Book Review: A Doctor’s Impassioned Critique of Big Pharma

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In “Sickening,” Harvard professor John Abramson chronicles the deceptive marketing practices of the drug industry.


COMPARED TO OTHER high-income countries, the fitness of Americans is in dismal shape — and has been declining for decades. Even before the Covid-19 pandemic accelerated health disparities, crisis on top of crisis has compounded to create even more devastating conditions for a growing number of people, especially marginalized groups. There is the diabetes crisis, the obesity crisis, and, of course, the despair crisis, which includes the rising tide of suicides, alcohol poisoning, and drug overdoses — claiming an average of 70,000 lives annually from 2005 to 2019. Meanwhile, life expectancy in the U.S. trails behind the average for 28 other countries.

According to John Abramson, a health care policy lecturer at Harvard Medical School, the sap of this poisoned tree is so-called Big Pharma, the coalition of drug companies that have structured American health care into a money-generating machine. In “Sickening: How Big Pharma Broke American Health Care and How We Can Repair It,” Abramson sets out to answer the “paradox of American health care,” building his case using the testimony of patients and former drug executives.

In the book, Abramson reveals how doctors are regularly duped into prescribing expensive drugs with extreme side effects while major pharmaceutical companies rake in record profits. Yet recent research suggests that 46 million Americans can’t afford health care. According to a 2020 survey, two-thirds of consumers live in fear of medical bills.

The book is a crash course in the profit-driven systems built by Big Pharma that dominate the U.S. health care industry and how they can cause undue suffering, starting with several recent pharmaceutical scandals that have cost the lives of thousands of Americans while enriching major corporations.

Abramson, who has also worked as a family physician for years, has served as a legal expert in about 15 civil trials involving drugmakers, in which he highlighted the drug industry’s flawed research and shrewd marketing tactics. The first few chapters are sprinkled with dramatic courtroom sequences, demonstrating his long-standing reputation, as writer William Heisel described him in 2009, as an “outspoken critic of the pharmaceutical industry.”

“As an expert in litigation, I have had access to manufacturers’ scientific data as well as their business and marketing plans,” Abramson writes. “These are the pieces of the puzzle that, when put together, show how drug companies convince doctors to prescribe their expensive new drugs even when they offer little or no added value (and sometimes harm) compared to less expensive alternatives.”

In one illuminating scene, Abramson explained to a jury how Pfizer persuaded doctors to overprescribe the epilepsy drug Neurontin (gabapentin) off-label for bipolar disorder. In the late 1990s, Pfizer sponsored numerous swanky dinners and held meetings where the pharmaceutical company presented misleading data showing remarkable improvement. But they withheld data “which had shown the drug was significantly worse than placebo,” Abramson writes.

Pfizer later pleaded guilty to illegally marketing their drug, but the company’s profits from Neurontin only increased. This example — far from an anomaly in the biotechnology sector — demonstrates how deeply corporate interests have infected nearly every aspect of the American medical system, and why it will be so difficult to fix.

Abramson reveals how doctors are regularly duped into prescribing expensive drugs with extreme side effects while major pharmaceutical companies rake in record profits.

At the core of this issue, which the book repeatedly emphasizes, is a corrupted scientific process that drastically needs reform. The peer review process is inherently broken, Abramson writes, at least regarding drug development, chiefly because the raw clinical trial data is kept secret from reviewers and medical journals.

And as an increasing amount of medical research is funded by drug companies, it creates a perverse incentive to develop treatments that are profitable, rather than to “determine optimal care,” he explains. “Without this commitment, the results of clinical research, which are received by physicians and other health care professionals as valid scientific evidence, function as little more than marketing tools.”

It’s little wonder then that drug costs are out of control: The federal government is unable to negotiate lower prices, so drug companies can basically write themselves a blank check. “The United States does not regulate drug prices, and it does not have a national program to determine whether new drugs provide added value that justifies their higher cost,” Abramson writes. A recent report by the RAND Corporation, a nonprofit think tank, found that Americans pay 256 percent more for pharmaceuticals than those in 32 other countries. And clearly, based on the overall decay of our health, he argues, we aren’t getting much in return for these costs…


F. Kaskais Web Guru

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