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Ethical behavior can be a bridge-builder in an era where Big Pharma needs to find new partners. Is it up to the challenge?
The global health space continues to expand, and with it comes the gravitational pull from a new set of actors determined to play a role in shaping the destiny of one of its oldest but sputtering stars—the biopharmaceutical industry. In the following conversation, Pharm Exec launches a series of exchanges with these "non-traditional" stakeholders beginning with Elie Wiesel, the 1986 Nobel peace laureate and lead sponsor of the Prix Galien awards for innovation in medicine. His focus is on reinforcing ethical behavior in the industry, the importance of CEO leadership, and the moral obligation to change the way we think about the elderly, highlighted by the imperative to find new cures and treatments against the afflictions of age, as a way to avert generational conflict.
— William Looney, Editor-in-Chief
Pharm Exec: As a noted author of more than 50 books, you have said that when words produce a dialogue among the disconnected, great deeds are possible. Your life is filled with examples of how a simple conversation can serve as a catalyst for action. How are you building on this premise to support cooperation in science, research, and the medical enterprise?
Wiesel: The Wiesel Foundation for Humanity Marion and I established in 1987 serves as a forum for an ongoing series of exchanges with Nobel laureates in medicine, the healing sciences, and other disciplines. Shortly after our launch, the French President accepted our idea to convene a select group of these leaders in Paris at the Elysée Palace—eventually we attracted 79 laureates—to serve as a bridge between cultures and integrate perspectives on science and the humanities, with the aim of fostering international peace and conciliation. This conference took place in 1988 and at that time it was a very novel concept.
Subsequently we organized a series of "Anatomy of Hate" conferences in New York, Oslo, Moscow, and Hiroshima. Most recently we held four annual conferences of laureates and senior government and international organization officials, hosted by the King of Jordan and held in the ancient city of Petra [in 2008]. We also created a Middle-East Science Fund with the King Abdullah II Foundation to sponsor joint scientific research in a range of disciplines—including medicine—and to promote exchanges among scientists and academic institutions in the region.
Pharm Exec: You believe the scientific enterprise creates a larger social dynamic by forcing countries to focus more on common global interests. Must it also have a moral purpose?
Wiesel: Because scientists converse in a universal language based on the search for verifiable truths, their work can transcend national boundaries and reduce distrust. Science is an engine of innovation and material well-being, a goal for all civilized and democratic societies. Although my laureate award is for peace, I owe a debt to scientists like the late fellow Nobelist Joshua Lederberg, who showed me how medicine can in fact be an enormous moral force for change. Everything we do in medical research today should have an "end point" linked to progress—not just against the clinical manifestations of death and disability, but against the dark barriers of the closed mind as well: fear, fanaticism, superstition, and ignorance.
Pharm Exec: You are also a lead convener of the Prix Galien, a global movement to promote innovation in pharmaceuticals, vaccines, and medical devices.
Wiesel: This annual awards program is managed directly by six Nobel laureates in the biosciences. What is distinctive about Prix Galien is the way the program demonstrates the diversity of the sources of pharmaceutical innovation—Prix Galien has active award programs in 12 countries and is now expanding to Asia and some emerging country markets.
The potential of this organization is significant. Not only does Prix Galien serve as a vehicle for publicly recognizing the initiative of private enterprise in developing new cures and treatments, it also has a policy mission that is attractive to other stakeholders outside industry, especially the international community. One policy issue that certainly dominates the agenda today, where the effects of globalization and economic crisis are so apparent, is who shall pay for the next generation of treatments. More important, what are the terms of access to them, especially for the neglected populations of the world? The "convening expertise" offered through the Prix Galien, organized by Bruno Cohen, can help us answer that question.
Pharm Exec: To what other ways would you attribute your influence in the field of science and medicine?
Wiesel: Nobel laureates assume a moral obligation which allows us to try and persuade through dialogue, to sensitize people to ignorance, hate, and prejudice. When language fails, violence escalates.
Pharm Exec: How do you—as an author, philosopher, and acute observer of the human condition—make the case for the role of the biopharmaceutical industry in society?
Wiesel: The biopharmaceutical industry is a force for life, when so much of our world is consumed by illness and death and the activities and conditions that contribute to it. To see the array of novel and useful new medicines up for awards at the annual Prix Galien dinner on Sept. 28 should be a revelation—33 in all, each providing a new standard of care for conditions ranging from mass killers like diabetes and malaria to complex, select, and hard-to-treat diseases that attract less attention, such as autoimmune disorders. Tackling both is a moral imperative, if you approach disease from the basic biblical perspective that should guide all research: "Thou shalt not stand idly by."
It is less well known how much the industry invests in studying medicines that may never be approved for patients. When this is discussed, the emphasis is always on the money. But what appeals to me is the way the industry provides dedicated scientists with a place to do ethical, honorable work. One CEO told me his company employs some 80 scientists to study the physiological origins of Alzheimer's disease. It is very basic research—a task entirely separate from the related commercial task of advancing a new drug to registration. There is an enormous secondary social benefit in making such a commitment, but I am not sure it is communicated. Clearly, industry provides a productive outlet for the efforts of some very motivated scientists. Without this outlet, medical progress would suffer.
