She turns her pen on drug makers

For more than a decade, physician Marcia Angell served as executive editor and then editor in chief of the New England Journal of Medicine, one of the country's most prestigious medical journals. Under her watch, the journal published hundreds of studies of new drugs. It also published blunt editorials harshly critical of the pharmaceutical industry and the way drugs are tested and approved in the United States.

Angell left the journal's editorship in 2000, and is now a senior lecturer at Harvard Medical School. She has written a scathing critique of the pharmaceutical industry, "The Truth About the Drug Companies: How They Deceive Us and What to Do About It" (Random House, 2004). In a recent conversation, she talked about why so many of the drugs on the market are so costly, and also about her contention that many of them are not as effective as they're promoted to be.

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Question: We all know drugs are expensive. But doesn't that reflect the high cost of researching and developing new drugs?

Answer: No. That's what the drug makers would like you to think. But it's simply not true. In 2002, the biggest drug companies spent only about 14% of sales on research and development and 31% on what most of them call marketing and administration. They consistently make more in profits than they spend in R&D. And their profits are immense. In 2002, the combined profits of the 10 drug companies in the Fortune 500 were $35.9 billion. That's more than the profits for all the other 490 business put together, if you subtract losses from gains.

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Q: The system may be flawed, but hasn't it generated hundreds of new medications?

A: That's another myth the drug makers would like you to believe. In fact, the number of truly innovative new drugs is quite small. True, many drugs are coming to market. But most of them aren't new at all. They are minor variations of bestselling drugs that are already on the market.

There are dozens of examples of these "me-too" drugs. There are now six different statins to lower cholesterol. The first, Mevacor, which was approved in 1987, was indeed an innovative drug. Other companies wanted to capitalize on this extremely lucrative market and they began creating other statins. Lipitor is now the biggest-selling drug in the world. But it's a me-too drug. There's little scientific evidence that any of them is better than the others in comparable doses.

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