Marcia Angell is a member of the faculty of Global Health and Social Medicine at Harvard Medical School and former Editor-in-Chief of The New England Journal of Medicine.
(December 2015)

Medical Research on Humans: Making It Ethical

Tony, a seven-year-old boy with artificial limbs, July 1963. He was born without arms as a result of the drug thalidomide.
In the first part of this review, I discussed principles and codes of ethics concerning human experimentation, including the Nuremberg Code and the Declaration of Helsinki.1 But principles and codes are not the same as laws and regulations, even though they might inspire them. The first US statute dealing …

Medical Research: The Dangers to the Human Subjects

Dr. Herta Oberheuser, whose war crimes included conducting medical experiments on concentration camp prisoners, being sentenced to twenty years in prison at the Nazi Doctors’ Trial, Nuremberg, August 1947
Given the American faith in medical advances, it is easy to forget that clinical trials can be risky business. They raise formidable ethical problems since researchers are responsible both for protecting human subjects and for advancing the interests of science. It would be good if those dual responsibilities coincided, but often they don’t.

Health: The Right Diagnosis and the Wrong Treatment

President Obama with Senators Max Baucus and Christopher Dodd at the White House after making a statement on Medicare prescription drugs, June 2009
Steven Brill has achieved the seemingly impossible—written an exciting book about the American health system. In his account of the passage of the Affordable Care Act, he manages to transform a subject that usually befuddles and bores into a political thriller. And his description of our dysfunctional health system is dead-on. But he is misguided in his recommendation for reform by turning over the administration of the system to hospitals.

A Better Way Out

Georges Seurat: Anaïs Faivre Haumonté on Her Deathbed, 1887
In his newest and best book, the surgeon Atul Gawande lets us have it right between the eyes: no matter how careful we are or healthful our habits, like everyone else, we will die, and probably after a long period of decline and debility.

The Women at the Top

A woman at work, from the ‘Lean In Collection’ presented by a new partnership between Getty Images and, intended to promote ‘images of female leadership in contemporary work and life’
In just the past two or three decades, women in more than token numbers have taken their place alongside men at the upper levels of government, the professions, and business. They now earn more than half of all college degrees, and they will shortly make up a majority of lawyers, doctors, and college faculty. While they still account for only a small minority of political and business leaders, that, too, is changing. The rapid ascension of women to the most influential sectors of society—occurring in all advanced Western countries—is likely to have profound implications for public policy, and perhaps even more for the way families construct their lives and raise their children.

What Is a Good Life?

Fairfield Porter: July, 1971
In 1938, Dr. Arlen V. Bock, professor of hygiene and chief of Harvard’s student health services, launched a study of 268 Harvard sophomores (all male, of course), selected as the best and the brightest in the classes of 1939 through 1944. The study was meant to last for fifteen to …

May Doctors Help You to Die?

Jacques-Louis David: The Death of Socrates, 1787
On November 6, Massachusetts voters will decide whether a physician may provide a dying patient with medication to bring about a faster, easier death if the patient chooses. On the ballot will be a Death with Dignity Act. If this ballot initiative passes, it will be binding, and Massachusetts will join Oregon, which implemented a virtually identical statute in 1998, and Washington, which did the same in 2009, as the only states where voters approved this form of physician-assisted dying, sometimes called aid-in-dying.

The Illusions of Psychiatry

Mimi Sarkisian, Louise Fletcher, and Jack Nicholson in One Flew Over the Cuckoo's Nest, 1975
The pharmaceutical industry influences psychiatrists to prescribe psychoactive drugs even for categories of patients in whom the drugs have not been found safe and effective. What should be of greatest concern for Americans is the astonishing rise in the diagnosis and treatment of mental illness in children, sometimes as young as two years old. These children are often treated with drugs that were never approved by the FDA for use in this age group and have serious side effects.

The Epidemic of Mental Illness: Why?

An advertisement for Prozac, from The American Journal of Psychiatry, 1995
It seems that Americans are in the midst of a raging epidemic of mental illness, at least as judged by the increase in the numbers treated for it. Are we learning to recognize and diagnose mental disorders that were always there? On the other hand, are we simply expanding the criteria for mental illness so that nearly everyone has one? And what about the drugs that are now the mainstay of treatment? Do they work? If they do, shouldn’t we expect the prevalence of mental illness to be declining, not rising?

FDA: This Agency Can Be Dangerous

Lexington Avenue at East 79th Street, New York City, 2008; photograph by James T. and Karla L. Murray from their book Store Front: The Disappearing Face of New York, published last year by Gingko Press
The US Food and Drug Administration (FDA) is a vital public agency. It is responsible for ensuring the safety of the foods we eat and many of the medical treatments we receive, and thereby regulates about a quarter of the nation’s domestic economy. I strongly believe in the FDA’s mission, …

Drug Companies & Doctors: A Story of Corruption

An advertisement for Paxil in The American Journal of Psychiatry, October 1999; from Christopher Lane’s Shyness: How Normal Behavior Became a Sickness. Paxil is one of the drugs about which unfavorable research has been suppressed by pharmaceutical companies.
Recently Senator Charles Grassley, ranking Republican on the Senate Finance Committee, has been looking into financial ties between the pharmaceutical industry and the academic physicians who largely determine the market value of prescription drugs. He hasn’t had to look very hard. Take the case of Dr. Joseph L. Biederman, professor …

Your Dangerous Drugstore

###1. On April 5, 2006, a New Jersey jury found that Merck’s arthritis drug Vioxx caused John McDarby, a seventy-seven-year-old retired insurance agent, to suffer the heart attack that left him debilitated in 2004. (The drug was not blamed for the heart attack of a second plaintiff in the same …

The Body Hunters

Shortly before I started work on my book The Truth About the Drug Companies: How They Deceive Us and What to Do About It,[^1] a friend gave me John le Carré’s newly published novel, The Constant Gardener, and urged me to read it right away. I did as I was …

The Truth About the Drug Companies

Every day Americans are subjected to a barrage of advertising by the pharmaceutical industry. Mixed in with the pitches for a particular drug—usually featuring beautiful people enjoying themselves in the great outdoors—is a more general message. Boiled down to its essentials, it is this: “Yes, prescription drugs are expensive, but that shows how valuable they are. Besides, our research and development costs are enormous, and we need to cover them somehow. As ‘research-based’ companies, we turn out a steady stream of innovative medicines that lengthen life, enhance its quality, and avert more expensive medical care. You are the beneficiaries of this ongoing achievement of the American free enterprise system, so be grateful, quit whining, and pay up.” More prosaically, what the industry is saying is that you get what you pay for.