review of
Marcia Angell, M.D.'s The Truth About the Drug Companies - How They Deceive Us and What to do About It
by tENTATIVELY, a cONVENIENCE - December 25-27, 2020

For the full review: https://www.goodreads.com/story/show/1319242-big-pharma

One of the many things that I've found annoying about the pseudo-dialog around what I call the PANDEMIC PANIC, the discussion about what's 'real' & what's a media-fabrication regarding COVID-19, has been some people's asking for "the science" that supports any position taken contrary to the mainstream narrative. This isn't because I'm opposed to science, although I do find it as potentially fallible as anything else, but because the people asking for it haven't generally, in my experience, much notion of what science is - nor wd they truly understand any science that they might encounter.

In other words, again in my personal experience, the people asking for "the science": 1. aren't scientists, 2. aren't intellectuals, 3. don't even read bks - except for, perhaps, the occasional thriller or bk relevant to some subcultural concern such as bike-riding. Nor are they people likely to've ever asked for "the science" to support much of anything else they've ever encountered in their life. Nor wd they be able to explain "the science" that backs what're hypothetically 'their own' positions on anything. The responsibility is solely on the person whose opinion they're attacking to 'prove' w/ "the science" that what they're saying is 'true'.

I, on the other hand, am a person who not only reads bks (thousands of them), but also writes bks (15 to date); who watches documentaries, & also makes documentaries (hundreds of them to date); & someone who writes & publishes criticism (something like 1,500 pieces to date). As such, I can easily demonstrate actual experience w/ critical thinking that the people asking for "the science" can't. At best, they can quote talking points from a radio program that they heard. Because they have other friends who heard the same program or something similar & because these friends can also paraphrase from these programs this parroting takes on a 'reality' to them.

W/ all this, & more, in mind, I've been accumulating bks that address medical science issues w/ the intention of actually reading them & quoting them & writing about them. Some of these bks, such as this one, are too based in commonly acccepted scientific legitimacy for most people to be able to easily dismiss them as somehow 'lunatic fringe' or 'conspiracy theorist'. Others are bks written by people so widely lambasted by what I call Fact Chokers (censors) that I'm curious about what they actually say instead of what people are being told they say in an attempt to discourage readers from finding out for themselves. I may or may not agree w/ them, I won't know until I actually read one of their bks. Finally, at least a few may say things that I find completely egregious & full of hidden agendas.

I decided to start reading these bks w/ this one b/c the title promised to support opinions & observations I already have AND b/c the author is fully credited in the area she's criticizing & is, therefore, difficult for people wanting "the science" to easily write off (w/o being told to do so by the people who tell them what 'to think' in the 1st place).

The author's bio in the back of the bk informs us of the following:

"The former editor in chief of The New England Journal of Medicine and a physician trained in both internal medicine and pathology, Marica Angell is a nationally recognized authority in the field of health care and an outspoken proponent of medical and pharmaceutical reform. Time magazine named her one of the twenty-five most influential people in America. Dr, Angell is the author of Science on Trial." - p 307

TO BEGIN: READ THIS BOOK, IT'S ABSOLUTELY IMPORTANT.

"Prescription drug costs are indeed high—and rising fast. Americans now spend a staggering $200 billion a year on prescription drugs, and that figure is growing at about 12 percent per year (down from a high of 18 percent in 1999).1" - p xii

"1. There are several sources of statistics on the size and growth of the industry. One is IMS Health (www.imshealth.com), a private company that collects and sells information on the global pharmaceutical industry. See www.imshealth.com/ims/portal/front/articleC/0,2777,6599_3665_41336931,00.html for the $200 billion figure." - p 267

It's important to inform you that everything Angell refers to is reinforced by endnotes that one can use to follow up. Alas, I DID just follow up on that one & got this message: "The page you requested was removed.". Given that this bk was published in 2004, it's no wonder that links might be broken. It's also possible that the recent spate of censorship (worse than any I've previously noted in my life) has something to do w/ it as might litigious behaviors of Big Pharma.

