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Subject: Big Pharma / Pot Shrinks Tumors

Hi, Bart,

I read Tab's response to my post. Here are my comments:

1. Tab asked if I had personal experience. The answer is, yes, more than I wanted to. My sister was diagnosed with ovarian cancer over five years ago; my best friend's mother also fell victim to the same disease. My sister got lucky; she had excellent care from a very good and very expensive health plan, because she was covered under her husband's plan (he worked for the federal government), and because her cancer was caught early. One major surgery (total hysterectomy) and an intensive course of chemo later, she came out of it cancer-free. She's still cancer-free, over five years and counting. My friend's mother was not so lucky. She died slowly and horribly, in agony of both mind and body. According to what my friend told me, the hospital and medical personnel treated her "by the numbers", with no concern either for the patient or the family. Tab says he's being treated at Dana Farber; I understand that is an outstanding facility, with excellent and innovative patient care. I also understand that only a very small fraction of cancer patients get that kind of care. Dana Farber unfortunately is not the rule in cancer treatment; it is the exception.

2. Tab wrote, "It may be that some places don't [have the patient's health as the uppermost priority], or it may be that Big Pharma exacts a high price (although these probably are not cheap drugs to develop, or at least that's what they want us to believe) but I don't think my cancer center (Dana Farber) is trying to milk me - they're trying to save me." Speaking once again from personal experience, I worked for Big Pharma for four years. Any illusions I had that the pharmaceutical industry operated with patients' needs in mind, or that the cost of development justified the high prices charged in the United States for any class of drugs, cancer drugs included, were shattered by what I learned. I was hired by the company's library to catalog the Marketing Department's collection. During the time I was there, the firm experienced budget cutbacks in almost every department, including research and development. It so happened that I got into a discussion about this with the head of the Marketing Department, and I will never forget his response. He casually leaned back in his chair, smiled, and said, "I don't have that problem. My budget is discretionary." If anyone doesn't know what that means, I'll explain it, exactly as he explained it to me. He told me, in so many words, that whatever he wanted, he got. This, while R&D was being starved. I have since found out that is typical in the pharmaceutical industry. Would anyone like to explain to me how the high costs of drugs could be justified by the cost of R&D when those departments typically operate on a shoestring? Read these documents for a fuller exploration of this issue. (report from the FTC on competitive and antitrust issues in the pharmaceutical industry) (discussing the increase in drug company profits after passage of Medicare drug legislation) (2004 article by Marcia Angell, Senior Lecturer at Harvard Medical School) (2008 article from PLoS Medicine on costs of R&D vs. costs of promotion in the pharmaceutical industry. 
Conclusion: "... it appears that pharmaceutical companies spend almost twice as much on promotion as they do on R&D."

3. Finally, on how expensive these drugs are to develop, here's a little factoid, also from my personal experience. While I worked for the Big Pharma company, I also cataloged the libraries in five of their R&D facilities located in various places. Most of the collections consisted of organic chemistry texts, some of them dating back almost 200 years, many of them in German (the Germans have been the leaders in the organic chemistry industry since the early 19th century). I had a discussion one day at lunch with one of the chemists; some of what he told me shed some interesting light on just what WMDs are and why Bill Clinton bombed the chemical plant in the Sudan in 1998, but that's a story for another time. The main point I want to make here is that most of the chemistry of pharmaceutical manufacturing is very well settled. There has been very little innovation in the use of petrochemicals for drug manufacture (most conventional pharmaceuticals are based on petrochemicals, FYI), so little in fact, that books and journals published almost 200 years ago are still considered valid as reference materials.

There's a lot more information I could provide, both from my own personal experience and from research I have done, 
but many people more knowledgable than I have already written a lot on this topic. Three of the four articles I cited above 
have extensive bibliographies for those who wish to find out more.

The Original Ninjalibrarian

It's hard to argue with The Original Ninjalibrarian - she has so many facts and citations :) 

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