‘The Truth about the Drug Companies: How They Deceive Us and What to Do About It’
By Marcia Angell, M.D.
Random House, 2004
Hardcover, 336 pp., $24.95The U.S. health care system means misery for many, abundance for others. Parts of the story are easily told: low life expectancy and high infant mortality for the poor and racially oppressed, and millions who are uninsured or have poor coverage. But to categorize the system’s benefits and gains takes some effort, because wealth, profiteering, and privilege often skulk behind closed doors. The pharmaceutical industry, however, is an exception. Its desecration of the public interest is writ large.

In her recent book “The Truth about the Drug Companies,” Marcia Angell lays the whole story out in a clear, easily read fashion. Her achievement is to have breathed new life into the muckraker tradition pioneered by Upton Sinclair (“The Jungle,” 1906). Her book is essential reading for anyone engaged in, or thinking about, the fight for universal health care.

She brings authority to her task. As editor of the New England Journal of Medicine for 20 years, Angell monitored changes in medical practice, research developments, and drug company inroads into the nation’s political, scientific, and huckstering discourse. In her book, she covers these areas.

To justify high prices, the drug industry exaggerates both its research innovations and risks. Of the 78 drugs approved by the Food and Drug Administration in 2002, only 17 contained new ingredients. Only seven represented therapeutic advances, and major U.S. corporations produced none of them. U.S. companies specialize in “me-too” drugs for replacing those drugs that are about to lose patent protection.

• In 2002, 13 percent of the industry’s income went for research, much of it to pay physician “thought leaders” who perform fake research aimed at recruiting patients and who push for unapproved uses for approved drugs.

• The Bayh-Dole law of 1980 enabled universities, scientists, and corporations to patent discoveries emanating from publicly funded research. Drug companies gained exclusive marketing rights in return for royalty payments. Universities now are dependent upon drug company largesse, and moonlighting academicians grow rich.

• A lot of the research produced by drug companies is unreliable. The conclusions too often favor company products. Negative results go unpublished. Adverse drug reactions remain secret. Violating standard research methods, the companies often compare “me-too” drugs with placebo (“sugar pills”) rather than with other drugs already in use.

• Behind the façade of education, drug companies spend much of their $54 billion marketing outlay on physicians, paying for their continuing education and bestowing “food, flattery, and friendship” upon doctors.

Angell highlights monstrous contradictions. Drug sales rose from $40 billion in 1990 to $205 billion in 2004. In 2003 health care costs consumed 15.3 percent of the U.S. GNP; in Canada, 9.5 percent of its GNP. Yet health statistics continue their downward trajectory.

Profits consumed 17 percent of the industry’s revenue in 2002 and 10 drug corporations on the Fortune 500 list took in $35.9 billion, while 490 others divided up $33.7 billion. And the costs of health insurance are astronomical. Twenty-five percent of U.S. older people cannot afford to fill prescriptions. Supplies of childhood vaccines fall short because company resources are directed towards drugs that are likely to be profitable.

Angell concludes with a few remedial suggestions, new regulatory measures, for example, and changes in medical education. But she relies mainly on the persuasiveness of aroused individual citizens. “This is where you come in,” she declares. “Your representatives will not deviate much from the industry script unless you force them to.”

She notes that “what finally matters most is concerted public pressure.” The author is short, however, on specific strategies, and her good intentions seem to fall into the realm of wishful thinking. In contrast, Victor Navarro (“Dangerous to your Health: Capitalism in Health Care,” Monthly Review Press) looked at the experience of rich, industrialized nations and found that for a universal health care plan to materialize, the ground must be prepared by a working people’s party and strong labor movement.

It’s the job of united popular forces to turn the health care system around, and in the process bring the drug companies to heel. Marcia Angell’s contribution stops at having provided activists with a useful tool: “I have tried to arm you with the facts.”