A blog from the Centre for Research Ethics & Bioethics (CRB)

The pharmaceutical industry and altruism

Pär SegerdahlI am currently thinking about a common gut reaction to the pharmaceutical industry. I sometimes have this reaction too, so this is an examination of my own reaction.

The reaction is a feeling of discomfort, when a central actor in the management of something as important as human health and disease is a multibillion-dollar industry with profit as overall goal.

Is it really possible to combine such a businesslike aim with a genuine desire to cure the sick?

Let us compare with another industry that radiates more compassionate desire to cure, namely, alternative medicine. Here too products are sold to people with various ailments. There is clearly a market and a business mindset. Yet the actors on this market radiate more love of mankind. It can sometimes even appear as if the products were manufactured and sold out of pure goodness!

What makes these business practices seem imbued with good will to cure? I suggest that it depends on the strong belief in the healing effects of the products. I do not deny that many of the products have beneficial effects. My point is only that beliefs about good effects are at the forefront and can make the provision of the products appear like an ethical act of noble actors.

The pharmaceutical industry is different from alternative medicine partly through being prohibited from being permeated with beliefs about the healing effects of the products. It is actually illegal for the pharmaceutical industry to act as nobly and compassionately as the actors within alternative medicine. It could invite quackery.

The pharmaceutical industry operates on a highly regulated market. There is specific legislation for pharmaceutical products and special authorities supervising the industry. Satisfying the quality and safety demands often requires decades of research and development. This means huge investment costs, which presupposes profits.

This is how we have solved the problem of providing safe and effective treatments through the health care system. By having a pharmaceutical industry that is not permeated with good faith and good intentions, but instead is highly regulated and supervised. The products must satisfy the quality requirements, period. Beliefs and good intentions are irrelevant.

Research, industry and healthcare together constitute a regulated system for managing health and disease. Within this system, researchers can be driven by curiosity, and industry by profit, while doctors want to cure their patients, and research participants want to support research that could lead to more effective treatments.

The point I am trying to make is that the gut reaction probably overlooks just this division of motives: In order for a whole system to work for the good, not every actor in the system needs to place good intentions first. It can rather pose a risk for the entire system.

There is no reason to glorify the pharmaceutical industry. Rather there are reasons to question it, for example, the marketing of products, which sometimes tries to create the faith that is prohibited in the development and approval of the products.

The industry is not altruistic. It is driven by profit. But through its place within the system it can make altruism and good will possible.

Pär Segerdahl

This post in Swedish

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  1. Josepine Fernow

    An interesting perspective! I suppose public-private partnerships (like the Innovative Medicines Initiative) are put in place to get the best out industry, academia and health care. But it raises questions of conflicts of interest and exploitation of public resources. Deborah Mascalzoni and others hosted an interesting workshop on the topic (http://www.crb.uu.se/ppp) a couple of months ago.

  2. Deborah

    Super interesting. Thanks. A couple of considerations to foster the discussion.
    I think that here we are considering two separate issues:
    1) do we want high quality scientific research based drugs?
    2) Is the pharma industry the only sustainable model to deliver those?
    While the answer to the first question is positive (I think that we definitely want drugs and therapies that responds to high quality scientific standards) I am not sure that it follows that the pharma industry is the only answer.
    Yes, it is correct that good will alone will not do, but at the same time I do not think that at the moment the big Pharma model alone will do a good service to society either.
    In fact in the blog article it is assumed that the counterbalance in place work effectively for ensuring societal interests.
    Is drugs-production really so regulated that will pursue societal interests and are counterbalances in place really enough to ensure patient safety and interest? Is this model pushing innovation?
    1) In recent years the innovation in molecules production has rapidly decreased. As ethical board member I am often faced with requests of trials that test molecules highly more expensive for the system and only slightly more beneficial for the patients.
    This is a serious problem because the National HealthCares are not able to bargain contracts with big Pahrma Industries (that comprehend many items) that exclude the new drugs once approved on the market.
    2) When new molecules are marketed they are so expensive that only few can afford them. This lead for instance Countries like India to reject patents on the new HVC treatment (http://www.ip-watch.org/2015/01/14/key-hepatitis-c-patent-rejected-in-india-for-lack-of-novelty-inventive-step/). In Europe patients organize hope trips to Hospitals in India in order to afford the treatment that in many countries is not available to everyone that needs it (including Italy).
    The Center for Ethics at Harvard also raises some basic and very relevant questions that may deepen the discussion.
    3) “To promote research and development, patent laws protect drug firms from competition and tax subsidies increase their profits. These incentives, however, are not directed to particular kinds of patents (such as new molecular entities) or particular kinds of research, or the development of new therapies and so may not effectively stimulate activities that policymakers seek. What changes could direct incentives more appropriately?
    4) Drug firms provide substantial discretionary funding for important medical activities such as continuing medical education, medical research, medical journals, and professional medical societies. Pharmaceutical firm funding, however, can compromise these activities and bias their direction. How might changes in the control or direction of funding reduce or eliminate these risks?” (http://ethics.harvard.edu/pharmaceutical-industry-institutional-corruption-and-public-health)
    So, to conclude, while scientific basis for the development of drugs is paramount, I think that we still probably need to rethink models that account for sustainability on both levels: financial and social.

    • Pär Segerdahl

      Thank you for these good comments, with more detailed descriptions of problems and trouble in the current system or model! I don’t know what an alternative model might look like, but I am open to possibilities, although alternative models will mean alternative trouble, which continually must be dealt with. That’s life. The aim of my blog post was not to defend any model as the only sustainable one, it wasn’t meant ideologically. I am a philosopher, and I merely wanted to point out how a certain tempting way of reacting to and thinking about the pharmaceutical industry, and about profit, overlooks a division of motives within the overall system we are trying to think about. That is the kind of problems that invigorates me as a philosopher. But I agree that there is a lot of friction and trouble in the system, and I’m happy that you point them out and consider how to deal with them.

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