Pharmaceutical companies have too much influence over the education of physicians in this country. They have too much control over the evaluation of their own products, and that's a conflict of interest. I think the industry needs to be regulated, but I've never suggested taking it out of the market altogether.

Marcia Angell

Categorized in : Thinking Country Conflict

It is simply no longer possible to believe much of the clinical research that is published, or to rely on the judgment of trusted physicians or authoritative medical guidelines. I take no pleasure in this conclusion, which I reached slowly and reluctantly over my two decades as an editor of The New England Journal of Medicine.

Marcia Angell

editors two believe

Over the past two decades the pharmaceutical industry has moved very far from its original high purpose of discovering and producing useful new drugs. Now primarily a marketing machine to sell drugs of dubious benefit, this industry uses its wealth and power to co-opt every institution that might stand in its way, including the US Congress, the FDA, academic medical centers, and the medical profession itself.

Marcia Angell

fda two past

Consider the clinicaltrials by which drugs are tested in human subjects.5 Before a new drug can enter the market, its manufacturer must sponsor clinicaltrials to show the Food and Drug Administration that the drug is safe and effective, usually as compared with a placebo or dummy pill. The results of all the trials (there may be many) are submitted to the FDA, and if one or two trials are positive—that is, they show effectiveness without serious risk—the drug is usually approved, even if all the other trials are negative.

Marcia Angell

fda effectiveness two

A review of seventy-four clinical trials of antidepressants, for example, found that thirty-seven of thirty-eight positive studies [that praised the drugs] were published. But of the thirty-six negative studies, thirty-three were either not published or published in a form that conveyed a positive outcome.

Marcia Angell

eight drug negative

It is time for the scientific community to stop giving alternative medicine a free ride There cannot be two kinds of medicine — conventional and alternative. There is only medicine that has been adequately tested and medicine that has not, medicine that works and medicine that may or may not work. Once a treatment has been tested rigorously, it no longer matters whether it was considered alternative at the outset. If it is found to be reasonably safe and effective, it will be accepted.

Marcia Angell

medicine giving two

In economic terms, health care is a highly successful industry - profitable, growing, and virtually recession-proof - but it's a massive burden on the rest of the economy.

Marcia Angell

growing care successful

Drug companies say they need to charge ever-higher prices to cover their research costs, but they spend far less on research and development than they do on marketing and administration, and afterwards they actually keep more in profits.

Marcia Angell

research-and-development marketing drug

The United States is the only advanced country that permits the pharmaceutical industry to charge exactly what the market will bear, whatever it wants.

Marcia Angell

united-states bears country

Illness and death are not optional. Patients have a right to determine how they approach them.

Marcia Angell

illness-and-death approach patient

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.

Marcia Angell

sick should-have needs

The pharmaceutical industry isn't the only place where there's waste and inefficiency and profiteering. That happens in much of the rest of the health care industry.

Marcia Angell

inefficiency waste care

Why should anyone - the state, the medical profession, or anyone else - presume to tell someone else how much suffering they must endure as their life is ending?

Marcia Angell

medical-profession suffering life-is

Alternative medicine plays into this exaggerated notion that you can prevent disease simply by doing the right thing.

Marcia Angell

medicine alternatives play

The use of psychoactive drugs - including both antidepressants and antipsychotics - has exploded...[yet] 'the tally of those who are disabled...increased nearly two and a half times.

Marcia Angell

half-time drug two

Few things a doctor does are more important than relieving pain. . . pain is soul destroying. No patient should have to endure intense pain unnecessarily. The quality of mercy is essential to the practice of medicine; here, of all places, it should not be strained.

Marcia Angell

pain practice should-have

We should be willing to spend the money in return for the innovation.

Marcia Angell

innovation

You see that the people who are drawn to alternative medicine are often fairly healthy and they go to alternative medicine for what I call the 'symptoms of life.' Fatigue, joint pains, inability to concentrate, perhaps, the kinds of things that anyone over twenty-five gets at some point.

Marcia Angell

medicine pain people

There is something so biologically implausible that your attitude is going to cure a disease. Theres a tremendous arrogance to imagine that your mind is all that powerful.

Marcia Angell

arrogance powerful attitude

Brand-name drugs have no competition, since the government grants them very long, exclusive marketing rights.

Marcia Angell

government rights names

The pharmaceutical industry likes to depict itself as a research-based industry, as the source of innovative drugs. Nothing could be further from the truth. This is their incredible PR and their nerve.

Marcia Angell

nerves drug likes