Views & Reviews Review of the week

Should we loosen the grip on drug companies?

BMJ 2007; 335 doi: (Published 30 August 2007) Cite this as: BMJ 2007;335:454
  1. Richard Smith, executive director, UnitedHealth Europe, London
  1. richardwsmith{at}

    It costs $40bn a year to produce just a handful of new drugs. Richard Smith reviews a highly publicised new book that claims over-regulation is holding the drug industry back.

    The American drug industry is over-regulated and consequently innovation is stifled and patients are denied drugs that could help them. This conclusion of Richard Epstein, a professor of law from Chicago, in his widely quoted book, probably sounds shocking to many BMJ readers. The more familiar story is that the US Food and Drug Administration (FDA) is in the pay of an industry that makes excessive profits, spends more on marketing than research, produces mostly “me too” drugs, medicalises much of life's problems, and is a malign and excessive influence in all of health care. That story was well told by Marcia Angell, former editor of the New England Journal of Medicine, in her best selling book The Truth about Drug Companies: How They Deceive Us and What to Do About it (review BMJ 2004;329:862 doi: 10.1136/bmj.329.7470.862). Epstein's book might be regarded as the antidote, and he is scornful of what he sees as the shallow thinking of Angell and many other critics of the industry.

    Epstein's book …

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