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.
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:
- What companies like AbbVie most want to hide is how much they are doing drug promotion under the guise of scientific research
- People who talk like this simply cannot be trusted to negotiate in good faith; all they care about is competitive advantage, and if screwing the public provides competitive advantage, so be itThere is a third lesson highlighted by a BMJ News account from which the blog draws some of its information—the drug firms themselves are divided over this issue with other firms not wanting to go as far as AbbVie. Other firms seem to have decided that with public trust in them now down in the toilet, the only “competitive advantage” they might enjoy is tied to coming clean.
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.
"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."