Thursday, April 9, 2009

The PharmaScolds Strike Back: Latest from Stossel

David A. Shaywitz, a management consultant, and Harvard's and the Manhattan Institute's Dr. Thomas P. Stossel let loose at "Pharmascolds" like me in yesterday's Wall Street Journal, which is making life much easier for us by no longer requiring paid subscription to access some content:

Usually Dr. Stossel is sufficiently entertaining, and also wrong in an instructive way, to make taking his writing apart a worthy exercise. So here goes.

"Relationships between university researchers and medical product companies are under relentless attack by critics who portray these associations as a morality play in which noble academics struggle to resist the dark, corrupting influence of industry." Hmm. Some of thought that rather than attacking industry associations, we were trying to figure out a way that these relationships could move forward to benefit the public health without being encumbered by financial conflicts of interest. What has been "relentless" in recent months has not been the work of academic critics, but rather the flood of press releases listing which drug company has just had to pay which huge fine, or is being indicted in which court for claimed fraudulent or illegal behavior. Makes it a lot harder on those of us who prefer to claim that our beef is not with industry but rather with the unethical behavior of our own medical peers.

"The answer is that by prioritizing the needs of patients, these medical philanthropies [that are eager to partner with industry] remain keenly aware of something academic critics of industry may have forgotten as they've scaled the university ladder. The goal of medical research is not to publish papers, but to develop new treatments for people suffering from disease." Nice point. In the same vein, industry might be reminded that the goal of medical research is to develop new treatments for people suffering from disease, and not to maximize their own revenue by marketing the hell out of ineffective or unsafe drugs.

"And translating laboratory research into new therapies ... is something "academics are really not good at.'" This needs some unpacking. It is quite true that no academics can go into their garage and stir up a batch of a new drug and hand it out to patients, no matter how groundbreaking the basic science discovery. But it is also true that whenever a study is done that looks at where new drugs came from, the role of government- or publicly-funded labs is huge, and the contributions of industry labs, until you get to the mass-production stage, is often marginal--a fact that is routinely reversed in the industry's own PR.

"Given the vital role of medical products companies and the magnitude of their challenges, one might imagine that this industry would be admired. ... But this enlightened view of industry is not widespread. This is largely because of the disproportionate influence of a coterie of prominent critics we have previously dubbed 'pharmascolds,' who routinely vilify the medical products industry and portray academics working with it as traitors and sellouts." I missed the "previously" so am just now being introduced to the term "pharmascold." A cute term. I'll now announce a contest to come up with an equally cute term for people like the authors of this paper, who apparently never met a drug industry dollar they wouldn't pocket. It is getting a bit repetitious to call them "shills." We bloggers need something fresh.

"These critics are pious academics, self-righteous medical journal editors, and opportunistic politicians and journalists. Their condemnation of anyone's legitimate profit -- it's all 'corruption' in their book -- has in fact materially enhanced their own careers." A fresh diagnosis from Dr. Stossel. In previous writing he has accused us pharmascolds of being motivated principally by envy--meaning presumably that Stossel was making the big bucks while our own careers were stagnating. So it is nice to hear that from his vantage point we are making headway. Apparently his own stock portfolio is losing value these days.

"In response to these attacks, drug company spokespeople seem content to offer up measly press releases. When challenged by reporters, most academic consultants to industry refuse to comment or offer a meek explanation, instead of retorting that industry pays them because they add critically important value. This evasion has only emboldened industry critics, disheartened company employees, and caused even allies to wonder if there really is something to hide." Well, of course there is something to hide--see the deluge of press releases of company malfeasance, or at least half the previous entries on this blog. But the larger point is interesting. Pharmascolds like me notice that the usual response we generate from the industry is silence. The industry seems to view us as fleas of such a puny species that we are not even worth the energy to scratch. By contrast, an actual academic scientist who starts to criticize a popular drug--a Nancy Olivieri-type figure--immediately causes the industry to bring out its biggest guns and to try to destroy that individual's career. Given how big those guns are, and how well-funded the ammunition store, most of us pharmascolds are frankly delighted we have been relegated to the sub-flea category.

"For the sake of the many patients whose diseases require innovative treatments ... it's time for the leaders of the medical products industry to take pride in their purpose and start fighting back. And discovering a few important new medicines wouldn't hurt either." Really good advice to the industry, and an amazing attack of frankness at the end of the article. Does anyone really believe that if the truth were as Dr. Stossel likes to portray--that the history of drug development in the past 20 years is the history of one after another highly effective and reasonably safe drug, all aimed at diseases that are truly life-threatening, that there would be as much criticism today against the industry? The industry has brought on its own criticism by forgetting the insight that one of its earliest turncoat-insiders, Dr. Dale Console, former medical director of Squibb who became a star witness before the Kefauver congressional committee in the 1960s, shared with that hearing panel:

Q: [Isn’t it true that the costs of research for the pharmaceutical industry are high because so many initially promising drugs turn out to be failures?]
A (Dr. Console): “This is true, since it is the very essence of research. The problem arises out of the fact that they market so many of their failures.” (Hooked, Ch.6)


Howard Brody said...

A colleague who responded to me by e-mail rather than on the blog suggested as the opposite of "pharmascold" the word "pharmastute."

Anonymous said...

How about "pharmasycophant."

Anonymous said...

Just to be clear, the opposite of a pharmascold would be a "pharmasycophant."

Roy M. Poses MD said...

See also this post on Health Care Renewal:

It is ironic that at the end of the op-ed, Shaywitz and Stossel call for academics with industry relationships to proudly proclaim them, but that Stossel failed to disclose any of his complex relationships in the op-ed.

Anonymous said...

Hi, I think the author provided the best hint: pharmashill.

Toad In the Hole said...

A variant of pharmasycophant is pharmatoady, or pharmatoad for short.

Toady: one who flatters in the hope of gaining favors (sycophant, parasite)


Toad In the Hole With Bacon said...

What is a pharmascold's favorite dish?

A: Pharmatoad in the hole with bacon

Anonymous said...

Is the Nematoad a Pharmatoad?

Anonymous said...

Opposite of pharmascold:


Professor Pharmatoad said...

Mr. Anonymous,
To answer your question, a Nematoad is not a Pharmatoad because Nematoads do not possess the apparatus necessary for speaking and writing. However the two species share many of the same traits. For example,
a) there are many different varieties within the species
b) some create disease in a host
c) the few that are responsible for creating disease have received a lot of attention
d) the predatory variety eats others within its own species
e) they are concentrated near their prey groups
f) some varieties are beneficial, others are parasitic

Click on my name for information about Parasite Trappers.

Lili Velez said...

I'd put my vote for pharmashill, or pharmashrill, but really the problem is not what the catchy names are, but what is standing behind them.

It's interesting to watch people who would ordinarily insist that people be paid for their efforts to the extent the market will bear [whether that is a banker, a CEO, a surgeon or a writer] complain that certain people have found a market for their "scolding" of the pharmaceutical industry.

The issue for many of us who would like to see more transparency in the dealings of doctors, pharmaceutical companies, and HMOs is NOT that money is being made in medicine. The issue is knowing who is being paid, by whom, and how much.

We are urged to 'follow the money' in every other situation: don't you want to know who's funding your political candidates? [and who writes their speeches...] Why should funding for medical professionals be any different?

Unknown said...


Nematoad said...

"Look out, Pharma. The rebels are gaining on the apostles." Click on Nematoad for the story.