Arnold S. Relman and Marcia Angell, "America's Other Drug Problem: How the Drug Industry Distorts Medicine and Politics"

Arnold S. Relman is professor emeritus of Medicine and of Social Medicine at the Harvard Medical School. Dr. Relman served as the editor of the Journal of Clinical Investigation from 1962 to 1967 and as editor of the New England Journal of Medicine from 1977 to 1991. Over the course of his career, he has served on the faculty of the Boston University School of Medicine, Boston City Hospital, and the University of Pennsylvania School of Medicine. He has written extensively on the economic, ethical, legal, and social aspects of health care.  

A board-certified pathologist, Dr. Marcia Angell joined the editorial staff of the New England Journal of Medicine in 1979 and was promoted to Executive Editor in 1988 and interim Editor-in-Chief in 1999. Currently Senior Lecturer in the Department of Social Medicine at Harvard Medical School, Angell writes and speaks publicly on medical ethics, health policy, and the nature of medical evidence. In 1997, Time magazine named Marcia Angell one of the 25 most influential Americans.  

Angell is the author of the critically acclaimed Science on Trial: The Clash of Medical Evidence and the Law in the Breast Implant Case (1996), which explores the influence that junk science has in the court system and in the public sphere more generally. Arguing that the value of science resides in its commitment to assessing evidence objectively, Angell details the ways in which this commitment is undermined in the courts, where scientists are tempted to sell their expert opinions to the highest bidder. Angell's more recent work, The Truth About the Drug Companies: How They Deceive Us and What to Do About It (2004), explores how conflicts of interest in the scientific community are further undermining the unfettered pursuit of truth. As Angell sees the issue, it is the responsibility of scientific journals like the New England Journal of Medicine and of academic medical centers to conduct objective research and to subject the findings of such research to rigorous and unbiased analysis. Fulfilling this responsibility has become increasingly difficult, Angell believes, precisely because the doctors, scientists, and technicians who carry out the research rely on medical and pharmaceutical corporations to fund their work. This is a problem because the mission of investor-owned companies is quite different from "the mission of academic medical centers. The primary purpose of the former is to increase the value of their shareholders' stock, which they do by securing patents and marketing their products. Their purpose is not to educate, nor even to carry out research, except secondarily or as a means to their primary end. I believe academics often forget this, and allow themselves to believe that marketing is really education."

In "America's Other Drug Problem," we find Relman and Angell asking a similar set of questions: What ethical standards should scientists be held to? What role should science have in a civil society? And is it possible to preserve science's commitment to "service and disinterestedness" once scientists move out of the lab and into the courtroom and the marketplace?  

Relman, Arnold, and Angell, Marcia. "America's Other Drug Problem: How the Drug Industry Distorts Medicine and Politics." The New Republic 227(25), Dec. 16, 2002: 27-41.
Quotation taken from Angell's remarks at the Health and Human Services Conference on Financial Conflicts of Interest.
Additional biographical information taken from the Canadian Health Coalition.
Digital images drawn from the University of Arizona Health Sciences Center and the PBS web site.

Link to Explore:

http://www.physics.nyu.edu/faculty/sokal/: The homepage of Alan Sokal, an NYU Physicist who has been a vocal proponent of the value of scientific objectivity. His site is a convenient index of the principal documents of the so-called "Sokal Hoax."

Question for Learning:

• In 1996, Alan Sokal submitted an article, meant to be a parody of the postmodern critique of science, to the cultural studies journal Social Text. The article was accepted for publication, and, when Sokal revealed the hoax, a controversy flared up. Interviews followed; debates were held; arguments and counterarguments were made. What are the consequences of this debate for the kinds of concerns raised by Relman and Angell? Which criticisms of scientific objectivity are justified, and which might lead to abuses of evidence?

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Question for Connecting:

• Does advertising have a place in the pharmaceutical industry? Relman and Angell are deeply concerned about the health care industry's marketing practices and recommend greater regulation in this area, but they leave to other readers the work of imagining what these regulations might be. Is Virginia Postrel's argument about the aesthetic value of surface applicable to this situation? Or is health care an area where the consideration of aesthetics, particularly the aesthetics of advertising, is out of bounds? Does Postrel's argument only apply to "trivial" situations where the items being advertised-shoes or homes-don't have "intrinsic qualities" in quite the same way that drugs do? Write an essay in which you discuss the obstacles and the opportunities for regulating the pharmaceutical industry's future advertising practices.

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