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The Pharma = Evil Narrative

flying cadeucii“People hate pharma,” my Forbes colleague Matthew Herper observed recently–and at times I can understand why. There’s not much to admire about executives like Martin Shkreli, or businesses like Valeant.

But I’ve started to worry that the “pharma = evil” narrative has become so ingrained that it’s taking on a life of its own, as readers instinctively anticipate this storyline, and journalists reflexively provide it. Coverage of a recently announced innovative training collaboration between Johns Hopkins and MedImmune (a subsidiary of AstraZeneca ), for instance, focused primarily on potential conflicts of interest.

(Disclosure/reminder: I work at DNAnexus, a health data management company in Silicon Valley and Boston; our partners include universities, government agencies and private companies.)

This narrow view, however, not only fails to capture the urgent need for effective, new therapies, it overlooks entirely the vital role played by companies in translating fragile but promising scientific ideas into robust medicines for patients.

For university “discoveries to matter most,” says former UCSF Chancellor, Genentech executive and current CEO of the Gates Foundation Susan Desmond-Hellman, “they need to get to humans.”

She adds, “The easiest thing to do to avoid conflicts is to never talk to industry, never interact with industry and have nothing to do with it–and no patients would benefit from [academic] discoveries.”

Desmond-Hellmann is hardly alone; many innovative academic physicians and scientists recognize the importance and value of close private-sector relationships. As UCSF professor and serial entrepreneur Atul Butte has recently emphasized, this is “the right way to truly change the world, by going beyond writing papers.”

Companies are exquisitely focused on driving the science from research paper to marketed product–a journey that simply wouldn’t happen without the concentrated effort, broad expertise (from medicinal chemistry to data management) and significant capital resources companies bring to this process. Even so, the trek is perilous, the failure rate notoriously high.

While academic training traditionally assumes a future in academic science is the ideal outcome for students, trainees may discover a passion for some of the more translational aspects, which industry does best. It’s hard to see how broader exposure to a range of career paths and opportunities would not be in the best interest of graduate and medical students.

The concern that working with industry scientists will somehow contaminate the purity of academia is especially hard to stomach in the context of science’s ongoing reproducibility crisis, the observation that a surprising number of published scientific results don’t seem repeatable. As Robert Califf, the newly installed head of the FDA, has pointed out, on balance, “academic analyses have more major errors and are not as reproducible as industry analyses.” (Califf also pointed out issues that seem more common in industry-funded studies, including framing of the questions and comprehensiveness of the analysis.)

Because companies often use licensed academic research as a starting point, industry researchers are constantly pressure-testing the scientific literature, and are often the first to discover replication problems–though they might do a better job of publicly pointing these out.

There is also increasing awareness that many flaws originally attributed to industry research–such as failing to report results to a designated government website and publish results in a journal–seem at least as common in academic research, suggesting these issues are more systemic.

Academics and industry researchers each tend to believe they are responsible for the heavy lifting of new medicine development, yet the truth is the process is far more difficult and daunting than either group tends to appreciate, and there’s essential work that must be done every step along the way.

Turning science into medicines is an important and worthy challenge, pursued with passion, intelligence and integrity by many physicians and scientists. New medicines do not fall easily and inevitably out of academic research, but require deliberate, painstaking development–and unreasonably resilient drug hunters able to cope with a staggeringly high failure rate.

We should encourage innovative partnerships that bridge the translational divide, and inspire more journalists to capture the value of this difficult and ambitious mission.

David Shaywitz is based in Mountain View, California. He is Chief Medical Officer at DNAnexus, a Mountain View based company and holds an adjunct appointment, Visiting Scientist, in the Department of Biomedical Informatics at Harvard Medical School. 

