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Big Pharma: a former insider’s view

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Abstract

There is no lack of criticisms frequently levelled against the international pharmaceutical industry (Big Pharma): excessive profits, dubious or even dishonest practices, exploiting the sick and selective use of research data. Neither is there a shortage of examples used to support such opinions. A recent book by Brody (Hooked: Ethics, the Medical Profession and the Pharmaceutical Industry, 2008) provides a précis of the main areas of criticism, adopting a twofold strategy: (1) An assumption that the special nature and human need for pharmaceutical medicines requires that such products should not be treated like other commodities and (2) A multilevel descriptive approach that facilitates an ethical analysis of relationships and practices. At the same time, Brody is fully aware of the nature of the fundamental dilemma: the apparent addiction to (and denial of) the widespread availability of gifts and financial support for conferences etc., but recognises that ‘Remove the industry and its products, and a considerable portion of scientific medicine’s power to help the patient vanishes’ (Brody 2008, p. 5). The paper explores some of the relevant issues, and argues that despite the identified shortcomings and a need for rigorous and perhaps enhanced regulation, and realistic price control, the commercially competitive pharmaceutical industry remains the best option for developing safer and more effective medicinal treatments. At the same time, adoption of a broader ethical basis for the industry’s activities, such as a triple bottom line policy, would register an important move in the right direction and go some way toward answering critics.

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Notes

  1. Edmund Burke, Reflections on the revolution in France, Conor Cruise O’Brien, ed. (London: Penguin Books, 1984), 151–152. Quoted in O’Neill (2005).

  2. I use the terms medicine or its plural form medicines or drug or pharmaceuticals variously to denote a proprietary therapeutic product.

  3. Congressional Budget Office of the United States, CBO Study, Research and Development in the Pharmaceutical Industry 2006, p. 23.

  4. See: Dawber (2010). OFT fines Reckitt £10m for Gaviscon market abuse. The Independent, October 16.

  5. ‘Giant takes up fight against rare diseases'. The Times, October 19, 2010, p. 48.

  6. An Inquiry into the Nature and Causes of the Wealth of Nations, Book IV, chapter II, p. 184—Edinburgh 1827.

  7. For further discussion, particularly on the pricing and distribution of pharmaceuticals see Buckley and Ó Tuama (2005).

  8. For a discussion on Daniel’s justification of the special nature of health care, see Segall (2007). In particular, Segall points out that justifying the specialness of health care on the basis of opportunities to pursue life plans fails to account for medical treatment of the elderly. Larmore (1999) gives a fuller account of the notion of life plans.

  9. See also Arrow (1963, p. 941): “The causal factors in health are many, and the provision of medical care is only one. Particularly at low levels of income, other commodities such as nutrition, shelter, clothing, and sanitation may be more significant”.

  10. Adopted by UN General Assembly Resolution 217A (III) of 10 December 1948 (added italic).

  11. O’Neill attributes the phase manifesto rights to Feinberg’s (1980).

  12. For a discussion of O’Neill’s account of rights and obligations and a rethink on duties imposed by human rights, see Ashford (2006).

  13. Grossman and Lai (2008, p. 399) indicate: “Many countries impose price controls on pharmaceutical products to hold down the cost of medicine to national health plans and local consumers. Such controls have generated sizable differences in the prices of similar drugs in different countries. The price gaps in turn create incentives for arbitrage in the form of “reimportation” or parallel trade. Current trade rules leave the legality of such trade in the hands of the importing country. In many of these countries, the question as to whether intellectual property rights should be exhausted nationally or internationally has been highly controversial. Consumer advocates argue for parallel importation as a means to temper monopoly pricing, whereas the pharmaceutical lobby points to the adverse effects of price controls on the returns to research. By allowing parallel imports, they claim, a country would import its trade partner’s price controls and thereby undermine intellectual property and dampen incentives for innovation”.

  14. In the UK, the term ethical is often used to denote prescription medicines.

  15. Angell (2004, pp. 115–135) bluntly refers to ‘food, flattery, and friendship’.

  16. The edition of the code currently in force is 2008. www.abpi.org.uk Accessed October 2010.

  17. www.pmcpa.org.uk.

  18. Available from: http://humanethics.prod2.imcms.net. I am grateful to Professor Henk Ten Have for making me aware of the Novo Nordisk initiatives.

  19. The author is appreciative of the comments of the 2 anonymous referees all of which have been carefully considered, but not all resulted in amendment of the text.

  20. A new Health and Social Care Bill is being progressed in the UK. In a letter to the editor of The Times newspaper (19 October 2011), Professor Geraldine Van Bueren (a commissioner for the UK Equality and Human Rights Commission) indicates that the bill ‘ought to incorporate the basic principle that everyone has the right to the highest standard of attainable physical and mental health, which government is under a progressive duty to provide, according to the maximum of its available resources’.

  21. Original quotation by Sir Winston Churchill, British politician and Prime Minister, ‘Many forms of Government have been tried, and will be tried in this world of sin and woe. No one pretends that democracy is perfect or all-wise. Indeed, it has been said that democracy is the worst form of government except all those other forms that have been tried from time to time’. Hansard, November 11, 1947 British politician (1874–1965).

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Conflict of interest

Having worked in research & development for some 30 years the author is in receipt of an occupational pension from the pharmaceutical industry. He is not a spokesman for the industry and the views expressed are entirely his own.

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  1. Centre for Applied Ethics, Cardiff University, Humanities Building, Colum Drive, Cardiff, CF10 3EU, UK

    David Badcott

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Badcott, D. Big Pharma: a former insider’s view. Med Health Care and Philos 16, 249–264 (2013). https://doi.org/10.1007/s11019-012-9388-6

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