Rich Murray: CIRCARE: Angell & Relman: Wash. Post: pharmaceutical corruption 6.20.1 rmforall

[Guest guest]

Rich Murray: CIRCARE: Angell & Relman: Wash. Post: pharmaceutical

corruption 6.20.1 rmforall

Subject: Former NEJM Journal editors call for congressional

investigation of pharmaceutical industry_WashPost

Date: Wed, 20 Jun 2001 13:11:09 -0400

To: " President W. Bush " ,

" Vice Pres Dick Cheney "

CIRCARE: Citizens for Responsible Care & Research

A Human Rights Organization

Tel: FAX:

veracare@...

Vera Hassner Sharav 142 West End Ave, Suite 28P New York, NY 10023

Writer Adil E. Shamoo, Ph.D. is vice president and co-founder of CIRCARE

Former editors of the New England Journal of Medicine, Marcia Angell

and Arnold Relman call for Congressional hearings to contain abuses by

the pharmaceutical industry whose business interests collide with both

the public interest and the integrity of science.

" The pharmaceutical giants spend two or three times as much on

marketing and administration as they do on R & D,

and their profits are about twice their R & D costs. "

" The number of innovative drugs reaching the market has actually

declined in the past five years. "

~~~~~~~~~~~~~~~~~~~~~

Prescription for Profit

By Marcia Angell and Arnold S. Relman

Washington Post Wednesday, June 20, 2001; Page A27

Few Americans appreciate the full scope and consequences of the

pharmaceutical industry's hold on our health care system. Prescription

drug costs are rising at an unsustainable rate-- 19 percent per year --

and will soon exceed payments to doctors as the largest item

on the health bill after hospital costs.

The drug companies maintain that this is the price of success. They

portray their industry as a highly risky one in a competitive market --

just able to cover its enormous research and development costs but

managing nonetheless to deliver a stream of innovative drugs in the

public interest.

Here are the facts. The pharmaceutical giants spend two or three times

as much on marketing and administration as they do on R & D, and

their profits are about twice their R & D costs. To cite a typical

example, last year GlaxoKline spent 37 percent of its revenues

on marketing and administration and only 14 percent on R & D,

while making a 28 percent profit. Overall, the pharmaceutical

industry is by far the most profitable in the United States.

As for being innovative: Yes, the industry has brought important new

drugs to market over the past few decades, but many of them stemmed

from basic research at the National Institutes of Health or in academic

laboratories supported by the NIH. Others were first developed by

smaller biotech companies and then licensed to the large companies.

It was recently reported that only two of Bristol-Myers Squibb's top

10 drugs were discovered in-house. Moreover, the number of

innovative drugs reaching the market has actually declined

in the past five years.

The pharmaceutical giants are now putting a major part of their

resources into the development and marketing of

" me-too " drugs -- variants of drugs already on the market.

Among many examples, Claritin is one of a number of similar

antihistamines; Zoloft is like many other antidepressants; and

Zocor is just one of a family of cholesterol-lowering drugs. " Me-too "

drugs are relatively easy to develop but require massive promotion

campaigns to attract consumers to a particular brand and persuade

physicians to prescribe one instead of another. Hence, the huge

marketing budgets.

Far from being an exemplar of the free market, the pharmaceutical

industry enjoys many government protections and subsidies. In addition

to benefiting from publicly funded research, drug companies have

low tax rates, because they can deduct their marketing expenses as well

as their research and development costs.

Most important, their drugs enjoy l7-year (or longer) patent

protection. Once a drug is patented and given a brand name,

no one else may sell it, and the company is free to charge whatever

the market will bear without fear of competition from generics.

No wonder drug companies fight to extend the life of their patents

and to obtain new patents for old drugs. That can be done merely

by proposing a new use or a different dosage form, or by

combining two old drugs into a single new pill. The anti-diabetes drug

Glucophage XR, for example, is Bristol-Myers Squibb's newly patented

once-daily replacement for the twice-daily Glucophage, whose patent

expired last fall.

The drug companies devote enormous sums to promoting their interests.

