Tag: healthcare

GENERIC DRUGS

Katherine Eban believes generic drugs are important for global health because of affordability and accessibility. One wonders if anyone who reads or listens to “Bottle of Lies” will take generic drugs if they can afford the original FDA approved product.

Books of Interest
 Website: chetyarbrough.blog

Bottle of Lies (The Inside Story of the Generic Drug Boom)

Author: Katherine Eban

Narrated By: Katherine Eban

Katherine Eban (Author, American Rhodes scholar with a MPhil from University of Oxford.)

“Bottle of Lies” is a history of duplicity and dishonesty in the generic drug industry. It is a damning dissection of the lure of money at the expense of human life. On the one hand, affordability, healthcare savings, global health, and the value of regulation are made clear in “Bottle of Lies”. On the other, Katherine Eban shows how the lure of capitalism and greed creates an incentive to evade regulation and kill innocent people seeking drug treatment for their illnesses.

Katherine Eban reveals the history of an India drug company named Ranbaxy that was founded by two brothers, Ranbir Singh and Gurbax Singh.

In 1937, these two entrepreneurs recognized the economic opportunity of creating a drug manufacturing operation with lower labor costs in India to capture the market in drugs nearing their patent expiration dates. They were focused more on organizational cost cutting and the money that could be made than the efficacy of the drugs they could produce. The company was sold in 1952 to their cousin Bhai Mohan Singh. This cousin transformed Ranbaxy to a pharmaceutical giant, but his experience was in construction and finance, not pharmaceuticals. However, his son Parvinder Singh joined the company in 1967 and was a graduate from Washington State University and the University of Michigan with a master’s degree and PhD in pharmacy.

Parvinder Singh (1944-1999, became the leader of Ranbaxy in 1967.)

Eban argues Parvinder Singh looked at his father’s business as a scientist with a pharmaceutical understanding and a desire to produce lower cost drugs for the world for more than a source of wealth. Parvinder appeared to value quality, transparency, drug efficacy, and long-term credibility for Ranbaxy. Parvinder recruited talent who believed in lowering costs and maintaining the efficacy of drugs the company manufactured. However, Parvinder dies in 1999 and the executives who took over the company focused on maximizing profit rather than the efficacy of the drugs being produced. Parvinder’s leadership is succeeded by Brian Tempest who expands the company by navigating the regulatory restrictions on generic drug manufacture. Tempest tries to balance profitability with global health efficacy of generic drugs. Parvinder’s son, Malvinder Singh eventually becomes the CEO of the company. He returned control to the Singh family. The corporate culture changed to what its original founders created, i.e., a drug producer driven by profit. Malvinder was not a scientist.

Malvinder Singh (Born in 1973, Grandson of Bhai Mohan Singh and son of Dr. Parvinder Singh.)

Under Malvinder, Eban shows the company turns from science to economic strategy to increase revenues of Ranbaxy. Internal checks on the efficacy and testing of their drugs is eroded. Criticism from regulators and whistleblowers are either ignored or sidelined by company management. Peter Baker Tucker’s role in exposing Ranbaxy is detailed in Eban’s history. With the help of Dinesh Thakur, an employee of Ranbaxy, Tucker bravely exposed the company’s fraud. (Thakur received $48 million compensation as a whistleblower award.) Tucker is an FDA investigator who reviewed Ranbaxy’s internal documents that revealed their fabricated data about their drug manufacturing process.

Peter Baker Tucker (aka Peter Baker, former FDA investigator.)

Ranbaxy is sold to a Japanese company called Daiichi Sankyo in 2008. Eban explains that Malvinder concealed critical information about FDA investigations and data fraud in the company’s sale. Malvinder and his brother, Shivinder Singh, are arrested in 2019 and remain in custody in 2021, facing multiple fraud accusations.

Sun Pharma acquires the remnants of the Ranbaxy-Sankyo’ sale.

Though Eban does not focus on what happens after the sale to the Japanese company, it is sold at a loss to Sun Pharmaceutical Industries and Singh family’s ownership is sued by Sankyo for hiding regulatory issues of the company. Daiichi received a $500 million settlement but effectively lost money on their investment. Eban, in “Bottle of Lies” offers a nuanced indictment of generic drug manufacturer and sale.

Eban believes generic drugs are important for global health because of affordability and accessibility.

