Ten Drugs plus Drugs, Money, and Secret Handshakes

TEN DRUGS by Thomas Hager is subtitled “How Plants, Powders, and Pills Have Shaped the History of Medicine” and Hager writes about both breakthroughs and unintended consequences of experimentation and development. In his Introduction, he stresses that “No drug is good. No drug is bad. Every drug is both.” Leaving out more well-known drugs like penicillin and aspirin, Hager uses each of ten separate chapters to highlight the history of a drug (like CPZ, the first antipsychotic) or family of drugs (like statins), writing “my preference is for lively stories and memorable characters.” For example, one chapter briefly covers efforts through the 1930s to isolate the hormone progesterone, outlines the continued research in the 1950s with support from Margaret Sanger and Katharine McCormick, and touches upon restraints from local laws and possible ethical concerns with regard to informed consent of patients. Hager then notes, “by 1967 [after FDA approval], thirteen million women around the world had taken some form of the Pill. The number of users today, with greatly improved formulations, tops one hundred million.” Other chapters discuss opium, vaccines (especially smallpox), or chloral hydrate (knock-out drops). His summaries are indeed brief and readers will want to explore elsewhere for more details; what I found amazing, though, is our relative ignorance – even thirty years ago – about how some systems in the body work and therefore about how drugs might interact. TEN DRUGS received a starred review from Kirkus which commented also about how “nowadays, lifesaving drugs attract less attention than those that improve the quality of life.” 

DRUGS, MONEY, AND SECRET HANDSHAKES by Robin Feldman is subtitled “The Unstoppable Growth of Prescription Drug Prices.” Feldman is a Professor of Law at the University of California Hastings and has written other books about the intersection of science and law, including ones which focus on patent law and drug pricing strategies. In her latest text, she documents the “high cost of brand medications for common conditions,” and the extent to which government budgets are “struggling to cover the cost of new, expensive medicines.”  She argues that “internal incentives push every market participant towards behaviors that increase prices, knocking out the normal checks that should operate as brake-points on the market.” After background information on the market and the effects of rising prices, she uses subsequent chapters to explain how incentive structures for insurance companies, pharmacies, doctors and patient groups drive prices higher. Another chapter looks at drug company efforts to keep out lower priced competitors. And, finally, she suggests some changes for “realigning the industry’s incentives with society’s interests.” 

Feldman addresses an extremely complex topic and provides a much needed overview for policy makers, although this seems quite complex (e.g., while some changes would seem to increase competition they may move oversight from a Federal to a State level) even for those of our students who are very interested in the impact and power of the pharmaceutical industry.  DRUGS, MONEY, AND SECRET HANDSHAKES contains truly extensive notes (more than a third of this roughly two-hundred page book), plus a helpful index and several diagrams.