Hooked: Ethics, the Medical Profession, and the Pharmaceutical Industry

The kind of book I normally like has lots of car chases, gun fights, and amusing dialog as the good guys and bad guys struggle. This book opens with an amusing "Car Talk" anecdote, but sadly has no gun fights. What it does have is the bizarre and fascinating story of the way the pharmaceutical companies have gotten in bed with the medical establishment. Dr. Brody is a medical ethicist, and he paints a very balanced picture of what's happened since the establishment of "ethical" drugs. I assume if you're academically inclined, you'll be convinced by the evidence presented. It's exhaustive. If you're like me, however, what you really want is an entertaining read that tells you something you really ought to know, mainly that a lot of medical research is profit-driven crap, and that many physicians are prescribing expensive name brand drugs because they're being influenced, although they claim not to be, by their drug reps, or they're simply giving in to patients who have seen an ad on TV for a miracle pill. Although the book for 15 chapters carefully builds the case against the current cozy arrangement between the drug companies and the medical profession, it does so not only in a rigorous manner, but more importantly to readers like me, it sprinkles the chapters with real cases, including dialog from real people that will definitely get your attention. Before the table of contents, the lead quote from a drug company president sets the tone: "If we put horse manure in a capsule, we could sell it to 95% of these doctors." And there are plenty more outrageous statements made by real people. Here's my disclaimer. I knew Dr. Brody as an undergraduate many years ago and I was curious about what he was doing and about this book. I probably wouldn't have purchased it otherwise because I read almost no non-fiction, except work related technical material, far from the medical profession. I don't know any more about drugs and medicine than the next person, although I have been bothered in the past when I signed in at the doctor's office, using a clipboard with a prominent drug displayed on it, and then been prescribed that same drug a half hour later. But I do read the paper, and over the years there have been an awful lot of drug scandals, enough to make you wonder what's going on. A few months ago Merck agreed to pay $4.85 billion to settle thousands of cases of heart attacks and strokes brought on by their painkiller, Vioxx. And a few days after reading the book, Merck agreed to pay $671 million for overcharging government health programs for 4 of their popular drugs, including Vioxx and Pepcid, when it was still a prescription drug. And this is just one drug company. The book lists many examples, sprinkling them in the chapters like short stories from hell. The odds are you've probably taken some of these drugs before. Although suspicious of whether this book was worth my time, in the first chapter I was "hooked" when I read about C

from The NYTimes- April 24, 2007 Medicine and the Drug Industry, a Morality Tale By ABIGAIL ZUGER, M.D. It was in 1949 that Elvin Stakman, president of the American Association for the Advancement of Science, issued the membership their marching orders: "Science cannot stop while ethics catches up." And sure enough, from bombs to clones, the ethicists have generally kept to the rear of the scientific parade: they are the ones with the big brooms trying to restore order after the floats and the elephants go by. Those brooms sweep slowly. Often, by the time the ethicists finish laying out facts and weighing relevant moral values, the worst of any given crisis has passed. But recently, those who work in medicine have moved closer to the fray: they staff acute-care hospitals and monitor events in real time, aiming for a little less retrospective philosophy and a little more damage control. In this proactive spirit Howard Brody, a medical ethicist, has brought his discipline's tools to the relationship between the medical profession and the pharmaceutical industry. This problematic tangle of moral compromise (or triumphant health-promoting collaboration, depending on your point of view) has inspired several polemics by physicians in recent years, all of them straightforward indictments of the pharmaceutical industry and its for-profit webs. Dr. Brody is also a physician, but he aims for the measured cadences of the ethicist instead, calmly laying out the relevant facts and then reasoning from basic principles to determine whether the medicine-pharmaceutical relationship, as it stands now, is an ethical one or not. That Dr. Brody manages to deliver a hundred-odd pages of determinedly objective analysis before he, too, lets the righteous indignation roll should not really be called a failure of methodology: even as he carefully lays out the facts in this impressively comprehensive book, those facts begin to speak damningly for themselves. The small-time operations that grew up into modern medicine and Big Pharma joined together back in the late 19th century, allied in the name of scientific medicine against a variety of dubious health-care entrepreneurs. The A.M.A. actually called the early pharmaceutical companies the "ethical" drug makers, to distinguish them from unscrupulous patent-medicine peddlers. Over time, this casual alliance has been reinforced with such complex and often invisible bonds that, in Dr. Brody's title metaphor, medicine and pharma are now "hooked" like two pieces of Velcro, tethered by a million barbs and as dependent on each other as any addicts are on their substance of choice. Dr. Brody systematically analyzes the levels of connection, from the lowly drug salesman buying lunch for a roomful of medical students (future customers all) to the lucrative contracts and patents that simultaneously fuel medical research, fill corporate coffers and give us, as the industry doggedly and quite correctly points out, dozens of