Hooked Is A Good Read Even For Guys Like Me, February 17, 2008 By Paul Barkley (Washington DC Metro Area) - See all my reviews
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 Claritin, a very common antihistamine that I've taken in the past, and its shady history.
Like a good mystery, I won't spoil the story by explaining what happened with Claritin, but if you've ever taken it, you should read how marketing triumphed over science.
There are a few places in the book where, by necessity, it bogs down a little in setting the next stage for the extended academic treatise that it is. Chapter 2 was the low point for me, but after a few examples in chapter one I already had an idea that the rest of the book would be more entertaining, an admittedly shallow view. In fact after that the book keeps building outrageous case after case, and letting the facts speak for themselves.
In this day and age of hype, both political and marketing, it's hard to read something that is balanced when the conclusion you're being led to is incontrovertible.
So, if you want to learn more about the subject, this is an entertaining book, albeit one that makes some very important points. And if you're a member of the medical or pharmaceutical establishments and you're reading this because it affects your livelihood, then you have all the endnotes and citations that you'd ever need, and I'm pretty sure that Dr. Brody makes his case convincingly.
I can guarantee you that I didn't stop to look up any of the endnotes while reading the book, and I was even a little put off that every chapter had pages of them at the end, but I must admit I couldn't help peeking at some of the longer ones when I found they contained interesting mini-stories in their own right. So for the rest of us who need a break from Clancy and Grisham, and yet want to be entertained as well as informed, I'd highly recommend "Hooked".
By Leif (Seattle, WA USA) - See all my reviews from The NYTimes- April 24, 2007
Medicine and the Drug Industry, a Morality Tale 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 truly miraculous life-saving drugs.
Many of these interactions are probably now familiar to most readers: the omnipresent logo-bearing trinkets festooning medical offices, the free samples of the latest, most expensive drugs, the "ask your doctor" television ads.
Less familiar may be some of industry's other friendly overtures: the lavish junkets and cash rewards for some "high-prescribing" doctors; the subtle manipulations of research data; the way-too-generous financing of postgraduate medical education; the very cozy relationship with the Food and Drug Administration and its physician consultants; and a casually Orwellian interference with the average physician's prescription pad.
A drug salesman recalls for Dr. Brody the time his company asked a local doctor to evaluate various sales presentations for a particular drug: "He'd been selected because our data showed that he was a relatively low prescriber. ...Basically, the company was willing to bet $500 or $750 that if he heard the same drug pitch all day, by the end of the day he'd be so brainwashed that he could not possibly prescribe any other drug but ours."
All this mutual back-scratching would be fine if patients' interests were indeed being served. But ample data indicates quite the reverse. Patients, after all, are the ones who pay for expensive drugs when cheaper would do as well, and the ones who swallow dangerous drugs nudged to market by their manufacturers.
Many individual problematic drugs make an appearance here. Chloromycetin, a toxic antibiotic from the 1950s, was relentlessly promoted by its manufacturer for routine use until the day its patent expired. (Still available in generic form, it is now used only as a last resort.) Thalidomide never caused an epidemic of birth defects in this country, as it did in Germany, only because a single stubborn F.D.A. officer was dissatisfied with the drug's safety profile, despite the manufacturer's repeated assurances that everything was fine.
The epitaph of the recently withdrawn painkiller Vioxx, whose virtues were subtly spun to the medical community in prestigious research journals, is still being written in litigation around the country.
"Research that is driven by marketing rather than by scientific aims would seem, in the end, to be low-quality research," Dr. Brody comments mildly about the Vioxx fiasco.
His overall conclusion is similarly low-key: "A profession is not just a way of making money; it's a form of public trust. ...Medicine has for many decades now been betraying this public trust."
It is not a particularly surprising conclusion, and, in fact, there is relatively little in this book to surprise anyone familiar with the territory. Rather than new material, it provides a meticulously referenced compendium of all the relevant history and commentary (including, for full disclosure, excerpts from one of this reviewer's columns in this newspaper).
Its breadth translates into a lack of depth in some areas, especially the final section, in which Dr. Brody tries to outline a feasible solution to the mess. His suggestions are cogent but a little skimpy, given that absent an act of God, it will probably take an act of Congress to pry medicine and industry apart someday, preferably as part of thoroughgoing health care reform.
Still, for a detailed overview of this very jagged terrain, if not for a map of the pathway out, a better general guide than this one is hard to imagine.
Abigail Zuger, a regular contributor, is a physician in Manhattan.
-------------------- Neil Posts: 697 | From Tucson, AZ USA | Registered: Apr 2002
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bettyg
Unregistered
posted
neil, the long address caused your post to go SUPER WIDE!
please copy your LONG super wide link and use the tinyurl.com link to SHORTEN it!!
go to tinyurl.com, and then paste in the super long one.
you'll get a short one;
now go to lymenet and DELETE LONG LINK and paste the short one in there so it's NORMAL WIDTH ... not super wide like your link caused.
click edit send! thx! ********************
then i can enlarge my print to read this without scrolling back/forth on EVERY LINE! thanks!
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shazdancer
Frequent Contributor (1K+ posts)
Member # 1436
posted
Hi Neil,
I am reading the book now. The kind of thing we are seeing is certainly not limited to Lyme, and it would take some crusading federal politicians who really want to clean up the healthcare industry to run with this.
I would also recommend
Groopman, J. (2007). How Doctors Think. New York: Houghton Mifflin Company.
Regards, Shaz
Posts: 1558 | From the Berkshires | Registered: Jul 2001
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shazdancer
Frequent Contributor (1K+ posts)
Member # 1436
posted
Brody's book is a lot of discussion on medical ethics. For a more condensed version of the issues, try reading this article (cited by Brody):
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