Jerry Avorn, MD, Co-Director of NaRCAD, Professor of Medicine at Harvard Medical School and Chief of the Division of Pharmacoepidemiology and Pharmacoeconomics at Brigham and Women's Hospital
Consider the following recent news development:
A large multinational company is discovered to have purposely hidden the risks of one of its best-selling products by suppressing information about its adverse effects and presenting only a selective set of data about its impact, to cast it in a more favorable light than was accurate. The magnitude of this distortion was so great that it posed health risks for hundreds of thousands of people throughout the industrialized world. The company admitted guilt and said it would try to do better in the future. No criminal charges were pressed, and none may ever be.
I refer, of course, to Volkswagen. Last year, the carmaker was found to have rigged the pollution-control devices in its diesel cars to make it appear they were reducing emissions, but only when the car was being inspected. The rest of the time the autos spewed out pollutants far in excess of the allowed limits. The engineers and executives who perpetrated this enormous hoax were not demons. They were employees of a large corporation who let the need for profit (or shareholder value, a more polite term) push them beyond the limits of accurately presenting data about their products. These things happen in large companies, including drugmakers, who have in the last decade or so had to pay over $15 billion in legal settlements, most of which dealt with such mis-statements of benefits and harms. Nothing personal; it’s just business.
Anyone who is shocked about this should go back to review the imperatives of corporate life, as defined by the Nobel Prize-winning economist Milton Friedman. In a 1970 article, he noted that “There is one and only one social responsibility of business -- to use its resources and engage in activities designed to increase its profits….” Unfortunately, the second half of that sentence is often omitted: “…so long as it stays within the rules of the game, which is to say, engages in open and free competition without deception or fraud.” In an era of an overstretched and sometimes overmatched FDA, there’s a greater need than ever to present clinicians with an accurate depiction of the good and harm that medications can do.
Of course, academic detailing is about far more than just correcting the excesses or misstatements of drugmakers. Our job is to present a comprehensive, un-skewed overview of the benefits and risks of medications and other health care decisions. But in doing so, we sometimes have to address misconceptions generated by some drugmakers who are, I suppose, just trying to give their shareholders a good return on their investment. Whether a company makes cars or drugs, its staff at all levels are under tremendous pressure to increase sales. This can often draw otherwise reasonable employees close to – or sometimes over – the line of what’s deceptive.
In academic detailing, we don’t have to worry about sales goals or profit margins. The only currency we need to maximize is accurate evidence; our only “shareholders” are patients and the clinicians who care for them. In a way, that’s the easiest and best part of our jobs.
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