Quality and drug efficacy must be insured through international regulation. Eban endorses unannounced inspections, routine testing of the drugs, and strict legal enforcement against poor manufacturing systems. Without transparency and oversight of all drug manufacturing, human lives are put at risk.

This is quite an expose, but it ends with criticism of inspections of China’s drug manufacturing capabilities.

The inspections of foreign companies that manufacture generic drugs, like those she refers to in her book, are conducted by similar inspectors who do not know the culture or language of the countries in which generic drugs are being produced. The FDA was paying their inspector in India $40,000 per year at the time of Ranbaxy’s investigation. It is by instinct, not interrogation, that malfeasance is detected. Too much is missed when one cannot talk to and clearly understand employees of manufacturing companies.

It seems America has two choices: one is to increase the salaries of FDA inspectors and require that they know the language of the countries in which they are working and two, set up a system of random reverse engineering of generic drugs allowed in the United States. This not to suggest all other FDA regulations would not be enforced when a generic drug is proposed but that site reviews would be more professionally conducted. One wonders if anyone who reads or listens to “Bottle of Lies” will take generic drugs if they can afford the original FDA approved product.

AI & HEALTH

Like Climate Change, AI seems an inevitable change that will collate, spindle, and mutilate life whether we want it to or not. The best humans can do is adopt and adapt to the change AI will make in human life. It is not a choice but an inevitability.

Books of Interest
 Website: chetyarbrough.blog

Deep Medicine (How Artificial Intelligence Can Make Healthcare Human Again)

Author: Eric Topol

Narrated By:  Graham Winton

Eric Topol (Author, American cardiologist, scientist, founder of Scripps Research Translational Institute.)

Eric Topol is what most patients want to see in a Doctor of Medicine. “Deep Medicine” should be required reading for students wishing to become physicians. One suspects Topol’s view of medicine is as empathetic as it is because of his personal chronic illness. His personal experience as a patient and physician give him an insightful understanding of medical diagnosis, patient care, and treatment.

Topol explains how increasingly valuable and important Artificial Intelligence is in the diagnosis and treatment of illness and health for human beings.

AI opens the door for improved diagnosis and treatment of patients. A monumental caveat to A.I.s potential is its exposure of personal history not only to physicians but to governments and businesses. Governments and businesses preternaturally have agendas that may be in conflict with one’s personal health and welfare.

Topol notes China is ahead of America in cataloging citizens’ health because of their data collection and AI’s capabilities.

Theoretically, every visit to a doctor can be precisely documented with an AI system. The good of that system would improve continuity of medical diagnosis and treatment of patients. The risk of that system is that it can be exploited by governments and businesses wishing to control or influence a person’s life. One is left with a concern about being able to protect oneself from a government or business that may have access to citizen information. In the case of government, it is the power exercised over freedom. Both government and businesses can use AI information to influence human choice. With detailed information about what one wants, needs, or is undecided upon can be manipulated with personal knowledge accumulated by AI.

Putting loss of privacy and “Brave New World” negatives aside, Topol explains the potential of AI to immensely improve human health and wellness.

Cradle to grave information on human health would aid in research and treatment of illnesses and cures for present and future patients. Topol gives the example of collection of information on biometric health of human beings that can reveal secrets of perfect diets that would aid better health during one’s life. Topol explains how every person has a unique biometric system that processes food in different ways. Some foods may be harmful to some and not others because of the way their body metabolizes what they choose to eat. Topol explains, every person has their own biometric system that processes foods in different ways. It is possible to design diets to meet the specifications of one’s unique digestive system to improve health and avoid foods that are not healthily metabolized by one’s body. An AI could be devised to analyze individual biometrics and recommend more healthful diets and more effective medicines for users of an AI system.

In addition to improvements in medical imaging and diagnosis with AI, Topal explains how medicine and treatments can be personalized to patients based on biometric analysis that shows how medications can be optimized to treat specific patients in a customized way. Every patient is unique in the way they metabolize food and drugs. AI offers the potential for customization to maximize recovery from illness, infection, or disease.

Another growing AI metric is measurement of an individual’s physical well-being. Monitoring one’s vital signs is becoming common with Apple watches and information accumulation that can be monitored and controlled for healthful living. One can begin to improve one’s health and life with more information about a user’s pulse and blood pressure measurements. Instantaneous reports may warn people of risks with an accumulated record of healthful levels of exercise and an exerciser’s recovery times.

