Drug companies say they need to charge ever-higher prices to cover their research costs, but they spend far less on research and development than they do on marketing and administration, and afterwards they actually keep more in profits.

A review of seventy-four clinical trials of antidepressants, for example, found that thirty-seven of thirty-eight positive studies [that praised the drugs] were published. But of the thirty-six negative studies, thirty-three were either not published or published in a form that conveyed a positive outcome.

Drug companies say they need to charge ever-higher prices to cover their research costs, but they spend far less on research and development than they do on marketing and administration, and afterwards they actually keep more in profits.

The United States is the only advanced country that permits the pharmaceutical industry to charge exactly what the market will bear, whatever it wants.

Over the past two decades the pharmaceutical industry has moved very far from its original high purpose of discovering and producing useful new drugs. Now primarily a marketing machine to sell drugs of dubious benefit, this industry uses its wealth and power to co-opt every institution that might stand in its way, including the US Congress, the FDA, academic medical centers, and the medical profession itself.

Liberals are wrong to think that opposition to health reform is a rejection of big government. If health reform consisted of extending Medicare to everyone, people would be delighted. There are millions of 64-year-olds out there who can hardly wait to be 65.

It is simply no longer possible to believe much of the clinical research that is published, or to rely on the judgment of trusted physicians or authoritative medical guidelines. I take no pleasure in this conclusion, which I reached slowly and reluctantly over my two decades as an editor of The New England Journal of Medicine.