My wife and daughter were talking up their new favorite television program a few weeks back, so I watched with them and had
the pleasure of seeing the most loathsome portrayal of a pharmaceutical executive I've ever experienced. The program is Fox
Broadcasting's hit doctor show, House, which stars the British actor Hugh Laurie
as Geoffrey House, a brilliant, arrogant, impossibly rude diagnostician. He mocks his patients, taunts the doctors who work
for him, and does end runs around hospital policies, while making brilliant diagnoses of ludicrously rare diseases. (If there's
a real-life physician in House's home state of New Jersey who in a single month has diagnosed rabies, leprosy, sexually transmitted
African sleeping sickness, and acute naphthalene toxicity caused by breathing fumes from termites, I'd love to hear from him
House's nemesis is Vogler, the wealthy owner of a pharma company, who contributes $100 million to the hospital and demands
the job of chairman. He wants to turn the hospital into a clinical trial mill, even if it lowers standards of care. He bullies
the doctors and blackmails House into giving a speech for his company's overpriced new ACE inhibitor. He denies a dying woman
his company's experimental drug because she might screw up his data. In short, he's a swine. (Chi McBride, the actor who plays
Vogler, said in a recent interview that even in Canada—where presumably the cost of his fictional ACE inhibitor would be far
more reasonable—people approach him on the street to say, "I hate you.")
It's painful to watch a well-executed satire of your own profession. But despite the Vogler character, I'd encourage you to
catch an episode of House. More than anything I've seen in the movies or on TV in many months, this program serves pharma's interests, by providing
a mass audience with a vivid weekly lesson on risk/benefit ratios.
When you get right down to it, risk in its various forms is House's main subject. The doctors are never quite sure what disease they're dealing with. (Could it be a heart infection? No, but
how about a sinus infection overlaid on hypothyroidism? An error at the pharmacy that gave the patient gout medicine instead
of cough medicine? No, it's just tainted Ecstasy.) The point is to watch House being brilliant, but the message is that disease
can be bewildering. Good message.
Medications on the show are incredibly powerful for good and ill. The right drug brings patients back from the brink in seconds.
The wrong one triggers computer-animated respiratory shut-downs and EKG flatlines. If the public in general believes that
drugs are safer than they really are, they'll get a counter-education (only moderately exaggerated) here.
The best, to me, is the way the show's writers have made risk/benefit part of the drama. A husband has to weigh the dangers
of a drug that kills one time in six against the chance that his wife (now comatose) was lying when she denied having the
affair that would have infected her. A mother-to-be with fast-moving cancer has to balance the danger to herself of delaying
for a C-section and the danger to her unborn child of having one right away. This is the kind of material that patients often
have a hard time understanding. Here, in the setting of a TV melodrama, it's emotionally compelling and remarkably easy to
That's important. The current furor over pharmaceutical marketing will eventually pass. The need to make patients understand
risk will always be with us. When an entertainment company makes millions of people eagerly tune in each week for a reasonably
accurate lesson, they're doing a public service. Evil exec character notwithstanding, we owe them thanks.
Patrick Clinton is Pharmaceutical Executive's editor-in-chief and can be reached at firstname.lastname@example.org