In a highly favorable review published in Journal of the American Medical Association , Michael Wilkes treats the two books as largely reinforcing each other, with only trivial differences in viewpoints or policy proposals. However, this is a misconception of the situation.
Angell and Kassirer have written different books that are at odds in fundamental ways. She brings to her task a remarkable background as the long-time managing editor and, then, editor of the New England Journal of Medicine.
Angell also possesses formidable skills as a popular writer who can translate difficult material not all of it purely medical into highly accessible prose. Science on Trial is an admirable account of how the tort liability system leveraged what proved to be slipshod science of silicone breast implants into product withdrawals, which was followed by a wave of bankruptcies among firms for which the product was no more than a modestly profitable sideline. Angell devotes considerable attention to pharmaceutical marketing, which she defines broadly to include a multitude of relationships, financial and otherwise, between the industry and the physicians, clinics, and hospitals that are its targets.
Some of this material is intriguing precisely because of its breadth. The extra amounts are presumably spent on continuing medical education, speaker and consultant fees, and myriad other activities that in one way or another induce physicians to favor one brand over another and to inform their colleagues about it.
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She has a point, though she pushes it too far. What she mainly has in mind are clinical trials designed to accustom doctors to prescribing a drug rather than to add to the science base. Perhaps this is common, though hard data are scarce.
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However, I find it difficult to believe that this amounts to much compared with the complex trials that cost tens or hundreds of millions of dollars that are launched to meet Food and Drug Administration FDA standards for approving new drugs or to persuade either the FDA or the medical community to endorse new indications for old drugs. Nonetheless, that marketing and research overlap is undeniable. That research was the first to demonstrate persuasively that reducing serum cholesterol would prevent heart attacks Langreth ; Shephard et al.
This marketing-driven result proved extraordinarily valuable in the treatment of coronary heart disease by all statins, not just Pravachol.
On The Take : How Medicine\\\'s Complicity With Big Business Can Endanger Your Health
Angell dwells at length on the strength and variety of pharmaceutical industry influences on the FDA, academia, government research institutions, and government health care payers. Although these sections are written in a tendentious style, there is nothing wrong with a reminder that pervasive regulation and government funding will eventually entwine private and public parties in what, at times, is a mutually satisfying embrace with scant regard for the welfare of the rest of the world. She argues that most breakthrough drugs are actually developed by the National Institutes of Health NIH and the academic research it supports.
The argument is largely anecdotal, however for a more authoritative treatment of the main examples, which include erythropoietin, a biotechnology treatment sold as Epogen and Procrit for treating the side effects of cancer chemotherapy and kidney dialysis, respectively, and the cancer drug Gleevec, see Goozner She does not address why the NIH fails to command huge license fees, instead often needing to search for takers when promising new drugs are ready for expensive clinical testing at great financial risk.
On The Take : How Medicine\\\'s Complicity With Big Business Can Endanger Your Health 2005
Her sweeping claims include such important therapeutic classes as the statin cholesterol-reducing drugs and the selective serotonin reuptake inhibitor SSRI antidepressants beginning with Prozac , for which follow-on drugs using similar biological mechanisms have been successful even after the pioneers lost patent protection and became available as cheap generics. The obvious question is why even the best-trained physicians and most prestigious clinics persist in prescribing newer statins, SSRIs, and so on.
However, other factors provide better explanations for the prominence of new drugs in old therapeutic classes. Largely developed parallel to rather than in the wake of pioneer drugs, follow-on drugs are usually priced below predecessor brands and rapidly erode the capital value of pioneering brands by stealing market share DiMasi and Paquette ; Lichtenberg and Philipson New brands typically do what marketing theory would predict, which is to cater to patients who are poorly served by existing drugs in terms of efficacy and side effects Lee All this seems more like competition than an assault on consumer welfare.
In addition, follow-on drug research greatly expands the science base, which otherwise would become stagnant as patents on pioneer brands expire. I mentioned research on statins, but that is far from the only example: SSRIs have evolved into tools for exploring the many potential roles of serotonin reuptake Holden , and the Cox-2 inhibitors, including Celebrex and Vioxx before the latter was withdrawn for safety problems that appear to be common to most of the older nonsteroidal anti-inflammatory drugs [Jenkins and Seligman ] are also relevant.
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Nonsteroidal anti-inflammatory drugs include popular over-the-counter drugs, such as ibuprofen sold as Advil and other brands and naproxen sold as Alleve , and a variety of prescription pain relievers for arthritis and other conditions. Kassirer details the shocking extent of these financial enticements and explains how they encourage bias, promote dangerously misleading medical information, raise the cost of medical care, and breed distrust. Among the questionable practices he describes are: the disturbing number of senior academic physicians who have financial arrangements with drug companies; the unregulated "front" organizations that advocate certain drugs; the creation of biased medical education materials by the drug companies themselves; and the use of financially conflicted physicians to write clinical practice guidelines or to testify before the FDA in support of a particular drug.
A brilliant diagnosis of an epidemic of greed, On the Take offers insight into how we can cure the medical profession and restore our trust in doctors and hospitals. Medical Ethics in Applied Ethics. Edit this record.
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Understanding Physician-Pharmaceutical Industry Interactions. In On the Take, Dr. Jerome Kassirer offers an unsettling look at the pervasive payoffs that physicians take from big drug companies and other medical suppliers, arguing that the billion-dollar onslaught of industry money has deflected many physicians' moral compasses and directly impacted the everyday care we receive from the doctors and institutions we trust most.
Underscored by countless chilling untold stories, the book illuminates the financial connections between the wealthy companies that make drugs and the doctors who prescribe them. Kassirer details the shocking extent of these financial enticements and explains how they encourage bias, promote dangerously misleading medical information, raise the cost of medical care, and breed distrust.