The best books about the entanglement of medicine, politics, and pharmaceuticals

I found, as a history buff, The Struggle for Drug Reform to be an eye-opener about how America’s exceptionally high drug prices among other deficits in health care quality and coverage resulted from the past exercise of power by the pharmaceutical industry, the lynchpin of America’s “medico-industrial complex.”

I was impressed by historian Tobbell’s meticulously researched account of the industry’s strategic alliances with self-interested medical scientists, not just conservative political forces, and its use of anti-communist propaganda to fight off the threat of drug pricing regulations.

I personally found important her discussions of how the industry allied with the American Medical Association against universal health care, against FDA demands for evidence about drug efficacy and safety before allowing drugs on the market, and against the threat to its profits from generic drugs. 

I find Angell’s The Truth About the Drug Companies extremely valuable for teaching students about how the pharmaceutical industry translates high profits into power resources to protect and increase those profits over time.

The former New England Journal of Medicine editor exposed how drug companies enlist politicians, the FDA, and medical academia for their cause. And armies of lawyers to extend monopoly marketing rights for years.

It was my first introduction to how they spend more on marketing than research, much of that on “copy-cat” drugs of dubious superiority to ones with expired patents.

As a tax (and high drug price) payer, I was disturbed to learn how they use government funds for basic research and then rig and spin their reporting of clinical studies to inflate their products’ therapeutic value and underplay their risks. 

Kassirer, also like Angell a highly respected physician and former editor of the New England Journal of Medicine, first opened my eyes to how extensively drug companies use their vast wealth to turn physicians into promoters and middlemen.

I knew about the small and not-so-small gifts, speaking fees, travel junkets, and the like to individual doctors and “key opinion leaders” of the profession, but not about the “institutional conflicts of interest” gladly entered into by specialty medical societies heavily dependent on drug money for their events and activities such as scientific meetings, journal publishing, clinical practice recommendations, and, not least “continuing medical education” required by law for license maintenance.

Although Kassirer, also like Angell, proposed reforms, from what I know about conditions today, not much has changed, so On the Take remains an indispensable window into corrupted medicine. 

I was deeply impressed by how Psychiatry Under the Influence combines medical history, clinical knowledge, and investigative journalism about pervasive institutional conflicts of interest in medicine.

In Whitaker’s and Cosgrove’s case study of “institutional corruption” they trace the development over time of an alignment of the psychiatric profession’s “guild interests” in turf maximization and scientific legitimation with drug companies’ drive to market a widening array of drugs massively profitable drugs.

It is a fascinating illustration of the medicalization of life resulting from what I would call the “commercial construction of disease.”

Particularly eye-opening was the role of the American Psychiatric Association in constructing pseudo-scientific diagnostic categories of psychoses, panics, anxieties, depressive states, and the like for drug companies to capitalize on—and concealing, distorting, and fabricating research results that facilitate mass overprescribing of potentially harm-causing drugs.

If you think that medical journals published by respected medical societies are full of good science, think again.

For me, Abramson’s Sickening nailed the case for a conclusion that the net effect of the many hundreds of medical journals published here and around the world is to subtract from the sum of human medical knowledge.

Abramson, as an expert witness in criminal and civil cases against drug companies, draws in part on subpoenaed documents to expose how medical science, as part of the entire medical-industrial complex, is corrupted from start to finish by the drug industry’s funding of most clinical trials, their control over the data analysis, and even their ghost-writing of articles submitted to journals.

New and disturbing was the withholding of clinical trials’ raw data from journals’ peer reviewers. Instead, they get biased summaries bearing drug manufacturers’ fingerprints.