them vs. a placebo instead of existing drugs, or by testing a new drug vs. an inappropriate dosage of something else), 3)companies spend more on marketing than research, 4)considerable extra profits derive from minor tweaking of existing drugs to all extending their patent protection, 5)that in 2002 the top ten drug companies made greater profits than the other 490 businesses on Fortune's Top 500 list, 6)how pharmaceutical companies' consulting agreements" with government officials at the FDA and NIH distort regulation, 6)that drug companies only publish and report positive results from tests, and 7)the strong hold drug companies have on Congress through their political donations.

This book cries out for change!

I will try to keep my review as non-partisan as possible, but I have to say - after reading the one star reviews that have blind faith in the drug companies, they are either naive, rich enough to afford the latest greatest meds (which may or may not be that great), or have a financial stake in big pharma. Read them and laugh or grimace. Certainly, there are people who are so pro-corporate that they will keep insisting that corporations have their best interest at heart. This book is not for you.

Compared to a lot of other books in this genre (basically, pro pharma reform), this one shines. Mostly this is due to the authors front row seat experience, and her style translates well to a lay audience - a rare skill. That is why I recommend this book instead of others.

We desperately need more quality nonbiased research that does not choose to put a product in a unfairly favorable or unfavorable light due to the deep products of a sponsoring company. The public deserves better. I encourage all of you who hear about this study or that on whatever news outlet you listen to - take a look at 1 - what the study actually compared and 2 -who sponsored it. There's a lot of bias out there.

I loved the book, some of it seemed a bit fragmented, but understood, tis a complex issue. As referenced, it does not suprise me in the least that drug companies account for more than the profits of the top 5 fortune companies. I have met the "wonderful" drug reps, scurrying around with the luggage on wheels and bags of goodies (pens, pads of paper, other gizmos) and "drug lunches". They corner you in the break room, when you are lucky to get a break, before you even sit down, you are forced to sign in and listen to their well practiced lectures in their expensive suits. I would appreciate less of the "goodies" and more research funded by those other than the drug companies themselves or others associated with those companies as discussed in her book. Anther topic I found to be interesting was how R&D is less than advertised and much of the expense is d/t advertising. From my own experience, the fact that a few Zofran cost $400, so you don't vomit is ridiculous! It's interesting to me now to have an idea where this money is going according to this publication. I also enjoyed the section on new medical conditions arising now that were unheard of in the past, PMMD for example. I also found it frightening that, according to the book, drug complanies are promoting to doctors the use of medications for unapproved uses by the FDA, so they will prescribe more of the medication. I thought the discussion in her book regarding cutting off the last leg of unfavorable research findings to publish a fantastic looking study was disgusting (Celebrex anyone?). She talks about why HIV/AIDS meds are so expensive and the impact on people desperate for medications and could die if they don't get them. Again, thank you for writing this- I think that those who idolize drug companies and even those who work for them who are unaware may benefit from your lengthy research on the topic.

Let's pick one topic in this book, just to illustrate the lies that is being spread regarding the pharma industry ....

Paraphrasing: Most drugs come from the Universities and tax subsidized government programs and very little inovation comes from the industry itself.

We can analyze this two ways .... the first way is by use of some common sense. Who do you folks think are paid higher, scientists in the Unis and government programs, or scientists in the industry? Who do you think is better equiped, ie. who has better laboratory toys, the Univeristies/government programs or the Industry?

If the industries have smarter scientists and better lab equipment, logic tells you the industry must produce better drugs, no? Besides, when was the last time anything run by the government was actually productive and efficient? Have you been to the DMV lately? Come on!

Marcia saying the Universities and the NIH are more innovative in developing drugs than the Pharma Industry is like saying (using sports analogy) Minor League baseball is better than the MLB. Which players do you think are paid more? Common sense my friends.

That's using plain old logic.

Now the second way, is to actually do some research. Go down the list of drugs and find out where they were discovered. But based on common sense, do we really need to do that?

Just one of the many LIES this book is spreading. Angell has an agenda and is merely profitting from the emotional issue of being unable to afford medicines.

The issue is much more complex than simply BASHING the drug industry.

Some things to keep in mind before you join the bashing:

1. Tomorrow's cures (despite what Marcia thinks) will not be coming from academia, it will come from the Drug Industry. Our children's future are depending on the health of this industry.

2. The drug industry is one the last remaining industries America has. Haven't you noticed, everything is made in China. Keep up the drug bashing and soon your medicines will be coming from India.

