I thought that my HSA post from Friday might stir one of my noted contributors into action. Not so; instead The Industry Veteran thinks that in a recent post where I’ve been a little critical of Marcia Angell, I’ve misinterpreted her and, worse, been overly cosy-ing up to big Pharma. He writes to me:

The fact that you printed a reasonable exchange of views on single-payer vs. HSAs is not what leads me to second the suggestion that you sit down and apply old compresses. It’s the fact that twice earlier this week you showed signs of developing Bush-Cheney patellar reflexes. First you throw your two cents into the Vioxx scandal by admonishing people not to be too hard on Big Pharma. I suppose that, in essence, THCB is a promotional site for your professional services, but I was still astonished by such a bald-faced plug. Then you proceeded to review Marcia Angell’s radio talk by claiming that the logic of her argument must inevitably lead to a misguided nationalization of the pharmaceutical industry. I half expected that you would then start calling her a flip-flopper and push your surrogates to claim she never really edited the New England Journal of Medicine.

Now after all, it is your Blog so I won’t dispute your right to use it for cozying up. It’s just that I had always considered you a man of advanced Fabian persuasions, one who reminded me of my former LSE prof, Richard Titmuss. It was disappointing, for that reason, to see you adopting the postures normally taken by those who favor a “competitive, materialistic, acquisitive society based on hierarchies of power and privilege.” as for Dr. Angell, I know that she explicitly disavows the idea of a nationalized pharmaceutical industry. Her position parallels that of Merrill Goozner, Sid Wolfe and an ample number of other industry critics who merely seek greater transparency (disclosing actual R&D costs, publishing the results of all trials, et.al.), the strict removal of marketing concerns from continuing medical education, greater supervision and penalties concerning conflicts of interest, and an allocation of R&D resources based more on medical needs and less on the profits from exploiting fetishism. This last goal, for example, can be readily accomplished by maintaining patent and tax benefits for company efforts to develop products that genuinely advance the standards of medical care and by denying these advantages for products that create four-hour erections, smooth wrinkles by paralyzing facial nerves or act as high-tech versions of Spanish fly. In fact I don’t know any experienced industry people who would favor a nationalized system. In a government-managed system we might still be waiting for penicillin while your AWOL-playboy President would forbid potentially fruitful areas of research in an effort to appease his base constituency of self-righteous, religious morons.

I am of course expecting Fred Hassan and Hank McKinnell to drop the bribe money off any day now….