The Truth About the Drug Companies
How They Deceive Us and What to Do About It
By Marcia Angell
Random House
HC, 336 pages US$24.95
ISBN: 0-3755-0846-5

The demonization of a life-saving industry 

By Dr. Elizabeth M. Whelan
web posted November 22, 2004

America's pharmaceutical industry is under attack. Critics have
pejoratively nicknamed the industry "Big Pharma" (to conjure up
an image of it being in a line-up next to "Big Tobacco") and
characterize it as uncaring, duplicitous, profit-hungry and
manipulative. The resentment of the industry is palpable --
whether in my own conversations with relatives and friends
(particularly elderly and/or infirm ones) or in Congress, where
advocates are demanding the legalization of drug importation
from Canada and elsewhere in a desperate (and in the long run,
futile) attempt to bring prices down.

Perhaps nowhere does the strident criticism of the industry come
together in a "perfect storm" as it does in Dr. Marcia Angell's
recent book, The Truth About Drug Companies: How They
Deceive Us and What to Do About It.

Angell comes to this attack with impeccable credentials. She
spent years as editor of the prestigious New England Journal of
Medicine, and for that reason alone, she is a force to be
reckoned with. Her take-home message is that Big Pharma is
depriving poor and middle-class citizens of the life-saving, life-
enhancing drugs that they deserve by charging exorbitant fees
and making people choose between having food in the
refrigerator or medicine in the cabinet.

Further, she argues that the industry, which describes itself as
innovative and research and development oriented actually
produces few new drugs, only pumping out "me too" or copy cat
versions. Dr. Angell recommends radical measures such as the
government taking over the industry and treating it as a public
utility.

Her arguments, however, are contradictory, inconsistent and
often in error. For example:

She claims in the same breath that a) essential life-saving
medications are withheld from needy people by greedy
companies, and b) people are unnecessarily medicated, that
drugs do not work and there are no truly innovative drugs out
there. Which way is it? Are Rx companies saving lives with
spectacular new drugs or are they not?

She (like most consumers) thinks drugs are different from any
other consumer product. They are an "entitlement," because they
are essential to life and health.

But why are pharmaceuticals not like other consumer products?
Housing and food are essential for life -- is it the right of
everyone to have these at below-market prices? Certainly, our
society has a "safety net" for people who truly cannot afford
these basics. What entitles people to expensive pharmaceuticals?
How many older Americans would not think twice about
discretionary spending annually at the rate of $10,000, $20,000
or more for cruises, golf, clothes, dining out or other non-
essential fare but are outraged when they have to spend $5,000
per year on drugs that keep them alive and healthy?

Dr Angell argues that drug company profits are too high and
drugs cost too much.

But in making this argument, she overlooks the importance of
economic incentives for innovation. The "pot of gold" prospect is
what fuels research and development. What is wrong with big
profits if companies are producing drugs that prolong and
enhance our lives? It is a win-win scenario.

When she states drugs are too expensive, the logical follow-up
is, "Too expensive compared to what?" Premature death?
Weeks or months of hospitalization? Pain and suffering let's say
from osteoarthritis?

She claims that there are no new drugs coming to market—that
they are all copycat drugs. This simply is not true. In the past 10
years, over 300 new drugs have been approved by FDA,
including vaccines, medicines to treat AIDS, modest steps
toward treating Alzheimer's, a spectrum of anti-depressants and
of course miraculous cholesterol-lowering drugs.

Most incredible perhaps is the fact that Dr. Angell maintains that
importing drugs from Canada and elsewhere pose no health
risks. At best this is just plain naïve. Just last week, there was a
warning from acting FDA Director Lester Crawford about the
possibility of terrorists using contaminated pharmaceuticals as a
weapon against us. That should cause everyone to reflect on the
real risks associated with importing less expensive prescription
drugs, which claim to be "from Canada" but could be from
anywhere.

Her final rallying call is that we would be all better off if
pharmaceutical research and development were taken over by
the government, or if, we at least put in national price controls to
keep prices down. I wonder if Dr. Angell knows how many new
drugs countries with price controls like Canada put on the
market each year. The answer is none.

Price controls or nationalization of the industry would be
equivalent to morphing the current energetic, innovative,
productive private-sector drug industry (think FedEx) into the Rx
equivalent of the U.S. Post Office.

Random House, the publisher, has declared this to be a "deeply
unsettling book." I agree. It has great potential for destroying the
goose laying the golden Rx eggs.

Dr. Elizabeth M. Whelan is president of the American Council
on Science and Health (see ACSH.org and the blog
HealthFactsAndFears.com)

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