Pharma: Tamed But Still A Big Beast

Everyone knows that Big Pharma go around lying, concealing data and distorting science in an effort to sell their pills. Right?

Actually, not so much. They used to, but most of the really scandalous stuff happened many years ago. The late 80's through to about the turn of the century were the Golden Age of pharmaceutical company deception.

This is when we had drugs that don't work getting approved, with the trials showing that they don't work buried, and only now being uncovered. Data on drug-induced suicides seemingly fudged to make them seem less scary. Textbooks "written by" leading psychiatrists that were, allegedly, in fact ghost-written on behalf of drug companies. Ghost-writing programs with chuckle-some names like CASPPER. And so on.

But today, we have to give credit where credit's due: things have improved. Credit is due not to the companies but to the authorities who put a stop to this nonsense through rules. Mandatory clinical trial registration to ensure all the data is available and stop outcoming cherrypicking. Anti-ghostwriting rules (albeit they're not universal yet.) etc.

What's shocking is how long it took to get these simple rules in place. The next generation of scientists and doctors will look back on the 1990s with disbelief: they let them do what? But at least we woke up eventually.

Still, there's more left to do. At the moment, the main problem, as I see it, is that different jurisdictions have different rules, with the best ideas being confined to one particular place. For instance, the USA has by far the most sensible system of clinical trial registration and reporting. Europe needs to catch up (we are, but slowly.)

Yet the USA is also one of the only countries (with New Zealand) to permit direct-to-consumer (DTC) advertising for prescription drugs. To the rest of the world, this is really weird. We all have a right to free speech. But drug companies pushing drugs directly to patients just isn't a free speech issue, in Europe. Corporations don't speak, they advertise.

By encouraging self-diagnosis and self-treatment, DTC replaces medical judgement with marketing, undermining the doctor-patient relationship. The patient is meant to present his symptoms and the doctor is meant to make a diagnosis and prescribe a treatment. DTC encourages self-diagnosis and self-prescription: the fact that a doctor is still, technically, in charge and has to sign that prescription, means little in practice.

So there's a lot to be happy about, but there's also a lot still to do.