PHARMACEUTICAL CONFLICT OF INTEREST.
A guy I knew some years back was a senior employee in a large Pharmaceutical Company in Cork. He was highly intelligent and assured and very obviously comfortable in his life.
One night I waxed lyrical on the (possible) wrongs of the Pharma. Industry in general, while being careful not to point any specific finger at his employer. Maybe I was only hopping the ball in the hope of starting a lively debate but his response surprised me. “You have no idea how bad they are,” he muttered darkly. Of course I pressed him and begged and pleaded for more but he wouldn’t say much more about it. To finally kill the conversation he pointed me to some book on the subject whose name I had forgotten before I got home.
But as a customer of theirs with a deep suspicion that they bankrolled a lot of the anti-tobacco efforts in order to push their own alternatives as a result, I did a little digging. I knew before I started that they were in the business of making money and growing their business. As a result of that, you would have to conclude that It is not in their financial interests to prevent common diseases. Indeed the maintenance and expansion of diseases is a precondition for the financial growth of this industry. That alone is a very dangerous conflict of interest because they must publicly portray a caring determination to cure disease with their products while endeavoring to ensure that doesn’t happen.
The marketplace for the pharmaceutical industry is the human body, but only for as long as the body hosts diseases. When a disease is cured in a particular patient, they stop buying the pills and cease being a Pharma customer. A steady line of revenue is lost and if you extrapolate that out to a wider population, well you could see how those big companies might quickly start to shrink. Nothing I’m saying here is incorrect and in fact it makes perfect sense if you think it out. But I believe most people don’t even want to go there. Instead they prefer to take the tablets and live in hope.
To further expand their pharmaceutical market, the drug companies are continuously looking for new applications for the use of drugs they already market. For example, Bayer’s pain pill Aspirin is now taken by 50 million healthy US citizens under the illusion it will prevent heart attacks. Remember, Viagra was originally conceived as a treatment for hypertension until it was discovered that it had, ahem, not unpleasant side effects. It limped along in the limited hypertension market place until the marketing men got the horny news and then Viagra positively, ahem, sprung into life.
But on a serious note. Did you know that the acknowledged deadly side effects of prescription drugs are the fourth leading cause of death in the industrialized world, surpassed only by the number of deaths from heart attacks, cancer and strokes (Journal of the American Medical Association, April 15, 1998). In an earlier piece entitled, “Good pill, Bad pill,” I listed the side effects from the maker’s own small print on my own medication and it surprised even me. From the company’s point of view, the advantage of listing them, (in six-point text on a cluttered page), is that they lower their chances of being successfully sued.
By market valuation, the combined Pharmaceutical Industry is absolutely massive. In 2001, worldwide revenue was around 390.2 billion U.S. dollars. Ten years later, this figure stood at some 963 billion U.S. dollars. In 2014, global pharmaceutical revenues for the first time increased to over one trillion U.S. dollars. This provides billions for marketing. While a small amount of this is aimed at the general public through mass advertising, the Pharmas spend the bulk of it on the medical profession. Well, think about it a moment. You would not voluntarily stop off at a chemists shop out of the blue one day and on a whim, buy some heart disease or cancer treatment medications, would you? For that to happen, you would have needed a confident doctor to present you with a prescription and warm you sternly to get and take such medicine in order to avoid dying. Knowing this equation, the companies begin their activities in the Universities at first year med. They sponsor and help to write the textbooks and medical manuals, they confer with the Professors and lecturers to keep them abreast of new medicines and treatment and they hold open nights with inducements for aspiring doctors to come and be trained/brainwashed on the miracles of their latest offerings. For any GP in practice, the medical rep can be the source of a golfing holiday abroad if the required amount of their medicines have been prescribed. Is it any wonder then that the budding graduate’s first recourse in any patient setting is the prescription pad and biro.
This state of affairs is further aided by general, or mass advertising aimed at the healthy. How many times have you seen one of their ads that lists common complaints such as, tiredness, coughing, waking up at night to pee, stomach ache, dizziness, periodic breathlessness, headache, irregular bowel movements, loss of appetite, on a list of ten items on a billboard. The punchline will always read something like, “If you have experienced any three of the above ‘symptoms’ in the last month, contact your doctor immediately. The company behind the advertisement is likely to have been holding a promotion to GP’s in that area recommending their particular pill as the treatment for all ten things on the list. It nearly goes without saying also that in any given month you will likely have experienced at least five of the items listed. It’s called marketing!
All of the above is true and correct but to go even further, one needs to move into the realms of speculation without hard proven evidence and assume also that ethics in medicine can be bought. My friend from the past that I alluded to, was hinting darkly about the more secretive actions of ‘Big Phama.’ Specifically, that the cartel of the largest ones have purposely suppressed the cure for cancer for example. The conspiracy goes that they discovered a cheap and successful method of ensuring nobody got cancer, (or somebody else did), and the ‘cure’ was entombed in lead and buried thousands of feet under. Dark stories abound all over the free space about cures for many things which died with their inventor. This is speculation but on a similar note, there actually was a man who did invent a device to run cars on water much to the chagrin of the oil companies and the motor industry. He of course died in mysterious circumstances and his invention never saw the light of day.
Another troubling idea that is difficult to swallow, if you presume a high standard of ethical behavior, is the notion that Big Pharma do spend millions “creating” diseases and epidemics in labs in order to profit from the treatment/s they are also working on in parallel. In business, this would be called creating a new market and the best market ever is the captive market. It has a profound effect on the bottom line and is hugely popular with investors. Developing and selling medical treatments from the high moral ground of unquestionable integrity is a very difficult thing to do, especially with the huge margin medicines, such as those to treat cancer. You see, poor people get cancer and most cannot afford the best remedy. In theory then, the members of the high moral ground of unquestionable integrity would provide the charity of free medication to those short of money. Pigs might fly! They consistently brazen that one out and indeed spend a fortune suppressing any such stories lest people begin to question their combined integrity.
In short then, at the very core of modern medicine lies a huge anomaly and yet another question of trust for the whole society regarding an essential institution, which should be above reproach. Is the Pharmaceutical Industry itself a deadly epidemic that could take us all with it, or is it, as portrayed, a force for good.
What do you think?