"I witnessed firsthand the influence of the industry on medical research during my two decades at The New England Journal of Medicine. The staple of the journal is research about causes of and treatments for disease. Increasingly, this work is sponsored by drug companies. I saw companies begin to exercise a level of control over the way research is done that was unheard of when I first came to the journal, and the aim was clearly to load the dice to make sure their drugs looked good. As an example, companies would require researchers to compare a new drug with a placebo (sugar pill) instead of with an older drug. That way the new drug would look good even though it might actually be worse than the older one." - p xviii

It's also important to emphasize that this bk is very solid in its presentation of the objectionable practices of Big Pharma. There are, in fact, so many issues brought to light & explained so clearly that this review can only hint at a few that I found most compelling. Again, I encourage the reader of this review to read the entire bk from front-to-back in order to thoroughly understand its well-developed points.

It might help the reader to understand my position here to explain that I don't take medicine except under truly extreme circumstances. I've taken many illegal drugs, esp important being consciousness-expansion drugs (a term I prefer to "psychedelics"). I'm particularly in favor of LSD & mushrooms — but I don't recommend them for everyone & I don't recommend using them frivolously. I also essentially stopped using those decades ago. Otherwise, I don't even take aspirin. I also rarely get headaches, & the worst headaches I've ever gotten have been from stupid excessive use of alcohol (I strongly warn people against hangovers where it hurts to think or move!). It used to be a joke of mine that all drugs that keep politicians alive shd be illegal. That upset some people b/c the implication was that I think medicines shd be illegal & many people I know are very dependent on them.. or at least think they are. Given my objection to a medicated society it was very welcome to me to read Angell's critique of the drug industry. Heroin is definitely a problem (& we can 'thank' Bayer for the early days of that) but pharmaceutical pushers are at least as bad — & they're legal!

"From 1960 to 1980, prescription drug sales were fairly static as a percent of U.S. gross domestic product, but from 1980 to 2000, they tripled. They now stand at more than $200 billion a year.1" - p 3

"1. These figures come from the U.S. Centers for Medicare & Medicaid Services, Office of the Actuary, National Health Statistics Group, Baltimore, Maryland. They were summarized in Cynthia Smith, "Retail Prescription Drug Spending in the National Health Accounts," Health Affairs, January-February 2004, 160." - p 268

That probably wdn't've been online as of the writing of the bk but there's some sort of gateway to it online now: https://www.healthaffairs.org/doi/abs/10.1377/hlthaff.23.1.160 .

Angell starts off w/ some historical philosophizing about how the Reagan presidency inaugurated much of the unrestrained greed of Big Pharma as we know it today. She doesn't however, blame the problem entirely on Republicans, she's quite frank in her look at similarly acting Democrats.

"You could choose to do well or you could choose to do good, but most people who had any choice in the matter thought it difficult to do both. That belief was particularly strong among scientists and other intellectuals. They could choose to live a comfortable but not luxurious life in academia, hoping to do exciting cutting-edge research, or they could "sell out" to industry and do less important but more remunerative work. Starting in the Reagan years and continuing through the 1990s, Americans changed their tune. It became not only reputable to be wealthy, but something close to virtuous. There were "winners" and there were "losers," and the winners were rich and deserved to be." - p 6

Of course, the author is referring to her own professional class here; simultaneously there were punks & anarchists & other 'lunatic fringe' types whose priorities were definitely not w/ getting rich but were instead w/ Truth, Justice, & the Unamerican Way. I was solidly in that camp. How many of us were following legal developments such as what Angell details next I don't know, I certainly wasn't. But the Reagan administration in general was definitely high on the shit list.

"The most important of these laws is known as the Bayh-Dole Act, after its chief sponsors, Senator Birch Bayh (D-Ind.) and Senator Robert Dole (R-Kans). Bayh-Dole enabled universities and small businesses to patent discoveries emanating from research sponsored by the National Institutes of Health (NIH), the major distributor of tax dollars for medical research, and then to grant exclusive licenses to drug companies. Until then, taxpayer-financed discoveries were in the public domain, available to any company that wanted to use them." - p 7

Hhmm.. Taxpayer money pays for research, results enter Public Domain. That seems reasonable to me. But it also seems reasonable for researchers to benefit from their hard work above & beyond just salaries. Surely, a compromise solution cd be reached in wch the research stays in the public domain but the researchers are still rewarded for their exceptional accomplishment. At any rate, the Reagan admin was about benefitting big business, not the public. & the following is still from his January 20, 1981 – January 20, 1989 reign.

