"The Truth About Drug Companies" - A Book Review

Dr. Marcia Angell is a physician trained in internal medicine and pathology. She is the former editor-in-chief of The New England Journal of Medicine, and was named by Time magazine as one of the twenty-five most influential people in America. In addition to writing "Science on Trial" in 1996, she published "The Truth About Drug Companies" in 2004.

This book takes a good look at the pharmaceutical industry from the perspective of someone who not only worked at a prestigious medical journal that published drug studies, but who also prescribed medications and treated patients. Much of the information that is discussed in this book is stuff that you won't find mentioned by the establishment media or in the ubiquitous commercials on TV. Yes this book is twenty years old, but the drug companies operate the same way now that they did back then (if anything, they are less scrupulous now). Chapter 4 poses the question, "Just how innovative is this industry?" The drug companies often complain about the hurdles they must clear in order to receive Food and Drug Administration (FDA) approval for innovative drugs that save lives, but on closer inspection these companies are not as inventive as they would have us believe. According to Dr. Angell, "At least a third of big pharma's drugs are now licensed or otherwise acquired from outside sources - including smaller companies all over the world." That doesn't sound all that innovative. On this topic, she goes on to say that, "Researchers supported by the National Institutes of Health (NIH) usually do the initial work of drug discovery. Then the drug companies keep stringing out and exploiting those discoveries."

Chapter 5 sheds some light on what are called "me-too" drugs. These are drugs that are classified by the FDA as being no better than existing drugs that are already on the market to treat the same conditions. "Me-too" drugs are often introduced just as an existing drug is scheduled to go off patent, and she gives the example of Nexium (a popular heartburn drug) and its predecessor Prilosec. This was in spite of the fact that Nexium was only a marginal improvement over Prilosec in just two of the four clinical trials that were conducted. "Me-too" drugs usually target very common and long-term conditions, such as high blood pressure, depression, and arthritis. There is more money to be made by treating the condition than by curing it with lifestyle modifications. According to the author, "Once upon a time, drug companies promoted drugs to treat diseases. Now it is often the opposite. They promote diseases to fit their drugs. Nearly everyone experiences heartburn from time to time. The remedy used to be a glass of milk or an over-the-counter antacid to relieve the symptoms. But now heartburn is called 'acid reflux disease' or 'gastroesophageal reflux disease disease (GERD)' and marketed, along with the drugs to treat it, as a harbinger of serious esophageal disease - which it usually is not."

Stretching out the length of patents is another tactic that the drug companies use to extend exclusivity and enhance their profits. Patents are usually granted for twenty years, but it can take several years for a drug to go through clinical trials and gain FDA approval. This impacts the profitability of a drug, so the drug companies will go to great lengths to extend their patents. The Hatch-Waxman Act extended drug patents for up to five years if FDA approval was delayed due to clinical testing. Additionally, the Food and Drug Modernization Act of 1997 provided an additional six months of patent protection if companies test their drugs on children. Brand-name companies may also collude with generic companies to keep prices high or delay their entry into the market. And, as I mentioned earlier, drug companies will launch virtually identical drugs with new names just as the patents are set to expire. This was the case with well known drugs such as Prilosec, Claritin, and Prozac. The fact that our federal government has created these giant loopholes for drug companies to exploit should illustrate to you that meaningful positive change to the system isn't likely to come anytime soon.

While I was disappointed that there is not more of an emphasis in this book about the importance of lifestyle modification as an alternative to taking potentially harmful medications, there is very useful advice in the afterword section. Dr. Angell provides several questions to ask your doctor if he or she wants to prescribe you a drug.

1. What is the evidence that this drug is better than an alternative drug or some other approach to treatment?

2. Has the evidence ever been published in a peer-reviewed medical journal?

3. Or are you relying on information from drug company representatives?

4. Do you have any financial ties with the company that makes this drug?

Polypharmacy is a real concern in a medical industry that simply prescribes a drug for every little malady. The author mentions the tale of a 50 year old woman who was on eighteen different medications for a variety of ailments, and as a result could barely get around, was constantly dizzy, and could hardly stand up. This is a problem! According to the author, "What she probably needed was less medication and more medical attention. Experienced specialists are familiar with this phenomenon of overmedication and often start their evaluation of a patient who is not doing well on multiple drugs by eliminating most of the medications. Frequently, the patient improves."

You are being lied to by the drug companies. They are not honest and they do not care about you. They aren't even innovative! As Dr. Angell explains, "Over the four years beginning in 2000, there were just 32 innovative drugs out of a total of 314 approved drugs." This is not the first book about the pharmaceutical industry that I have reviewed for this blog; in fact, I have reviewed several. Every book highlights something new for me, and I appreciate the perspective of someone who has both treated patients and reviewed clinical trial data for a prestigious medical journal. This book is worth reading, and I encourage you to draw your own conclusions.