They have the largest lobby in Washington, and contribute copiously to

political campaigns. Half the FDA's budget for the evaluation of new

drugs now comes from drug company users' fees, making the agency

dependent on the industry it regulates -- an obvious conflict of

interest. The industry also spends lavishly to influence doctors,

who write the prescriptions, and medical researchers,

who test the drugs.

Last year drug companies spent more than $8 billion and employed

83,000 sales representatives to woo doctors. They provided them

with gifts, meals and trips, as well as another $8 billion worth of

free drug samples. The companies fund and thereby influence much

of the continuing medical education doctors need to renew their

licenses, and they handsomely support the scientific meetings of

medical societies, where they hawk their wares and often sponsor

their own programs.

The companies also want to influence researchers who test drugs

in human subjects. Increasingly, they are entering into financial

arrangements with academic medical centers and their faculties,

arrangements that threaten the objectivity and credibility of clinical

research. A growing number of drug trials are being managed by

investor-owned businesses that are even more beholden to the

drug companies because the companies are their only clients.

Furthermore, in their contracts with academic researchers, drug

companies now often insist on controlling how the research is done

and reported, and whether the results will even be published at all.

Recently, there have been several widely publicized instances of

drug companies suppressing research results that were

not favorable to their drugs.

Prescription drugs are not like discretionary consumer products. For

millions of patients, they are necessary to health and even survival.

Yet, the drug companies often behave as though their only

responsibility is to their shareholders.

It's time to take a hard look at the pharmaceutical industry and hold

it accountable. This is particularly urgent now, given the move to add

a drug benefit to Medicare. The industry would like to see such a

benefit without any new regulation, but that would cause drug prices

to rise even faster and hand the companies yet another windfall.

Future policy on this and other matters related to prescription drugs

should be based on a thorough understanding of the industry's

behavior, best achieved through in-depth congressional hearings.

We can't think of a more urgent investigative assignment for the

Senate Committee on Health, Education, Labor and Pensions.

Marcia Angell is a senior lecturer and Arnold S. Relman is professor

emeritus at Harvard Medical School. Both are former editors-in-chief of

the New England Journal of Medicine.

© 2001 The Washington Post Company

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Marcia Angell M.D.

Academic Title: Senior Lecturer on Social Medicine

Administrative Title: Not present in entry.

Department: Social Medicine

Address: New England Journ. of Medicine

10 Shattuck St. Boston, MA 02115

Phone: Fax:

Institution: Harvard Medical School

http://www.prospect.org/print/V11/23/angell-m.html

Placebo Politics by Marcia Angell

in The American Prospect Vol. 11, No. 23

Marcia Angell, M.D. is a senior lecturer at Harvard Medical School and

former editor-in-chief of The New England Journal of Medicine.

Vol. 11, No. 14: Conversation: Open Science or Junk Science?

Vol. 5, No. 17: Health Care: Reformers' Rounds Organizing Reform

" The United States is unique in treating health care as a market

commodity distributed according to the ability to pay instead of as

a social good distributed according to medical need.

The fact that the system targets market transactions, not

medical need, is highly inefficient because it requires

constant tinkering to deal with the inevitable result:

People who cannot pay still get sick and need to be taken care of. "

http://aspe.hhs.gov/sp/coi/angell.htm

Remarks of Marcia Angell, M. D. Delivered 8/16/00

at the HHS Conference on Financial Conflicts of Interest

" What about the integrity of the scientific literature?

As Tom Bodenheimer summarized so well at this conference, there is

plenty of good evidence that investigators with financial ties to

companies whose products they are studying are indeed more likely

to publish studies favorable to those products. And in my two decades

at the NEJM, it was my clear impression that papers submitted by

authors with financial conflicts of interest were far more likely to be

