{"id":50900,"date":"2014-10-23T13:19:12","date_gmt":"2014-10-23T17:19:12","guid":{"rendered":"http:\/\/1boringoldman.com\/?p=50900"},"modified":"2014-10-23T15:03:18","modified_gmt":"2014-10-23T19:03:18","slug":"restoring-pharma-ii","status":"publish","type":"post","link":"https:\/\/1boringoldman.com\/index.php\/2014\/10\/23\/restoring-pharma-ii\/","title":{"rendered":"restoring pharma II\u2026"},"content":{"rendered":"
My interest in this article [restoring pharma I…<\/a>] has a personal component. I’m not being coy when I say that I was stunned when Senator Grassley revealed what I would now call the Academic·Psychiatry·PHARMA·Alliance<\/em> and all the corruption among, around, and in-between<\/em>. I have figured out some of the reasons – medical school to internal medicine residency to NIH fellowship to Air Force overseas to psychiatry residency to academic psychiatry <\/em>means that I was mid forties before I ever had the kind of office that a drug rep might visit [and they hardly haunt the offices of psychoanalytic psychotherapists who work with no office staff and rarely writes prescriptions]. So that Pie Chart showing that PHARMA spends $25 B\/year on targeting me is still an eye opener: <\/div>\n
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Restoring the pharmaceutical industry’s reputation<\/a><\/div>\n
by Mark Kessel<\/div>\n
Nature Biotechnology<\/font><\/strong> 2014 32[10]:983–990.<\/div>\n
[full text on-line<\/a>] <\/div>\n

<\/p>\n

<\/div>\n<\/blockquote>\n
But more than that, Kessel’s opening sentence was what I recalled from the Internal Medicine days… <\/div>\n
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It wasn’t that long ago that the pharmaceutical industry was considered among the most respected industries and Merck the most admired corporation in the United States. <\/em><\/div>\n<\/blockquote>\n
and when I woke up forty years later, this is what I found: <\/div>\n
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This is in sharp contrast to consumer attitudes today, when the industry’s reputation is not much better than that of the financial sector or tobacco companies<\/a><\/sup>. Why has an industry in the business of developing lifesaving drugs garnered such a negative reputation, and how should it go about fixing it?<\/em><\/div>\n<\/blockquote><\/div>\n
Washington Irving’s Rip Van Winkle slept through the whole American Revolution. I guess I’d done some power sleeping of my own, because we now see PHARMA as among the greediest and most unscrupulous of the lot – from Paxil Study 329 to Gilead’s pricing of Sovaldi and the table from the paper in the last post in which the word criminal<\/font><\/strong><\/em> appears much too often. Kessel’s analysis of the reason for the change is detailed and contains a lot of food for thought. It’s there for all to read, but here’s where he starts:<\/div>\n
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Big pharma and big business<\/u>:<\/font><\/strong> To some extent, reputational decline can be attributed simply to the fact that many pharma companies are large multinational corporations that are now facing strategic issues that require an adjustment to the traditional business model.<\/font> The increasing price and cost pressure, patent expirations on blockbuster drugs leading to aggressive generic competition, public policy and changes in how consumers access medicine are leading to erosion of profit margins. Big pharma, like other industries, is not immune from the pressure of having to meet Wall Street quarterly earnings expectations; indeed, today’s companies are measured on how well their stock performs and boards of directors incentivize management accordingly to meet Wall Street’s demands. The needs of patients are secondary.<\/div>\n<\/blockquote>\n
As I read through the various factors and forces he describes, I thought they could apply to PHARMA, or the Insurance and Managed Care industry, or the Hospital Corporations, or for that matter Medicine [eg the collection of physicians] and the other medical professional groups. There’s an erosion in the overall ethic and morality in all of the elements of medicine – PHARMA just seems to have jumped into the lead and made it all the way over to the dark side, becoming its own caricature. <\/div>\n

Kessel makes an eloquent plea for the value of corporate reputation, and outlines changes that would, indeed, improve both the company’s image and function. But I expect most of the multinational PHARMAs already have a "workgroup"<\/em> "tasked<\/em>" with the same thing. GSK has Sir Andrew Witty out front carrying a banner of reform while his Chinese division is bribing physicians to prescribe their drugs. Alex Gorsky of Johnson & Johnson masterminded Risperdal®’s meteoric rise, and now an army of lawyers works to keep him out of a courtroom as they try to cut their losses in the aftermath. In the legal actions, PHARMA settles the government suits rather than allowing them to go to a jury, and later "denies any wrong-doing<\/em>" – no matter what they admit in the settlement agreements. In the Civil suits, they play the legal chess in the appeal courts when they lose – much like the culture of jail-house lawyers inhabiting our crime dramas.<\/p>\n

Whether cynicism or pragmatism, I doubt Kessel’s good advice will change the directions of PHARMA:<\/div>\n
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According to Alexander Brigham and Stefan Linssen of the consulting firm Ethisphere Institute, over the past three decades, the percentage of a company’s value attributable to tangible assets has dropped from 90% to just 25%. Other estimates also suggest that it is the intangible assets of a company [including reputation] that currently represent as much as 40–60% of a corporation’s market capitalization. Thus, a company’s reputation is among its most valuable assets.<\/div>\n<\/blockquote>\n

My read is that these major pharmaceutical corporations have completed the move from being drug·<\/em>discovery and drug·manufacturing companies, part of the legitimate health care effort, to being drug·<\/em>selling cash·<\/em>cows in the business of "doing business"<\/em> [in the Bernie Maddof\/Enron tradition]. I would suspect any moves they made in the reform arena would be called "brand·building<\/em>" in their meetings – illusions they definitely know how to create [that should probably be followed with mumbles like at the end of the DTC ads as we watch the cured patients and colorful butterflies]. Meanwhile, here<\/a>‘s the Forbes’ version of a PHARMA argument lest you’re hoping for anything but the business of "doing business."<\/em><\/p>\n

No, as most of us have long preached, rapidly escalating fines and criminal prosecution of the actual people involved is the only real recourse for the moment. But, like Kessel, I can have my fantasies. The most disillusioning piece of this story is the complicity of physicians that are apparently easily "hired on." Medicine, unlike the pharmaceutical industry, does have an intrinsic ethic, a traditional morality to draw on. Without the complicity of physicians, this whole game is dead in its tracks. If there’s a place to make a dent in this madness, it’s in aiming for a time when an accurate Physician Payments Sunshine Act Database<\/span><\/a> is every bit the Hall of Shame it’s intended to be… <\/div>\n","protected":false},"excerpt":{"rendered":"

My interest in this article [restoring pharma I…] has a personal component. I’m not being coy when I say that I was stunned when Senator Grassley revealed what I would now call the Academic·Psychiatry·PHARMA·Alliance and all the corruption among, around, and in-between. I have figured out some of the reasons – medical school to internal […]<\/p>\n","protected":false},"author":2,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_bbp_topic_count":0,"_bbp_reply_count":0,"_bbp_total_topic_count":0,"_bbp_total_reply_count":0,"_bbp_voice_count":0,"_bbp_anonymous_reply_count":0,"_bbp_forum_subforum_count":0,"footnotes":""},"categories":[5],"tags":[],"class_list":["post-50900","post","type-post","status-publish","format-standard","hentry","category-opinion"],"_links":{"self":[{"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts\/50900","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/comments?post=50900"}],"version-history":[{"count":21,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts\/50900\/revisions"}],"predecessor-version":[{"id":51101,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts\/50900\/revisions\/51101"}],"wp:attachment":[{"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/media?parent=50900"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/categories?post=50900"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/tags?post=50900"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}