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.

In economic terms, health care is a highly successful industry - profitable, growing, and virtually recession-proof - but it's a massive burden on the rest of the economy.

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.

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.

Illness and death are not optional. Patients have a right to determine how they approach them.

Pharmaceutical companies have too much influence over the education of physicians in this country. They have too much control over the evaluation of their own products, and that's a conflict of interest. I think the industry needs to be regulated, but I've never suggested taking it out of the market altogether.