Hard to swallow.

The Truth About the Drug Companies By Marcia Angell Random House US$24.95

Marcia Angell, a doctor and a lecturer at Harvard Medical School, has written an expose of the drug industry at a pivotal moment. U.S. consumers, who finance most of the drug development in the world, face a massive rise in prescription drug prices and in premiums paid for Medicare, the U.S. health safety net for retirees and disabled persons.

During the years she held the position of editor-in-chief of the influential U.S. medical journal The New England Journal of Medicine, Angell has seen the pharmaceutical industry turn into a powerful marketing machine with increasing influence over how doctors work and in what way they practice medicine.

Currently, she writes, U.S. citizens spend close to US$200 billion a year on drugs. The drug makers claim that high prices are necessary to cover the cost of research and development, which leads to new products. But Angell disagrees with that argument. She presents a strong argument that corruption is in fact the problem among the biggest drug companies. The bulk of the resources the industry spends, she argues, is spent not only on marketing--which has few and doubtful benefits--but on an aggressive lobbying effort aimed at the government and at U.S. research universities, which conduct and finance much of the basic science drug makers need. Through enormous contributions to political campaigns, it curries favor with the Congress and the U.S. federal pharmaceutical regulator, the Food and Drug Administration.

According to Angell, pharmaceutical companies regularly use publicly financed institutions to conduct research then manipulate clinical results so that their products appear to be more effective than they really are. In addition, she writes, they make a constant legal effort to extend patents and exclusive marketing rights for years and flood the market with copies of drugs that are less effective than the original medicines, which they try to sell as new products.

Angell also alleges that giants in the sector, like Pfizer and AstraZeneca, push doctors to prescribe drugs by giving them gifts and through marketing programs, often junkets to golf resorts or Caribbean islands. According to her, the cost of this kind of publicity campaign directed at doctors and at consumers is far higher than the costs of research and drug development alone. Profitable. In 2002, the 10 main drug companies reported earnings of US$35.90 billion. Angell says it is the most profitable industry in the United States, thanks to the disproportionately high drug prices, generous tax breaks from Washington and the exaggeratedly long extensions granted to their patents. This last trend goes beyond U.S. borders, since U.S. intellectual property laws make it difficult to manufacture cheaper generic drugs in developing regions like Latin America.

Angel concludes by arguing for a series of measures designed to save the public the cost of drugs and to save the industry. Among the changes she favors include restoring the objectivity of clinical testing and the end of drug-company influence on medical education. She doesn't spell out exactly how to carry out these reforms, but her work is a public call for steps to reign in an industry out of control.