DNF

I did not read this book and I know longer have any interest in reading it. This was during the beginning of my NetGalley “everything looks great so I am going to request it without looking into the book. I have definitely become more selective in choosing what books I want to request and read.

This book is a great read. It is criminal what the medical companies are able to to do to us the consumers and what our governments are allowing them to do. There were no surprises though, which is unfortunate as everybody knows that this corruption is going on around us all of the time- legal corruption, legal theft, it's criminality at the highest order. This book is based in the USA but its events are common world wide. There are multiple incidents of back slapping, collusion and brown envelopes happening all around us and we, the consumers are paying the price. Ireland, where I live has so many cases of this evident in the pharmaceutical industry here with those in need of medicine are paying through the nose for premium brands as generic brands, which cost a fraction of the price are unavailable here. This has to end, but will it in our lifetime? Not as long as the pockets of those in power are being lined. This is a very interesting and informative read. It has multiple facts and figures to back up all if the assertions, supporting all of the claims that Feldman is making, all of the accusations that are being thrown at the pharmaceutical industry. This book can not help but infuriate anybody with an ounce of scruples. It's a really interesting read.

This book was awesome and relevant to read.
The title just fit perfectly to its content and wasn’t boring at all.

Thank you netgalley for providing this ARC in exchange for an honest review.
I thought this book was informative and compelling. Although a bit dense and at times hard to follow if you're not in the healthcare world, it does reveal some very provocative arguments about how drug prices rise. It's a unregulated, corrupt system where the middle man and drug companies make out by raising prices and cutting out the competition. It's a scary world but hopefully regulation will soon come to the rescue.

If you or anyone in your family depends on prescription drugs, you need to read this book. If I had unlimited financial resources, I would send a copy of this book along with my notes, thoughts and suggested resolutions to every member in Congress and every member in my state government. This book needs to be read and I commend the author for having the courage to write it and attempt to answer the question so many of us ask each time we visit the pharmacy - Why in the world is my medicine so expensive? Even with insurance????

Big Pharma, while they have life saving drugs is also a Big Bully to us patients. We all know the healthcare system is messed up, it's a jumbled ball of yarn that the government keeps making worse instead of better. And the pharmaceutical industry is just as messed up and corrupt. I never knew quite how corrupt until reading this book. The author does an exquisite job of laying out how the industry is structured and analyzing all the ways the drug prices get raised. It is alarming, it is scary, it is horrifying how the current system is structured to rob the patient blind while padding the pockets of drug companies. PBM's (pharmacy benefit managers) and insurance companies. Within reading the first 15% of this book, I had 7 solutions to help lower drug costs. And that's just me, one lone reader. Now imagine if the powers that be, that we elected to be our voice and our feet to move justice would take the time to really read this, research it and discuss solutions what could happen!

I have two diseases that require extensive medicines to keep me somewhat healthy - Multiple Sclerosis and Congestive Heart Failure. I have no problem paying a premium for a product or service that is of extensive value to me. And I understand the need for companies to make a profit. I have no problem with that. One of the medicines I take for MS keeps me walking and out of a wheelchair (I consider that to be extensive value). What I do have a problem with, a big point in this book, is why is that medicine now $58,000 a year when 20 years ago it was $30,000 a year? And there is a generic on the market now that is $36,000 a year. You want me to believe in 20 years the pharmaceutical company hasn't found a more cost efficient way to manufacture this medicine? And with seven other competitive MS medicines out there, this is not an issue of cost and demand. As the title says, there is alot of money and secret handshakes that go into this dishonesty. The book points out on average a brand name drug has a 76% profit margin.

A huge part of the deception is this middle group of players who are the ones determining coverage levels for patients and the formularies for insurance companies. Someone in a suit is sitting in an office making a decision on what medicine I should be allowed access to based on how much money they are getting paid, not on what is in the best interest of my disease and health, as determined by my doctor.

There are moral, ethical and legal concerns raised in this book that as a country we need to address. The author does a spot on job of backing up everything with solid facts, figures, examples and legal cases. In the end the author offers a few solutions that could be pursued to start the conversation and get the ball rolling. If you take the time to read this book, I feel confident you will find additional ideas and potential solutions as I did (by books end I had 16. Not saying all would work or are even feasible, but it's a start). The point being that if we can get the right minds to the table, there are solutions out there where patients could get affordable medicine that won't break the bank while still allowing the pharmaceutical companies to make a decent profit.

My thanks to the author, publisher and netgalley for a copy of this book in exchange for an honest review.

Drugs, Money and Secret Handshakes delves into the world of pharmaceutical price gouging and all the many hidden players behind it. As expected, collusion, secret agreements and greedy middlemen conspire to conflate medication prices. The reader is left surprised by just how many middlemen have a stake in keeping medications pricey.

