Marcia Angell has been on a tear lately promoting her new book. She has a brutal interview in the LA Times which essentially summarizes all the complaints about drug companies made in the last decade. Here’s a sample:

Conflicts of interest are rampant. When the New England Journal of Medicine published a study of antidepressants, we didn’t have room to print all the authors’ conflict-of-interest disclosures. We had to refer people to the website. I wrote an editorial for the journal, titled "Is Academic Medicine for Sale?" Someone wrote a letter to the editor that answered the question, "No. The current owner is very happy with it." That sums up the situation nicely.

To my mind pharma companies need to understand two very important points here. First, while a few academics have been complaining about pharma company practices for several years, this is the first time that I remember one book about pharma having such a sustained impact. Angell has already been on 60 Minutes, this interview is not in some minor blog or academic journal, it’s in the main paper in the nation’s second largest metro area, and she’s also had a recent column in the Financial Times. And this is at a time when the reputation of pharma companies is already heading into uncharted low territory amongst the public. Second, pharma needs to both start making some new arguments about what it’s doing and how it’s trying to improve. Big pharma also needs to consider what life might be like in a world where HHS officials have not only decided that they can bargain about the price of the drugs Medicare is paying for, but one in which they’ve read Angell’s book. This is not necessarily a doomsday scenario, but a little bit of "what if" scenario planning wouldn’t hurt big pharma right now.