"Starting in 1984, with legislation known as the Hatch-Waxman Act, Congress passed another series of laws that were just as big a bonanza for the pharmaceutical industry. These laws extended monopoly rights for brand-name drugs. Exclusivity is the lifeblood of the industry because it means that no other company may sell the same drug for a set period. After exclusive marketing rights expire, copies (called generic drugs) enter the market, and the price usually falls to as little as 20 percent of what it was." - p 9

A justification for the original drug's high price is basically that the drug company had to spend a fortune on R&D (Research & Development). A significant part of this bk is spent debunking that as a PR myth.

"By 1990, the industry had assumed its present contours as a business with unprecedented control over its own fortunes. For example, if it didn't like something about the FDA, the federal agency that's supposed to regulate the industry, it could change it through direct pressure or through its friends in Congress." - p 10

Bypass democratic process anyone? The good ole 'merican way being pay-offs-every-wch-way. Profits before People, eh?

"The fact that Americans pay much more for prescription drugs than Europeans and Canadians is now widely known. As estimated 1 to 2 million Americans buy their medicines from Canadian drugstores over the Internet, despite the fact that in 1987, in response to heavy industry lobbying, a compliant Congress had made it illegal for anyone other than manufacturers to import prescription drugs from other countries." - p 15

I'm reminded of my friend Vermin Supreme ( https://archive.org/details/VerminSupremeHisHumbleBeginnings ), a perpetual candidate for just about any political office that he might be had by, & his proposed Health Plan shd he get into power: a bus ticket to Canada. Yes, for some reason, the Canadian medical system doesn't seem hell-bent on sucking every last asset out of its patients before drugging & starving them to death in a hospice.

Every once in a while, one of these greedy big companies gets caught committing a crime in pursuit of the Great American Dream (getting rich as fuck & not giving a damn about who gets hurt by it) & has to pay the piper - but like all big corporations busted in similar manner they've made so much profit off their crime that the fines, enormous tho they may be, just come out of the profits as an unfortunate expense.

"TAP Pharmaceuticals, for instance, paid $875 million to settle civil and criminal charges of Medicaid and Medicare fraud in the marketing of its prostate cancer drug, Lupron." - p 19

But there're all sorts of shenanigans going on that you're probably not aware of. Have you ever been unwittingly used by a dr in a study w/o realizing that you're a cash cow?

"To get human subjects, drug companies or contract research organizations routinely offer doctors large bonuses (averaging about $7000 per patient in 2001) and sometimes bonuses for rapid enrollment. For example, according to a 2000 Department of Health and Human Services inspector general's report, physicians in one trial were paid $12,000 for each patient enrolled, plus another $30,000 on the enrollment of the sixth patient. One risk of this bounty and bonus system is that it can induce doctors to enroll patients who are not really eligible. For instance, if it means an extra $30,000 to you to enroll a patient in an asthma study, you might very well be tempted to decide your next patient has asthma, whether he does or not ("Sounds like a little wheeze you have there. . . ."). Obviously, if the wrong patients are enrolled, the results of a trial are unreliable, and that is probably often the case." - pp 30-31

Now you don't think that 6th patient enrolled is getting $30,000 too do you? Of course not.. & they're getting hoodwinked into thinking that they're advancing science & not being used for profiteering at the possible expense of their health.

For the full review: https://www.goodreads.com/story/show/1319242-big-pharma ( )

In the five years 1998 through 2002, 415 new drugs were approved by the Food and Drug Administration, of which only 14 percent were truly innovative. A further 9 percent were old drugs that had been changed in some way that made them, in the FDA’s view, significant improvements. And the remaining 77 percent? Incredibly, they were all me-too drugs – classified by the agency as being no better than drugs already on the market to treat the same conditions. Some of these had different chemical compositions from the originals; most did not. But none were considered improvements. So there you have it. Seventy-seven percent of the pharmaceutical industry’s output consisted of leftovers.

Marcia Angell is perhaps best known for her outspoken objections to the use of placebo controls in the testing of low-dose antiretrovirals for the prevention of maternal-fetal transmission of HIV in the developing world during the 90’s. Her now infamous editorial in the New England Journal of Medicine sparked a major controversy, and ultimately resulted in Angell’s retirement from the Journal. In The Truth About the Drug Companies, Angell takes aim at big Pharma and their deceptive practices here at home.