Marie Curie (Scientist, chemist, and physicist who played a crucial role in developing x-ray technology, received 2 Nobel Prizes, died at the age of 66.)

Topol offers a number of circumstances where AI has improved medical diagnosis and treatment. He notes how AI analysis of radiological imaging improves diagnosis of body’ abnormality because of its relentless process of reviewing past imaging that is beyond the knowledge or memory of experienced radiologists. Topol notes a number of studies that show AI reads radiological images better than experienced radiologists.

One wonders if AI is a Hobson’s choice or a societal revolution.

One wonders if AI is a Hobson’s choice or a societal revolution greater than the discovery of agriculture (10000 BCE), the rise of civilization (3000 BCE), the Scientific Revolution (16th to 17th century), the Industrial Revolution (18th to 19th century), the Digital Revolution (20th to 21st century), or Climate Change in the 21st century. Like Climate Change, AI seems an inevitable change that will collate, spindle, and mutilate life whether we want it to or not. The best humans can do is adopt and adapt to the change AI will make in human life. It is not a choice but an inevitability.

MEDICINE

A government designed to use public funds to pick winners and losers in the drug industry threatens human health. Only with the truth of science discoveries and honest reporting of drug efficacy can a physician offer hope for human recovery from curable diseases.

Books of Interest
 Website: chetyarbrough.blog

Rethinking Medications (Truth, Power, and the Drugs You Take)

By: Jerry Avorn

Narrated By: Jerry Avorn MD

Jerry Avorn (Author, professor of medicine at Harvard Medical School where he received his MD, Chief Emeritus of the Division of Pharmacoepidemiology and Pharmacoeconomics)

Doctor Avorn enlightens listener/readers about drug industry’ costs, profits, and regulation. Avorn explains how money corrupts the industry and the FDA while encouraging discovery of effective drug treatments. The cost, profits, and benefits of the industry revolve around research, discovery, medical efficacy, human health, ethics, and regulation.

Drug manufacture is big business.

Treatments for human maladies began in the dark ages when little was known about the causes of disease and mental dysfunction. Cures ranged from spirit dances to herbal concoctions that allegedly expelled evil, cured or killed its followers and users. The FDA (Food and Drug Administration) did not come into existence until 1930, but its beginnings harken back to the 1906 Pure Food and Drug Act signed into law by Theodore Roosevelt. The FDA took on the role of reviewing scientific drug studies for drug treatments that could aid health recovery for the public. The importance of review was proven critical by incidents like that in 1937, when 107 people died from a Sulfanilamide drug which was found to be poisonous. From that 1937 event forward, the FDA required drug manufacturers to prove safety of a drug before selling it to the public. The FDA began inspecting drug factories while demanding drug ingredient labeling. However, Avorn illustrates how the FDA was seduced by Big Pharma’ to offer drug approvals based on flawed or undisclosed research reports.

Dr. Martin Makary (Dr. Makary was confirmed as the new head of the FDA on March 25, 2025. He is the 27th head of the Department. He is a British-American surgeon and professor.)

What Dr. Avorn reveals is how the FDA has either failed the public or been seduced by drug manufacturers to approve drugs that have not cured patients but have, in some cases, harmed or killed patients. It will be interesting to see what Dr. Marin Makary can do to improve FDA’s regulation of drugs. Avorn touches on court cases that have resulted in huge financial settlements by drug manufacturing companies and their stockholders. However, he notes the actual compensation received by individually harmed patients or families is miniscule in respect to the size of the fines; not to mention many billions of dollars the drug companies received before unethical practices were exposed. Avorn notes many FDA’ research and regulation incompetencies allowed drug companies to hoodwink the public about drug companies’ discovered but unrevealed drug side-effects.

A few examples can be easily found in an internet search:

1) Vioxx (Rofecoxib), a pain killer, had to be withdrawn from use in 2004 because it was linked to increased risk of heart attacks and strokes. It was removed from the market in 2004.

2) Fen-Phen (Fenfluramine/Phentermine), a weight-loss drug had to be taken off the market in 1997 because of severe heart and lung complications.

3) Accutane was used to cure acne but was found to be linked to birth defects and had to be withdrawn in 2009.

4) Thalidomide was found to cause birth defects to become repurposed for treatment of certain cancers.

