Sickening

John Abramson’s new book Sickening is in my opinion the best book written to date about the malignant influence of the pharmaceutical industry on American health care. Dr. Abramson is a Harvard professor who studies and teaches health care policy. He attempts to answer the question that has puzzled me: Why does the US, the second wealthiest country in the world (China recently surpassed the US), have the poorest health care as measured by multiple metrics compared to other wealthy countries? In large part, Dr. Abramson blames deregulation of the pharmaceutical industry in the 1970s allowing direct-to-consumer advertising, control of clinical trials by industry with no external access to research data for fact checking, and a prohibition of negotiated drug prices by Medicare and Medicaid. New drugs with marginal and sometimes no advantage over cheap, generic drugs are marketed heavily to the public and to prescribing physicians. Even the prestigious medical journals like the New England Journal of Medicine (NEJM), JAMA, and The Lancet, journals that are preferred for publication of clinical trial results for new drugs, are not able to see the raw data from the clinical trials. They have to take the word of the company authors that the data are accurate and complete, and historically that has not always been the case. Also troubling is that these journals make millions of dollars from publishing the positive results of clinical trials.  How can that be? The drug companies buy reprints of their papers and distribute them to physicians as “education.” The sale of reprints accounted for an estimated $31.7 millions of income in one year for The Lancet. NEJM refused to disclose this information, but it was estimated to be even higher. Dr. Abramson points out that often our lifestyle choices can have a larger impact on our good health than many medications.  Examples include managing and preventing type 2 diabetes, heart disease, and, as I have written in Tattoo, Alzheimer’s disease. “Big Pharma’s intense marketing seduces us into assuming that we can achieve optimal health simply by taking a pill, obscuring the fact that our health is mostly determined not by medical care but how we live our lives.” (Sickening, page 228)