Tuesday, November 30, 2010

Villains and Victims: Where Does Commentary Turn to Mudslinging?

Bruce Wilson of Montreal wrote an excellent comment on the recent post quoting Alastair Matheson:

I started to respond by appending a comment of my own, but decided that the matter was too important to risk burying in a pile of comments.

Both Wilson and Matheson, in the main post, address this issue. Basically both of them work for the drug industry. Both wish they were not forced to do so. Both, in the present economy, are happy to have a paying job. Both have found of late a lot more paying jobs in the drug industry than in the field of academics that they'd prefer to work in.

So-- do blogs like this one unfairly and unproductively villify people who are stuck in those circumstances? And what about all the other people who work for Pharma in one capacity or another, are decent and ethical people, and in their small corner of the world work as hard as they can to do good and not to do evil, sometimes managing to mitigate what would otherwise be a serious problem (like when the marketers threaten to completely dominate a writing project, and the science writer manages to veer the result back towards real science)?

I think it is always helpful to be reminded of this question and I have three answers.
  1. I know that at times I get too much into the flow of blame and recrimination, because of feeling self-righteous or whatever other character flaw I am indulging in that day. When all is said and done, we need to find allies within the industry who want it to live up to its real potential for human betterment. Without such allies we will never have an ethical relationship between medicine and the pharmaceutical industry, which is what this blog is all about.
  2. Having admitted as much, I wish the drug industry would send up fewer clay pigeons for me to shoot at. I tell people regularly that just when I think I have probed this whole issue to the very bottom, and nothing that any drug company is found to be doing would surprise me any more, the next week I learn of some new revelation that surprises me. If we pharmascold bloggers seem to be going overboard, it is at least partly because we have such a rich supply of material. I for one would love it if I had a lot less material. (I make no money off this blog, as should be obvious, and I certainly am not paid by the word. Having to do a post once a month instead of several times a week would be no sacrifice for my to-do list.)
  3. At risk of boring long-time readers, I must again repeat just who this blog is primarily aimed at (just as was the case with its parent, the book HOOKED). I assume (at least for purposes of argument) that it's part of our great capitalist system for drug companies to turn a handsome profit, and that people who work for the drug industry are supposed to do its bidding and help it to make a profit. (If they happen to have ethical values as well, and try their best to make the world a better place, great.) But I make a sharp distinction between medicine's role and industry's. Medicine is supposed to be a profession--a concept that has not yet, I fervently hope, been relegated to the ashheap of history. A profession is supposed to be about the patients and not about the profits. So if there are any villains in this blog (there ought to be none, I agree), they are the physicians, especially the highly placed academic leaders, who have allowed money and privilege to divert and distort their professional obligations. Getting down to the issue that Bruce Wilson is writing about, the science writer working for the MECC that works for the company is not my main target; it's the academic KOL who allows his name to be put on the ghostwritten article and who pockets the speakers' and consulting fees. That character already has a paying job and could make plenty of bucks--much more than the average joe--just doing his job. If in order to make even more money he abandons his duty of advocating for the patients' health, and becomes a shill for the industry, then I hold him morally accountable.

I hope I've been able to offer some clarification of my intent.

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