Angell’s primary target here is the R&D myth that drug companies invest billions of dollars into the production of new, life-saving drugs, and that strong patent laws are required in order to protect the ability of Pharma to continue to produce these invaluable outputs. In fact, the largest portion of Pharma’s spending appears to go to marketing, in the form of direct-to-consumer advertising, continuing medical education, and direct-to-physician advertising (often disguised as something else) – all in support of me-too “blockbuster” drugs which offer minimal improvements over already-existing treatments. And at the other end, most of the basic research which goes into the discovery of new molecular entities is funded publicly – through the NIH and non-profit research organizations. Drug companies come in at the back end – buying copyrights to data which was generated through the use of public funds, then patenting the final product and selling drugs back to Americans at outrageous prices.

I have mixed feelings about this book. On the one hand, Angell is preaching to the choir insofar as I tend to agree with her substantive positions regarding industry influence on the medical profession, the testing and marketing of me-too drugs, the invention of new diseases and drug markets, and the unmitigated mess that has been made since the passage of the Bayh-Dole Act and the Medicare Prescription Drug Benefit. On the other hand, I found Angell’s arguments often sloppy and under-cited, with many of her factual claims undermined by her heavy rhetorical style. Much of Angell’s writing comes off as mere vitriol, which is frustrating since although my familiarity with the material helps me to know that she is right, her approach to the topic undermines her credibility – I would imagine especially with those who are inclined to disagree with her or who aren’t as familiar with this literature. There’s no need for the heavy-handed approach Angell takes: truly, the facts can speak for themselves, and her arguments would be better served if she could present them more objectively, and with less exaggeration.

The other big problem with this book (and this is no fault of Angell’s, it is just the natural course of things) is that much of the data is already obsolete. This book was first published in 2004, before we could really see the results of the prescription drug benefit pan out; before the financial collapse in 2008; and before the passage of Obamacare. Given all of the important changes which have been implemented since the writing of this book, many of the arguments bear further scrutiny, and the long-term effects of much legislation is, as of yet, unknown. Ultimately, a book worth reading, but I worry about the effect her tone has on her credibility. ( )

How the medical profession and 'Big Pharma'interact.

Blick in die „Blackbox“: Pharma auf dem Prüfstand

Eine Rezension von Gudrun Kemper

Es gibt sie sicherlich noch, pharmazeutische Firmen mit idealistischen Forschern, die zum Wohle des Menschen arbeiten, das hoffe ich zumindest. Bei Krebspatientinnen wie mir stehen Medikamente hoch im Kurs – versprechen sie doch, den das Leben bedrohenden Zellen wirksam etwas entgegen zu setzen. Die Pharmakonzerne, die diese Medikamente herstellen und vertreiben, hat eine Frau unter die Lupe genommen, die es wissen muss, Marcia Angell.

Die Autorin: Marcia Angell, die bis zu ihrem Eintritt in den Ruhestand im Jahr 2000 Chefredakteurin des New England Journal of Medicine (der übrigens weltweit bedeutendsten medizinischen Fachzeitschrift) war, wurde vom US-Magazin Time im Jahr 2005 zu den 25 einflussreichsten Menschen Amerikas gezählt. Die Pathologin und Internistin ist eine Institution in Sachen „Unabhängigkeit“, aber auch eine exzellente Insiderin.

Das Buch: „Die Wahrheit über die Pharmaindustrie“ (The Truth about the Drug Companies, so der Originaltitel), verlegt bei Random House in USA, erschien nun im Kompart-Verlag, der gesundheitspolitischen „Verlagsschiene“ von AOK und dem „Corporate Publisher“ mit Schwerpunkt im Gesundheitswesen wdv.

Das Vorwort: Prof. Dr. Norbert Schmacke hat die deutsche Ausgabe mit einem kleinen Vorwort versehen. Der Versorgungsforscher von der Universität Bremen fand das Buch so spannend, dass er ihm im Handelsblatt „beinahe-Krimi-Qualität“ zuschrieb.

