Hat-tip to Ross at the Bloviator for this one. I know I promised that I’d try to stop writing about pharma, but….. a synopsis of her thesis. Nothing here that you wouldn’t know if you’d been observing the industry for 20 years, but really interesting to see so may arguments put together in one place. Her main thrust is that:

Marcia Angell, former editor of NEJM has been working away on a damning book about big pharma. Her long article is presumably

a) Pharma is not innovative (mostly gets its products from NIH backed research, and from smaller biotech) b) The big money is spent on marketing not R&D c) They use monopoly protection to continually increase prices d) Pharma buys protection by huge contributions to politicians e) The major players are not trying to innovate their way out of the current situation

How is the pharmaceutical industry responding to its difficulties? One could hope drug companies would decide to make some changes—trim their prices, or at least make them more equitable, and put more of their money into trying to discover genuinely innovative drugs, instead of just talking about it. But that is not what is happening. Instead, drug companies are doing more of what got them into this situation. They are marketing their me-too drugs even more relentlessly. They are pushing even harder to extend their monopolies on top-selling drugs. And they are pouring more money into lobbying and political campaigns. As for innovation, they are still waiting for Godot.

Angell’s book is presumably going to be a hatchet job (albeit a justifiable hatchet job) on the industry. Her explicit intention is to make what insiders and observers know about the industry well understood amongst the public, hoping to get the political winds to change and reform the industry.

These are just two of many reforms I advocate in my book. Some of the others have to do with breaking the dependence of the medical profession on the industry and with the inappropriate control drug companies have over the evaluation of their own products. The sort of thoroughgoing changes required will take government action, which in turn will require strong public pressure. It will be tough. Drug companies have the largest lobby in Washington, and they give copiously to political campaigns. Legislators are now so beholden to the pharmaceutical industry that it will be exceedingly difficult to break its lock on them. But the one thing legislators need more than campaign contributions is votes. That is why citizens should know what is really going on. Contrary to the industry’s public relations, they don’t get what they pay for. The fact is that this industry is taking us for a ride, and there will be no real reform without an aroused and determined public to make it happen.

So what’s the likely impact of this book? There have been similar screeds about the pharma industry for over 20 years, many coming from academic docs like Angell. They’ve had zero impact on the industry or on its relationship with non-academic physicians. What may be different this time is that the polls are now showing the decline in the industry’s public image happening at a time when pipelines are drying up. Meanwhile the genomic and information revolutions are going to allow much better tracking and understanding of what drug works on whom. That in turn will begin to make more inevitable demands from payers for better understanding of what they are buying when they pay so much for drugs. So perhaps the pressure on pharma will finally be great enough that they’ll be forced into a change one way or another.   Some innovative people in pharma are planning for that day, trying to integrate the desire to intervene in care with the right cost-effective drug at the right time into their R&D activities. (On a personal note, I’m about to start working with a Foundation that is creating partnerships to promote that model). In the end, to paraphrase Craig Ventner, I believe the greatest days of the pill business are actually in front of us.  But they may not be quite so fantastically profitable, and they will probably not look like the business as usual approach that Angell excoriates.  However, this is an industry that is very conservative (big and small Cs). It’s primary need now is to ensure that it goes into the future on terms that are best for it and the system, rather than invite on itself the kind of dramatic regulation and intervention that Americans frankly do poorly.   Like their kissin’ cousins over at the AMA and their obsession with liability caps, PhRMA and its members need to start fighting the right fight, and their obsession with reimportation is not that.