The ‘Big Bad Pharma’ Wolf: Is It As Bad As The Media Say?
Nowadays, most public connotations of ‘Big Pharma’ have become synonymous with ‘Bad Pharma’. Undoubtedly the pharmaceutical industry is historically laden with scandals of questionable ethics, dishonesty and the promotion of bad science. Due to their prominent role in the health care system, this industry is under constant scrutiny and criticism, and it has become a trend in media not only to criticise ‘Big Pharma’, but to demonise it. Is this cynicism called for, and is it constructive for the industry and the welfare of its consumers, the patients?
As a profit-driven industry, one of many concerns is that pharmaceutical companies do not have the incentive to produce drugs that provide cures, but rather deliver treatments for chronic symptoms. The media is outspoken on this issue, pointing out that the most profitable drugs on the market don’t ever cure you.
The most profitable drugs do seem to be the ones that require repeated and prolonged dosing and that treat symptoms without providing an outright cure (table 1). But does this point towards foul play within the pharma industry? Is it deliberately churning out blockbuster medicines that treat symptoms rather than the cause?
At first glance, this may seem likely. However, upon further reflection, high profit probability may be a necessary prerequisite for prescription drugs. In essence, drugs that must be continuously and frequently consumed will naturally bring in more money; a drug that could provide an outright cure wouldn’t have the same sustainability in driving profits. As such, using the profitability of drugs as a measure of good conscience is a flawed and pre-determined construction from the start.
Nevertheless, as John LaMattina, former Pfizer President of R&D, admits in his book Devalued and distrusted, big pharmaceutical companies cannot address an obvious unmet medical need for new antibiotics because the “commercial return on a new antibiotic would pale in comparison to a new treatment in areas like cancer or Alzheimer’s disease” (2). LaMattina attributes this to the fact that antibiotics are generally used acutely, not chronically, making them unattractive for a big company. A likely extrapolation from this would be that ‘Big Pharma’ prioritises research towards moneymaking prescription drugs and treatments over one-off, outright cures. However, before pointing a damning finger, an in-depth analysis into the type of research that ‘Big Pharma’ invests in is first required.
Similarly to the criticisms for being profit-driven, the pharmaceutical industry has also been condemned for investing excessively on marketing and promotion, even more than on research (3). Moreover, a 2012 report in the British Medical Journal suggested that “current incentives reward companies for developing large numbers of new drugs with few clinical advantages over existing ones” (4). So investing a lot of resources in new, ground-breaking medications is less profitable than creating products that only differ marginally from drugs already on the market.
Indeed, it does seem that an astonishing amount of money is needed to bring a new drug to market. According to an article on Forbes.com, the average drug developed by a major pharmaceutical company costs at least £2.7 billion, with AstraZeneca spending £8 billion on research for every new drug approved (table 2) – as much as their top-selling drug made in annual sales (5).
With figures like these, can ‘Big Pharma’ be blamed for investing in less risky ventures? A quick comparison of tables 1 and 2 shows that the average R&D expense is considerably higher than the annual sales profit from top grossing drugs. ‘Big Pharma’, like any other industry, are cogs in a capitalist system, and the business of inventing new drugs seems like a pretty unsustainable one. We might like ‘Big Pharma’ to act as saviours of the 21st century. However, in reality, not only do they have a responsibility towards the well being of mankind, they are also liable to shareholders, employees and the financial security of the company. So while as consumers we condemn them for over-pricing or over-marketing drugs, as businesses it would be irresponsible not to maximize profits where they can.
Today, the pharmaceutical industry is widely blamed for creating a culture of drugged-up, over-prescribed denizens. Some have gone so far as to accuse Big Pharma of inventing new diseases to create demand for their medication. An article by Martha Rosenberg for AlterNet viciously attacked the pharma industry, compiling a list of eight diseases, including fibromyalgia and adult autism, which were all allegedly invented (6). In the case of autism, where academic longitudinal studies have shown poor outcomes for many adults, regarding it as a “created” disease is an insult to its sufferers and to the wider mental health community. The case of fibromyalgia, an umbrella diagnosis of widespread muscle pain with fatigue and poor sleep, might be more complex. The FDA requires a drug to be indicated to treat a disease, not just their symptoms. So while it could be that fibromyalgia was invented in order to create demand for a product, it is also possible that ‘Big Pharma’ made up a condition so that it could sell a drug that only alleviates symptoms, as the cause of fibromyalgia remains largely unknown.
Big pharmaceutical companies have done many inexcusable things: suppression of unfavourable research findings; intimidation of doctors and researchers; dishonest marketing and more. But for all their faults, being profit-driven isn’t one of them. They are placed within a broken system, the same way we all are; they are no saints, but importantly, they make no claims to be; they aren’t non-profit organisations or charities but large, revenue-maximising, multinational conglomerates. These companies have undoubtedly earned their reputation as wolves. However, society seems to have thrust upon them the role of our gentle grandmother, expecting them to provide care and support as a matter of duty, and so we are vexed and appalled when we get bitten. It’s not that there’s nothing wrong here. There are a thousand things wrong with a system in which the major incentive to save lives and cure diseases is money. And so we should continue to be critical, always mindful of marketing gimmicks and never stop calling for open access to data from drug studies and clinical trials.
However, it shouldn’t stop there. Short of overhauling the current economic system within which healthcare operates, it is not enough for us to only focus our attention on the pharmaceutical industry. We also need to hold doctors responsible; it is their duty and obligation to patients not to be drug-mongers for the pharmaceutical industry and patients must be able to trust their advice and recommendations – these drugs cannot be over-prescribed if doctors do not pander to the will and whims of the pharmaceutical industry. The onus is also on us, as patients and as consumers, to be well informed and diligent when it comes to our own health.
As an industry, ‘Big Pharma’ faces a moral conundrum: a conflict of interest between their own survival and their basic obligation towards their fellow man. In the long run, the sustainability of a profit model within healthcare is at best questionable. For now, rather than spreading vicious depictions of ‘Big Pharma’, the media should be a source of education and impartial information. So, while we should always keep a critical eye on ‘Big Pharma’, we should also save some scepticism for what is written about them. Ultimately consumer decisions must be information driven and evidence based, neither falling prey to marketing ploys nor to sensationalist media propaganda.
- U.S Pharmaceutical Sales (2012) Top 100 Drugs for 2012 by Sales. Drugs.com
- LaMattina JL (2013) Devalued and Distrusted: Can the Pharmaceutical Industry Restore its Broken Image? John Wiley & Sons.
- Eichler A (2012) Pharmaceutical Companies Spent 19 Times More on Self-Promotion Than Basic Research: Report. The Huffington Post
- Light D & Lexchin JR (2012) Pharmaceutical research and development: What do we get for all that money? BMJ
- Herper M (2012) The truly staggering cost of inventing new drugs. Forbes.
- Rosenberg M (2010) 8 invented diseases big pharma is banking on. AlterNet.org