“This book is a necessity for understanding the pharmaceutical industry. Both the pluses and minuses of the present system are set forth with a judicious combination of historical narrative, economic analysis, and statistical data. The highly original proposals for reform will be a major stimulant to analysis and policy-making.”

–Kenneth Arrow, Nobel Laureate in Economics, Professor Emeritus, Stanford University

“This is a timely book by authors who know what they are talking about. They tackle a big problem: rising drug prices that are threatening to overwhelm us all–and especially those with limited or absent health care insurance. Will we drive people overseas for healthcare? Will there be social unrest? This book describes the problem and then offers a solution. Worth a careful read by everyone, pharmaceutical manufacturers and government policymakers especially.”

–Roger Williams, M.D., Chief Executive Officer of the United States Pharmacopeia and a former

senior official of the Food and Drug Administration

“This book confounds two sets of skeptics: Those who say there’s no way to resolve the conflict between the need to fund pharmaceutical research and our desire to keep medicine affordable; and those who think that economics never has anything good to say.”

–Honorable Barney Frank, Congressman from Massachusetts

“This book comes at the right time and could become the starting point of discussions, which will eventually lead us into new era in the healthcare care industry. It will without a doubt become a must for insiders of the pharma- and biotech industries.”

–Dr. J�rgen Drews, retired President of Roche Pharmaceutical Group Global Research

Acknowledgments viii

About the Authors ix

Introduction xi

Chapter 1: Drugs and Drug Prices 1

Chapter 2: The American Way to Discover Drugs 21

Chapter 3: The Drug Industry Today 39

Chapter 4: Are Drug Companies Risky? 59

Chapter 5: How Not to Lower Drug Prices 77

Chapter 6: Squandering R & D Resources 103

Chapter 7: How to Lower Drug Prices 129

Appendix: Our Solution in Detail 155

Index 177

About the Author

STAN FINKELSTEIN, M.D., is a Senior Research Scientist at MIT, Co- Director of the MIT Program on the Pharmaceutical Industry (POPI), and serves as a Senior Lecturer on Health Care Policy at Harvard Medical School.

PETER TEMIN, Ph.D., a widely cited economist and economic historian, is currently Elisha Gray II Professor of Economics and former head of the Economics Department at MIT. He is the author of Taking Your Medicine: Drug Regulation in the United States.

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