biased in both design and interpretation. "

http://www.pbs.org/healthcarecrisis/Exprts_intrvw/m_angell.htm

Marcia Angell " Are we in a health care crisis? " [photo]

" We certainly are in a health care crisis. If we had set out to design

the worst system that we could imagine, we couldn't have

imagined one as bad as we have. Here's a system in which we spend

over twice what the next most expensive country spends on

health care -- that's Switzerland. We spend roughly $4500 for every

American, whether they have insurance or not. Switzerland

spends maybe $2500 for every citizen. Canada spends

maybe $2,000. Great Britain, poor little Great Britain,

spends about $1,000 for every British citizen. And what do

we get for it? What do we get for that $4500? Well, we

certainly don't get our money's worth. We have roughly 43

million people with no insurance whatsoever, and among the

rest of us, many of us are underinsured. That is, we have

shrinking packages. This might be covered, but that won't

be covered.

Our life expectancy is shorter. Our infant mortality is higher.

Our childhood immunization rate is lower. And look at how

often we get to see the doctor, how long we get to stay in

the hospital. Canadians see their doctors far more often

than we do. Americans really can't afford to go see their

doctor. There's always some co-payment, some deductible,

or they have to pay out of pocket, or something isn't

covered. But in Canada, where everybody is covered for

everything, they go to the doctor much more often. When

they are hospitalized, their hospital stays are longer. If

they're having a baby, they get to stay four or five days.

Japan has very long hospital stays. Ah, it's almost a rest

cure. People in Japan who are hospitalized might lie around

the hospital for a week or two just to take a rest. So we're

really not getting our money's worth. It's going to all sorts

of things, but not to doctors and patients.

What are the dangers that we're facing right now?

Well, the danger is that our health care outcomes will start

to drop. As I said, they're not all that good in the

developed world. We're of the 25 richest countries in the

world, we're somewhere around 22-23 in terms of our health. "

http://web.med.harvard.edu/healthcaucus/ac_angell.html

Biographical Sketch of Marcia Angell, M. D., F.A.C.P.

Marcia Angell, M. D., is Senior Lecturer in the Department of Social

Medicine at Harvard Medical School.

She stepped down as Editor-in-Chief of the New England

Journal of Medicine on June 30, 2000.

A graduate of Boston University School of Medicine, she trained

in both internal medicine and anatomic pathology and is a

board-certified pathologist. She joined the editorial staff of the

New England Journal of Medicine in 1979, became Executive

Dr. Angell writes frequently in professional journals and the popular

media on a wide range of topics, particularly medical ethics,

health policy, the nature of medical evidence, the interface of

medicine and the law, and care at the end of life. Her

critically acclaimed book, Science on Trial: The Clash of

Medical Evidence and the Law in the

Breast Implant Case, was published in June, 1996,

by W. W. Norton & Company. In addition, Dr. Angell is

co-author, with Dr. Stanley Robbins and, later, Dr. Vinay Kumar,

of the first three editions of the textbook, Basic Pathology.

She also wrote chapters in several books dealing with ethical issues.

Dr. Angell is a member of the Association of American Physicians, the

Institute of Medicine of the National Academy of the Sciences,

the Alpha Omega Alpha National Honor Medical Society,

and is a Fellow of the American College of Physicians.

In 1997, Time magazine named Marcia Angell

one of the 25 most influential Americans.

Arnold Seymour Relman M.D.

Academic Title: Professor of Medicine, Emeritus

Administrative Title: Not present in entry.

Department: Emeritus

Address: Brigham and Women's Hospital

75 Francis St. Boston, MA 02115

Phone: Fax:

Institution: Brigham and Women's Hospital

**************************************************************

Rich Murray, MA Room For All rmforall@...

1943 Otowi Road, Santa Fe, New Mexico 87505

M.I.T. (physics and history, BA, 1964), Boston U. Graduate School

(psychology, MA, 1967): As a concerned layman, I want to clarify the

aspartame toxicity debate.

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long 40K summary

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http://www.aspartameispoison.com/contents.html 34 chapters

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