Pharm Exec: Looking forward, are there trends and developments that suggest an erosion in the capacity of innovation to sustain itself and maintain a high level of public support and investment?
Wiesel: The basis for social progress in any field is inherently fragile. There is always a competing rationale—an excuse —for greed, intolerance, and blight. My own life experience is testament to that. Maintaining support for medical innovation requires fundamentally that it be considered as much more than a business process. If it were nothing more, I would not be engaged in the discussion nor would most other laureates. Hence it has to be linked to something much larger, and that is a moral imperative central to our human inheritance—rooted in our past, shaping our present, and driving the destiny of the next generation so that it will be in a better place tomorrow. Innovation always has to be presented in the context of a positive vision of the future.
Pharm Exec: Is this not too much to expect from primarily private enterprises, whose mission is to make a profit? It appears grandiose.
Wiesel: I don't think the emphasis on a larger moral mission is at odds with the operation of the market. President Clinton said it well in his remarks as a humanitarian award winner at last month's Prix Galien: "At no time have we asked you in private industry not to make money; just to make it in different ways." I hear many CEOs talk about the need for a new business model, so is his request not itself a way of encouraging more innovation?
Pharm Exec: Are there other threats to the integrity of the scientific enterprise?
Wiesel: Intolerance and declining support for education. The degradation of language, as evidenced by the failure of people to communicate through active listening; and the individualization of information against the interests of community. Fanaticism of all kinds.
Pharm Exec: What do you see as the key obligation of the CEO in maintaining a high level of public support for the industry and its innovation mission?
Wiesel: Industry leaders must re-engage around a business profile that puts more emphasis on ethical performance. It should be the highest priority for the CEO because a culture of best practice begins at the top. Reputations of individual companies have suffered as a consequence of abuse of basic rules of engagement. It is also short-sighted to treat corruption and other ethical lapses as a regulatory, legal, or compliance matter. The implications are far larger in terms of public support and the overall "license to operate" that is critical for an industry whose biggest customer is often government.
The biopharmaceutical industry is a force for life, when so much of our world is consumed by illness and death and the activities and conditions that contribute to it
A suggestion I have made to industry CEOs is that they devote at least one afternoon a month to a "morality in management" discussion to which a range of outside experts would be invited to identify new ways of meeting society's expectations. It should be informal and open and in that way expose the CEO to issues and people outside the traditional comfort zone in which people of power tend to operate. I also emphasize supplementing this with strict internal guidelines designed to make ethical behavior a performance metric for individual managers.
Pharm Exec: What else can the industry do to improve ethical behavior?
Wiesel: One imperative is to help spread the reliance on ethics in the constituencies you work with. I have fought tirelessly for the introduction of a compulsory course on ethics in all medical schools, with case precedents involving the nefarious role that some physicians, scientists, and indeed pharmaceutical companies played during the Holocaust. I lived through that. It can happen again if we don't invoke that memory for future generations.
Pharm Exec: Is the industry's research agenda continuing to meet the needs of society? Is there a metric that ought to guide the prioritization of research beyond a potential commercial return?
Wiesel: Serving a therapeutic market is important but we also want to see how the industry is building more access to medicines for those who need them most: the helpless.
Now, who are these helpless? Broadly speaking, it is children and the elderly. I believe there is a moral issue here, in that society—including the private sector in healthcare—tends to focus more on protecting the young from disease than the old. Yet statistics indicate that for the first time in history the world will have more people over age 65 than under age 15. A broader research agenda built around diseases of the aged should be welcomed, with a focus on new medicines that improve cognition and enhance the quality of life. The toll imposed by dementia alone is a moral affront, afflicting not only the patient but the millions of caregivers who must witness this deterioration on a daily basis. If a medical science oriented toward youth results in longer life spans, what will be the consequences, especially if much of these added years are squandered by more disability and infirmity, with their huge associated welfare costs? Drug companies have an obligation to address this question.
Pharm Exec: Is access to health care and medicines a basic human right?
Wiesel: Absolutely. It underscores my interest in medicine, as the commitment to peace that brought me the Nobel award revolves around the broadest possible construct of human rights. The right to obtain and enjoy good health is a key element in the lexicon of human rights. The industry's business mission should find expression in this commitment as well.
Pharm Exec: The essence of communication today is the 30-second "elevator speech" that seeks to define who you are. Would you care to craft one for this industry?
Wiesel: I am a storyteller at heart. And I know that all good stories carry a message that is simple and basic about the human condition. For the innovative pharmaceutical industry it is this: Because the world regards the alleviation of illness, pain, and suffering as an honorable enterprise, it is the duty of that enterprise to act honorably.