Marcia Angell, former Editor in Chief of The New England Journal of Medicine, refers to the pharmaceutical industry as the “Wizard of Oz—still full of bluster but now being exposed as something far different from its image.” Her views are corroborated by many others, including Wall Street. The ramifications of this crisis are huge and far-reaching, and they are also touching our day to day lives.

We now know that the industry is not developing as many new molecules as we thought; that it is reluctant to develop new antibiotics; and their interest in protecting their profit margins is above saving the lives of people, including Americans. Did you know that 35-40 percent of California chronic diseased patients can't pay for their medicines? And yet during the last 20 years (except 2003 and 2004) the 10 pharmaceutical industries included in Fortune 500 had a rate of return that was about five-times that of the rest of the Fortune 500 industries? And that their profits in 2002 were $56 billion, the equivalent of the profits made by the other 490 industries in the Fortune 500 list? Having grown up in Europe, where there is universal access to health care and medicines, I am deeply disturbed when I see people struggling to get the care they need. However, those who have access to medicines are not free of problems.

In 2002, Bill Moyers anchored a program (NOW) where he exposed how the pharmaceutical industry used researchers and writers to advertise drugs. I knew that the industry spends an exorbitant amount of money in marketing (double than they spend on research), especially when considering that needed medicines do not need much advertising, but I did not know that the industry would infiltrate the scientific channels that we had always trusted. A series of disturbing revelations followed, for instance, only ten percent of the technical personnel working at the Food and Drug Administration (FDA) declared not having any conflict of interest with the pharmaceutical industry, and there have been instances where the FDA has not followed the advice of the drug review panels. The editors of major medical journals admitted that some of their publications had been influenced by the industry. Others documented that drug representatives were the main source of information for many prescribers (physicians and dentists), and just last month Nature published a study documenting that 33 percent of the authors of medical guidelines had ties to relevant drug companies.

The Vioxx trial uncovered how Merck manipulated the information made available to physicians to increase the sales, knowing that people could die. The timing of the trial was not the best for Merck, Americans were growing increasingly frustrated with the industry, and the media used the occasion to raise the visibility of the industry's behavior. The trial ended with the award of $253 million to the plaintiff, but according to analysts and to interviews with the jurors, the intention was to punish an industry that had betrayed their trust.

However, with this information comes a general sense of powerlessness. Who are we to trust? This question assaults our minds every time a loved one gets sick. Why this medicine? Where did the doctor get the information? Is it a safe drug? Are all the adverse reactions and side effects known? The number of patients who will question the physician's advice is likely to increase. Physicians could raise our level of comfort by doing away with all the industry's paraphernalia that tends to decorate their offices, they could also joint the No Free Lunch movement by taking the pledge of not taking any gifts from the pharmaceutical industry; after all we end up paying for those gifts with higher drug prices. There are also sources of independent information that can be trusted, albeit they are not as easy to access as those sponsored by the industry, among others you can search the websites of the FDA, the National Institute for Health and Clinical Excellence (NICE), and Public Citizen.

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Dr. Nuria Homedes is an Associate Professor at the University of Texas School of Public
Health, and co-edits Boletin Farmacos (www.boletinfarmacos.org)