I began reading The Truth about the Drug Companies as a skeptic of the pharmaceutical industry and its influences upon the healthcare system, because of the prominent conflicts of interests that by nature exist between patients, doctors, insurance companies, and the pharmaceutical industry when monetary incentives are involved. I appreciated being guided through Angell's many examples and arguments, as well as the presentation of her statistical information. However, while the reading contributed to the existing feelings of unease I had about the industry, and added to my knowledge of what is involved in the current power dynamic in America concerning patented drugs, her clear subjectivity, often loaded with dramatic diction, made it difficult for me to completely trust or wholeheartedly believe what she was saying. If anything, it made me even more uncertain of the entire topic. To clarify, I find myself at the end, only a fraction closer to supporting her argument, although I remain on the same side.
Myriad counterarguments came to mind when I was reading; I found myself highlighting and redlining at least 2-3 times a page, at least for the first 30 or so pages. Then, when these counter-arguments were addressed by her later in the book, she often rhetorically presented the topic as a PR gimmick or industry excuse, and then brought home her points that the counterargument was not true and unsubstantiated by the numbers-- which were then laid out. Rarely did she explore the issue further.
I was at a dinner event just today with family friends, a few of whom are a generation older and significantly involved in the pharmaceutical industry; one a C-level executive at a small biotech company. I approached them as a student, and as an individual who has no leverage or conflicting interests, to fact check the book page by page, off the record-- for two hours I read aloud at the table and heard their thoughts. I learned that the story and the dynamic are both not as two-dimensional as I felt she presented; nor is the bottom line exactly where she places it.
It's interesting because afterwards, I can see how some of the same stories told to me from Angell's perspective could be extremely insidious. The individuals I spoke with were people who had spent their entire lives in the pharmaceutical industry-- one woman spends three days out of every week on the other side of the country, away from family, to perform quality assurance and customer service. She told me about how she was interviewing a potential job candidate from another pharmaceutical company: when she was presenting the company story, she said to the candidate, that her critical care company was about the patients. The candidate responded with flat disbelief, citing how his original company had low profit margins and sold generic drugs, while this company (I'll assign an arbitrary number) maintained 87% profits. For every $13 needed to create a unit, the company would sell for $100. How was this considering patient needs?
I was given a point by point breakdown of the $87 profit. One component I remember in particular is a quirk of customer service: if a client (a doctor) calls the company from miles away and says that his patient is struggling and needs the inhalant immediately, the company sends it to him express, at no additional charge, in under two hours-- a service executable from any facility in the continental US. She has received handwritten thank you notes from many doctors, who have through this call managed to save lives. The cost of this express shipping is ~$20. This cuts directly into the profits for this unit; an often event in this company, specializing in critical care. Several other similar actions, including sending trained, highly paid, college-educated employees to explain the drug in person at the hospital, giving information not on the outside labeling to doctors, are also a part of the company's customer service. These services are not a part of any public advertisement or promotion, but are a given customer right whenever the situation arises, no further questions asked.
As this individual shared with her job candidate, not many companies do this-- especially if their profit margin does not allow for it. She related to me that in her opinion, product quality, customer service, and profit are intrinsically linked, and that at its heart, every corporation begins under the same umbrella of looking after their best interests.
A second person presented a hypothetical situation: if a drug costs $8 to produce, but attains a market value of $300, the first reaction from a consumer might be anger. However, the pricing is balanced by the insurance companies-- it is only able to be $300, if the health complications, quality of life, and other related factors would have ballooned the cost for the insurance company's coverage to $600. While it appears as if the company is taking way too much, in fact they could ask more, and secondly, that they are actually in the process of driving the prices down.
To end this post: some of the claims I list here are hard to present concisely and concretely without the numbers and the facts. I can write a little more on the topic with more specific industry examples, but would vertically stretch this post even further past the word limit. What I gained from this overall introductory experience was the opinion that each of the conflicting voices must be heard and counterbalanced for the system to work functionally, to the advantage of all. I understood that Angell's book works in favor and defense of the victims of the system, but wish that it was written in a more moderate and less subjective tone both, with more material from the opposition. There was a lot of needless drama that read to me as propagandistic and detracting from the substance of her worthwhile cause.
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