3. Why would anybody pay for an unproven, unreliable herbal remedy but will question the value of a drug? Is it really drugs or food or is it more like Casino money or drugs?

4. What would the world be today, if not for the thousands of pharmaceutical professionals who brings us these cures?

SO BEFORE YOU JOIN THE BASHING - Think first. Not emotionally - logically!

Somehow there is this notion that our health and well being MUST be free. The negative publicity that the drug industry is experiencing right now is further proof about the intelligence level or lack thereof, of the American public.

This book further feeds into that stupidity and negativity. Drug companies are actually being COMPARED to the tobacco industry. WHAT??!!!

I have a son who has Asthma. Have you seen a small child gasp for air? Can you put a price on that? What's the point? If I could meet the individual who invented and discovered Albuterol, I would kiss his/her feet with bountiful thanksgiving.

Angell claims that much of drug discovery originates from the Universities and government funded organizations such as the NIH.

For anyone who believes this ... would you like to put money on the validity of that?

Let's go down the list:

Lipitor? Viagra? Zocor? Cancer drugs? Etc etc etc etc.

Originate from Universities ... HAH! .... what a bunch of HOGWASH!

Incidentally, if all these drugs all came from the Universities, how come no one is blaming any University for Vioxx? Heh, Marcia?

The next time you feed into this negativity, ask yourself "How much is my health worth?" These same seniors complaining about drug prices would readily blow their money in a casino .... go figure.

Just to illustrate the height of the stupidity of drug industry bashing? Drugs, which require a heck of a lot more intelligence to produce, can be copied by generics but music and movies have lifetime copyright protection.

You want industries to complain about ... have you seen your cable bill lately? How about the last time you filled up your car? I mean talk about deceit, greed and monopoly.

I cannot think of an industry with nobler purpose for its existence than that of the drug industry. Just think of what the world would be today if not for this industry. It's a shame that society has come to this.

I've read this book, and it has been an eye opener. Dr. Angell presents her case in a very convincing, beautifully written argument that is very well researched. the implications of this industry on economy at large, government and international policy, are enormous and thus anyone, regardless of their health, should educate themselves about this horribly corrupt industry.

Amazing revelations from a doctor and the former editor in chief of The New England Journal of Medicine. The fact that the numbers the drug companies give about how expensive it is to develop a drug are completely false, they use most of their money for marketing and use publicly funded research for the bulk of their work. It really makes much more sense to me now.

Dr. Marcia Angel provide us interesting notes about research and development in some drug companies. An excellent book that makes one wonder why scientific community has to be encouraged to publish complete data about drug design, even thus some companies refused to do it. People deserve to know what is happening to choose a better way to survive in the pharmaceutic jungle. Also, a good book to understand the caveats in drug research.

A lack of accuracy and depth make the subtitle of the book incredibly misleading. The truth is not to be found in its pages. A better understanding of business theory would be useful for an author suggesting ways to "reform" a business.

I thought I knew how messed up our healthcare system was, but this book really opened my eyes. the real culprits in the problems are our elected officals who have whored themselves to the drug companies in return for campaign contributions.

Several excellent reviews have already been submitted. Permit me to add a comment.

Dr. Angell makes clear that most innovative drugs originate from academic or government research, but a related point was overlooked. Many companies announced plans to expand pharmaceutical businesses in the `90s. But the govt did not increase support for academic research. Expanded research efforts can require years to adequately staff and equip. Hence, the pool of good ideas for new drug development requires time to expand. More resources in drug research is not likely to pay off without increased support for academic and government research.

I have not finished book, but start to feel the bias of Dr. Angell. She is great to challenge the ever rising problem of the healthcare overall. However, I wonder if she is aware why docotors always charge a lot and make a huge amount of money. Can she answer this question as an MD?

This is a highly credible first-hand account of how the pharmaceutical industry operates. The author, former editor in chief of The New England Journal of Medicine and now a member of Harvard Medical School's Department of Social Medicine, presents an extraordinarily well researched assessment of "big pharma."

The seven broad problems addressed in the book are:

1. Drug companies produce too many me-too drugs and too few innovative ones.
2. The Food and Drug Administration (FDA) is too much in the thrall of the industry it regulates.
3. Drug companies have too much control over clinical research on their own products.
4. Patents and other exclusive marketing rights are undesirably long and too elastic.
5. Drug companies have too much influence over medical education about their own products.
6. Important information about research and development, marketing and pricing are kept secret.
7. Prices are too high and too variable.

