I suppose, when you get right down to it, I've gotten used to the idea that in this country we don't actually debate issues. We holler and call our political enemies names. We play elaborate games of spin control and do our damnedest to ensure that every question of policy, no matter how straightforward and practical, gets linked in the public mind with abortion rights, gun control, and a half dozen other completely intractable hot-button issues. But discuss rationally? Not really. As I said, I'm used to it. We're all used to it.
So I was surprised this summer at how infuriating I found the uproar (Should we really dignify it with the word "debate"?) over drug reimportation. Here was an extremely important subject, one that should have laid the groundwork for a whole sequence of discussions over the future of healthcare. And it was handled atrociously.
The worst offender, for my money, was Congress, where it was rare to hear a word that displayed any kind of intellectual integrity. It's not easy to single out the worst failure of logic or responsibility. Maybe it was the absurd assumption that if a few people in border towns can save money by buying their drugs from Canada, then everybody can save by buying drugs from Canada. Maybe it was the insincerity (common enough in the House of Representatives) of politicians who felt they could please their constituents by casting a vote that they knew would never have any practical effect. Maybe it was my own pick-the notion that somehow it was okay for the US to borrow someone else's price controls rather than construct its own.Pharma for its part didn't fare much better. Industry pronouncements about product safety, though they contained more than a little truth, mostly came across as self-serving and insincere. (What's worse, they put American pharma companies in the position of seeming to argue that their own products, once they cross the border, are somehow life threatening.) And the succession of news stories in the Washington Post and elsewhere revealing industry funding of groups such as the Traditional Values Coalition-which outrageously attempted to tie reimportation to abortion, alienating even hard-core anti-abortion groups in the process-were an ongoing embarrassment.
In the long run, the strongest case for pharma is one built on value. (See pages 66 and 80 of this issue for stories that explore the concept.) It won't necessarily be easy to sell to the public-a case built on numbers rarely is. And it won't necessarily benefit every company and product; some drugs really are overpriced. But this is an industry that creates products that by and large work, that improve people's lives, and that are often the key to controlling healthcare costs. If you believe that-and you should-why would you want to defend the industry any other way? Who knows, once the public gets to hear some facts in public debate, they might develop a taste for them. Factual discussion in American public life? It's not the kind of cure pharma usually provides, but it would be a welcome one.
Patrick Clinton, Editor-in-Chief