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Book Review   |    
Bruce Hurter
Psychiatric Services 2006; doi:
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by Merrill Goozner; Berkeley, California, University of California Press, 2004, 296 pages, $24.95

Dr. Hurter is assistant professor at University of Massachusetts Medical Center, Worcester.

Merrill Goozner's The $800 Million Pill reviews recent scientific and economic developments of the biotechnology and pharmaceutical industries. Mr. Goozner extols the creativity of scientists and research groups, which has led to the discovery of many clinically valuable medications. However, in reviewing the important development of medicines such as Epogen, the AIDS cocktails, Ceredase, and Gleevec, the author argues that though the large pharmaceutical companies have profited significantly, their roles in the creations of these drugs were limited. He makes several strong arguments to refute the pharmaceutical industry's claims that large profits are necessary to drive future research.

Mr. Goozner, the former chief economic correspondent for the Chicago Times, presents evidence to challenge the often-quoted $800 million price tag for a new medication. In reviewing important medical advances, he suggests that years of basic research and development by the National Institutes of Health (NIH) have usually preceded the development of breakthrough drugs. He also argues that pharmaceutical costs have shifted to the increased creation of "me too" drugs and that the industry has increased marketing budgets to support the sale of these drugs. He notes that the pace of development of recent new molecular entities has dropped at the same time that the cost of drugs as a percentage of the health care dollar has increased dramatically.

Mr. Goozner suggests a number of directions for drug innovations, including government support of unbiased studies, such as the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial and the Clinical Antipsychotic Trials in Intervention Effectiveness, which would compare existing drugs. He recommends an institution of clinical practice in the NIH to generate independent best practice guidelines. He suggests that new drugs should be measured against other therapies and also suggests patent law reform.

The $800 Million Pill is a cogent and important addition to a number of books exploring the costs of our current system. The author's arguments are well documented, and the issues are particularly significant given the increased pressure to provide affordable medical care. At the same time, Mr. Goozner also presents a readable, informative, and even reverent history of the biotechnology revolution and some of the remarkable advances in molecular biology.

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