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GOOD PHARMA: the Public Health Model of the Mario Negri Institute (4.65 MB)

(Linked flyer, discount offer, and review by David Healy in The Times Higher Education) This book describes how a large institute (51 labs) devoted to developing better medicines for patients provides a public health model works without patenting any of its discoveries or new uses in an open-science, collaborative, self-critical style at much lower costs with data transparency than commercialized research.

THE RISKS OF PRESCRIPTION DRUGS ($15, Columbia University Press) has short chapters for general readers and students about how drugs have become a leading cause of death, disorders, accidents, and hospitalizations.
Kindle or Nook Paperback $15.00 167 pages Hardcover $46.00




1. "Most new drugs are 'life-saving' and must be rushed to patients who need them."

a. Most new drugs not for life-threatening conditions. Perhaps 10 percent.

b. Independent reviewers judge about 90% new drug products as clinically little or no more effective or safe than existing drugs. Consistent pattern for 40 yrs

c. Therefore about 1% new drugs would be “life-saving.” (10% x 10% = 1%)

d. Companies spend most R&D on developing minor variations for new patents. Massive marketing promotes them as "better."

e. Inverse Benefit Law: More marketing dilutes benefits and proliferates risks of harms.

2. "The FDA screens out unsafe and ineffective drugs. Approved drugs are safe and effective."

a. Better than placebo means new drugs may be less effective than existing ones. Often, little useful evidence for prescribing or how new drugs compare to others.

b. "Non-inferior" means new drugs are no worse than -20% the comparator drug. No useful evidence on how superior new drugs are, if they are.

c. Evidence on risks of harms in minimal. Company trials designed to minimize evidence of harms.

d. Most evidence is based on a carefully chosen, ideal population most likely to benefit and not have adverse reactions. Real patients and real patterns of use usually less beneficial and more harmful.

e. Since 90% of new drug products are little or no better, they cannot be safe.

f. Are the FDA and EMA proliferating ineffective, unsafe drugs?

3. An epidemic of harmful side effects (with few offsetting benefits).

a. Properly prescribed drugs are a leading cause of death. About 113,000 deaths a year in the U.S., just in hospitalized patients.

b. Drugs cause about 2.5 million serious reactions and 1.7 million hospitalizations a year in the U.S.

c. Drugs cause about 50 million adverse reactions, mostly mild but impair performance & judgment

d. Drugs are a major cause of falls, accidents, anti-social behaviors.

e. Risks of harm increase through the cascade effect of taking multiple drugs.

f. Harmful side effects generate still more prescription sales.

4. Market is flooded with new drug products of little or no advantage that consume 80% of increased pharmaceutical costs. 

a. A self-reinforcing syndrome: high prices, protected by government from free market competition, fund the development of these drugs and their costly marketing, which generate more revenues to develop more of these drugs.

5. “US prices have to be high to recover $2.9 billion in R&D costs per new drug and recover what lower prices abroad do not recover.”

a. The $2.9 billion figure is inflated by unverifiable R&D costs which companies have strong incentives to inflate from the start. Half the “costs” are estimated profits that companies would have made if they had not invested in R&D for new products vital for their survival. Another half are costs subsidized by taxpayers. In addition, the $2.9 billion estimate is based on the most costly 20 percent of new drugs but attributed to all drugs – a three-fold distortion. Just these three factors mean that net, corporate costs are usually low. Another third of the total comes from backing in an estimated large amount for the unknown cost of discovery. And there’s more… See “Demythologizing the high costs…”

b. The BMJ article “Foreign free riders…” drew on data from the National Science Foundation, companies and government to conclude that companies earn back all expenses and make a profit at Canadian and European prices. US high prices simply make extra profits from government protections from free-market competition.

c. The USA is the primary market where drug companies raise prices each year on last year’s models because they are protected from free-market competition.

d. Pharmaceutical companies make solid profits at European and Canadian prices. 

e. Cancer drugs should be relatively cheap. First, most R&D is paid directly or indirectly by the public, not companies. Second, trials are smaller and shorter than for other drugs. Third, in most cases we have no verifiable evidence that manufacturing costs are higher. Why, then, are cancer drugs priced higher than statin drugs? Many cancer drugs cause serious harms and provide little additional benefit, with exceptions.

Donald Light is a professor of comparative health care at Rowan University School of Osteopathic Medicine. He is an economic and organizational sociologist who compares health care systems and analyzes health care policies. He has written about the history and dynamics of health care markets and health care insurance, countervailing powers, the medical profession, immigrants and health care, and global justice.

As a founding fellow of the Center for Bioethics, Light is concerned about the high prices of medicines and barriers to their access. His research aims to provide a demythologized, more realistic account of costs, relative effectiveness and harms, and innovation than is promoted by commercial interests and sponsored academics. He is concerned that current incentives, laws, and regulations encourage companies to develop many new drugs with few advantages, rather than focusing on really superior new drugs.