Is Big Pharma Shifty?

The allegations against Avandia have re-ignited the criticisms of pharmaceutical marketing. An Adweek article claimed that a recent poll conducted by Harris Interactive for the Pharmaceutical Safety Institute showed that "Consumers think Big Pharma is shifty as well as greedy."

Adj. shifty - 1. characterized by insincerity or deceit.

In other words, Big Pharma is a big fat liar!

According to Adweek:

"[The poll] documents the degree to which people don't trust the industry to disclose bad news about its wares. Asked how confident they are that drugmakers 'will eventually disseminate all information—positive or negative—that they have regarding the safety of their drugs,' few said 'extremely' (4 percent) or 'very' (10 percent). Thirty percent said they're 'fairly' confident, with another 27 percent 'somewhat' so. But even such lukewarm trust was more than could be mustered by the 29 percent who declared themselves 'not at all' confident of such disclosures. The numbers were nearly identical when people were asked how confident they are that companies will release news of adverse reactions to any of their drugs 'as soon as they have such information.' "

"Given such distrust, one might expect consumers to shun direct-to-consumer sales pitches for prescription drugs. Instead, the survey shows many find such ads useful."

Adweek set up false expectations by looking at the data as a glass half empty (29% "not confident) rather than half full (30% "fairly confident").

Consumers, it seems, can recognize advertising for what it is: "carefully wrought bullshit," which is distinguishable from lying in that the bullshitter has a complete disregard for facts, according to Harry G. Frankfurt, a Princeton University professor of philosophy who authored the book "On Bullshit" (see "Is Pharmaceutical Marketing BS?".

"[The bullshitter's] eye is not on the facts at all," says Frankfurt, "as the eyes of the honest man and of the liar are, except insofar as they may be pertinent to his interest in getting away with what he says…this indifference to how things really are—that I regard as of the essence of bullshit."

In light of this distinction between lying and BS, I offer this second definition of "shifty," which I found online along with the first:

Adj. shifty - 2. Able to accomplish what is needed; resourceful.

Now, that describes marketers, including pharmaceutical marketers, to a tee. What Big Pharma needs is to sell product like any other capitalist enterprise. Marketing is a tool Big Pharma uses to accomplish that which is needed. Therefore, it should not be news to anyone that pharmaceutical marketers are "shifty" and as the poll shows, most consumers realize this and can live with it (they think drug ads, despite being shifty, are useful). There's no contradiction here.

Being shifty, you can't expect pharmaceutical marketers, therefore, to be completely transparent about drug side effects -- not if you leave it up to them, that is. And because it is so important to be transparent as possible about the risks of drugs as well as the benefits, we have laws that regulate direct to consumer (DTC) and physician promotion by pharmaceutical companies. The FDA is primarily responsible for enforcing these laws.

In Avandia's case, the FDA did repeatedly warn GSK that it was being "shifty" about the drug's side effects -- it wasn't lying, but it wasn't being completely sincere (transparent) either.

In this age of risk-benefit analysis, everyone -- depending on which side of the spectrum they are on -- overemphasizes one side or the other of the equation.

Industry proponents are guilty of overemphasizing the benefits to make the risks look more palatable. Bob Erhlich of DTC Perspectives, for example, claims in relation to Avandia-caused deaths that "Those deaths [attributable to increased risk of MI] pale in comparison to lives saved. That part of the story gets lost because 'greedy uncaring drug company' makes better copy."

No drug I know of has been approved on the basis of saving lives as the endpoint of a clinical trial. Outsiders and consultants like Erhlich can make the "saves lives" claim, but pharmaceutical marketers cannot, thank God!

Unfortunately, none of this helps patients understand how to evaluate the risks and benefits of drugs.