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Devalued and Distrusted: Can the Pharmaceutical Industry Restore its Broken Image?

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Review

"Oz should invite LaMattina back on his show.  Since LaMattina treats all concerns respectfully, Oz needn’t worry about feeling devalued or distrusted."  (Barron's, 5 May 2014) “This is an honest book by an insider who believes in the basic good that the industry does.”  (The Quarterly Review of Biology, 1 September 2013) “Summing Up:  Recommended.  General audiences.”  (Choice, 1 September 2013) “For those more loosely associated or aspiring to work with in it, I particularly recommend this book as a balanced and informative read on the pressures the industry faces. It should also provide the basis for more reasoned argument and forewarn anyone else potentially ambushed by a TV show.”  (ChemMedChem, 19 July 2013) “That said, the suggestions made by LaMattina for improvements in productivity and transparency are timely, and the book makes interesting if unexciting reading.”  (Chemistry & Industry, 1 June 2013) “John LaMattina (ex-head of Pfizer's global R&D) has a new book out about the industry, called Devalued and Distrusted.  He tells Pharmalot that he got the idea to write a sequel to his earlier book, Drug Truths, when he appeared on the "Dr. Oz" show.”  (In The Pipeline, 1 December 2012)  

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Review

“ … the book is laden with so many facts, critical insights and pearls of wisdom that it deserves the attention of a wide audience, from lay people to professionals in R&D, medicine, government, business and mass media. Dr. LaMatina has performed a public service by drawing on his broad experience to clarify the issues and the many challenges that have to be faced if progress in therapeutic molecular medicine is to continue, and to illuminate the ongoing tensions that are bound to arise with ever increasing risks and costs in pharma and biotech R&D, never-perfect new medicines and constantly rising consumer expectations and government involvement.”—E J Corey, Harvard University

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Product details

Paperback: 136 pages

Publisher: Wiley; 1 edition (January 9, 2013)

Language: English

ISBN-10: 1118487478

ISBN-13: 978-1118487471

Product Dimensions:

6.1 x 0.4 x 9.2 inches

Shipping Weight: 4 ounces (View shipping rates and policies)

Average Customer Review:

4.0 out of 5 stars

14 customer reviews

Amazon Best Sellers Rank:

#1,539,909 in Books (See Top 100 in Books)

My brain is aware of what this book calls sedation, dry mouth, and arrhythmia as side effects from some medications that I associate with people in Minneapolis who thought I was crazy and tried to turn me into a highly medicated individual. Our society functions on high mobility, but those who are not mobile try to avoid phone conversations with anyone who is likely to tell us to call 9-1-1 to be taken to someplace where we will be treated for derangement. The F.D.A. failed to approve a combination drug that fools the brain into thinking anything sweet is unappetizing because symptoms arising from old man fat dread are not always the best way to get our society to only 500,000 first-time heart attacks each year. LaMattina calls himself a senior partner who would have occupational glee if only 500,000 Americans had a first-time heart attack each year because they take enough statins to keep from having 510,000 heart attacks. Millions of Americans would be taking pills to reduce the risk factors associated with the way Americans live, eat, and throw what they are not using right now in the trash.In my lifetime, institutional thinking has assumed that hundreds of millions of Americans can be treated like patients so hundreds of thousands will have extra years of life. I took beta blockers to slow my heartbeat so the heart muscle would not have fatal arrhythmia before I had lived a normal lifespan. I seem young now compared to old people walking around like zombies on pacemakers and former stroke victims. The F.D.A. wants 10,000 users of a new drug to live long enough for five years of test results before we get new forms of brain control that reduce diabetes, cardiovascular events, and the terror of meaningless activities becoming expenses of the last illness that reduce estates.

