Well, AFM called me up on the Insight post for painting my town¹ a little too apologetic for our phriends in Pharma (possibly due to some comments I made on this post of his, and these over at The Scientist, and also just today on Flickr…) .
So I guess I should make some self-apologetics, that my point has *not* been that Pharma is cute and cuddly and can always be trusted – c’mon they are industry – the wonderful Merck saga unfolds beyond just deceptive journals – this sort of awful ‘hit list’ language to “neutralise” and worse, “discredit”, critical doctors makes me cringe (and if you’re sick of hearing about Vioxx, you can get upset at Lilly’s innapropriate off-label Zyprexa marketing instead). There is nothing I can concoct to attempt to downplay the totally unethical nature of that sort of behaviour, to me it is indefensible. There are bad elements out there. Even if we rule the Vioxx shenanigans as an exceptional exception (which is the closest I can get to a defence) just take a look at the US statistics on Pharma fines and settlements made by over the last 9 years (and that just to the government, does not include private parties, class actions etc.)
Pharmaceutical companies are corporations. And yes, they are motivated by making money. And AFM is right, some guy in marketing will try to put that goal ahead of making quality medicines. But let’s remember that’s also what these companies are about making medicines. Medicines that help people. People do not get into this industry because they want to hurt people.
And that is where I start to get annoyed by anti-Pharma movements.
Not only is it not nice to those who studied for 3-12 years to work on cures for cancer. It is counterproductive. It is taking the stance that Pharma is the bad guy and cannot be expected to ever want anything other than money. Honestly, if all they wanted to make was money, they would be making porn. Making medicine is hard folks. Making medicine is also pretty damn expensive. They need to make money to make more medicine. So we need to settle priorities – is the company making medicine just to make money, or are they making the money so they can make more medicine. And I feel that’s a principle you can apply to any industry (say… open access publishers…).
By reducing the industry to just a money making machine, in effect that is what we will make them. Pharma should not be discouraged from being involved in medicine because they are “all about the money”, they should be encouraged to become involved in medicine so they realise that there are all these other things than just money the should be focused on. When I say medicine here, I do not just mean physical medicines, it is about quality use of medicine (QUM), which is why we should not be kicking them out of educational and community health activities either. Remember those pharma sponsored textbooks, did they push their own expensive treatments over generic lithium and talk therapy, no. Industry is not necessarily out to get you.
Yes, the industry needs regulation to prevent corruption. Just like, oh say, ever other industry on the planet. We should be skeptical of the actions they take and the words they say. Industry knows how industry works. Which means it is promising when they recognise the need to self-regulate. The recent ASCO con in Florida saw a dearth of free stationary. Could that be a result of research that shows that *gasp* they affect physician behaviour? Can we expect free drug samples be next to go?
But we also need to remember Pharma does not act in isolation. Pharma work with doctors. Doctors who also work for *gasp* money. Those doctors pay money to get training from educational institutions, who also *make money*. And they operate with government and insurers who *make money*. And lets not forget you, the consumer, who wants to, well, not make money out of being sick², but certainly conserve it. So the whole “pharmaceutical industry is only in it for money” mantra starts to run very dry after a while. You and I can all dream and fanasize as much as we want to about the socialist paradise where money is no longer interferes with everyone doing stuff for the good of everyone, but we just are not there yet.
So what has been the whole point? I’m still not quite sure. Maybe it’s just that I like arguing and showing you that you’re wrong. But I’m sure there was another point in there. I think it was that it is not healthy to consider industry as inherently evil, I mean they *do* pay those fines after all, and that by making industry a scapegoat we actually avoid serious issues like fostering an environment of trust and cooperation built upon common goals.
¹Does that make me a sheriff?
²I am sure there are people somewhere who at least try, those people probably meet more than one definition of “sick”.
¤Apologies that not all links necessarily make direct sense to the text, but I think all articles linked herein are still valuable and semi-relevant information nonetheless.