Public Health or Corporate Wealth?

I am sitting in an auditorium at Georgetown University attending a symposium on the influence of the pharmaceutical industry on scientific publications and continuing medical education.  This is a decidedly hostile crowd.  The crusaders are all here, including Arnold Relman, MD, professor of medicine at Harvard Medical School.  He is a former editor of the New England Journal of Medicine (1977–91) and evidences such vigorous idealism I cannot believe he was born in 1923.  I am overwhelmed by the energy, vehemence and righteousness of the faculty for this course. 

So what is happening here?  Basically, I have been sitting in this lecture hall (ironically in the business school) watching a parade of experts bash the pharmaceutical industry for two days straight.  There are no industry representatives…no dialogue, no counterpoint, no exchange. 

The arguments are that the pharmaceutical industry exerts too much influence over thought leaders, scientific publications, and information dissemination to students and doctors (and the public).  The speakers take umbrage with direct to consumer advertizing and social media, and accuse the pharmaceutical industry of trying to “medicalize” everything, creating new [non existent] diseases.   You have “low T”; your wife needs the purple pill;  your brother  has restless legs; and your kid has ADHD because he talks all the time in school.

In the entire two days, not one kind word has been offered about pharma.  And I am left with this question —can a scientist work in industry maintain intellectual and ethical integrity, or does the great God Mammon contaminate everything we do.  

I really don’t know how to answer this overarching question. I will admit that I have my own unease about my colleagues in marketing sometimes.   But I do know a few things.   I know that the scientists and statisticians I have worked with in industry have been brilliant.  I know that during  clinical trials, my medical monitors have been scrupulous and diligent about patient safety. I know that many of the medical liaisons I have worked with (who were particularly maligned) are my intellectual peers and trusted experts in their fields.   I know that I have never been asked to fabricate or alter data.  [But there have been times at the end of a study, where we put the numbers into the “data-matic” and sliced it and diced it, looking for the pony in a pile of manure.]

So I ask all of you, do doctors, nurses, pharmacologists and other health care specialists working in pharma serve the public health or shareholders or some chimera?    Is the well being of the populous and wealth of corporations incompatible?   Can we serve two masters?