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alfachemistryBobbyGvegasBrian KlepperPaul @ Pivot ConsultingLLCTed Recent comment authors
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alfachemistry
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alfachemistry

Thank you for sharing. Alfa Chemistry provides an integrated platform with small molecule APIs/intermediates development and manufacturing capabilities from preclinical to commercial stages. http://www.alfa-chemistry.com/

Paul @ Pivot ConsultingLLC
Member

Pretty typical…anyone who suggests that the hyper regulated medical /health sector (state mandates/ACA/Hitech/etc) might benefit from a little thought and care before layering on another layer of regulation and central control (such as banning drug ads) is labeled an uber free market ideologue. Re Brian’s well presented thoughts, here is my attempt at a reply: 1) By making huge campaign contributions, Pharma has convinced Congress that it would be harmful for Medicare to negotiate pricing. The result is that we pay ANY price they ask for an FDA approved drug, no questions asked. It’s hard to imagine a better sweetheart… Read more »

Brian Klepper
Member

David, This article is seriously naive and misguided. You begin by challenging the pharma = evil narrative, which is fine, if a stretch to anyone familiar with the facts of pharma’s business practices and power politics, and then you center on the dynamics between academic and industrial developers. Nobody I know thinks that developing new drugs isn’t important or that the process isn’t fraught with difficulties. That said, the mainstream of pharma’s reputation for profiteering and predation isn’t due to what happens in academic settings, but derives from the ways that industry has relentlessly spun and compromised policy and the… Read more »

BobbyGvegas
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“Free Market” uber alles. If private markets are “free,” then those who control them are “free” to collude and game them opaquely for their own transient benefit (notwithstanding that under neoliberal economic theory, such “control” simply cannot happen — that “free markets” are beneficent and wholly self-correcting). He Who Dies With The Most Toys WINS!

Ted
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Ted

Yep. Basically this. Except Brian said it better than I did.

Paul @ Pivot ConsultingLLC
Member

Ted, I will give it a try. 1. How pharma records profit margins that dwarf insurers, hospitals, and everybody else except Medtronic Usually it is because insurers, hospitals etc are non profits. Beyond that, pharma companies are trying to come up with innovations that save lives or provide dramatic improvements in symptoms…while insurers and even hospitals provide necessary but more routine things like facilities or transaction processing services. 2. Why extravagant year on year price increases are necessary Pricing is up to the owner of the product….most drugs do not have extravagant year over year increases. The few that grab… Read more »

Ted
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Ted

Paul – appreciate the thoughtful response – I remain unconvinced though. Certainly I think your arguments reflect the spin that PhRMA tends to put on things, but I remain unconvinced. 1. Insurer profits are effectively limited by the ACA and mandatory Medical Loss Ratios. Hospital profits (including for profit hospitals and networks) often hover around 2%, rarely ever rising beyond 6-7%. I would argue that innovations in hospital care, surgical techniques, etc are more innovative and life-saving than producing the 16th ARB or Proton Pump Inhibitor. Honestly, my biggest issue about this is that Pharma charges ridiculous prices and then… Read more »

John Irvine
Member

I agree with Ted.

There is a pharma reality distortion field narrative that needs to be examined.

We live in a complex world = both A and B can be true.

Ted
Member
Ted

I have respect for the scientists, and completely agree – making good drugs is really hard. But to get rid of the narrative, I need someone to explain to me (among other things): 1. How pharma records profit margins that dwarf insurers, hospitals, and everybody else except Medtronic 2. Why extravagant year on year price increases are necessary 3. Why negative trial data gets buried 4. Why DTC advertisting still exists 5. Why anytime something is about to go off patent, a fixed dose combination or reformulation of the brand just happens to show up… Mostly, I’m just not sure… Read more »

John Irvine
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What % of new drugs are “translating fragile but promising scientific ideas into robust medicines for patients?”

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John Irvine
Member

Narratives = evil

Here are some others running lose these days —

1. Regulation will kill my product

2. Doctors refuse to use technology

3. Transparency makes all things better

4. People will shop for healthcare if ______

5. EMRs suck

6. Measuring things is scientific, therefore better

John Irvine
Member

The pharma = evil narrative works for me.

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