Constable £12.99 pp266

If you thought that you knew the worst about the pharmaceutical industry, think again. Jacky Law, a journalist who has reported on health care for 25 years, sets out in this important book the story of a monster that has grown in our midst so quickly we have yet to grasp the implications. During a single human life span the international pharmas have expanded from an industry struggling to market drugs into a global combine of colossal power and wealth. It now delivers better financial returns than all other industries. The figures are astounding. Ten drugs earned $48.3 billion in 2003. Top drugs such as Lipitor (prescribed to lower cholesterol) can earn tens of billions of dollars per annum — one product accounting for more money in one year than most companies earn in a lifetime. The pharmaceutical companies make such enormous profits, Law says, that the whole business has a momentum of its own that seems impossible to check. As a result the very reason for the existence of the industry needs a fresh evaluation.

What is its aim? In offering an answer, Law, with scrupulous objectivity, does not blame only the pharmas. She writes: “The problem has been that the regulators and the industry that they are paid to regulate have been able to coexist rather too cosily for too long. In the case of the UK, there are historic reasons why commercial issues have become so entangled with public health, but in fact all countries are driven by political agendas that have always put greater weight on the creation of wealth than health.”

So it is no good relying on the government either to hold the industry in check or make certain that its drugs provide us with value for money. The truth is that the industry is left to its own devices, what it researches is driven by market forces and the result is that only a minority of new drugs offers any clinical advantage over old ones. But what about science? Where are all our objective, independent scientists? Why haven’t they noticed all this and blown the whistle? Reading this book gives you the impression that nowadays it is hard to find a scientist who does not work for a drug company. Law writes, “Just finding experts with absolutely no connection with a drug to sit on the regulatory panels that decide whether a drug should get a licence is not easy.”

She writes that this is a possible explanation for what happened in the Vioxx scandal in America. Trumpeted as a brilliant new painkiller, Vioxx turned out to cause heart attacks and strokes. An official of the Food and Drug Administration (FDA) told a US Senate hearing in 2004 that his agency’s approval of Vioxx had led to “the single greatest drug-safety catastrophe in the history of this country or the history of the world”. Another FDA officer estimated that 28,000 Americans had had heart attacks and strokes as a result of taking Vioxx while he was arguing with his superiors about its risks. Yet the final twist, Law points out, came when a 32-member committee of the FDA voted 17-15 to allow the drug back on the market.

Despite the book’s devastating indictments, the final picture is not without hope. Law points out that the human race can survive perfectly well without an endless supply of new drugs but the pharmaceutical industry cannot. So there is the possibility of a transfer of power. It seems to me that we might have subconsciously realised this. Otherwise how to explain the fact that in Britain we do not bother to take at least half the drugs prescribed for us? They go gently out of date in the bathroom cabinet. But a radical change would require a decision by us to play a bigger role in our own health care. Thanks to the internet we are already better informed about illnesses and possible treatments than ever before. Law says we now need to move away from the medicalisation of society, the belief that every problem requires a medical solution, and break the pharmas’ stranglehold by insisting that our leaders treat public health separately from the commercial interests of the pharmaceutical industry. We need to seize back control of our medical destinies, and this book’s great strength is that it inspires us to do just that.

Available at the Books First price of £11.69 on 0870 165 8585

Times Recommends

• The 100 Best Books of the Decade
• The Times picks the 50 best paperbacks of 2009
• The conversation: James Ellroy