Paul Holmes 14 Mar 2023 // 12:05PM GMT
The pharmaceutical industry is its own worst enemy.
I don’t know whether this is the result of paranoia bred by decades in a highly-regulated environment, an innate dislike of transparency and openness, or by a genuine failure to understand the difference between what is actually entirely ethical and what is cynical and underhand. But the pharmaceutical industry’s tendency to shoot itself in the foot for no good reason is one of those things that has not changed in 30 years watching the industry at work.
Before we get to the story that triggered this observation, I’d like to take everyone back through those 30 years, to a story that appeared in the Washington Post in May of 1998, under the headline “Ozone, Asthma And Inhalers: Drugmaker's Lobbying Assailed.”
In summary, the federal government was planning to have the inhalers used by millions of asthma sufferers to be reformulated, to reduce chlorofluorocarbons. Pharmaceutical companies, alarmed at the prospect of new regulations, were concerned, and decided to push back.
Leaving aside the merits of the case and the actual impact of inhaler-related CFCs on the ozone layer, what made the case interesting to me was that Glaxo Wellcome, a British company now part of Glaxo Smithkline responded with what the Post described, not at all unfairly, as “an expensive, frenetic, sometimes secretive lobbying war on Capitol Hill” that stoked the fears of asthma patients and ultimately obstructed the proposed regulation.
Glaxo was the principal financial supporter of a short-lived called The Emergency Committee to Save MDIs, which mailed letters to asthmatics suggesting that the government was on the verge of banning their inhalers. As a result, the FDA received 9,600 letters protesting the plan. Glaxo got what it wanted. Yay!
Except that eventually, the whole lobbying campaign became public knowledge. It became clear to asthma patients that the industry had used exaggerated scare tactics to spread undue alarm among asthma sufferers and employed a phony front group to sway lawmakers. So a short-term victory came at a cost in terms of long-term trust and credibility. Relationships were first manipulated and ultimately eroded.
My question now, as it was at the time: why didn’t Glaxo reach out to patient groups in an honest and transparent manner. “Hey, we make one of the things that helps keep you alive. There’s some new regulation coming down that seems to be ill-considered. Let’s work together, and see if we can’t make it better.” All open and above board, nothing remotely unethical or inappropriate, no reason to be anything other than fully transparent.
The result would almost certainly have been the same, except that nobody would have been unnecessarily frightened or come away feeling used, and the relationships between the company and the patient community would have been strengthened. Transparency would have been all upside, no downside.
Which brings me to this weekend, when an Observer investigation revealed “Experts who praised new ‘skinny jab’ received payments from drug maker.”
The story, which was briefly the front-page lead on The Guardian’s website, discussed the fact Novo Nordisk donated “£21.7 million to health organisations and professionals who in some cases went on to praise the treatment without always making clear their links to the firm.” One “clinical expert” who received Novo Nordisk money testified that the so-called “skinny jabs” were a “gamechanger.” The World Obesity Federation, which calls for treatment to be funded as an “essential health service,” was paid £4,326,698 by the company between 2019 and 2021.
The thing is, there’s nothing inherently wrong with any of this. Very few health-related NGOs would be able to function (certainly not at the level they do) without corporate cash. Pharmaceutical companies routinely fund scientific research, most of which is understandably related to their own mission. Even The Observer acknowledges: “There is no suggestion the payments broke any rules.”
Except perhaps the rules of common sense, which suggest that if you’re not doing anything wrong, you shouldn’t act as if what you’re doing is sneaky and underhand.
It would have been the simplest thing in the world for Novo Nordisk to do all the things it did in this instance openly and transparently, to ask obesity charities to be transparent about the sources of their funding (especially when interacting with the media), to instruct physicians and researchers to always make it clear that they had been the recipients of industry funding. Such financial relationships are subject to legal disclosure rules anyway, so there is no reason they should not also be revealed at the when dealing with the media or the public.
The principle here, of informed consent, should apply to everything public relations firms do: provide the audience with all the information they might find useful in making a good decision, particularly whether the source of information and advice has been funded by specific interests. The news that scientists sometimes receive industry funding is more shocking and alarming when it is apparently kept secret; transparency normalizes it and makes it less sinister.
Not only is it the right approach philosophically and pragmatically, it's even more important right now, as the pharmaceutical industry faces an onslaught of misinformation and conspiracy theorizies from people who would demonize it. Why play into their hands?
(As an aside, we work with many public relations agencies who are told by pharmaceutical industry clients not to disclose the identity of the companies they work with. There is literally no reason for this, unless the work those firms are doing is somehow unethical or otherwise shameful. And yet the industry's aversion to honesty and transparency extends even to such entirely innocuous information.)
In 30 years, the pharmaceutical industry has been unable to shed its preference for working in the shadows, even when what it is doing is necessary, appropriate and in the interest of the people who use its products. At this point, it’s beginning to look like a pathology.
There must be a cure for that?