Tony Daniels: Don't blame the drug companies for the problems of the world

'Drug firms are scapegoats for the intractability of reality. Our indignation costs us nothing'

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Everyone loves to hate a drug company: hatred of wrongdoing being the nearest most of us can come these days to virtue. And the guilt of the drug companies is assumed, like a truth universally acknowledged. But is the truth actually true?

Everyone loves to hate a drug company: hatred of wrongdoing being the nearest most of us can come these days to virtue. And the guilt of the drug companies is assumed, like a truth universally acknowledged. But is the truth actually true?

The case against the drug companies is by now familiar, and appears to have been strengthened by their offer, under pressure from an Indian manufacturer of generic drugs, to cut yet further their prices to African countries of anti-viral drugs for Aids. If they can afford to cut their prices now, why did they not do so to begin with? Does not their conduct prove that they are to human suffering what vultures are to carcasses and carrion?

The other complaints against the drug companies are that their research is often trivial, mere chemical tinkering with compounds that are already well-known, that their research is directed to the treatment of diseases (or discomforts) of the rich rather than those of the poor, and that they resort to promotional methods more appropriate to the selling of washing powder or chocolate bars than to compounds that might affect the lives of people profoundly.

The fundamental or underlying objection to drug companies is that they are in the business to make profit rather than to alleviate suffering. But if it is distasteful to make a profit from man's susceptibility to illness, why is it less distasteful to make a profit from his susceptibility to hunger or to cold?

Pharmaceutical firms behave like what they are: joint stock companies whose primary responsibility is to their shareholders rather than to humanity at large. There is more money in impotence than in malaria, which is why there is more effort to produce and market a drug for impotence than one for malaria: though, malaria is the more serious medical problem.

But attempts to produce a world in which human efforts are ordered according to "rational" criteria have resulted in disaster: and the question is not whether drug companies (unlike us) ever behave badly, but whether we should be better off without them. The answer must surely be no.

Of course, many doctors feel uneasy at the tactics used by drug companies to promote their products. Although I accept no gifts from drug company representatives, I look round my desk and find a pen marked with the name of an anti-asthmatic inscribed upon it, a Rubik's cube advertising an antidepressant, and an audiotape advertising an antibiotic. I am sure that if I looked further, I would find further pharmaceutical knick-knacks that have somehow insinuated themselves on to my desk, goodness knows how.

I open a medical journal at random, and what do I find in an advertising feature? A picture of an elephant crossing the Grand Canyon on a tightrope, to the accompaniment of the slogan, "Bound to Drop".

What is bound to drop? A patient's level of low density lipids, if the doctor prescribes a certain drug. Whether patients would find reassuring the prospect of a doctor being influenced in his prescribing habits by a computer-generated image of an elephant is a question I cannot answer definitively, but I suspect that they would not.

Drug companies offer doctors educational trips abroad, to symposia on drug treatment of diseases, but it takes little insight into human nature to guess what such trips are really for. I went on one once, and felt soiled at having done so, especially when I heard colleagues proudly boast that they hadn't spent a single penny of their own money from the moment they left their front door to the moment they arrived back.

But before working ourselves up into a pleasant lather of moral indignation about the conduct of drug companies, we should consider the legal and cultural environment in which they are obliged to work.

For example, it now costs huge sums - perhaps £150,000,000 to bring a new drug to market. There is, moreover, no guarantee that it will have to be withdrawn soon afterwards. And by the time a drug is brought to market, the patent on it lasts but a handful of years: a mere five, six or seven.

The necessity to recover development costs and make a profit naturally has an effect both on pricing policy and on marketing. The pressure to sell both dear and quick is immense, otherwise huge sums might be lost.

Why do drugs cost so much to bring to market? In part, because we insist that no accidents happen, and that more and more tests be performed to prevent them. This insistence does indeed prevent foreseeable accidents, but it also means that the introduction of life-saving products is delayed. It has been estimated that the delay in the introduction of beta-blockers on to the American market led to many preventable deaths.

Once a drug has been brought to market, the spectre of litigation, should problems emerge, hangs like a pall over the company. And let us be quite clear about it: some of the litigation against companies has been at least as crooked as anything done by the drug companies. In my experience, it is a moot question whether symptoms cause litigation more frequently that litigation causes symptoms.

For example, the litigation about breast implants in America that drove the manufacturing company into liquidation was based upon inadequate science. Compensation was granted on a huge scale before it was clear whether or not there had been any injury done, let alone done negligently. It turns out that, in an era of litigation and compensation (or "compo", as one of my patients called it, as if it were an old and familiar friend), ordinary people are at least as capable as any drug company of lying, concealment, exaggeration and so forth.

Our intolerance of risk drives up the development cost of drugs, as well as lengthening the time needed to develop them. Our patent laws, which only protect the companies from infringement for a limited time, then add to the pressure to sell, from which much of the distaste for the pharmaceutical industry stems.

Drug companies are scapegoats for the difficulties and intractability of reality itself. Our indignation against them costs us nothing. I have even heard doctors denigrating them while eating the lunch they have provided at hospital meetings. For myself, I can resist anything - except a free lunch.

The author is a doctor who has worked extensively in Africa

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