A Brief Postcard from Lebanon

I am appearing this week at conferences sponsored by the new Salim El-Hoss Bioethics and Professionalism Program of the American University of Beirut Faculty of Medicine, under the capable leadership of Thalia Arawi, PhD. Today I spoke at an internal medicine conference (before an audience of perhaps 30-40) on "Ethics, Medicine, and the Pharmaceutical Industry: Current Controversies." I was able to leave about 25 minutes for questions and comments and hoped thereby to learn about the status of the issues of interest to this blog among Lebanese physicians.

I found myself preaching to the choir as virtually no one took any issue with my call for significant reforms. (Dr. Arawi informs me that AUB is developing new policies on conflicts of interest on US and European models just this year, and that while there was initially some physician opposition, it was soon superseded by general support and a sense that something needed to be done.)

The first comments that I received were to the effect that the problem was generally worse here than in the US, and even worse yet in the developing world. "More and more physicians are on the drug companies' monthly payroll" was how one comment put it (sadly I was not able to follow up to ask just what that meant). Lebanese patients seem to resemble many Americans in believing that if they do not leave the physician's office with a prescription in hand, the physician provided them with no service. Another academic commented on the vast amount of research money spent by companies merely to "evergreen" profitable drugs rather than to discover truly innovative drugs. I received a startled question about my description of the practice of ghostwriting from a professor of philosophy, who obviously could not believe that such things went on. Another question dealt with the FDA and why its regulatory authority had not set matters right. Perhaps the most challenging question came from a neurologist who wanted nto know why I did not support remaking drug firms into non-profit institutions--as he said, we understand that universities are supposted to be non-profit; why not the companies that discover and manufacture drugs for the public health? (I didn't want to mention that the emergence of for-profit universities seems to be the latest fad in US higher education.)