5) A more recent failure of the FDA is their failure to regulate opioids like OxyContin that resulted in huge fines to manufacturers and distributors of the drug.

Lobbyists are hired by drug companies to influence politicians to gain support of drug companies. In aggregate, this chart shows the highest-spending lobbyists in the 3rd Qtr. of 2020 were in the medical industry.

Dr. Avorn argues Big Pharma’s lobbying power has unduly influenced FDA to approve drugs that are not effective in treating patients for their diagnosed conditions. Avorn infers Big Pharma is more focused on increasing revenue than effectively reviewing drug manufacturer’ supplied studies. Avorn argues the FDA has become too dependent on industry fees that are paid by drug manufacturers asking for expedited drug approvals. Avorn infers the FDA fails to demand more documentation from drug manufacturers on their drug’ research. The author suggests many approved opioids, cancer treatment drugs, and psychedelics have questionable effectiveness or have safety concerns. Misleading or incomplete information is provided by drug companies that makes applications an approval process, not a fully relevant or studied action on the efficacy of new drugs.

Avorn is disappointed in the Trump administrations’ selection of Robert Kennedy as the U.S. Secretary of Health and Human Services because of his lack of qualification.

The unscientific bias of Kennedy and Trump in regard to vaccine effectiveness reinforces the likelihood of increased drug manufacturers’ fees that are just a revenue source for the FDA. Trump will likely reward Kennedy for decreasing the Departments’ overhead by firing research scientists and increasing the revenues they collect from drug manufacturers seeking drug approvals.

Trump sees and uses money as the only measure of value in the world.

It is interesting to note that Avorn is a Harvard professor, a member of one of the most prestigious universities in the world. Harvard is being denied government grants by the Trump administration, allegedly because of Harvard’s DEI policy. One is inclined to believe diversity, equity, and inclusion are ignored by Trump because he is part of the white ruling class in America. Trump chooses to stop American aid to the world to reduce the cost of government. American government’s decisions to starve the world and discriminate against non-whites is a return to the past that will have future consequences for America.

Next, Avorn writes about the high cost of drugs, particularly in the United States. Discoveries are patented in the United States to incentivize innovation, but drug companies are gaming that Constitutional right by slightly modifying drug manufacture when their patent rights are nearing expiration. They renew their patent and control the price of the slightly modified drug that has the same curative qualities. As publicly held corporations, they are obligated to keep prices as high as the market allows. The consequence leaves many families at the mercy of their treatable diseases because they cannot afford the drugs that can help them.

Martin Shkreli, American investor who rose to fame and infamy for using hedge funds to buy drug patents and artificially raise their prices to only increase revenues.

The free market system in America allows an investor to buy a drug patent and arbitrarily raise its price. Avorn suggests this is a correctable problem with fair regulation and a balance between government sponsored funding for drug research in return for public funding. Of course, there are some scientists like Jonas Salk in 1953 who refused to privately patent the polio vaccine because it had such great benefit to the health of the world.

Avorn notes the 1990’s drug costs in the U.S. are out of control.

Only the rich are able to pay for newer drugs that cost hundreds of thousands of dollars per year. Americans spend over $13,000 per year per person while Europe is around $5,000 and low-income countries under $500 per year. These expenditures are to extend life which one would think make Americans live longest. Interestingly, America is not even in the top 10. Hong Kong’s average life expectancy is 85.77 years, Japan 85. South Korea 84.53. The U.S. average life expectancy is 79.4. To a cynic like me, one might say what’s 5 or 6 more years of life really worth? On the other hand, billionaires and millionaires like Peter Thiel and Bryan Johnson have invested millions into anti-aging research.

Avorn reinforces the substance of Michael Pollan’s book “How to Change Your Mind” which reenvisions the value of hallucinogens in this century.

Avorn notes hallucinogens efficacy is reborn in the 21st century to a level of medical and social acceptance. Avorn is a trained physician as opposed to Pollan who is a graduate with an M.A. in English, not with degrees in science or medicine.

In reviewing Avorn’s informative history, it is apparent that patients should be asking their doctors more questions about the drugs they are taking.

Drugs have side effects that can conflict with other drugs being taken. In this age of modern medicine, there are many drugs that can be effective, but they can also be deadly. Drug manufacturers looking at drug creation as only revenue producers is a bad choice for society.

