Is big pharma stalling innovation?

Marcia Angell, M.D., former editor of New England Journal of Medicine, says the relationship between academic medical centers and pharmaceutical companies is becoming too symbiotic.


The drug companies are portraying themselves as great successes in independent and free market. They say "Look how wonderful this is. Look at all the drugs we make. "At the same time they're on welfare big time.

They get government granted monopoly rides, patents exclusive marketing rights. So they really are doing very well, society is taking good care of them. It seems to me that society could ask for something in return. And to say as a price of some of these goodies that we give you, you cannot stop making antibiotics or vaccines or important drugs. This is a part of what you have to do to be so richly rewarded in our society.

We actually have shortages in some important and even life saving drugs. And why is that? Because the drug companies don't find them particularly profitable. They would rather make one more CRESTOR, one more LIPITOR, than to make important drugs, vaccines, antibiotics.

One of the shortages is anti-venoms, there are fewer and fewer companies making anti-venoms, and so there are real shortages now. And so I was telling somebody if you get bit by a rattlesnake on your trip to Utah, you may have trouble getting an anti-venom, but you can certainly get something for your cholesterol. That's the way it is.

I had been at the New England Journal of medicine as an editor on the editorial staff, and ultimately editor chief for 21 years, from 1979 until 2000, and I had seen the relationship of academic medicine to the pharmaceutical industry change greatly over those 21 years. Now that included the year of [inaudible 00:02:13], and an increasingly close relationship between the pharmaceutical industry, and academic medicine with more, and more control, and influence by drug companies over research on their own products, and education about their own products.

Look what has happened to us. We've sold ourselves and rather cheaply too. The drug companies would pay the medical schools royalties for their discoveries, but the drug companies were the ones who made the money. And they were buying the hearts, and minds of faculties, and medical schools.

What we do now, what we've found that is profitable to do is to pretend that the drug companies and the medical schools are in the same enterprise, that what we're both trying to do is to come up with innovative, important new drugs. And that's simply not true. The drug companies are investor owned businesses, and their job is to come up with the most profitable drugs they can, and to maximize their shareholders interest. That's what they do. They want to maximize their profits. That's their fiduciary responsibility.

Medical schools have no such responsibility. Their responsibility is to the public, to educate the next generation of doctors, to do scientifically important research, not commercially important research. And to take care of the sickest and neediest members of society and that is what justifies its tax exempt status. So these missions are very different.

I think sometimes when we talk about innovation, we're distracting ourselves from what we're missing in the healthcare system which is making available the knowledge that we do have to everyone. I think that in some ways clinical research is less important than changing the healthcare system, so that healthcare is distributed according to medical need. What I'm saying I guess is we do know enough, so let's make it available to the people who need it.