Behind these big themes is a larger one, which began in the 1950s and has become clearer with each passing year. Where once the pharmaceutical industry was a sideshow to medicine, in recent decades it has become more and more a full partner in patient care.
Yes, doctors remain necessary, but the physician's role has become inextricably intertwined with the products created by pharmaceutical companies. That's a good development, and one there's no turning back from. Hardly anyone would deny that we're better off with products that effectively fight cancer, control diabetes, reduce the risk of heart attack, and hold AIDS at bay. But there's obviously a lot of discomfort with the idea of for-profit companies taking a full seat at the healthcare table.A 2003 survey from Harris Interactive showed hostility across the board toward for-profits in healthcare:
Those numbers make a point. Consumers, not unreasonably, want their healthcare to come to them through a different system than the one that brings them cars, DVD players, and frozen pizzas.
The system is different of course, with FDA and physicians there to put a rein on the optimism, enthusiasm, and (from time to time) greed of pharma companies. But that system seems to have worked a lot better when pharma played a less significant role in treating and informing patients. Physicians, as they're fond of pointing out, feel beleaguered; FDA is under fire, less for anything it has done than for the reputation of the industry it regulates; and trust in pharma is approaching snake-oil levels.
That needs to change. The road forward for pharma—and for public health—is going to involve more trust and intimacy between patients, physicians, pharma, and FDA. Sharing of data, an intelligent approach to risk management, a cooperative approach to achieving compliance—all these and more are needed. But they can't happen until we work out a way to fix the basics. Patients need to look at a mixed system of medical professionals, government regulators, and for-profit companies and perceive it not as an embodiment of conflict of interest, but as a fully functioning system of checks and balances.
That's a lot to accomplish. But look what industry has done in 25 years. It's not impossible.