1 Boring Old Man

… internal tactical decisions on how we are going to run a study, engage with regulators, and confront and solve problems and challenges we have uncovered during clinical trials… This information cannot be patented nor have exclusivity, but can give other companies a tremendous competitive advantage by revealing our strategic thinking for proving safety and efficacy of our products.

Is the pharmaceutical industry like the mafia?

BMJ Group Blogs

by Richard Smith, former editor of the BMJ

September 10, 2013

… Most of Peter’s book is devoted to building up the case that the drug industry has systematically corrupted science to play up the benefits and play down the harms of their drugs. As an epidemiologist with very high numerical literacy and a passion for detail, so that he is a world leader in critiquing clinical studies, Peter is here on very solid ground. He joins many others, including former editors of the New England Journal of Medicine, in showing this corruption. He shows too how the industry has bought doctors, academics, journals, professional and patient organisations, university departments, journalists, regulators, and politicians. These are the methods of the mob.

The book doesn’t let doctors and academics avoid blame. Indeed, it might be argued that drug companies are doing what is expected of them in maximising financial returns for shareholders, but doctors and academics are supposed to have a higher calling. Laws that are requiring companies to declare payments to doctors are showing that very high proportions of doctors are beholden to the drug industry and that many are being paid six figures sums for advising companies or giving talks on their behalf. It’s hard to escape the conclusion that these “key opinion leaders” are being bought. They are the “hired guns” of the industry.

And, as with the mob, woe be to anybody who whistleblows or gives evidence against the industry. Peter tells several stories of whistleblowers being hounded, and John Le Carré’s novel describing drug company ruthlessness became a bestseller and a successful Hollywood film.

So it’s not entirely fanciful to compare the drug industry to the mob, and the public, despite its enthusiasm for taking drugs, is sceptical about the drug industry. In a poll in Denmark the public ranked the drug industry second bottom of those in which they had confidence, and a US poll ranked the industry bottom with tobacco and oil companies. The doctor and author Ben Goldacre, in his book Bad Pharma raises the interesting thought that doctors have come to see as “normal” a relationship with the drug industry that the public will see as wholly unacceptable when they fully understand it. In Britain doctors might follow journalists, members of Parliament, and bankers into disgrace for failing to see how corrupt their ways have become. At the moment the public tends to trust doctors and distrust drug companies, but the trust could be rapidly lost…

It’s not about the cards, but about the poker player’s skill at the game. And a major part of that skill relies on the hidden cards. That’s what Peter Gøtzsche is talking about. It’s the "organized" in organized crime – refining those techniques behind a curtain of quaisi-legitimacy. There was a time when I would’ve thought Peter Gøtzsche’s analogy was melodramatic and fanciful. Not any more. And then there’s this from the EFPIA [European Federation of Pharmaceutical Industries and Associations], sponsors of the Roadmap for Sharing Clinical Data conference:

I smell a strategy coming from PhRMA about this business of AllTrials and RIAT. Two recent articles address the public version. In do the time…, I looked at GSK’s white paper in the New England Journal of Medicine [available via Medscape’s write-up GSK Opens Access to Data From More Than 200 Clinical Trials]. Later, in the spice must flow…, I reviewed the head-to-head article from PhRMA in the British Medical Journal [Are clinical trial data shared sufficiently today? Yes]. The private version comes from the leaked memo reviewed in a closing argument… which includes an article from the Guardian [Big pharma mobilising patients in battle over drugs trials data], a retort in eye·for·pharma [Exclusive: The Devil is in the Details], and the actual memo from EFPIA & PhRMA.

I doubt that my rage makes much of a dent in their battle plan which is what this really is. Like Mr. Parker’s "internal tactical decisions" and "strategic thinking," these arguments are carefully constructed to move the unreasonable label from their folder and stamp in on the data transparency dossier and the EMA itself. There is one interesting thing of note. They don’t mention the motives of the EMA or the advocates of data transparency – a usual ploy in such maneuvering. I expect that’s because they couldn’t think of anything to say. The motives of the EMA are self evident and intrinsically valid.

And as for their bullet points, I don’t think any of us care about "other individuals identified in marketing authorization application [EMA] dossiers." Anonymize them too. I’ve commented on their Number 2 already. Number 3 is their business, not the EMA’s. Their "internal tactical decisions" and "strategic thinking for proving safety and efficacy of our products" is as much a part of the problem as anything else. Looking to the EMA to protect their poker game is an insult. And as for the blackmail clause ["Weaken incentives for companies to invest in biomedical research by disclosing companies’ commercially confidential information [CCI], without due consideration of the competing interests that may or may not justify disclosure"], we doctors and patients will limp by with the medications we already have and any legitimate entries that come along until a rational and transparent pharmaceutical industry emerges. No problem. I would welcome the opportunity.