The dominance of Big Pharma: unhealthy relationships?

Abstract

The multinational pharmaceutical industry is seldom out of the news for a variety of reasons. ‘‘Breakthroughs’’ in drug treatment are acclaimed in the press, yet the industry’s reputation is frequently tarnished by claims of profiteering, data ‘‘massaging’’ and inappropriate marketing techniques that include inducements offered to healthcare professionals, promoting misleading data and questionable direct-toconsumer advertising. The industry has also been accused of ignoring low-incidence diseases in developed Western countries and common, life-threatening disease in others on grounds of poor profitability. At heart, there are pressing concerns about power relationships, and considerations of trust at several levels that have never been fully resolved. Most of the papers included in this themed section emerged from those presented and discussed at a seminar held during a conference of the European Society for Philosophy, Medicine and Health Care at the University of Tubingen during August 2009. These papers are supplemented by a contribution that considers the potential for bias in the uncertain process of appraisals by the UK National Institute for Health and Clinical Excellence, a process whose outcomes are crucial for patients, prescribers and manufacturers, together with a polemical debate between two general medical practitioners, one from Germany and one from the UK concerning their personal views on attempts by some industry employees to subvert or evade regulatory practices to maintain progress. The paper by Badcott, Big Pharma: a Former Insider’s View summarises the main components that support a generally instrumental justification for the commercial and highly competitive nature of the industry. It is argued that the established operational model optimises development of increasingly more effective and better tolerated new medicines, funded by investment and maintained through the profits of direct market competition. Nevertheless, major ethical problems are acknowledged within the industry and whilst their seeming ubiquity and refractory nature is in itself problematic—human ingenuity at circumventing codes and regulation that are perceived as more of a challenge than a bar is undeniable—there are encouraging signs that some major multinational Big Pharma companies are beginning to adopt more rigorous and accountable ethical codes, some of which reflect acknowledgment of the value of adopting a triple bottom line policy and shouldering wider social and other responsibilities. General medical practitioners and hospital doctors are the principle targets for pharmaceutical promotion. In Of Mugs, Meals and More—the Intricate Relations Between Physicians and the Medical industry, Sahm explores some of the main aspects of this relationship which has often been plagued by ethical problems for both parties. Physicians are the principle gatekeepers for the accessibility of potent medicines by patients and Sahm recognises that ‘‘co-operation between profit-driven manufacturers of medical products and physicians caring for patients is D. Badcott (&) Centre for Applied Ethics, Cardiff University, Humanities Building, Colum Drive, Cardiff CF10 3EU, UK e-mail: badcottd@cf.ac.uk