Das Beispiel USA: Angell zeigt minutiös auf, wie die Pharmaindustrie sich besonders in den vergangenen 20 Jahren von ihrem ursprünglichen Ziel, der Entdeckung und Herstellung nützlicher Medikamente, verabschiedet und Politik und Ärzteschaft fest in den Griff genommen hat. Genau in dieser Zeit sind auch die Preise z.B. für Krebsmedikamente bei uns in astronomische Höhen geklettert.

Was der Markt hergibt: Die Amerikaner ärgern sich zunehmend über „Mondpreise“ für Medikamente, während sie die Kosten für Forschung und Entwicklung kritischer hinterfragen und die Gewinnspannen der Konzerne ins Blickfeld nehmen. Das Gefälle der Medikamentenpreise über nationale Grenzen hinweg zeigt, dass es auch anders geht. Insbesondere ältere Menschen, für die notwendige Medikamente mittlerweile nicht mehr finanzierbar sind, kaufen regelmäßig in kanadischen Apotheken ein, wo die Preise deutlich niedriger sind. Noch dramatischer ist die Situation für die über 45 Millionen Menschen, die in den USA gar nicht krankenversichert sind, ein Trend, der sich, am Rande bemerkt, auch bei uns mit rund 300.000 nicht Krankenversicherten bereits ankündigt.

„Ich-auch“ – keine Innovation in der pipeline? Hohe Arzneimittelkosten werden vielfach mit dem hohen Forschungsaufwand der Pharma begründet. Gewinnversprechender als Innovationen sind jedoch Nachahmerpräparate („Me-Too-Arzneimittel“). Marketingstrategisch treten sie als verbesserte Produkte in Erscheinung. Sind die Patente durch Veränderungen der Verabreichungsform und andere Strategien nicht mehr zu halten, schrauben Generika die Phantasiepreise der Medikamente auf ein realistischeres Maß mit mehr Bezug zu den Herstellungskosten herunter. Wenn das passiert, ist es – im Interesse des Profits – an der Zeit, mit einem geringfügig veränderten Präparat das alte Medikament selbst zu überflügeln und mit aufwändigem Marketing zu platzieren, weil das neue „das Bessere“ ist. Doch ist es das wirklich? Es ist oft schwer, sich hier Klarheit zu verschaffen. Endgültig Aufschluss geben erst Langzeiterfahrungen, in 20 Jahren wissen wir mehr. Dies ist für KrebspatientInnen eine bittere Erkenntnis, denn sie brauchen schnelle Hilfe und haben oftmals keine Zeit.

Die Macht des Geldes: Unabhängige Information zu Medikamenten muss von ausgewiesenen Experten bereitgestellt werden, die selbst keine finanziellen Interessen an der Informationsverbreitung und Vermarktung haben. Ärzte unabhängig auszubilden sei ureigenste Aufgabe medizinischer Fakultäten und ärztlicher Standesorganisationen. Angell vertritt die Auffassung, dass die Macht von „Schlemmen, Schmeicheln und Freundschaft“ und die Macht des Geldes zu Korruption und Missbrauch führen und stellt dar, wie entsprechende Mechanismen funktionieren. Ihre These: „Innovative Medikamente brauchen kein Marketing“.

Marketing vor Forschung oder „Forschung light“: Patente für die vielversprechendsten Substanzen werden in der Regel von Universitäten erworben. In den USA bekommen damit Universitäten – und zum Teil auch Wissenschaftler selbst – ebenfalls einige Krumen vom Kuchen. Bei dem Brustkrebs-Chemotherapeutikum Taxol war es zum Beispiel so. Knapp 30 Jahre wurden vorab an staatlich finanzierter Forschung am National Cancer Institute geleistet, bevor das Patent dafür an Bristol-Myers Squibb ging. Hohe Kosten in der Forschung? Ein riesiger Marketingapparat und viel Getöse um das Image, so Angell. Nicht Forschung und Entwicklung, sondern Profit und Marketing seien ursächlich für exorbitante Arzneimittelpreise. Die Ausgaben im Marketing übersteigen bei weitem die Kosten für Forschung und Entwicklung, wo die Industrie unzweifelhaft dennoch eine wertvolle Funktion erfüllt: Auch wenn einzelne Konzerne selbst keine neuen Wirkstoffe entdecken, entwickeln sie diese – durch klinische Studien z.B. – weiter und bringen sie auf den Markt.

