Dr. Marcia Angell, MD New England Journal of Medicine

In its work of exposing the truth about Joe American, MD and the American medical establishment, Doctor Watch introduces to you an MD who worked for the New England Journal of Medicine for 20 years.

Marcia Angell, MD, former Editor-in-Chief
New England Journal of Medicine

Following is a brief bio of Dr. Angell, a review of her 2008 book called "The Truth About the Drug Companies", a recent interview of Dr. Angell, and the beginning of her report that was published in the Journal of the American Medical Association.

Book Recommendation from Random House, Inc. http://www.randomhouse.com/catalog/display.pperl?isbn=9780375508462
author spotlight by Random House

Former editor-in-chief of The New England Journal of Medicine and now a member of Harvard Medical School’s Department of Social Medicine, Marcia Angell is a nationally recognized authority in the field of health policy and medical ethics and an outspoken critic of the health care system. Time magazine named her one of the twenty-five most influential people in America. Dr. Angell is the author of Science on Trial: The Clash of Medical Evidence and the Law in the Breast Implant Case.

“The Truth About the Drug Companies” by Dr. Angell, MD

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.

Dr. Angell interview by PBS
The entire interview is available at http://www.pbs.org/healthcarecrisis/Exprts_intrvw/m_angell.htm

Are we in a health care crisis?

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 on 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. That could get worse, but the greatest danger is that spending so much money on health care risks the feeling that we somehow have to cut back on access, we have to cut back on availability, we have to cut back on quality because it costs too much. Right now the economy is doing well. We're rolling in money. So we feel, yes, we can have it all. We can put all this money into health care and we can also have patients' rights bills and maybe a pharmaceutical benefit for Medicare patients. But that's going to increase the cost in this system. The only way to both reduce cost and increase access and quality is to change the system, to scrap it and start over.

Toss it out and start over?

Yes, because it's based on a false premise. Our health care system is based on the premise that health care is a commodity like VCRs or computers and that it should be distributed according to the ability to pay in the same way that consumer goods are. That's not what health care should be. Health care is a need; it's not a commodity, and it should be distributed according to need. If you're very sick, you should have a lot of it. If you're not sick, you shouldn't have a lot of it. But this should be seen as a personal, individual need, not as a commodity to be distributed like other marketplace commodities. That is a fundamental mistake in the way this country, and only this country, looks at health care. And that market ideology is what has made the health care system so dreadful, so bad at what it does. Yes, it does do what markets are supposed to do. It expands. That's what markets are supposed to do. And it distributes a good according to the ability to pay. But that sure is not what we want of health care.

What led us to this situation?

It's very American. This is a very capitalistic country with relatively few safety nets as compared with Europe and Canada. It's a cowboy country. It's always been a cowboy country, and health care, as I said, has been seen as just one more commodity and the genius of the marketplace will take care of it. People don't think, "Well, how will that play out? Suppose you're poor and you're sick, what will the marketplace do for you," because if you want a VCR, for example, and you're poor, you don't get it. So you do without a VCR. Are you really going to say that to someone that has a brain tumor? So you do without your brain surgery. And also what markets do is they put out a lot of goods. The consumer pays out of pocket. He or she looks around, looks for a bargain, decides maybe he can't afford a VCR this year, he'll get one next year. Well, imagine you have a brain tumor. You're gonna shop for a bargain? You're gonna say, "Well, I don't want an excellent brain surgeon. I want a mediocre brain surgeon. I want a cheap piece of brain surgery." No. And you can't say, "And I'll wait until next year," either. This is a life and death thing and we ought to treat it that way. We ought to treat it the same way we treat education. You don't personally buy education insurance or your employer doesn't buy you education insurance. It's something that a decent society supplies to everyone..........

For the full version of this PBS interview, visit PBS at
http://www.pbs.org/healthcarecrisis/Exprts_intrvw/m_angell.htm

Report in the Journal of the American Medical Association
JAMA REPORT

Abstract:
OVER THE PAST 2 DECADES, THE PHARMACEUTICAL industry has gained unprecedented control over the evaluation of its own products. Drug companies now finance most clinical research on prescription drugs, and there is mounting evidence that they often skew the research they sponsor to make their drugs look better and safer. Two recent articles underscore the problem: one showed that many publications concerning Merck's rofecoxib that were attributed primarily or solely to academic investigators were actually written by Merck employees or medical publishing companies hired by Merck; the other showed that the company manipulated the data analysis in 2 clinical trials to minimize the increased mortality associated with rofecoxib. Bias in the way industry-sponsored research is conducted and reported is not unusual and by no means limited to Merck…………….(we do not have access to the full report at this time. If you have access to this full report, please share it with us).
Source:
The Journal of the American Medical Association , 2008, 300 (9) : P.1069-1071
ISSN:0098-7484 Language: English

To Your Health!!

Gary Springer,
Author of They're Making You Fat and Sick
Founder of Perfect Health Institute