Marcia Angell

Bio: Marcia Angell is an academic researcher from Harvard University. The author has contributed to research in topics: Health care & Health care reform. The author has an hindex of 42, co-authored 95 publications receiving 7861 citations. Previous affiliations of Marcia Angell include City University of New York & Duke University.

The Truth About the Drug Companies: How They Deceive Us and What to Do About It

Abstract: “What does the eight-hundred-pound gorrilla do? Anything it wants to.” These are the first words of Chapter One, innagurating the pages of this monumental book with metaphoric clear-seeing that is beyond deniability. Indeed, America has made the drug companies (aka “Big Pharma”) a political and economic behemoth nearly incapable of stopping. A staggering $200 billion is now spent on prescription medication a year, lining the pockets of Big Pharma executives and milking an increasingly parched cash cow. In The Truth About the Drug Companies, Dr. Angell presents the grim details of Big Pharma’s rise to power and the manipulative and downright devious tricks it uses to stay there.

The Ethics of Clinical Research in the Third World

Abstract: An essential ethical condition for a randomized clinical trial comparing two treatments for a disease is that there be no good reason for thinking one is better than the other.1,2 Usually, investigators hope and even expect that the new treatment will be better, but there should not be solid evidence one way or the other. If there is, not only would the trial be scientifically redundant, but the investigators would be guilty of knowingly giving inferior treatment to some participants in the trial. The necessity for investigators to be in this state of equipoise2 applies to placebo-controlled trials, as . . .

Alternative Medicine--The Risks of Untested and Unregulated Remedies

Abstract: What is there about alternative medicine that sets it apart from ordinary medicine? The term refers to a remarkably heterogeneous group of theories and practices — as disparate as homeopathy, therapeutic touch, imagery, and herbal medicine. What unites them? Eisenberg et al. defined alternative medicine (now often called complementary medicine) as “medical interventions not taught widely at U.S. medical schools or generally available at U.S. hospitals.”1 That is not a very satisfactory definition, especially since many alternative remedies have recently found their way into the medical mainstream. Medical schools teach alternative medicine, hospitals and health maintenance organizations offer it,2 and . . .

Is Academic Medicine for Sale

Abstract: In 1984 the Journal became the first of the major medical journals to require authors of original research articles to disclose any financial ties with companies that make products discussed in papers submitted to us.1 We were aware that such ties were becoming fairly common, and we thought it reasonable to disclose them to readers. Although we came to this issue early, no one could have foreseen at the time just how ubiquitous and manifold such financial associations would become. The article by Keller et al.2 in this issue of the Journal provides a striking example. The authors' ties with . . .

The Truth About the Drug Companies

Abstract: 1 am delighted to have been asked to deliver the Hogan & Hartson Jurimetrics Lecture in honor of Lee Loevinger. I had many conversations with him about the interface between science and the law, a no-man's-land rife with misconceptions and hard feelings, as we both agreed, and I greatly admired his efforts through Jurimetrics to bring some clarity and civility to the area. His death last year is a loss to both science and the law, and 1 am particularly honored to be giving the lecture this year.

A Brief History of Neoliberalism

Abstract: Introduction 1 Freedom's Just Another Word 2 The Construction of Consent 3 The Neoliberal State 4 Uneven Geographical Developments 5 Neoliberalism with 'Chinese Characteristics' 6 Neoliberalism on Trial 7 Freedom's Prospect Notes Bibliography Index

Mindfulness-Based Interventions in Context: Past, Present, and Future

Abstract: studies from the Center for Mindfulness in Medicine, Health Care, and Society not reviewed by Baer but which raise a number of key questions about clinical applicability, study design, and mechanism of action, and (7) current opportunities for professional training and development in mindfulness and its clinical applications.

The Disease Burden Associated with Overweight and Obesity

Abstract: ContextOverweight and obesity are increasing dramatically in the United States and most likely contribute substantially to the burden of chronic health conditions.ObjectiveTo describe the relationship between weight status and prevalence of health conditions by severity of overweight and obesity in the US population.Design and SettingNationally representative cross-sectional survey using data from the Third National Health and Nutrition Examination Survey (NHANES III), which was conducted in 2 phases from 1988 to 1994.ParticipantsA total of 16,884 adults, 25 years and older, classified as overweight and obese (body mass index [BMI] ≥25 kg/m2) based on National Institutes of Health recommended guidelines.Main Outcome MeasuresPrevalence of type 2 diabetes mellitus, gallbladder disease, coronary heart disease, high blood cholesterol level, high blood pressure, or osteoarthritis.ResultsSixty-three percent of men and 55% of women had a body mass index of 25 kg/m2 or greater. A graded increase in the prevalence ratio (PR) was observed with increasing severity of overweight and obesity for all of the health outcomes except for coronary heart disease in men and high blood cholesterol level in both men and women. With normal-weight individuals as the reference, for individuals with BMIs of at least 40 kg/m2 and who were younger than 55 years, PRs were highest for type 2 diabetes for men (PR, 18.1; 95% confidence interval [CI], 6.7-46.8) and women (PR, 12.9; 95% CI, 5.7-28.1) and gallbladder disease for men (PR, 21.1; 95% CI, 4.1-84.2) and women (PR, 5.2; 95% CI, 2.9-8.9). Prevalence ratios generally were greater in younger than in older adults. The prevalence of having 2 or more health conditions increased with weight status category across all racial and ethnic subgroups.ConclusionsBased on these results, more than half of all US adults are considered overweight or obese. The prevalence of obesity-related comorbidities emphasizes the need for concerted efforts to prevent and treat obesity rather than just its associated comorbidities.

Randomized, controlled trials, observational studies, and the hierarchy of research designs.

Abstract: Background In the hierarchy of research designs, the results of randomized, controlled trials are considered to be evidence of the highest grade, whereas observational studies are viewed as having less validity because they reportedly overestimate treatment effects. We used published meta-analyses to identify randomized clinical trials and observational studies that examined the same clinical topics. We then compared the results of the original reports according to the type of research design. Methods A search of the Medline data base for articles published in five major medical journals from 1991 to 1995 identified meta-analyses of randomized, controlled trials and meta-analyses of either cohort or case–control studies that assessed the same intervention. For each of five topics, summary estimates and 95 percent confidence intervals were calculated on the basis of data from the individual randomized, controlled trials and the individual observational studies. Results For the five clinical topics and 99 r...

How to improve R&D productivity: the pharmaceutical industry's grand challenge

Abstract: The pharmaceutical industry is under growing pressure from a range of environmental issues, including major losses of revenue owing to patent expirations, increasingly cost-constrained healthcare systems and more demanding regulatory requirements. In our view, the key to tackling the challenges such issues pose to both the future viability of the pharmaceutical industry and advances in healthcare is to substantially increase the number and quality of innovative, cost-effective new medicines, without incurring unsustainable R&D costs. However, it is widely acknowledged that trends in industry R&D productivity have been moving in the opposite direction for a number of years. Here, we present a detailed analysis based on comprehensive, recent, industry-wide data to identify the relative contributions of each of the steps in the drug discovery and development process to overall R&D productivity. We then propose specific strategies that could have the most substantial impact in improving R&D productivity.