How did we get to this mess that produces untold suffering, impedes effective health care, and costs our economy sacks of bullion and much lost productivity?
Here's a very brief recounting:

Drugs and Movies

Remember the days of "ethical drug companies"? That was before movies like the "Fugitive" where vascular surgeon Dr. Richard Kimble (Harrison Ford) is framed for his wife's murder to prevent acknowleding the new potential cardiovascular blockbuster "Trivasic" causes liver failure. Sadly the film was prescient (though not quite a blockbuster,) appearing years before the Vioxx scandal demonstrated the lengths to which companies would hide data to protect yearly billions in profits.
Things did not start out that way.

In the seventies and eighties, drug companies learned like movie companies that "blockbusters" earned them so much money, especially in the superprofitable US market, that even lowly executives might buy a home in Palm Beach. The strategy was to spend the tens of billions of profit on R&D, and somewhere, somehow, a major drug will come.

But the glory days did not last.
The vastly complex information system that is the human body suddenly seemed much harder to understand. Drugs that worked beautifully in the lab, superbly in animals, and admirably in early drug trials, turned out to have ugly side effects that washed all the costly efforts out to sea. Approved new drugs plummeted.

The companies fought back to retain profits and keep stock markets satisfied. Though they kept up massive spending on R&D, executives realized what could not be achieved in the lab might be achieved through marketing and lobbying. Individuals doctors were deluged with drug reps, who changed from experienced pharmacists and nurses to young people so pretty they could work as models or Hollywood starlets; the trend was to hire college cheerleaders who were notably "upbeat." Academic physicians, watching their research budgets decline, signed up to run drug company studies and then sometimes stayed on to become well reimbursed flacks who pushed the drugs they were researching to other physicians through orchestrated road shows. Such "opinion leaders" included a well known Duke researcher who told me during the last drug company lecture I attended that statins had "virtually no side effects" and could be used in "everybody" - and said it with a straight face. Statins can be incredibly useful, but that was baldfaced lying.

Then it was on to Congress, which not only passed a bill declaring that Medicare could not bargain with drug companies over price, legally mandating you and I to pay vastly more than most anywhere else in the world, but also created a Medicare drug benefit that is now one of the major entitlements promising to help bankrupt Medicare and the federal government.

Government lobbying could go just so far. When Vioxx and Phen-fen and others turned out to have fatal side effects, most companies argued that fines and lawsuits were still far less than billions in profits - another cost of doing business.

Where We Are Now

Americans' love hate relationship with drugs is a hive of contradictions. We want our doctor prescribed drugs to work, but when they don't we're often furious - stuff that expensive should work as well as the company ads say they will. We often turn to herbal supplements instead, which often are uncontrolled, have liberal side effects, frequently do not contain what they claim and are often marketed in forms to fool people into thinking they're taking foods instead of drugs. Meanwhile the fascination with drugs has lessened reliance on non-pharmacologic therapies, as in depression, as well as people's self reliance on themselves to maintain health. I and many colleagues have met numerous patients claiming "I can eat what I want" because the statins keep his cholesterol level low, as if cholesterol was the only one of the 700-800 cardiac risk factors that counted.

Instead we should recognize:
1. Health, not Health Care, should be the concern of national policy
2. Drugs always have side effects - one of the "safest" American drugs, Tylenol, is rarely used or banned throughout much of Europe because of overdoses causing liver failure.
3. The present lottery of drug malpractice attends to public health disasters after the fact, enriches lawyers and a very few suffering families, terrifies physicians into expensive defensive medicine, and has not stopped companies from hiding unwelcome data.

What should you do personally? When a doctor prescribes a drug, ask questions. See that drug ads may neglect describing much less expensive generics that do the job. Recognize that medical miracles happen in movies more than real life. Understand that illness is complex and difficult, a major failure of the body to regenerate itself, and often requires changes in lifestyle to overcome.
And eventually we can do what most of the developed world has done - develop committees of efficacy to see whether national health services should pay for new drugs.
When you spend your money, you need to think about what you'll get - all the costs.