It’s a funny thing – getting old. When you read something that’s really wise, you still almost automatically think of the author as older and wiser, at least I do. I often feel that way when I read Howard Brody’s blog Hooked: Ethics, Medicine, and Pharma. He just seems to be able to step further back from the fray than I can. I feel that same way about Roy Poses of Healthcare Renewal. There’s a $5 word, perspecacious, that covers what I’m talking about. And for all I know, I’m older than both of them.
Recently, a lot of us have been stirred up by the testimony of Neal Parker, a former FDA lawyer now working for Abbot who spoke on behalf of AbbVie, one of the companies suing the European Medicines Agency to block their proposed data transparency program [see a deal-breaker?…, right on the money…]. Dr. Poses wrote about my take on things and added some of his usual wisdom [Why Trust Drug Company Executives After One Admits Commercially Sponsored Clinical Research Is All About "Competitive Advantage?"]. This week, Dr. Brody also weighed in. This is the part that struck me reading it:
Hooked: Ethics, Medicine, and Pharmaby Howard Brody MDSeptember 16, 2013
… “1 Boring Old Man” draws two conclusions from this presentation and the ensuing Q&A:
So what do I make of all this? Well, I agree at least in part with our fellow blogger, but I would add a further lesson.
First, I agree that when a guy starts a discussion by announcing that if I disagree with the position that his company takes, then I am opposed to both the public health and to “balance,” I would want to grab for my wallet and head for the door. That guy is just way too slippery for me to spend time with. So yes, whether such people could ever negotiate in good faith is a serious question.
But there is another issue here as well. I want to give Neal Parker just a little more credit than others apparently were. For all his slipperiness, he had decided that there were a couple of things at stake—preserving the public health and advancing science on the one hand; preserving his company’s competitive advantage on the other. In his own head he thought he had a formula for “balancing” these two goals. But what I think he proved is that the people in the audience who reacted with shocked disbelief to some of what he said, and Parker himself, were bound to misunderstand each other because they were speaking different languages. If you spoke Parker-ese, or Pharma-ese, then everything he said was perfectly logical and indeed irrefutable. Which shows to me one more reason why we must find a way to detach the scientific research enterprise from Pharma funding (as I argued in HOOKED). There is no way we can square the true goals of science and the public health with the clearly commercial agenda of the drug industry.
See what I mean about that stepping back further thing? He’s talking about a confusion of tongues, and of course, that has to be right. The most high-minded person in Pharma-dom is going to talk competitive edge talk. And most everyone with any sense in the medical science field could’ve told Neal Parker that the argument he thought would be so balanced would have closed a show off Broadway in a New York minute. Dr. Brody is right. We don’t speak the same language. BMJ Editor Fiona Godlee said it in a similar wise comment at a UK hearing recently [a sticky wicket…]:
"Unless we can find a solution to the commercial incompetence problem, we have to recognize that the pharmaceutical industry has an irreducible conflict of interest in relation to the way it represents its drugs, in science and in marketing. And unless we can resolve this in a way that is more in the public interest and in patients’ interest, I would argue that drug companies should not be allowed to evaluate their own products."
and I know I’m older than she is…
To some extent, there’s a fundamental and absolute conflict between capitalism and health care.
What should not get lost in the debate is that regulations would apply to all drug manufacturing companies, which is one of the purposes of regulations on industry. Where a conflict arises between business models and the public good, government regulation can level the playing field so that no particular company benefits from a practice that is damaging to the public.
Business leaders and spokespeople for publicly traded companies are always speaking on behalf of their investors. Naturally, they’ll oppose any threat to profits; but when all their competitors have to abide by the same rules, then the stockholders just have to deal with it and won’t see it as losing a competitive edge.
Neal Parker used to work at one of the regulators, the FDA. It is unclear that his views were any different then.
I agree, everything Parker said was bascially true. That’s the way pharma thinks, that’s how humans behave and rationlize in a large company.
There’s no way around that, that’s simply the way things are – so we must find a way to “detach the scientific research enterprise from Pharma funding”
I think the only way to do this is to use a felony conviction to take away federal program reimbursement of drug sales. Every year we get an opportunity to do this for a dozen phara companys, but no judge has been willing. Let the dinosaurs go, they are only criminals now. Let the newer privatly owned (or majority-owned but public) biotech companies take over. Nothing will be lost, only gained.
The funny thing is, this problem never would have happened if this was done in the first place. Why circumvent justice, for what? Pharma does not conduct pure research, they do not even do ‘research’ so much as ‘applied development’. They do not make cures, they do no research causes, they treat symptoms – and they lie about even that.
I don’t think we can reform criminals by rewarding them.