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

Questions for Making Connections within the Reading:  

1. Whenever we read a work of nonfiction, the author's credibility is always a significant concern. Especially in writing on a subject as controversial as pricing in the pharmaceutical industry, much of an argument's success or failure depends on the author's ability to sustain the persona of a true expert or of a well-informed observer. How well do Relman and Angell sustain this persona? In what ways does their concern for credibility shape both the form and the content of the argument they make? How well have they managed to defend themselves from counterattacks by the big drug companies? What qualities of good writing have Relman and Angell sacrificed in order to showcase their credibility?  

2. What arguments do the pharmaceutical companies offer in defense of their high profits? What counterargument do Relman and Angell offer? Have the two been fair in representing the position of the drug companies? What criteria should define "fairness" in such a case? Is agreement the only fair response, or is it possible to disagree with the drug companies in an ethical and well-informed way? If you feel that Relman and Angell have been unfair, what arguments might you regard as more fair? If you feel that the two authors have argued fairly, what arguments might you regard as unethical?  

3. Given Relman and Angell's analysis of how the drug industry conducts business, do you regard their solutions as adequate and likely to succeed? In order to explore this question, you might first make an outline of the problems Relman and Angell address. Would you say that all of the problems are equally important, or are some more significant than others? Is it possible to view the problems of drug pricing as systemic in origin-reflective of an entire system or industry? Now turn to the solutions proposed by Relman and Angell: Would you say that these solutions get to the heart of the problem?  

Questions for Writing:  

1. Do the practices of the pharmaceutical industry present a clear and present danger to the health of the American people? In what ways might these practices deform or disable the medical profession? Judging from the evidence, is there a real possibility that doctors will deliver inferior care because of the actions of drug companies? Even if physicians can still deliver effective care to their patients, in what ways might current pricing practices help to deprive other Americans of care by placing it out of financial reach or by draining off the resources of the entire health care system?  

2. Write a detailed and well-aimed defense of the drug industry. In doing so, you might look for possible omissions, contradictions, or oversimplifications in Relman and Angell's argument. You should assume that their research is accurate, but you should feel free to question the conclusions they draw from the evidence. "Detailed and well-aimed" means that you cannot ignore the particulars of Relman and Angell's position: You must respond to the argument as a whole, but you should also pay close attention to the logic and evidence they offer in support of that argument. Keep in mind that an effective defense of the drug industry might concede the truth of some of Relman and Angell's accusations, while at the same time offering a modified view that represents the drug companies in a more favorable light.  

Questions for Making Connections Between Readings:  

1. 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.  

2. In what ways does the account presented in "America's Other Drug Problem" confirm, contradict, or complicate the reasoning presented by Gregory Stock in "The Enhanced and the Unenhanced"? Stock envisions a genetics industry that will respond in a fairly direct and transparent way to the public's demand for genetic amelioration. But can we be sure that the response will be as direct and transparent as Stock assumes? Is it possible that, as in the drug industry, development costs in the field of genetics-whether these costs are real or not-might justify pricing that excludes large numbers of people, or that limits the range of options for all, regardless of their earning power? If you have doubts about the feasibility of Stock's proposal, what alternative arrangements might distribute in the fairest way innovations in genetic engineering?

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