John LaMattina's lengthy career in the pharmaceutical industry had prepared him for close encounters of many kinds, but nothing could have prepared him for his encounter with Dr. Oz. Perhaps it was ignorance that led him to believe that his appearance on one of Dr. Oz's television segments would be relatively benign, but he had another thing coming. Next time, no doubt, LaMattina will ask questions. A lot of them. Undoubtedly shock set in once he realized that he, along with big pharma, was the target of the day. Monstrous villains, evil money-mongers who were only out for one thing ... themselves and that buck. Right on down the yellow brick road LaMattina went in an effort to explain away the "Four Secrets That Drug Companies Don't Want You to Know."The statements, of course, were inflammatory and LaMattina answered them as best he could. The audience reaction clearly indicated that the questions needed further explanation. This book is a result of those four questions. I had only one problem with this book and that was to keep people from walking off with it before I had finished it. It is not a lengthy tome and in fact it can be read in a day if one is so inclined. It is written with the layman in mind, yet has sufficient references for those who wish to explore the topic further. The risks to the public, who may have decided to discard prescribed medications as a result of the show, were plentiful. LaMattina lamented that "oftentimes diet and exercise are not sufficient to reduce the risk of these diseases [diabetes, osteoarthritis, osteoporosis, etc.]; and at some point specific medicines may be required to restore a person's health to prevent long-term consequences of the disease." (p. 15)LaMattina decided to discuss many of the issues big pharma faces, particularly in R & D. The first thought that came to mind was that he would be biased wholly toward pharma, but I found the discussion to be extremely informative without being inflammatory. He fully acknowledges the shortcomings of the industry, but also is quick to point our "the value the biopharmacceutical industry adds to improving the world's health." (p.58) Historically, the discussion mainly focuses on the last decade, but has snippets relative to what is going on today. I found his insight to be invaluable, particularly because of his insider view of the pharmaceutical industry as the former president of Pfizer's Global R & D Division.I felt LaMattina sat down and asked himself those difficult questions we all are curious about. I ended up being quite enamored with this book and learned much more than I ever thought I would (or would want to) about the big pharma and R & D. The writing was in what I call a conversational format. The let-me-tell-you-about-what-I-know attitude had me mesmerized. I definitely came away feeling more comfortable with the industry and LaMattina left few stones unturned. It was probably a good thing that he never asked what Dr. Oz's segment was about or we wouldn't have this amazing book."Four Secrets That Drug Companies Don't Want You to Know."1. Drug companies underestimate dangerous side effects.2. Drug companies control much of the information your doctor gets.3. You're often prescribed drugs that you don't need.4. Drugs target the symptoms, not the cause.CHAPTER 1: THE FOUR SECRETS THE DRUG COMPANIES DON'T WANT YOU TO KNOWDrug Companies Underestimate Dangerous Side EffectsDrug Companies Control Much of the Information Your Doctor GetsYou're Often Prescribed Drugs That You Don't NeedDrugs Target the Symptoms, Not the CauseConclusionReferencesCHAPTER 2: WHAT HAS HAPPENED TO R&D PRODUCTIVITY?Impact of Mergers on R&D ProductivityHeightened FDA Requirements for NDAsHigher Hurdles Set by PayersConclusionReferencesCHAPTER 3: KEY THERAPEUTIC AREAS FOR IMPROVING HEALTHCancerDiseases of the BrainCardiovascular Disease (CVD)DiabetesBacterial InfectionsConclusionReferencesCHAPTER 4: IMPROVING R&D OUTPUTThe Views of OthersPharma's Blockbuster Mentality Needs to ChangeCan "Predictive Innovation" Lead to Greater Success Rates?Would Royalties Make Scientists More Productive?Will Drug Repositioning Help Fill the R&D Pipeline?Consultants Don't Always Have the FactsPersonal ViewsDiscovery Must Focus on ProductivityDoes Size Help or Hinder R&D Productivity?To Outsource or Not to Outsource? That's the Pharma R&D QuestionBig Pharma Early Research CollaborationsConclusionReferencesCHAPTER 5: RESTORING PHARMA'S IMAGEIllegal Detailing of DrugsPharmaceutical Companies Should Drop TV AdsThe Need for Greater TransparencyHow Committed Is Big Pharma to Rare Diseases?Pharmaceutical Companies and PhilanthropyPharma Needs to Have Its Scientists Tell Their StoriesConclusionReferencesCHAPTER 6: FINAL THOUGHTSReferencesINDEX

John LaMattina is a thirty-year veteran of the pharmaceutical industry and former president of Pfizer's Global R&D Division, an ultimate insider of the pharmaceutical world. While there is much I dislike about the pharmaceutical industry, it is very interesting to read his account.However his critique of traditional remedies is fraught with inaccuracies. For example the use of Ginkgo biloba leaves for cognitive impairment is not a traditional use- the Chinese never significantly used ginkgo leaves and this use was derived from the modern German pharmaceutical industry which is far more open to botanical treatments than the US. While it showed little effect for people of normal cognition as he rightly points out, smaller trials show some advantage for people with Alzheimer's.He points out that cysteine has a weaker effect at stopping smoking than Chantix, which is true. But unlike Chantix it doesn't have the psychopathological effects that I have seen in my own family members who attempted to use it to stop smoking. While he never points out the serious side effects of Chantix, now (but not initially) in the required list of side effects read in television commercials (always listen with your eyes closed to avoid distracting calming pictures) a lower efficacy is better than iatrogenic mental disease.He is also a strong proponent of statins, citing much lower side effects than I see clinically (which makes me suspicious of the statistics cited.) But since statins can cause diabetes, muscle dysfunction and can clog liver CYP450 liver pathways, prescribing them is not the slam dunk he believes.Much more interesting are his suggestions for managing R&D and improving the reputation of the industry by stopping the illegal detailing of drugs to doctors for unapproved uses, pulling all television ads (the side effect list is one reason why), engaging in greater transparency (the drug lawyers will howl), greater commitment to rare diseases and greater publicity of the stories of the science of drug discovery. He also decries mergers and acquisitions of companies researching new drugs- corporate cultures often are different and scientists are laid off to avoid duplication, usually to the detriment of R&D.

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