When it comes to health care, the public has high expectations. Patients demand strict ethical standards and believe that a certain degree of altruism should motivate not only health professionals, but pharmaceutical companies as well. The gap that exists between this ideal and the reality of Big Pharma’s business practices is the subject of Jeffrey Robinson’s latest book, Prescription Games.

Robinson has previously published a number of non-fiction works, including The Merger, an exposé of organized crime. In Prescription Games, he attacks the practices of the large multinational pharmaceutical companies, often focusing on those practices in Canada. Robinson argues that extended patent protection of medications has cost the health care system millions of dollars without proportionate benefits to patients, and that close links between pharmaceutical companies and academic researchers have corrupted medical science.

Robinson provides a thorough, detailed discussion of his subject, quoting from numerous sources and carefully developing his arguments. Each chapter is devoted to an individual topic within his larger thesis, though the occasional chapter lacks focus. Robinson is most engaging when he clearly defines his subject, as in the chapter on Nancy Olivieri, a physician at Sick Kids hospital in Toronto whose findings on a new drug were suppressed by the drug company that was financing her research.

Prescription Games is meant to be more of an exposé of the drug business than a discussion of how things could be done differently. But it would have been helpful if Robinson had offered something by way of alternatives to our current market-driven system of pharmaceutical research and development. The information in this book will probably be alarming to some readers, yet sadly familiar to those working in the medical field.