Thursday, December 9, 2010

Pharma: Angels or Demons? What Does It Matter?

Dr. Michael Kirsch, a private-practice gastroenterologist in Highland Heights, Ohio, who manages and occasionally favors us with comments, kindly sent me a copy of his recent paper:

Basically, Dr. Kirsch is upset with the media for vilifying the pharmaceutical industry. He attempts to set the record straight by listing some of the recent sins of industry but also the many things they do right, and the many sorts of social good for which they are responsible.

On the one hand I am happy to see this paper for two reasons. First, I try to stay abreast of what’s being written about the medicine-Pharma interface. Second, for those readers who think this blog is too one-sided in condemning industry behavior, here’s a chance to read something more to your liking. (If you don’t feel better after reading it, take two aspirin, lie down, and call me in the morning.)

On the other hand, I am also tempted to point out that this paper, however lovely and accurate it may be, is utterly irrelevant to this blog. Dr. Kirsch titles his piece: “The Pharmaceutical Industry: Angels or Demons?” My overriding attempt in this blog is to argue that I don’t know which they are and I don’t care. I care about exactly one thing—are the interests of the pharmaceutical industry reliably and consistently aligned with the goals and ethical duties of medical science and medical practice? I suggest that the answer is “no,” and once we know that, we know what we need to know. Calling them names is quite unnecessary, whether the names are nice or nasty.


Anonymous said...

Perhaps we should all go back to the stoneage, and die of infectious disease, a place with no pharmaceutical companies. You live to be 25, and no one has time to write about the evils of those companies who help us live past 75.

Joseph P. Arpaia, MD said...


No one is suggesting that we get rid of the pharmaceutical companies. Perhaps you fail to be able to comprehend the concept of a middle approach, i.e. restrictions on the marketing of drugs, restrictions on the influence of drug companies on medical education, clearer evidence that drugs are effective and safe before being promoted.

These are our goals and they will not impair the drugs companies from finding compounds that are helpful. In fact, these restrictions may enhance the discovery of truly helpful drugs instead of the next copycat drugs for erectile dysfunction or social anxiety.

If you really think that placing the restrictions I mentioned on the drug companies would send us back to the stoneage and give us a lifespan of 25 please explain your logic.

Michael Kirsch, M.D. said...

I think there is no doubt that Pharma has been demonized by the government and the press. Is this what we want and is it fair?

Howard Brody said...

Now that several others have had their chance to comment, I will respond briefly to Dr. Kirsch's question, "Is it fair?" I have already explained in the main post why the answer is irrelevant to the purposes of this blog. But I do have a personal opinion, and it is YES.
To defend my answer I could go on all day, so I will restruict myself to only two comments.
First: I appeal to the previous post from this fall, The mere fact that drug companies were far ahead of all other industries in Federal fraud penalties must say something about whether it's unfair to pick on them.
Second: A book that I strongly recommended in HOOKED, and that has never so far as I know gotten its proper dose of attention, is Leonard Weber's PROFITS BEFORE PEOPLE? ETHICAL STANDARDS AND THE MARKETING OF PRESCRIPTION DRUGS, Indiana U Press, 2006. Dr. Weber took the approach in his book of the business ethicist, not the medical ethicist. He started from a business ethics point of view and ask whether the drug industry is properly conduxcting itself as a business. His answer was NO and that they needed to clean up their act in quite a number of ways. Somewhat surprisingly to me, his prescriptions for change were almopst identical to those I advocated, coming it the industry from an outside perspective as one concerbned primarily about ethics in medicine. But anyone digestimng the message of Weber's book would have a hard time arguing that criticism directed against Pharma is unfair.
Thanks to all for your comments, Howard

Anonymous said...

Dr. Kirsch does make a valid point in that the press, in general, is falling down on the job. A good argument may be made that the fourth estates is crumbling under the weight of consolidation and corporatization (a similar ailment to Big Pharma, one could say). We tend to see more sensational content and less substantive context. Some have argued that salvation lies in the burgeoning fifth estate of the blogosphere…like yours!