Robin Feldman also shines a light onto the seedy little tricks pharmaceutical companies employ to keep prices high on drugs that have been around for a very long time. Using recycling and recombination strategies to obtain new patents to keep prices high on pharmaceuticals that would have otherwise become more affordable is just one of the sneaky techniques they employ.

Drugs, Money and Secret Handshakes is an apt title. The book is both interesting and educational.

DRUGS, MONEY, AND SECRET HANDSHAKES by Robin Feldman is subtitled "The Unstoppable Growth of Prescription Drug Prices." Feldman is a Professor of Law at the University of California Hastings and has written other books about the intersection of science and law, including ones which focus on patent law and drug pricing strategies. In her latest text, she documents the "high cost of brand medications for common conditions"” and the extent to which government budgets are "struggling to cover the cost of new, expensive medicines." She argues that "internal incentives push every market participant towards behaviors that increase prices, knocking out the normal checks that should operate as brake-points on the market." After background information on the market and the effects of rising prices, she uses subsequent chapters to explain how incentive structures for insurance companies, pharmacies, doctors and patient groups drive prices higher. Another chapter looks at drug company efforts to keep out lower priced competitors. And, finally, she suggests some changes for "realigning the industry's incentives with society’s interests."

Feldman addresses an extremely complex topic and provides a much needed overview for policy makers, although this seems quite complex (e.g., while some changes would seem to increase competition they may move oversight from a Federal to a State level) even for those of our students who are very interested in the impact and power of the pharmaceutical industry. DRUGS, MONEY, AND SECRET HANDSHAKES contains truly extensive notes (more than a third of this roughly two-hundred page book), plus a helpful index and several diagrams.

I thought this book would present a more balanced view but that wasn’t the case. I know this industry well and feel like the view is lopsided here.

A Klaxon Call. In this exceedingly well documented scholarship, Feldman presents the case well. And what an alarming case it is. Drug manufacturers have found ways to game the system at all levels such that the existing system in the US actually *encourages* ever higher drug prices - even as patients are crying out under the strain and in many cases forgoing life saving medication due to not being able to afford it. Feldman explains the problem at all levels though four of the six chapters of the book, with the first chapter being an overall introduction to the problem and the final chapter being suggested solutions - including a range going from possibly politically palatable yet likely ineffective to very likely effective but less likely to be politically palatable. Overall a stunning work that could - and likely should - drive at least some discussions through the 2020 election cycle.

Drugs, Money, and Secret Handshakes is a detailed critique of the pharmaceutical industry, the system that encourages high drug prices, and the perverse incentives that can drive prices even higher.

The book discusses the multiple factors that can lead to extremely high drug prices, and the slowed availability of cheaper generic molecules. The book is heavily-focussed on the politico-economic factors that shape the system. Between a pharmaceutical company with a new drug and their potential patients sit layers of pharmacy benefit managers (PBMs), insurance companies, the FDA, pharmacies and hospitals, the network of which make the cost of a drug very difficult to elucidate. All of these large players have financial interests that can be misaligned with the interests of the public.

Personally, I am predominantly interested in the drug design process, the costs associated with bringing a drug to market, and the general trends represented by Eroom's law. The book does not cover this, but focuses instead on the economics involved from the point at which a molecule is close to approval. Possibly these post-approval factors have a larger influence on the price point of a molecule than the "scientific" costs may have.

Feldman’s research is purely US focussed, which is not apparent from the cover or blurb. It did make me wonder how much the rest of the world is benefitting from the overpaying that occurs in the US; would the NHS see higher drug prices if there were smaller profit margins within the US? That US drug prices are subsidizing other countries health may be an effective motivation towards national healthcare for some Americans.

Overall, the book was educational, however was not an easy read, particularly when I was expecting a more general popular-science book. However, if enjoy the economic-focus, there is plenty in the book to leave you appalled.

This is a very interesting book. The introduction is a good example of a clear and interesting intro. It invites me to start reading and also explains what will be told. I worked in health care for six years and asked myself the same questions as the author asked, probably. Why does it all have to be so bloody expensive? This book is focused on the United States, but I can tell you that it's the same in Europe, and anywhere else on the world. The moral concerns raised by the people who are interested in this topic are just and that's why books like these need to be written and read by many people.

The story is supported by helpful figures and understandable analogies. It's a little number heavy, and not particularly an easy bedtime read. But it's very insightful and I really learned some new things. For example the recycling of drugs, newly released drugs are often old ones but in different capsules. They are then released under a new brand name and the makers can then benefit again from a patent-protected few years. (So they can get way more money for the drugs!)

So, if you are interested in health care, definitely read this book. Books like these should be mandatory for health care professionals, I think.