Eliciting axioms to enrich debates about the pharmaceutical industry.

Abstract

The study described in this chapter illustrates the utility of Little's model of values (Chapter 14) as a way of interpreting the discourse of professional groups — in this case, the discourse of employees of the pharmaceutical industry — and as a way of enriching debates about controversial professional issues. The problem with debates about the pharmaceutical industry In recent years, the pharmaceutical industry has come under fire for what is perceived to be pervasive misconduct, including developing medicines that are likely to be commer¬cially beneficial even if they do not address genuine unmet needs, carrying out research without sufficient concern for the wellbeing of research participants, distorting the design, conduct, interpretation and presentation of research in order to produce more positive results, overstating the costs involved in research and development in order to over-price medicines, abusing intellectual property laws, and engaging in ethically suspect marketing practices (Angell, 2004; Elliot, 2010). Clinicians, researchers, journal editors, educators and regulators are well aware of these actions on the part of the pharmaceutical industry, and steps have been taken to try to minimise the pharmaceutical industry's influence over research, publication, policy-making, education and practice. For the most part, these steps have taken the form of regulations that either prohibit certain activities and relationships At the same time, however, many health and biomedical professionals collaborate with industry in, for example, early drug development and clinical research. Indeed, academic basic scientists and clinical researchers are now actively encouraged, if not mandated, by their institutions to form such relationships (Schulman et al., 2002; Belcelman et al., 2003). Under these circumstances, one might expect, that there would be a great deal of ambivalence towards the pharmaceutical industry and rich debate about the pros and cons of industry engagement. But instead, publicly stated views about the industry tend to be polarised with people being either strongly critical (e.g. Angell, 2004; Elliot, 2010) or defensive (e.g. Stossel and Stell, 2011) of the industry and its activities. For the most part, academics and clinicians in the public sphere tend be highly critical of the industry, despite their ever more complex entanglements with it. While such a critical stance might be a good basis for avoiding harm, in its most extreme forms it might also represent a state of `hostile dependence' on the part of academics and clinicians — that is, a state of needing and wanting to engage with the pharmaceutical industry, at the same time as being deeply mistrustful of the industry and/or resentful of one's dependence. Relationships such as these are problematic because they tend to preclude dialogue and genuine cooperation. This is evident, for example, in debates about the disclosure of industry payments to clinicians and researchers, which are adversarial and lacking in genuine mutual recognition of alternative positions (e.g. Angell, 2004; Stossel and Stell, 2011). This raises the question: how can we improve communication between health and biomedical professionals, regulators and employees of the pharmaceutical industry so that they can communicate more effectively and thus collaborate more genuinely in devising pharmaceutical policy?