Review - The Big Fix
How the Pharmaceutical Industry Rips Off American Consumers
by Katharine Greider
PublicAffairs, 2003
Review by Christian Perring, Ph.D.
Jun 25th 2003 (Volume 7, Issue 26)

A recent PBS Frontline documentary, "The Other Drug War," discussed the pharmaceutical industry, presenting similar information to that in Katharine Greider's The Big Fix.  However, while the Frontline editors presented a balance of both pro and con on the way that the pharmaceutical industry operates, leaving viewers to draw their own conclusions, Greider has a single point of view.   She presents her case against the multinational corporations with an eloquent persistence, giving the reader little room to draw any other conclusion than it is an industry with far too much power, in need of either government regulation or else more open to genuinely free market forces.  She argues forcefully that Pharma currently both having its cake and eating it, able to dictate high prices for its products and able to manipulate government policy to protect its interests.  While consumers sometimes benefit from the new medications that the industry develops, they very frequently suffer because of the extortionate amounts that the manufacturers charge for their products. 

The Big Fix is written in straightforward often journalistic prose, and while it is full of relevant facts, it is not a scholarly work -- there are no footnotes or lists of works cited.  Greider illustrates her points often by referring to the case of the McCuddy family of Ohio: 77-year-old Melva who had breast cancer, diabetes, high blood pressure and depression, her son Jim, 50 years old, who had a heart attack recently and also has asthma and depression, and her 28-year-old grandson James, who has a stomach ulcer.  None of them can afford health insurance and have to spend large portions of their incomes on their prescribed medications.  Melva often travels up to Canada to buy her medications there, because they are considerably cheaper north of the border.  Indeed, they are cheaper in nearly every other country in the world, because those other nations impose greater government regulation.  Furthermore, most other countries do not allow direct-to-consumer advertising, and have great control over the inducements the drug manufacturers provide to doctors to prescribe their products.  Reducing the promotional budgets of the companies may help to keep down their prices. 

In short, Greider's excellent book is a damning indictment of the pharmaceutical business, that shows how the quest for profits is pursued at the expense of patients.  Very often the industry pushes medications that have few or no benefits compared to older, cheaper medicines and yet, through aggressive marketing techniques, manages to make billions of dollars profit.  The main defense of the profiteering of the industry lies in its claim that it needs to make the profit to be able to afford the huge costs of research and development of new medications that are major medical discoveries.  However, the industry is in fact very secretive about its expenditures, and Greider makes a strong case that often the costs of research are exaggerated in order to improve their image.  Some experts claim that if the companies were not allowed to charge whatever they liked for their medications and had greater regulation imposed on them, then there would be fewer new medications discovered.  This may be true, but given the past practices of the industry, they have about as much credibility as the tobacco manufacturers.  The US currently spends more on medical care per person than any other country in the world, yet as a nation, it has no better health than most other industrialized nation.  Although traditionally Americans have wanted the best possible treatments regardless of cost, the excesses of the pharmaceutical industry may convince many that it is well worth the possible risk of slightly fewer new medications available in the future if we can make medical treatments affordable for more people. 

© 2003 Christian Perring. All rights reserved.

Christian Perring, Ph.D., is Chair of the Philosophy Department at Dowling College, Long Island, and editor of Metapsychology Online Review.  His main research is on philosophical issues in medicine, psychiatry and psychology.