A chapter or two is devoted to each of these problems, then concludes with specific recommendations to improve the industry. After reading the book, a two things become clear:

1. The pharmaceutical industry and the medical profession need thoroughgoing reform.
2. Congress and the FDA need to be reminded that they exist to serve the public, not the drug companies.

What stands in the way of getting the message of this book out to the public? The drug companies themselves, and the mythology that they've spun out of their vast public relations apparatus.

This book sets out to expose the important of those myths - the claims that big pharma's prices reflect its R&D costs, that it is innovative and that it is a shining example of American free enterprise.

As is thoroughly documented in this book, this industry actually spends far more on marketing and administration than on R&D. It is not innovative. And it lives on government favors and shrinks from competition. If you know that, you should be immune to the kind of threat that the pharmaceutical industry specializes in: "Give us everything we want, or we might have to stop producing miracle drugs."

Finally, the book is written in a style that permits a fast read through. It uses plenty headings, subheadings, italics and paragraph spacing that make it a book which reads quickly.

This book is a thorough indictment of the pharmaceutical industry by someone who should know -- the former editor of the New England Journal of Medicine -- a rather nice credential. It's accessible to the lay person and extremely well-researched. The author makes serious indictments and supports her arguments with evidence that is quite convincing.

I have not understood since they started running prescription drug commercials why that has nothing to do with the outrageous price of drugs -- and it turns out it has everything to do with it. Since I work at a cancer research institution, I have also never understood why the drug companies get all the credit for coming up with innovative drugs; in fact, it's mostly the places like I work that do. So we pay for it twice -- our taxes go for grants given by government agencies to places that do the research, and our paychecks go for the drugs made from those discoveries. I've never understood why drug reps are allowed to stalk the halls of clinics, doctors' offices, and conferences with impunity -- now I learn that they bring doctors lots and lots of goodies, many of them colored a unique shade of green.

If the author is to be trusted -- and I think she is -- it seems that everything that's ever caused you concern about the drug industry SHOULD cause you concern. It's the kind of book that should produce outrage among the American people. It's well-argued and well-researched: very convincing. It's a bit dry but that's to be expected from an author trying very hard to support her arguments with facts . . . unlike the tabloids, REAL stories often come from the very boring exercise of gathering fact after fact after fact and then drawing conclusions from them. If you hang in there long enough, something will come along to outrage you and wake you up if you've wandered off. Highly recommended if you are at all suspicious of the drug companies.

I love this book. It's about time someone exposed the unethical, greedy nature of the pharmaceutical companies. I have believed for a long time that the doctors and hospitals were in the clutches of a greedy industry that wants to make lots of money over the death of our society by getting everybody on drugs. But now I see how much they influence our lawmakers and thus why it is so hard to keep our vitamins from being removed from our free access. If you read this book, you will say "No" to the pharmaceutical companies.

You can't go to a pharma industry conference these days without hearing at least one expert speaker recommending that pharma executives read the book "The Truth About the Drug Companies: How They Deceive Us and What to do About It," written by Marcia Angell, MD, former editor in chief of The New England Journal of Medicine. It's not often that you see pro-industry pundits recommend a book that "tears pharma a new one," as some would say.

Having great respect for these people -- including Richard Vanderveer, Chairman & CEO, V2 GfK and Rob Nauman, Principal, BioPharma Advisors and member of the PHARMA-MKTING discussion group (www.pharma-mkting.com) -- I necessarily went right out and bought the book.

Kudos from Pundits

"Pharma executives need to read this book in order to achieve balance in their own understanding of the industry," says Nauman. "Too often individuals within the industry cannot admit that some of what Angell says is really going on, because the industry is managed in various 'silos' and the overall issues are often things they are not addressing in their role."

What Are Her Points?

Angell really hammers the industry on its marketing, clinical development, and lobbying practices. At the end, she makes several recommendations for what should be done to "save ... this important industry...mainly from itself." Whether or not we agree with her remedies, saving the industry is a goal all pharmaceutical executives should focus on, especially as our incomes depend upon healthy, profitable pharmaceutical companies.

Here's a short list of problems for which Angell suggests remedies:

1. Drug companies produce too many me-too drugs and too few innovative ones

2. Drug companies have too much control over clinical research on their own products.

3. The Food and Drug Administration (FDA) is too much in the thrall of the industry it regulates.

4. Drug companies have too much influence over medical education about their own products.

There are other problems Angell discusses such as pricing, patents, and transparency, but I'd like to focus only on the above issues for this review.

