Pills, Power, and Policy: The Struggle for Drug Reform in Cold War America and Its Consequences by Dominique A. Tobbell (review)

Dominique Tobbell’s Pills, Power, and Policy documents the alliance-building activities of firms within the pharmaceutical industry in the second half of the twentieth century and illustrates how these alliances stalled and altered attempts at regulation and control. To take up this topic, Tobbell marshals in a creative and comprehensive fashion the relevant government and company archives as well as published materials. In so doing, her text serves as an excellent research template for emerging business historians focused on this time period and provides a historical overview to public policy officials (as befitting a text published jointly by the University of California and the Milbank Books on Health and the Public).

Tobbell’s primary argument is that the pharmaceutical industry has succeeded, in part, because of the multifaceted ways in which it built and supported alliances that would defend it for decades from calls for reform. With industry and researchers already having established a collaborative working relationship during World War II (WW II), Tobbell begins by showing how industry perpetuated these ties with fellowships, generous publication policies, and the employment of researchers as consultants. Tobbell finds extensive evidence of a network between researchers and industry existing in the 1950s, which balanced academic freedom and authority in such a way that innovation and growth were encouraged. This partnership not only generated research but also managed attempts to regulate pharmaceutical companies.

With the private funding and organization of research seen by those in industry as critical to pharmacology advances and superior medical outcomes, the industry’s trade association, the Pharmaceutical Manufacturer’s Association (PMA), was confronted in the mid-1950s with legislation that encapsulated the public’s resentment of high prescription drug prices, doctor concerns about the appropriateness of marketing, and pharmacist concerns about too many similar drugs. Industry was successful in using their partnerships to get the 1962 Kefauver-Harris Amendment to the Pure Food and Drug Act watered down to a focus on drug safety and advertising from an original call for weakened patent protections that would have impaired drug profitability.

The members of the PMA and their supporters then strengthened their alliance after passage of the Kefauver-Harris Amendment by calling for the creation of a Commission on Drug Safety to help the Food and Drug Administration (FDA) meet its enlarged responsibility for drug safety. This commission grew to become the Drug Research Board (DRB)—a group that was affiliated with the National Academy of Sciences and National Research Council but was populated by members of the industry and academic supporters. The DRB then countered and shaped, from the mid-1960s to mid-1970s, the FDA’s attempts to control drug research and stalled attempts at the federal level to mandate generic drug substitution. Tobbell’s text ends with an epilogue that continues her exploration of alliances in more recent decades. In her discussion of how industry shaped legislation in 1984, 2003, and 2010, she concludes that even though the politics faced by the pharmaceutical industry have changed, it still closely resembles the politics the industry has faced since the end of WW II. For policy makers, Tobbell’s epilogue would suggest that the pharmaceutical industry’s alliances are a permanent part of the landscape and that policy makers must confront and propose change in an environment where these alliances exist and wield significant influence.

There are three comments that bear mentioning, with two of these refining and extending Tobbell’s discussion and the third comment pertaining to Tobbell’s methodology. First, Tobbell’s narrative only makes brief mention of the events before WW II that influenced the relations between industry, researchers, and the government. As noted by Germaine Reed, Crusading for Chemistry, 2010, starting in 1918...