Few have confronted big pharma’s deceptive marketing techniques, lack of innovation and exaggerated research and development costs more vividly than Marcia Angell, MD. Having edited the prestigious New England Journal of Medicine (NEJM) from 1979 until 2000, she has just published The Truth About the Drug Companies: How They Deceive Us and What To Do About It (Random House, $24.95), a bracing primer on drug-profiteering and influence-peddling. Here, she gives POZ her damning prescription—and prognosis.

POZ: When did big pharma’s power start scaring you?
Angell: When I started at the journal, pharma would give grants to researchers, step back and hope the drug succeeded. Over two decades, I saw a gradual change that led the industry to exercise too much control over the evaluation of its products. By the time I left, they were intimately involved with research design, data analysis and deciding whether results would be reported.

HIVers and advocates have long protested pharma’s stranglehold on treatment and research. How can this be stopped?
In my book, I advocate for breaking drug companies’ hold on doctors. I also point out that bribes require bribees, who are harder to excuse than the bribers. Doctors need to ask themselves, “Why are these drug companies giving me a gift? Why should that be added to the price of peoples’ prescription drugs?”

By pushing the FDA to speed the drug-approval process in the late ’80s, did AIDS activists help create today’s problems?
Their desire to get lifesaving drugs quickly was understandable—but activists risked the [process] needed to tell if those drugs were safe and effective. Now [HIVers] are saying, “Hold on. You can’t just bottle anything and say that it works.” There was a learning curve.

Do you see HIV as being overmedicated?
HIV has come to be viewed as less like a lethal infection. Maybe we’ve gotten too comfortable with that notion. But I don’t feel that there isn’t an effort to try to make treating it more convenient.

Why is it cheaper and easier to develop a “me-too” drug [a reformulation] than an innovative one?
Pharma is waiting for innovative drugs to come to them. Academic research is in the public domain for anyone to use. After that, the only development expenses are clinical trials.

We still don’t have any way to compel FDA follow-up studies once a drug is approved.
The legislation for the FDA to hold pharma responsible exists—it just isn’t enforced. And now that the FDA depends on pharma for millions of dollars [via fees that pharma pays the agency to review each drug], it’s unlikely to crack down.

Your book argues that for researchers to merely disclose financial ties to pharma-sponsored research is inadequate.
I would rather have a “just say no” system, where certain financial ties to companies whose products you’re studying are prohibited.

Some argue that a zero-tolerance policy for federal officials with industry ties would leave no one to sit on advisory boards and clinical-trial committees.
That’s not true. Journalists cannot have financial interests in companies they write about, and yet medical researchers continually say, “Not to worry. I’m objective, even though I may own part of the company whose drug I am studying.

Do you think a magazine that depends on pharma ads, such as the NEJM or POZ, can maintain objectivity?
For most journals and magazines, [pharma] marketing folks call the shots. When I was at the NEJM, it was unique among medical journals because it could have survived on subscriptions alone.

What about AIDS activists who go on lavish pharma-sponsored junkets and claim that they’re still objective?
Activists are powerful, and drug companies have every interest in co-opting them. I don’t think it’s possible to take gifts from drug companies and not be compromised, even if only by developing warm feelings for them. A company is exactly the wrong place to go for critical, impartial information about a product it sells. If you are interested in how a Honda compares with a Toyota, you don’t go to the Toyota dealer.