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Pills, Power, and Policy

Pills, Power, and Policy: The Struggle for Drug Reform in Cold War America and Its Consequences

Copyright Date: 2012
Edition: 1
Pages: 310
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  • Book Info
    Pills, Power, and Policy
    Book Description:

    Since the 1950s, the American pharmaceutical industry has been heavily criticized for its profit levels, the high cost of prescription drugs, drug safety problems, and more, yet it has, together with the medical profession, staunchly and successfully opposed regulation.Pills, Power, and Policyoffers a lucid history of how the American drug industry and key sectors of the medical profession came to be allies against pharmaceutical reform. It details the political strategies they have used to influence public opinion, shape legislative reform, and define the regulatory environment of prescription drugs. Untangling the complex relationships between drug companies, physicians, and academic researchers, the book provides essential historical context for understanding how corporate interests came to dominate American health care policy after World War II.

    eISBN: 978-0-520-95242-3
    Subjects: Health Sciences

Table of Contents

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  1. Front Matter
    (pp. i-viii)
  2. Table of Contents
    (pp. ix-x)
  3. Foreword
    (pp. xi-xii)
    Carmen Hooker Odom and Samuel L. Milbank

    The Milbank Memorial Fund is an endowed operating foundation that works to improve health by helping decision makers in the public and private sectors acquire and use the best available evidence to inform policy for health care and population health. The Fund has engaged in nonpartisan analysis, study, research, and communication since its inception in 1905.

    Pills, Power, and Policy: The Struggle for Drug Reform in Cold War America and Its Consequencesby Dominique Tobbell is the twenty-third book in the series of California/Milbank Books on Health and the Public. The publishing partnership between the Fund and the University of...

  4. Acknowledgments
    (pp. xiii-xvi)
  5. Introduction: Pharmaceutical Politics, Then and Now
    (pp. 1-10)

    Since the early 2000s, barely a week has gone by without the pharmaceutical industry being in the news. Of particular concern has been whether pharmaceutical companies charge too much for prescription drugs, withhold negative clinical trial data, and produce too many so-called me-too drugs—drugs with similar chemical properties and more or less identical therapeutic functions. Equally alarming have been questions about whether physicians and researchers who receive money and gifts from drug companies act in the best interest of patients and whether the federal Food and Drug Administration (FDA) has been captured by the industry it’s charged to regulate.¹...


    • 1 Knowledgeable Relations: The Building of a Pharmaceutical Research Network
      (pp. 13-36)

      Between 1930 and the early 1950s, the American pharmaceutical industry underwent a transformation. Due to changes in the research and regulatory environments, the industry went from being one dominated by small and medium-sized companies specializing in the bulk manufacture of fine chemicals or the wholesale manufacture of pharmaceuticals to one dominated by several large, fully integrated companies, with extensive research facilities, growing medical departments, and significant marketing capability. This transformation did not come about smoothly; it required the concerted efforts of industrial and academic researchers, corporate managers, and government officials. Moreover, the changes taking place in the pharmaceutical industry depended...

    • 2 Workforce Relations: The Invention of the Pharmaceutical Postdoctoral Fellowship
      (pp. 37-58)

      American drug companies and their academic colleagues emerged from World War II with a sense of therapeutic accomplishment. Their prewar and wartime collaborations had produced an armory of new therapeutic innovations that included the sulfa drugs (copied from German firms), synthetic antimalarial drugs, and broad-spectrum antibiotics. For the first time, physicians had the means to eradicate some, if not all, infectious diseases. Yet, in spite of the therapeutic optimism of the period, in the decade after World War II drug companies, research universities, and medical schools were troubled by a perceived crisis in the biomedical workforce.¹ At the same time,...

    • 3 Professional Relations: Crafting the Public Image of the Health Care Team
      (pp. 59-86)

      In the first decade after World War II, the American pharmaceutical industry rode a wave of public and political support. Journalists wrote with awe about the introduction of new therapeutic innovations such as cortisone and streptomycin. In the spring of 1949, for example, theNew York Timespublished several articles on the first treatment of patients suffering from rheumatoid arthritis with cortisone, emphasizing the “dramatic relief . . . [cortisone] afford[s] in enabling long-time cripples to walk again.”² Citing the treating physician, theNew York Timestold of one “woman, unable to lift herself out of bed or feed herself”...


    • 4 Cold War Alliances: Kefauver’s Bid for Pharmaceutical Reform
      (pp. 89-120)

      By the time Senator Estes Kefauver launched his Senate Subcommittee on Antitrust and Monopoly investigation into the alleged administered pricing in the drug industry in December 1959, the American drug industry was finally taking its political troubles seriously. As Kefauver indicated in his opening remarks, the aim of the hearings were to determine whether the antitrust laws as applied to the drug industry were adequate “and, if not, to devise specific remedial legislation.”² At the center of Kefauver’s concern was the purportedly high price of prescription drugs and what seemed to him to be an absence of price competition in...

    • 5 Expert Alliances: The Creation of the Drug Research Board
      (pp. 121-162)

      Passage of the 1962 amendments to the Food, Drug, and Cosmetic Act marked a victory for pharmaceutical reformers. Although the drug industry had derailed much of Senator Kefauver’s reform agenda, the amendments did grant the Food and Drug Administration (FDA) significantly greater authority over the clinical testing, marketing, and distribution of drugs. Recognizing the limits of that victory, however, pharmaceutical reformers continued throughout the 1960s and 1970s to agitate for even tighter government control over the drug industry.

      At the center of the battle over pharmaceutical reform in the 1960s were questions about expertise, authority, and physician autonomy. Congressional reformers,...

    • 6 Generic Alliances and the Backlash against Regulatory Reform
      (pp. 163-192)

      In May 1967, Senator Gaylord Nelson launched what would become a decade-long investigation into the American drug industry. Like his reform-minded predecessor, Senator Estes Kefauver, Nelson regarded mandatory generic prescribing as the solution to rising prescription drug and health care costs. Over the course of the next decade, Nelson joined with other pharmaceutical reformers—most notably Senators Joseph Montoya, Russell Long, and Edward Kennedy—to push for legislation that would reform physicians’ prescription practices and add a prescription drug benefit to Medicare. From the late 1960s through the 1970s, these efforts to introduce generic prescription reform galvanized the political alliance...

  8. Epilogue
    (pp. 193-208)

    The substance and character of pharmaceutical politics changed little between the 1960s and 2009. Each episode of prescription drug policymaking was shaped by the same alignment of interest groups (brand-name manufacturers and organized medicine on one side; consumer and senior citizen groups, reformist congressional Democrats, and, increasingly, generic drug manufacturers on the other). The issues on which critics challenged the pharmaceutical industry and sought reform continued to be the high price of prescription drugs, the marketing practices employed by pharmaceutical firms, and the ability of regulators to ensure the safety of prescription drugs. Similarly, the industry’s response to proposals for...

  9. Notes
    (pp. 209-266)
  10. Bibliography
    (pp. 267-282)
  11. Index
    (pp. 283-294)