EVERYONE KNOWS HOW HIGH THE COST of prescription medicines is these days—for instance, medication to combat leukemia or multiple sclerosis can cost $5,000 to $10,00 per month, and treatment with the new pill that cures hepatitis C in nine out of ten patients costs more than $90,000. Those high prices are at least part of the reason that year after year, for over two decades the drug industry has been far and away the most profitable sector of our economy. However, many people are also inclined to accept high prices as the cost we must bear for drug research and the development of new medicines. But, in fact, the prices drug companies charge bear little relationship to the cost of making or developing them, and those prices could be cut dramatically without coming close to threatening their R&D budgets. Less than 15 percent of the sales revenue of the large pharmaceutical companies goes into R&D, half what they spend on “marketing and administration.”84 Moreover, the pharmaceutical industry is nowhere near as innovative as most people think. According to Marcia Angell, former editor in chief of the New England Journal of Medicine, only a handful of important drugs have been brought to the market in recent years, and they were based mostly on taxpayer-funded research. She writes, “The great majority of ‘new drugs’ are not new at all but merely variations on older drugs already on the market. These are called ‘me-too’ drugs. The idea is to grab a share of an established, lucrative market by producing something very similar to a top-selling drug.” This is made possible by the fact that the FDA will generally approve a drug if it is better than a placebo. “It needn’t be better than an older drug,” Angell says. “In fact, it may be worse. There is no way of knowing, since companies do not test their drugs against older ones for the same conditions at equivalent doses.” Of the seventy-eight drugs approved by the FDA in a recent year, only seventeen contained new active ingredients, and the FDA classified only seven of those as improvements over older drugs. And none of those seven came from a major U.S. drug company.