Avorn’s history of the drug industry shows failure in American medicines is more than the mistake of placing an incompetent in charge of the U.S.

Taking money away from research facilities diminishes American innovation in medicine and other important sciences. However, research is only as good as the accuracy of its proof of efficacy for the treatment of disease and the Hippocratic Oath of “First, do no harm”. A government designed to use public funds to pick winners and losers in the drug industry threatens human health. Only with the truth of science discoveries and honest reporting of drug efficacy can a physician offer hope for human recovery from curable diseases.

WELL BEING

Dr. Gawande’s fundamental point in “Being Mortal” is to provide the elderly or medically challenged the help to live based on a person’s dignity, purpose for living, and as much autonomy as their conditions allow.

Books of Interest
 Website: chetyarbrough.blog

Being Mortal: Medicine and What Matters in the End

By: Atul Gawande 

Narrated By: Robert Petkoff

Atul Gawande (Author, physician-administrator-of-the-u.s.-agency-for-international-development-for-global-health.)

One who has been fortunate enough to have lived long will appreciate Doctor Atul Gawande’s explanation and experience with people of a certain age and the terminally ill of any age. He explains “…What Matters in the End” when one is nearing death is quality of life, not survival that matters.

Quality of life is defined by Gawande as dignity, purpose, and autonomy in one’s last days.

When one is nearing the end of their life, Dr. Gawande has found in his many surgical procedures and interviews that those who have time left to them can be helped by others who assist them as best they can to achieve dignity, purpose, and autonomy. As a physician, Gawande asks what a dying person’s fears are to know what might be done to help them work through those fears. Gawande explains the trade-offs from what care an older person or terminal patient may be given to achieve what is most important to them in their remaining life.

Whether healthy or unhealthy, rational people realize death is part of life.

What “Being Mortal” explains is that the aged or medically challenged wish for as much independence as can be provided by their care. Desired independence is the gold standard for the remaining days or years of one’s life. Whether old or young, healthy or ill, the thought of incontinence, mental confusion, medical or physical limitation makes one fear loss of independence. Each of these maladies can be remedied by family members or properly organized assisted living facilities. Of course, the rub is in the cost of that assistance.

When a family member can no longer be cared for by family members, the medically or age challenged are left with two choices. One is to be institutionalized. The other is to die.

What Gawande explains is that the first alternative can be better and the second is dependent upon family research, financial commitment, religious beliefs, and States’ laws. Gawande notes his choice in the case of his physician-father is a family commitment to offer care as needed with the goal of giving as much autonomy as his aged father can handle. That is a laudable commitment but not what many struggling American families have time or willingness to do.

America has institutionalized elder and medically challenged people’s care to reduce the burden on families.

Gawande recounts the history of institutionalized care in the United States. From family aid to hospitalization to assisted living to hospice to State sanctioned euthanasia, care has evolved for the elderly and medically challenged. What Dr. Gawande explains is that any of these ways of caring must offer dignity, purpose, and as much autonomy as possible to the dying and terminally ill.

Every family has its care limitations, either temporal or financial (sometimes both).

Gawande shows research and preparation is needed to help families adjust to the physical and mental care of a significant other who is too old or too sick to take care of themselves. If a family cannot provide the dignity, purpose, and an appropriate level of autonomy to an aged or ill loved one than the job becomes the work of finding an institutional facility that can. This is where the tire hits the road because there is a cost for that service. Gawande notes there are institutions that can offer the services that are needed but family research and investigation is required.

Once an acceptable care facility is found, the next task is finding how it can be financed.

Gawande does not address cost but infers there are care facilities that are affordable. Dr. Gawande’s fundamental point in “Being Mortal” is to provide the elderly or medically challenged the help to live based on a person’s dignity, purpose for living, and as much autonomy as their conditions allow.

GENERIC DRUGS

Katherine Eban infers the lure of money, power, and prestige, continues to incentivize fudging, if not outright lies, about the effectiveness and safety of generic drugs.

Books of Interest
 Website: chetyarbrough.blog

Bottle of Lies (The Story of the Generic Drug Boom

By: Katherine Eban

Narrated By: Katherine Eban

Katherine Eban (Author, American investigative journalist focused on public health issues.)

