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INTRODUCTION

The woman’s anguished accusation was stunning. “The pharmaceutical industry killed my daughter,” she yelled at me. I had just finished taping an episode of the syndicated TV series, The Dr. Oz Show, where I had tried, with little success, to defend that same industry … once the world’s most admired.

In 1997, three pharmaceutical companies were in the top 10 of Fortune’s list including Merck (#3), Johnson & Johnson (#4), and Pfizer (#8). Earlier, Merck had been lauded by Fortune magazine as the “World’s Most Admired Company” for seven straight years.

But by May 2011, when Dr. Oz hosted “The Four Things Drug Companies Don’t Want You to Know” that admiration and high regard had vanished. I had been invited to debate Dr. John Abramson, author of Overdosed America: The Broken Promise of American Medicine.

Back in the 1990s, those drug companies were best known for their breakthrough medicines for heart disease, depression, AIDS, and bacterial infections. They prospered with products that benefitted hundreds of millions of people. How could they not be admired?

Two decades later, on one of America’s most popular TV shows, a fired‐up, suspicious audience applauded Dr. Abramson’s premise that placed my industry in the same hall of shame as tobacco and oil. The industry had lost its way. And I became even more determined to help overcome this prejudice with counter arguments and data.

On that day, I tried to express my sorrow to the distraught mother, but she abruptly turned and walked away. I learned a few years later from Dr. Abramson that this young girl was being treated for depression and, while on therapy, committed suicide. (I do not know which drug she was taking.) I cannot think of anything more tragic than losing a child. While it is uncertain that the drug was the cause of this suicide, her mother was persuaded. She was unable to accept my sympathy, nor consider my conviction – that the goal of pharmaceutical R&D is to alleviate pain and suffering, not cause it.

My advocacy began in 2006, when I was invited to give a lecture at the University of New Hampshire, which was open not just to the university community but also to the general public. The talk, “Pharmaceutical R&D: The World’s Hope for Tomorrow’s Cures,” was designed to help combat the broad criticism of the industry by answering a number of questions:

 What value do new medicines bring to society?

 Where do medicines come from?

 What innovation does Big Pharma bring?

 How are risks and benefits of medicines evaluated?

This 45‐minute talk began at 4 pm with an audience of a few hundred people. The ensuing question and answer period lasted another hour and a quarter and would have gone even longer if the organizers had allowed. The questions covered the entire spectrum of drug R&D.

People were more than curious. They had dozens of questions and wanted answers. They were stunned to hear how long and costly it is to discover and develop new drugs. People had little appreciation of the cutting‐edge science needed to be successful. They asked how scientists remain motivated when after spending years on a program, it suddenly dies. By the end of the session, people had a better understanding of the tremendous challenges involved in bringing forward new medicines. The audience began to see a major piece of the healthcare debate in a totally new light.

This experience led me to write Drug Truths: Dispelling the Myths of Pharma R&D. As a result of Drug Truths, I began to get invitations to speak, not just about pharmaceutical research, but also the industry itself. The call from The Dr. Oz Show invited me to debate some of the issues I addressed in my book: the safety of new drugs, the myth that the industry invents diseases, that people are overmedicated, etc. The opportunity to join this discussion appealed to me.

Looking back, I was incredibly naïve. The first time I saw that theme, “The Four Secrets that Drug Companies Don’t Want You To Know,” was when I walked on stage. Drs. Oz and Abramson were not buying my arguments and nor was the audience.

Confronted with the negative public perceptions of the pharmaceutical industry, I wrote Devalued and Distrusted: Can the Pharmaceutical Industry Restore Its Broken Image? It addressed a number of issues that pharma was facing at the time, including: improving its ability to measure not just the benefits but also the risks of new medicines; the need for greater transparency in the conduct as well as the outcomes of clinical trials; changing how drugs are marketed; changing how physicians are compensated for their work with pharmaceutical companies; etc.

Remarkably, the industry has made many changes to improve its accountability – albeit with some prodding from the government. For example, all clinical trials must be registered on the website: www.clinicaltrials.gov. In addition, the results of these studies – positive and negative – must be reported within 12 months of completion. Companies are also making public any payment in excess of $10 made to any physician resulting from collaboration with a company. With respect to payments to physicians, the Centers for Medicare and Medicaid Services (CMS) publishes all of these on its Open Payments website (www.CMS.gov/openpayments).

Despite this progress, there is still one reputational issue that dwarfs all others – the price of drugs. In fact, while our country is divided on almost every problem we face, drug pricing unifies political foes. It even brought together former President Donald Trump and his left‐leaning nemesis Senator Bernie Sanders. At a press conference in January 2017, President Trump said: “Our drug industry has been disastrous….And the other thing we have to do is create new bidding procedures for the drug industry, because they are getting away with murder [1].” Senator Sanders responded: “He’s right and I’ve been saying this for years. Pharma does get away with murder. Literally murder. People die because they can’t get the prescription drugs that they need [2].”

The pharmaceutical industry should not be surprised by the backlash. After all, stories about high drug prices appear almost daily. How can a single pill cost $1000? How can healthcare systems stay afloat when life‐saving gene therapies are priced at over $2 million per patient? Why is Senator Sanders taking busloads of Americans over the border to Canada to get insulin for their diabetes? How can Pfizer and Moderna justify billions of dollars in revenues for their mRNA vaccines? This book seeks to answer these and other questions. Is the drug industry filled with profiteers “getting away with murder” or is it an industry made up of companies that invest in a high‐risk business called “innovation” that makes reasonable returns on at‐risk capital? You decide.

REFERENCES

1 1. Karlin‐Smith, S. (2017). Trump says drug industry “getting away with murder” Politico, (11 January).

2 2. Carter, Zachary D. and Schumaker, Erin (2017). Bernie Sanders: Donald Trump is right about big pharma, HuffPost, (11 January).