Friday, June 08, 2012

Big Pharma

Dr. Frances is highly critical of pharmaceutical companies in the video I embedded below.  I don't disagree, and I have heard many doctors echo similar sentiments, but I always wonder when I hear these complaints - what do you envision as the right system.  These companies run as businesses, and certain practices flow from that rather naturally.  If we don't like that, then what not-a-business model are we preferring?  He notes with some sourness that drug company reps are attractive people.  Well, yeah.  The companies that look for unattractive representatives don't do as well.  It's rather like Kermit's protest to Marvin Suggs, who is hitting the muppaphones with a mallet to make them sing:

Kermit:  Wait, wait!  You can't do this!  Those are live creatures!

Suggs:  But of course.  You can't make music hitting dead creatures.

Or similarly, the objection to the phallic nature of weapons in fairy tales and stories, even up to the present day.  The tribes which had weapons based on breasts didn't survive quite so well, I suspect.  Whether there is some primal connection in all this or not, the fact remains that swords, arrows, knives, spears - they work pretty well as weapons.

Are there no doctors who seek profit?  Does Dr. Frances think that the whole profession should be made to act in a more goodness-of-your-heart fashion?  Drug companies try to hide or downplay information that costs them money.  That's a bad thing. But you can read the ads for down-home medical devices, OTC medications, and ridiculous practices in many magazines, on websites, on TV - heck you can get whole catalogues of the stuff.  Does he want to forbid this?  Or does he want more restrictive rules for "real" drug companies, so that alternative medicines have an advantage over prescription meds? What's the plan that isn't worse than the disease, doctor?

And don't get me started on Europe.  Whenever I hear as a complaint that America is the only developed country that does X (in this case, allowing advertising), I am not one who automatically assumes that we must be wrong and the others right.  I think, given history, it is equally likely that we are more right than the others.  I'm tired of this Paris Envy in everything.  European pharmaceutical delivery also has enormous difficulties.  Everything does, because reality is tradeoffs.

There seems to be some lurking idea that pharmaceutical companies should be run as something holy, or a public service, or a public utility - that medical care itself should be something of a public utility like electricity. I will note with meaningful irony that one has to pay to get the electricity, phone, cable, or water hooked up and pay for it as you go.  So we must want medical care to be something even more free than that.


Texan99 said...

Wouldn't it be nice if patients operated purely out of the goodness of their hearts with respect to their doctors? So they'd never get sick at inconvenient times, and they'd pay their doctors generously regardless of whether they'd been sick lately, and they'd obey their doctors' advice slavishly.

bs king said...

Have you read Bad Science by Ben Goldacre? He talks about how bad criticisms of pharmaceutical companies hide the real ones and basically that we're getting it all wrong.

He had a few simple tweaks around burying having a national registry for studies conducted in humans so you could see how many don't get published or if they moved the goalposts halfway through.

Texan99...your comment reminded me of the pediatrician meeting we had last night. It was a sort of open house for expecting parents, and they brought up vaccines. I was surprised but happy to hear them say they advised any parents not interested in vaccinating their children to look elsewhere. Apparently quite a few practices are sick of debating endlessly with parents any more. They put it nicely "our fundamental philosophy probably does not match yours"...the message was clear though.

Assistant Village Idiot said...

Bethany, as you may guess, there are more than a few of your classmates at CCS from the anti-vaccine, don't-you-think-God-wants-natural-solutions camp. Makes me absolutely froth at the mouth, and it is hard to contain myself, much as I am fond of these young people. (You would recognise many names from the list.)

It is sad that the response of these pediatricians is probably the best available in current culture. People have decided that God must think like them, but tell themselves they are thinking like God, in contrast to "The World," who are deceived.

I had not connected the issues, but it fits. Yes, of course pharmaceutical companies hide information from you and are not as protective of you as your mother would be. The same is true for car companies, publishers, politicians, restaurants, and barbers.

Thanks for the Goldacre tip.

Dubbahdee said...
This comment has been removed by the author.
Dubbahdee said...

*I'm going to try again to write something that makes sense.*

I thought the crack about attractive reps quite funny. In fact, if you actually consider it, that situation is completely the fault of the doctors themselves. If the doctors did not respond to attractive people as they do (in a manner that creates outcomes desired by the pharma corps) then the pharma corps would not hire attractive reps. So the solution is to make medical school graduate only doctors who dig ugly people. Problem solved.

See? This stuff really isn't so hard.

Sam L. said...

I was aquainted with one such rep--tall slim blonde. Ran a long relay race with a team all dressed in Xena-Warrior Princess outfits. Said her hubby wouldn't be seen with her. Also, not something you'd expect of a Republican woman with 2 kids.

V. K. Sinha said...

real pharma
Your Information is so Informative.