Prescription Games: Money, Ego and Power inside the Global Pharmaceutical IndustryBMJ 2001; 323 doi: https://doi.org/10.1136/bmj.323.7310.458a (Published 25 August 2001) Cite this as: BMJ 2001;323:458
Simon and Schuster, £17.99, pp 343
ISBN 0 684 85837 1
Appraisals of the pharmaceutical world tend to group themselves into heroic chronicles of progress or exposés of an industry that Robinson, in this book, styles Big Pharma. Either way, stereotype replaces reality. Robinson's work, predictably with one reliant on media reports from 1995, brings out nothing new. The usual and expected threats and failures are there: how the third world and unprofitable diseases are ignored; how everything from markets to medical education and research is manipulated; how doctors are offered improper inducements to prescribe or support certain products regardless of cost, relative efficacy, and, sometimes, even of risk.
The author presents himself as a fearless investigator, a daring David exposing the hidden sins and designs of the vast and sinister drug producing monolith. He does this through anecdotes, a series of gee-whiz case studies. Analysis, questioning (which is certainly necessary), and suggestions are, if present at all, largely superficial and definitely melodramatic. The anecdotes almost always are about the bad news. The scarce generalisations are based on this evidence alone.
The only good news reportage is an account of P Roy Vagelos's career with Merck. Vagelos, a headhunted researcher from a poor background who became chairman and chief executive officer, reshaped Merck's research activities and the industry copied. He championed the development of ivermectin (Mectizan) and then its donation to needy countries through the World Health Organization. A parasiticide which eradicates onchocerciasis — river blindness — Mectizan has since been used for lymphatic filariasis (elephantiasis), a fact that Robinson does not report.
While Vagelos was at Merck, the company also provided leadership in the pricing of drugs for third world countries. The story of this episode is paired with a selective and oversimplified telling of the paclitaxel (Taxol) story. Robinson sees the government funded pioneering of Taxol as amounting to a rip off of US tax dollars by Bristol-Myers Squibb, which he claims did not stick fairly to its reasonable price agreement. So while Mectizan has so far saved 25 million from river blindness, Taxol sales in 1999 amounted to £975m. Such simple reportage, however accurate, apparently designed to shame the industry, does not amount to a study or appraisal of drug company philanthropy. For that, serious research would have been required.
There is little doubt, at a time of increasing globalisation, that a serious questioning of Big Pharma would be useful. Unhappily this book does little to advance that questioning. Some serious analysis of finances is required either to support or to refute the companies' arguments for anticompetitive practices such as patents. An assessment of the history of relationships between manufacturers, governments, regulations and laws, various professions, research bodies, and the quality and costs of health would be helpful. How have anticompetitive capitalist practices compared with those in centrally planned economies in the development of beneficial drugs? This book, unfortunately, gives a bare and seriously incomplete sketch of the situation. One wonders, is not the venality Robinson sees everywhere in the drug industry also in evidence in his and his publisher's assessment of their market: are they, too, in it for profit, or as an exercise in philanthropy?
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