Research vs. Marketing

Angell doesn't buy the drug companies' argument that the price of new prescription drugs in the U.S. is high mainly because it supports the huge investment in scientific research done by the industry. She suggests that research costs are not as high as the industry claims. She uses industry data to estimate the pretax cost of developing a new drug to be $265 million per drug (vs. $802 million estimated by a much-cited Tufts study) and that much of this might be really marketing under the guise of Phase IV studies.

Angell, like so many pharma critics, suggests that much more money is spent on drug marketing than on research for new drugs. The pharmaceutical industry, of course, vigorously disputes this. "The R&D vs. marketing argument is not working any more," says Vanderveer. "A dollar spent on that argument is a dollar wasted as far as I am concerned."

Whatever the cost, Angell argues that large R&D expenditures "ought to raise the question of whether we are getting our money's worth." On average only 12 innovative drugs, which Angell
defines as new molecular entities that have received priority review by the FDA, are approved each year. Not only that, of the seven innovative drugs approved in 2002, only three were from American companies and "publicly funded medical research -- not the industry itself -- is by far the major source of innovative drugs. "...if prices and profits in excess of any other industry are indeed a stimulus for innovation," says Angell, "drug companies have not kept their part of the bargain."

"R&D is stagnant," says Terry Nugent, VP Marketing, Medical Marketing Service, Inc., "No one hates that more than the people who are paying for it -- companies and investors."

Angell further claims that seventy-seven percent of the industry's output consists of "leftovers" or me-too drugs classified by the FDA as being no better than drugs already on the market to treat the same conditions. She cites a "crucial weakness" in the law that new drugs only have to be proved "effective" and not "more effective than (or even as effective as) what is already being used for the same condition." She favors head-to-head comparisons rather than showing that a drug is better than nothing at all (placebos). "The last thing drug companies want," says Angell, "is a head-to-head comparison."

"Perhaps Angell is right," says John Hoey, M.D. in a review of the book published in the New England Journal of Medicine. "We must change the way we manage research and the development and distribution of new drugs. Not only are health and health care at risk, but so are the research enterprise and the reputations of universities and governments. The integrity of scientific research is too important to be left to the invisible hand of the marketplace."

Angell offers several solutions to address the problems she sees inherent in pharmaceutical-sponsored clinical research. Among these are:

[] FDA regulations should require that new drugs be compared not just with placebos but with old drugs for the same condition ("accomplished easily by congressional legislation")

[] Strengthen the FDA as an independent agency. ("It is now so dependent on the pharmaceutical industry [e.g., user fees] that it has become big pharma's handmaiden.") Repeal the Prescription Drug User Fee Act, increase public support, and keep experts with financial ties to the industry off FDA advisory committees.

[] Create an Institute for Prescription Drug Trials to "ensure that clinical trials serve a genuine medical need and to see that they are properly designed, conducted, and reported."

Pharmaceutical companies like to refer to themselves as "research-based." Angell says most big pharmaceutical companies are "hardly that." She suggests that they could better be described as "idea-licensing" and "marketing" companies. "That isn't a bad thing," says Vanderveer. "Pharma companies should emphasize that they are marketing companies. We are in the communications business and are a channel between development and consumers. This is a good thing."

"While I believe that clinical development of new drugs as it is currently practiced is broken," says Nauman, "Angell's solution to do all clinical research in academic institutions swings the pendulum too far in the opposite direction. Academia has its own priorities -- e.g., publish or perish -- and there is no guarantee that pure academic clinical research will result in better products."

"Pharma companies should not hold back smaller innovations that fulfill unmet medical needs by not developing compounds that they deem are not profitable," says Nauman. "They should sell their proprietary rights off, have smaller companies to complete the clinical development, and then partner with them to commercialize the drugs." Nugent agrees. "The solution," he says, "is perhaps to get these brilliant people focused on fighting disease instead of each other. Spin them off into little biotech empires with incentives -- i.e., money -- to get their acts together."

"The problem is that many of Angell's solutions are extreme and don't offer much compromise," says Matthew Holt, healthcare strategy consultant and author of The Healthcare Blog. Holt is concerned that extreme positions will cause pharma to "circle the wagons rather than engage in a dialog with critics to effect real change."

Education vs. Marketing

Angell suggests that pharma companies get out of medical education. Since education comes out of drug companies' marketing budgets, "that should tell you what's going on," says Angell.

