So Marcia Angell’s talk at the commonwealth Club was all that I expected. She is witty and charming and she really laid into big Pharma. Big pharma to her has no redeeming qualities. Everything they do is wrong and all they do is run biased clinical trials, and pay off the doctors (majority) and the politicians (minorly). A review of her book in the NEJM(BTW you can go to BugmeNot to break into these password protected sites, shh!!) from a Canadian Medical Association doc echoes her points, even though rational people (i.e. me) think that she was a little over the top.

I hope that there is a middle ground. Drugs save huge amounts of other health care costs and they do keep people alive who would otherwise be dead. If you read on in the review you get to this passage.

Angell’s concluding chapter, the least convincing one in an otherwise fascinating and penetrating book, contains the solutions, all of them predictable (and probably unattainable): control me-too drugs, re-empower the FDA, oversee Big Pharma’s clinical research, curb patent length and abuse, keep Big Pharma out of medical education, make company financial statements transparent (so we can tell what the costs of research really are, as distinct from marketing), and impose price controls or guidelines. Granted, the problems are so prevalent and the corporate tentacles so entwined with our way of being that it is hard to see what else to recommend.

But perhaps Angell is right. We must change the way we manage research and the development and distribution of new drugs. Not only are health and health care at risk, but so are the research enterprise and the reputations of universities and governments. The integrity of scientific research is too important to be left to the invisible hand of the marketplace.

The problem is that this logically leads to the idea that the only solution is heavy government regulation or even the total nationalization of the pharma business. Realistically, that’s not going to happen. So if you go to that extreme, all you can expect from pharma is a circling of the wagons and an attempt to keep paying off their servants in Congress and the Administration.

There needs to be a middle way, and I gave some ideas earlier this week about what that looks like. I don’t think Angell’s approach will get us there, even if 90% of what she says is true.