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Medicine, Science, and Merck. By Roy Vagelos and Louis Galambos. New York: Cambridge University Press, 2004. xi + 301. Index, notes, illustrations, photographs. Cloth, $30.00. ISBN: 0-521-66295-8.
The pharmaceutical industry today is beset by a complex set of challenges. On the one hand, its pricing model is under attack: in the United States, where the direct importation of medicines from Canada is gaining ground; in Europe, Japan, and elsewhere, health ministers and regulators have started to use pricing data in drug-approval decisions. Likewise, insurers around the world are developing reference lists of medicines they will reimburse, based as much on price as on effectiveness. As the industry responds by shifting some aspects of marketing-especially the development of comparative cost and efficacy data-to late-stage clinical trials, it is being pushed to register all trials publicly and to publish even negative results. On the other hand, the industry suffers from an apparent innovation deficit, as is evident in its lack of new first-in-class treatments under testing. According to some analysts, breakthrough drugs are coming out of small biotech startups, not from R&D labs in large pharmaceutical firms.
Merck is no freer of these competing pressures than any other company. In the past year alone, it went through a rare round of layoffs to improve its bottom line and announced that it is looking to form partnerships and launch joint ventures-rather than engaging only in internal research-as an expanded source of new drugs. New perspectives on the firm have been published, not just in newspapers, but also in a recent book, The Merck Druggernaut: The Inside Story of a Pharmaceutical Giant,...