Trust in Pharma?
Should we trust Big Pharma? Plenty of people don’t, and for good reasons familiar to readers of this blog.
Over at the Business Ethics Blog, I just posted a longish item about reasons for, and against, trusting Big Pharma — or rather, trusting particular companies on particular issues on particular days.
The “against” side is easy: pursuit of profits has clearly driven a pattern of disreputable behaviour within the industry.
The “for” side is more complex. I’ll just list 5 factors briefly (see my other blog entry for greater detail) and then make an additional comment about Research Ethics & the role of Ethics Boards.
1) Individual Ethics — Pharma, despite being a troubled industry, is full of normal people with normal ethics. Most of them are likely to be honest most of the time.
2) Regulations — The industry is highly regulated. Enforcement isn’t always great, but generally there are serious penalties for clear wrongs.
3) Peer Review — The basis for all pharma product claims is open to public, and especially expert, scrutiny. A good but imperfect system.
4) Scientific Overlap — Pharma may have too much influence in some parts of Medicine, but not all physicians are on the payroll, and nor are most of the biologists, chemists, statisticians, etc., who also get to see and critique published medical research.
5) Competition — Pharma is intensely competitive, as are medical researchers. Collusion and conspiracy are the exception, not the rule.
In the list above, I left out the role of Ethics Boards and scholars in research ethics. Ethics Boards are, in a sense, the public’s first line of defence, making sure that the clinical trials that get conducted are conducted ethically — and as it happens, good ethics in research overlaps very considerably with good science. On the scholarship side, you’ve got people like Charles Weijer, working to make sure that the principles according to which biomedical research gets done are the best ones. (Charles has argued, for example, that for ethical and scientific reasons, in almost all cases new drugs ought to be tested against the best drugs currently available, rather than against placebos.) To the extent that good scholarship influences policy, it helps ensure that drugs that make it to market really do deserve to be there.
The pharmaceutical industry has, alas, seemingly worked very hard at gaining its own lousy reputation. Trust Big Pharma, full stop? Clearly not. But we should be careful not to throw the baby out with the bathwater. We need instead to think clearly about the social and institutional mechanisms that help keep Pharma in line, and about how we can make those mechanisms better.