Katherine Eban’s book is tedious, but it tells a story that challenges the generic drug industry and exposes the strength and weakness of capitalism. Eban makes one suspicious of the efficacy of generic drug treatments. Society depends on drug discoveries that can return one to health when struck by known and unknown malefactors. At the same time, Eban indirectly attacks capitalism as a primary force for discovery of life saving drug treatments. Capitalism is motivation for drug manufacturers to discover new drugs, but profit motive and human nature incentivize deception that can harm the public.

America’s police department for the drug industry is the Food and Drug Administration.

The difficulty of a policing function is in human nature and an investigators’ effort to find incriminating evidence that proves guilt. The consequences of poor policing in the generic drug industry are loss of health, and sometimes, life. The FDA is responsible for protecting public health by ensuring the safety, efficacy, and security of human and veterinary drugs manufactured or imported to the U.S.

Just as every police force is not perfect, the FDA has made mistakes and failed to uncover evidence for crime. There have been instances of drug manufacturers around the world, including America, that have adulterated approved generic drugs. (A U.S. generic drug manufacturer, KVK Research Inc in Pennsylvania, pled guilty in 2024.) Generic manufacturers and distributors around the world have misled the public on the efficacy and/or addictive qualities of drugs. A primary source of generic drug manufacturing crimes is the lure of increased profitability.

Eban focuses on a pandora’s box opened when the world’s generic drug industry began producing substitutes for previously patented drugs.

Patents for new drugs have a determinate shelf life but expire after a stipulated period of time. One can complain and challenge the price of patented drugs, but patented drugs require a level of scientific experiment and reporting to prove efficacy. When patents expire, there is a rush by generic manufacturers to produce the same drug at a lower cost. The trouble arises when a generic drug’s lower cost is achieved with substituted or reduced ingredients; also, it may be adulterated by poor manufacturing practices.

Eban offers the history of the AIDS’ epidemic to illustrate how generic drugs became supercharged in the 1980s.

Three companies in India and one in South Africa began working with the Clinton Foundation to offer an AIDS’ generic drug that fell to a cost of $.40 per day when patented AIDS’ drugs cost as much as $8,000 per year. Millions of people were at risk, none more than those who live in Africa. However, the effectiveness of the generic drug came under suspicion. It was found that data was being falsely created by India and Africa. It was manufactured data that falsely reported generic drugs effectiveness in treating AIDS. The generic African and India manufacturers were cutting corners in production to increase profits. No one checked the effectiveness of the produced drugs and posted false patient reports. Because the data was not based on patient experience but on falsely created data, it became unclear whether the drug was working. Without any reports showing the generic drug’s effectiveness, incentive grew to continue reducing costs. Manufacturers pushed production, compromised AIDS ingredients, and falsely reported treatment results of patients.

Dinesh S. Thakur (Received the Joe A. Callaway award for Civic Courage in 2014.)

Eban explains how Dinesh Thakur. a former executive at Ranbaxy Laboratories, became a whistle blower who “spilled the beans” on falsely created data sent to the FDA.

Thakur was the Director and Global Head of Research information & Portfolio Management at the Ranbaxy company. He began asking questions of the people reporting the generic AIDS Drug efficacy data. Thakur found that 50% to 100% of information on generic AIDS drug’ efficacy was manufactured and not related to actual use by AIDS sufferers. Ranbaxy Laboratories pleaded guilty of falsifying information in 2003. Ranbaxy agreed to pay $500 million to settle their guilty plea.

Despite the Ranbaxy settlement, the author shows generic drug misinformation is still being produced. Further reviews by FDA inspectors found continuing violations of protocol and testing of generic drug manufacturing and reporting.

Ranbaxy is no longer an independent company. It was purchased by Sun Pharmaceutical Industries Ltd in 2014. Eban explains how FDA inspectors fell victim to India manufacturers malfeasance by accepting luxury hotel accommodations and gifts that clouded their judgement about the companies they were investigating. A bad report from an FDA inspector could and did cost millions of dollars to companies that produced tainted generic drugs.

Eban explains the FDA has changed their policy of giving advance notice of inspections while inferring inspectors are advised to avoid conflicts of interest in their inspections. One takes this inference with reservation because human nature is an immutable force.

The incentive for increased profitability by reducing the cost of manufacturing generic drugs continues to threaten the public. Eban infers the lure of money, power, and prestige, continues to incentivize fudging, if not outright lies, about the effectiveness and safety of generic drugs.