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Usually ships in 1 business days | | | During her two decades at The New England Journal of Medicine, Dr. Marcia Angell had a front-row seat on the appalling spectacle of the pharmaceutical industry. She watched drug companies stray from their original mission of discovering and manufacturing useful drugs and instead become vast marketing machines with unprecedented control over their own fortunes. She saw them gain nearly limitless influence over medical research, education, and how doctors do their jobs. She sympathized as the American public, particularly the elderly, struggled and increasingly failed to meet spiraling prescription drug prices. Now, in this bold, hard-hitting new book, Dr. Angell exposes the shocking truth of what the pharmaceutical industry has become–and argues for essential, long-overdue change.
Currently Americans spend a staggering $200 billion each year on prescription drugs. As Dr. Angell powerfully demonstrates, claims that high drug prices are necessary to fund research and development are unfounded: The truth is that drug companies funnel the bulk of their resources into the marketing of products of dubious benefit. Meanwhile, as profits soar, the companies brazenly use their wealth and power to push their agenda through Congress, the FDA, and academic medical centers.
Zeroing in on hugely successful drugs like AZT (the first drug to treat HIV/AIDS), Taxol (the best-selling cancer drug in history), and the blockbuster allergy drug Claritin, Dr. Angell demonstrates exactly how new products are brought to market. Drug companies, she shows, routinely rely on publicly funded institutions for their basic research; they rig clinical trials to make their products look better than they are; and they use their legions of lawyers to stretch out government-granted exclusive marketing rights for years. They also flood the market with copycat drugs that cost a lot more than the drugs they mimic but are no more effective.
The American pharmaceutical industry needs to be saved, mainly from itself, and Dr. Angell proposes a program of vital reforms, which includes restoring impartiality to clinical research and severing the ties between drug companies and medical education. Written with fierce passion and substantiated with in-depth research, The Truth About the Drug Companies is a searing indictment of an industry that has spun out of control. | | | |
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1 of 2 found the following review helpful:
 Good diagnosis but poor therapy Mar 07, 2008
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.
1 of 1 found the following review helpful:
 An eye opening book which aroused my interest in the whole field Mar 07, 2008
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.
1 of 1 found the following review helpful:
axe to grind Nov 18, 2007
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.
9 of 33 found the following review helpful:
 The truth? Not really... where to even start? Nov 11, 2007
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.
4 of 6 found the following review helpful:
Your Life depends on this information Sep 03, 2007
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.
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