Klinische Studien brauchen „Probanden“, also freiwillige Versuchspersonen. Bei der Suche kommen auch Selbsthilfegruppen ins Visier, denn nicht die amerikanische Arzneimittelzulassungsbehörde FDA, sondern die knappen Ressourcen an Probanden sind der Hauptgrund, warum die Markteinführung neuer Produkte sich verzögert. 2001 erhielten Ärzte in den USA im Durchschnitt 7.000 Dollar je eingeschriebener Versuchsperson.

Auch die Praxis, dass Pharmakonzerne die klinische Prüfung ihrer eigenen Medikamente überwachen, führe zur einseitigen Forschung zugunsten der Geldgeber, konstatiert Angell. Sie fordert die Übernahme und Überwachung der klinischen Studien durch eine staatliche Behörde. Klinische Studien seien zu wichtig, um sie von privaten Vertragsunternehmen allein durchführen zu lassen. Vorsicht in Sachen „Unabhängigkeit“ ist aber auch geboten, wenn Staat allein gemeint ist. Wissenschaft im unabhängigen „akademischen Umfeld“ stellt hier die notwendige Balance her.

Ist die FDA nicht unabhängig? Angell fordert die finanzielle Stärkung der Unabhängigkeit der Arzneimittelzulassungsbehörde FDA, damit sie ihre Aufgabe wahrnehmen kann, der Allgemeinheit in Sachen Medikamentensicherheit, Überwachung von Produktionsanlagen und wahrheitsgemäßer Werbung zu dienen. Dem steht entgegen, dass ausgerechnet die FDA durch Nutzungsgebühren „auf der Gehaltsliste der Industrie“ und damit in einem schweren Interessenkonflikt steht. Sie warnt, dass die Geschwindigkeit bei der Zulassung zu Lasten der Sicherheit gehen kann und fordert strikt, dass auch die FDA-Mitarbeiter keine finanziellen Verbindungen zur Industrie haben.

„Öffnet die Blackbox!“ Was Angell beklagt, sind Ausbeutung der Allgemeinheit durch wuchernde Arzneimittelpreise und erhebliche Transparenzmängel. Die Öffentlichkeit habe das Recht zu erfahren, wie hoch die Gewinnspanne ist und wohin die Gewinne fließen. Wie alle anderen Beteiligten im Gesundheitswesen schuldet die Industrie der Öffentlichkeit, so macht Angell eindringlich klar, die vollständige Rechenschaft, wie sie ihre gewaltigen Einnahmen verwendet.

Die Botschaft aus Marcia Angells Erkenntnissen ist unüberhörbar und fordert aus meiner Sicht als Konsumentin für ein menschengerechtes Gesundheitssystem, dass nicht nur die Menschen in unserer „modernen Konsumgesellschaft“ grundlegende Reformen – etwa im Gesundheitswesen – erdulden müssen, sondern dass dringlichst auch die Industrie – hier die Pharmaindustrie – an der Reihe ist, ihren adäquaten Beitrag für diese Gesellschaft, von der sie lebt, zu leisten.

Keine Konsumgüter wie andere auch: Medikamente sind etwas anderes. Übermedikalisierung, Multimedikation, Medikamentensucht, und dennoch: Von geeigneten Medikamenten hängen Gesundheit und Leben vieler Menschen ab. Wir brauchen Medikamente zum Leben. Sie sind keine normalen Konsumgüter, die wir nur konsumieren wollen und auf die wir einfach verzichten könnten, wenn sie unbezahlbar werden. Die ethische Dimension und Verpflichtung im Dienste von Menschen sind das, was fehlt – oder zumindest vernachlässigt wird –, trotz der Errungenschaften im Hinblick auf neue medikamentöse Therapien.

Das lesenswerte Buch bietet auch Frauen, die sich im gesundheitspolitischen Umfeld – z.B. rund um Brustkrebs – oder in anderen Frauengesundheitsorganisationen engagieren möchten, einen globaleren Überblick. Es erweitert den Horizont über die schöne Welt der Fachkongresse hinaus und regt ein kritischeres Bewusstsein zu den Pharmafirmen an, die Medikamente entwickeln, herstellen und auf den Markt bringen.

Diese Rezension ist auch erschienen in AKF-Info, (1) 2006 ( )

Mostly concerend with shock value, but most of us are unshockable with regard to Rx companies. ( )