During his campaign, President Donald Trump criticized big pharma. But now, says Dr. Marcia Angell, Trump is too wishy-washy to make a real change.

Angell, a corresponding member of the faculty of global health and social medicine at Harvard Medical School and faculty associate at the Center for Bioethics, spoke to Jim and Margery on Boston Public Radio Monday.

“I knew that his attention span was about a micro-second, and he had already demonstrated that. Essentially ... he’s a plutocrat, and he is going to go where the money takes him,” Angell said.

And when asked what Trump and his administration could do to stop pharmaceutical conglomerates from ruining the healthcare industry, Angell said that the answer was simple.

“Its very easy, because the pharmaceutical industry is on government welfare, big time. So that means the government has all kinds of hooks they can use. An example is that drug companies, to get FDA approval to sell a brand name drug, merely have to compare it with a placebo. And if [the drug] is better than a sugar pill, then it’s approved. If you have another antidepressant that comes on the market, you compare it with a placebo — you don't have to compare it with ... a huge family of other drugs that are on the market," said Angell. "So you get more and more brand name drugs in the same class, and all you know is that each one is better than a placebo. For all we know [the drugs] are getting worse and worse. So that creates a huge problem. We have huge classes of what I call ‘me too’ drugs, which are just drugs that are just different enough to get exclusive marketing rights. ... And the FDA lets them get away with that.” 

Angell continued her argument by referencing a measure that former President Obama promised to accomplish during his tenure, but did not.

“With drug companies, the first thing we could do is something that President Obama promised to do during his campaign and then backed away from, and that is to get rid of the provision in the Medicare Drug Benefit that says we can’t bargain with the drug companies for prices. And to be clear, what bargaining means is establishing a formula. You have to have a stick there, and that’s the stick,” Angell said.

More important, Angell says, are the cuts to NIH funding that Trump is pursuing. NIH-funded research in universities and medical schools is the single largest source of new and innovative drugs. 

"The most important way [big pharmaceutical companies] are on government welfare is that the NIH-funded research done in medical schools and universities, all of those drugs can be licensed exclusively to big drug companies, and then they turn around and charge whatever the market will bear," Angell said.

Angell added that the prices drug companies charge differ, depending on who they're selling to. And for change to happen, Angell said, big pharma's books need to be open. 

Dr. Marcia Angell is a corresponding member of the faculty of global health and social medicine at Harvard Medical School, and faculty associate in the Center for Bioethics. She stepped down as editor-in-chief of the New England Journal of Medicine in 2000. To hear the full conversation with Boston Public Radio, click on the audio player above.