I agree.  But I also mistrust big business as much as the government! I
realize the high cost of research, and the costs of bringing new drugs to
market, but I also know that the cost of pharmaceuticals are driven by
whatever the market will bear.  I wish I knew the answer to the dilemna many
face.  The wealthy can afford the drugs, and the poor are usually covered by
Medicaid.  Those in the middle bear the brunt of it. Again, I wish I knew
the answer.

Dennis

my point was that repugnicans tout is as a "benefit" when it's
clearly not a benefit to anyone except their corporate friends.

and expect to get re-elected because of it.

from the NY Times

A CONVERSATION WITH | MARCIA ANGELL
A Doctor Puts the Drug Industry Under a Microscope
By CLAUDIA DREIFUS

Published: September 14, 2004

ASHINGTON - In many ways, Dr. Marcia Angell is an unlikely muckraker. A
pathologist by training, she is the former editor in chief of The New
England Journal of Medicine. She is also a senior lecturer at Harvard
Medical School.

But just days short of her 65th birthday and her first Social Security
check, Dr. Angell is taking on the American pharmaceutical industry with a
new book, "The Truth About the Drug Companies: How They Deceive Us and What
to Do About It" (Random House)."I don't worry about labels," Dr. Angell said
in an interview at the Hotel Monaco, where she stopped during a book tour.

In a 1996 book, she noted, she argued "that there wasn't a shred of evidence
that the breast implants were causing all the disease they were said to."

"I was said to be a tool of the pharmaceutical and device companies," Dr.
Angell recalled. "I call them as I see them."

Q. Why produce an investigative book on the pharmaceutical industry?

A. Because everyone knows that prescription drug prices are sky-high.
Americans pay far more for our drugs than people in other countries. The
drug companies say, "We need high prices to cover our staggering research
and development costs, and if you do anything to squeeze our prices, it will
stifle innovation." The book was written to examine that argument.

Q. The pharmaceutical companies say their prices are steep because they
spend somewhere in the neighborhood of a billion dollars per drug bringing
them to market. Did your research support this assertion?

A. A group of economists - mainly funded by the drug companies - came up
with the widely quoted figure on this. They said that it cost $802 million
to bring a drug out. They, however, were looking at the most expensive drugs
to develop: new chemical compounds developed entirely in house. Most new
drugs aren't that at all. Most are what people call "me too" drugs, which
are slight variations of older drugs already being sold.

According to these economists, the real cost of bringing out those rare
original drugs is actually around $403 million. But they doubled it by
factoring in how much money the companies might have earned if they'd
invested that $403 million. Moreover, the economists did not figure into
their total the many generous tax breaks these companies receive for doing
research and development. This is a highly inflated figure.

The fact is that for the last two decades the drug companies have been
hugely profitable. Last year there was a little wiggle downward, but in
2002, the 10 biggest American drug companies had a median profit of 17
percent of sales compared to a median of 3 percent for the other Fortune 500
companies. In the 1990's, profits ran between 19 and 25 percent. Prices are
high to keep profits high.

Q. Exactly what are these "me too" drugs you argue against?

A. They are minor variations of old drugs already on the market. Sometimes a
company creates a "me too" drug as a way of extending a patent on an older
one. For example, AstraZeneca created Nexium to replace the virtually
identical Prilosec when its patent was about to expire. By putting out these
me-too's, the companies can get new exclusive marketing rights on what are
essentially the same old drugs.

Other companies come in with their own me-too's because markets are
expandable. It's been shown that when you advertise one me-too drug, you
increase the sales of all of them.

Q. Why do you have a problem with this?

A. The prevalence of the me-too's really says an awful lot about the lack of
innovation within the pharmaceutical industry. If you look at the new drugs
marketed over the last six years, 78 percent weren't even new chemical
compounds. They were just new combinations or different formulations of old
drugs. And 68 percent were classified by the F.D.A. as unlikely to be
improvements over drugs already on pharmacy shelves.

At the same time, there are shortages of some important drugs that the
pharmaceutical companies aren't much interested in making because they are
not as profitable as the me-too's. But the companies don't have to turn out
needed drugs, if they are not lucrative. And they don't.

Q. How much of the high cost of drugs is the result of marketing and sales
expenditures?

A. The companies spend over 30 percent of their revenues on marketing and
administration. Their marketing budgets are so enormous because they have to
persuade doctors and patients to prescribe one me-too drug over another. If
you had a truly innovative drug - a cure for cancer, for instance - you
wouldn't have to market it much. The world would beat a path to your door.

Q. Was there anything in your life that pushed you to write this book?

A. As a journal editor, I witnessed a disturbing trend in pharmaceutical
research. Twenty years ago, most drug trials were conducted at academic
medical centers and the pharmaceutical companies tended to stand back during
the testing period. However, in recent years, the companies have succeeded
in attaching strings to research contracts, often designing the studies
themselves, keeping the data in-house and deciding whether or not to publish
the results. They also began to contract with private research companies for
testing. Moreover, the medical schools and even individual researchers began
to enter into entrepreneurial arrangements with the drug companies.

While all this was occurring, I began to see bias creep into medical
research. And I saw a lot of it. The most obvious example were studies
comparing a new drug to a placebo. That may be enough to get a drug F.D.A.
approval, but it should not be enough for The New England Journal of
Medicine. Doctors don't want to know whether a drug is better than nothing.
They want to know if it's better than what they are already using.

Q. You've written that "because most medical journals are dependent on drug
ads for their survival, it probably also influences what they publish." Were
you speaking of The New England Journal of Medicine there?

A. No. That's because the Journal was virtually unique. We had a real wall
between the advertising people and the editorial offices. But many other
medical journals - and there are thousands of them - are little more than
vehicles for advertisements. Still others, while they are not quite that,
will put out occasional sponsored supplements, which I wouldn't have any
confidence in whatsoever.

Q. You left the editor's chair at The New England Journal of Medicine in
2000. Have there been any big changes there since your departure?

A. There's only one I know of - we had a policy that review articles and
editorials could not be written by anyone with any financial connection to a
company whose product was featured in that article. We said that disclosing
the connection was not enough.

When we printed papers on original research and there were often conflicts
of interests, we published those articles with disclosures. It's my
understanding that the policy on reviews and editorials is no longer in
place. I'm sorry they made that change. But they say it's too hard to find a
prominent author who doesn't have a conflict of interest.

Q. The first phase - the discount card phase - of the new Medicare drug
benefit is about to go into effect. Do you, as a newly minted senior,
believe it will make prescription drugs more affordable?

A. It's not going to have a major effect. These discounts are very small,
maybe 10 to 15 percent. At the rate of inflation of drug prices, they'll be
overtaken in a very short time.

Now, the main Medicare drug benefit that goes into effect in 2006 is
designed to funnel billions of dollars to the pharmaceutical industry. It's
an absolute bonanza for it. The pharmaceutical industry's lobbyists made
certain that the legislation contained a provision barring Medicare from
negotiating drug prices.

Interestingly, the federal government negotiates drug prices for the
Veterans Affairs system and gets very low prices because it is a bulk
purchaser. And Medicare would have been the biggest bulk purchaser of all -
so it could have negotiated very low prices. That provision allows the drug
companies to continue raising their prices faster than the inflation rate,
and the drug benefit will soon become unaffordable.