The accountability of the pharmaceutical industry is the subject of an editorial by Dr Marcia Angell in the New England Journal of Medicine for June 22. The question has arisen because of the rapidly increasing expenditure on drugs.
In the United States the annual rise in drugs costs is about 15 per cent, and now accounts for some 8 per cent of total health spending. The causes are said to be the wider use of new drugs and the higher cost of individual preparations. Pricing by the manufacturers is held to be capricious, not properly related to profit. The result of higher prices is that chronically sick elderly people are tempted to take lower doses than are prescribed, to share their medication with their spouses, or simply to manage to do without their drugs in favour of buying food and warmth. Another aspect of the problem is that people in underdeveloped countries are unable to obtain desperately needed medicines on account of their high cost.
When charged that they are overpricing their products, drug companies usually point out that during the past two decades they have produced remarkably effective new drugs, and that it is to be expected that high clinical value goes hand in hand with high costs. Manufacturers insist that they need to attract sufficient income from their products in order to sustain their research programme.
However, much of the argument offered by industry may be exaggerated or misleading. "An industry whose profits outstrip notably those of every other industry in the United States," writes Dr Angell, "simply cannot be considered very risky". And she asserts that the pharmaceutical industry enjoys massive government protection and subsidies, and is given great tax advantages into the bargain.
And although some recently developed drugs fill important new medical needs, many others add little to the therapeutic armamentarium, introducing confusion and added expense, combination products in particular. Important drugs do not require much promotion, whereas me-too preparations do, and doctors depend upon promotional material supplied by representatives of the maker. Manufacturers should become more accountable not only to their shareholders but to society at large.