CLINTON: These days virtually everyone talks about the ways in which marketing needs to talk to R&D earlier. That makes good business
sense—you want your products to do what people want them to do, and you want to prove the things that people need proven.
But that means marketing has influence over how the science is done, and that sounds dangerous.
SODEN: For me, as a primary care doctor for 25 years, it was real simple. I just worried about the patient. When I went to the business
side, it was like a whole new world opening up. There were new considerations like politics, competitive interest, and how
to make a return on investment. And what I found is that it's really dependent on the people in the executive suite.
Perea-Henze notes the PhRMA code has changed that dynamic.
LOUIS: Can I stick up for the pharmaceutical industry for a second? One of the reasons we're all sitting here is because there's
been a lot of bad press. In my experience, people are attracted to this industry not just because they can make money; it's
about trying to do things for patients.
Part of me gets annoyed at the bashing going on, because there are a lot of good people who generally want to do the right
thing. The trick is to help them develop processes to understand better which are the right things that we ought to get to.
CAPALDI: The pharmaceutical industry has been demonized. But there's a larger healthcare debate that isn't going to be solved simply
by articulating codes and making sure they're practiced. And I don't think the pharma industry is going to get out from being
demonized unless it takes on the whole issue of the larger healthcare debate and defends itself against the misrepresentations
that are going on within that debate. The in-house ethical stuff is great, but it's not enough.
COHEN: This is a good segue to the second question. Many people feel that pharma has an ethical obligation to make medications
affordable to everyone. Is this true?
CAPALDI: The question may be not whether the pharmaceutical industry has this obligation, but whether society has it. Suppose someone
said, "Does General Motors have an obligation to make an affordable car?" You might answer, "I don't know, but it's certainly
in their interest." But what if I then substitute this question: "Does General Motors have an obligation to make an affordable
Ferrari?" In other words, "Is everybody entitled to high quality at low cost?" And that's an impossible kind of question to
Soden, pictured center, says that companies wrongfully assume that physicians understand a product's science.
SODEN: I agree. No one defines what he or she means by healthcare. Does it mean having a right to healthcare? If that's the case,
why do we have 34 million people who are uninsured?
CAPALDI: Fifty percent of what we know about the human body has been discovered in the last 15 years, yet people say, "I used to spend
5 percent of my budget on healthcare. Why do I now have to spend 10 to 20 percent on it?" That's like saying, "I bought my
first car for $1,800. To buy that same car now would cost me $18,000. Isn't there something wrong with that?"