According to figures cited in Angell's book, over 60 percent of the costs of continuing medical education in 2001 was paid by pharmaceutical sponsors (ACCME reports that for 2003, pharma companies provided $943,608,302 for direct sponsorship of CME programs with a total income of $1,774,516,395. That works out to 53%. If you add in a good chunk of the $183,293,597 in advertising and exhibits income that pharma is probably responsible for, I am sure the 60% number is a valid estimate).

Angell points out that many ACCME accredited organizations are for-profit companies hired by drug companies. These MECCs (Medical Education Communications Companies), as they are called, promise to get audiences "to take action that benefits your product." This represents too much of a conflict of interest according to Angell and backs up her claim that there is a close connection between medical education and drug marketing.
Among the solutions offered by Angell:

[] Medical schools should teach students about drugs and not leave this up to industry-sponsored programs and teaching materials.

[] Teaching hospitals should regard drug company representatives just as they do other salespeople -- don't let them traipse around at will, promoting their wares.

[] The medical profession should take responsibility for continuing medical education. There should be no private medical education industry hired by the drug companies.

[] Professional associations should be self-supporting even if it means raising member-ship dues to gain independence from drug companies.

[] Direct-to-consumer (DTC) advertising should be prohibited in the United States just as it is in other advanced countries.

DTC advertising is facing a challenge from the public, regulators, and legislators even as more and more money is channeled into it by pharma companies (perhaps getting their last licks in before the hammer falls). "DTC's visibility is starting to blowback big time," says Nugent, "and it cripples the learned intermediary defense in the most expensive tort cases. Get it off TV and on to the Web -- better, faster, cheaper."

Angell also gives advice to patients about questions they should ask their physicians. For example, "Do you make time for visits from drug company representatives?" If the answer is yes, Angell says you should consider changing doctors. "I think she is right," say Vanderveer. "Docs shouldn't make any time to see reps unless they have something new to say. And industry executives should stop running to conferences on improving physician access and should think more about how rep visits can be more valuable to docs."

Tough Years Ahead?

A good point for pharma marketers to take away from this book is that 2000 marks the beginning of a perfect storm for the pharmaceutical industry. "Get ready for 5 years of change," says Vanderveer.

This review was first published in the November/December 2004 issue of Pharma Marketing News (www.pharmamarketingnews.com). The author, John Mack, is the Publisher and Editor of that online newsletter.

Both pharma and doctors are responsible for cost effective care of patients and both should be held to that responsibility.

First of all I would like to comment on the negative comments on this book. Angell is not a hypocrite. It takes one to know one. She had to have been employed in the industry to really recognize it, right? I like this book in only one respect. It exposes the side of pharma that the public may not always see, but taking a business opportunity in selling books to get this point across is cheap. Not hypocritical but cheap. Disgusting would be a better choice of words.

Who cares about people? No BODY. NO ONE CARES ABOUT PEOPLE. We don't care! So, it is easier for us to say we do through business endeavors and profitable ventures that are really noting more then greed. Doctors don't give a rat's a-- about people. I'll prove it. Let's say some poor person gets sick but is embarrassed that he doesn't have the money to go pay cash to see a doctor and is also very aware that one won't on God's green earth ever make him/her self available for a free service to come and see him so he suffers until an emergency arises in which case he is forced to go to the emergency room and end up with a bill bigger then you or I. Funny situation! I wonder who is really making money? The pharma or the doctors? I think they both should realize that their oath, their service is to humanity not to their pocket and nice cars and fancy homes. Oh I'm sorry! They got into the business for the money. Yes, If my services to humanity involve a "smart" brain and a tolerant personality I may also wish to be a doctor but never would I trap myself in a system that traps the very people that enlighten me.

The spirit of doctors and pharmaceuticals is not in their knowledge and humanity; it is in their greed. So go on writing and selling books and don't forget to practice medicine and rip the poorest of people off. I'm embarrassed to live in a society that informs people through business and not through extensions of themselves. I think Angell's attempt at this book affirms this belief in our doctors and pharmaceuticals.

This is an excellent book that comphrensively addresses the major problems faced by patients and consumers of precription medicine in the USA. The author correctly asserts that there may be yet another watershed for the pharmaceutical industry, only this time it may not be as profitable for big business. The author raises critical issues--although I do not think that "writing to congress" will change anything, nor do I think that MD's will answer pointed questions vis-a-vis their involvement in what could be viewed as dangerous practices.

"The Truth About The Drug Companies" by Marcia Angell, M.D., is an outstanding introduction to the abuses and greed of t