Marcia Angell

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… (más)

Whatever the pablum peddled by politicians and the media, the public attention span and memory are both short, so it's easy to forget the flap there was in the 1990s about the supposed dangers of silicone breast implants, especially in the wake of the 1992 FDA decision to call a moratorium on the sale and implantation of the devices until their safety could be properly, scientifically established: at first the rumour was that they could cause cancer, but after this nonsense had been laid to rest -- which didn't take long -- the next piece of pseudomedical quackery came along, which was the widespread conviction that they were responsible for the very unpleasant condition called mixed connective tissue disease, a malfunction of the immune system. And this time the rumour must be true, because after all wasn't it being demonstrated time after time in the nation's courts that the lives of poor, defenseless women were being destroyed by these infernal devices . . . with the massive damages awards being levied on the dastardly manufacturers serving as emphasis to the truth of it all?

Well, no. There never was any evidence at all that silicone breast implants represented the slightest health hazard. The "science" produced in court was the kind of stuff Snopes.com was invented to expose. Juries (and judges) were whipped up into hysteria by tort lawyers who realized they could earn themselves enormous fees by playing on people's fears of disease and detestation of ruthless corporations and abjuring any connection with such trivia as facts and reality. As a measure of the virulence of these people, when the first scientific reports came in, from 1994, demonstrating the near certainty that the implants were harmless, not only did the lawsuits continue but also legal attempts were made to silence the scientists who'd done the research! Not only had the inmates taken over the institution, they were being paid handsomely for doing so.

Marcia Angell, who was then Editor of the New England Journal of Medicine, is an excellent teller of this tale of confusion, ignorance, panic and, I'd suggest, criminal abuse of the law. She spells out early on that her own general pre-existing prejudices on approaching the task were those of a liberal feminist, and that some of her preconceptions about the rights and wrongs of the episode were very far from validated: in particular, she reveals that for once the corporations -- companies like Dow Corning, driven into bankruptcy by the fracas -- were the victims. She's right in this, obviously, although it's hard to feel undiluted sympathy for them because they were in good measure responsible for bringing this catastrophe upon themselves: Having grown accustomed, during the years of Genial Uncle Ronnie when human welfare was a distant second to the profits of big business and the greed of the wealthy, to an FDA that was sans teeth, sans eyes, sans taste, sans everything, when David Kessler, appointed by Bush Senior as the FDA's new boss, demanded from the implant manufacturers supportive scientific research to show their products were safe, they essentially didn't bother doing anything -- presumably assuming the silly little man would go away and stop bothering them. In the end, clearly frustrated beyond all bounds of patience and genuinely concerned there might be safety issues lurking behind the manufacturers' inaction, Kessler introduced the moratorium. It was the FDA ban that really opened the floodgates to all the claims of implant-caused illness, because after all the FDA wouldn't have banned them if they weren't really dangerous, would it?

Those of a delicate disposition -- me, for example -- might want to avoid Angell's Chapter Two, which describes the surgical procedures involved in various forms of breast augmentation and then all the many things that can go ruinously wrong with said procedures. I was reading this chapter in a pub in Toronto and was mighty glad I was positioned within easy reach of plenty of stomach-settling beer. (The rest of the pub was watching a World Cup match on t'telly, so assumed my occasional moans and retches were commentary on the state of play.) My only real complaint about the book was that the copy I had was defective, containing at the back a repeat of the first 32pp signature rather than the 32pp that should have been there, containing most of the notes/references, the biblio and, most devastatingly of all, the index. Grr!

Anyway, this is a very good book, and wonderfully readable. Don't be tempted to think its subject is ancient history: although the specifics may have changed a bit, its subject is highly topical in that, at the moment, he have a similar hysterical flap going on over the nonsensical belief that vaccination causes autism . . . to mention just one.… (más)