The pharma industry in the public imagination
pharmafile | July 16, 2013 | Feature | Business Services, Manufacturing and Production, Medical Communications, Research and Development, Sales and Marketing | Ben Adams, image, literary, pharma
Popular culture in both films and literature depict pharma and scientists as part of a nefarious industry, hell bent on controlling mankind’s urges, making a profit at any expense, or even perverting what it is to be human.
But is this a case of art reflecting life – or an image tarnished by past abuses, now long since consigned to the annals of history? And just what damage can fictitious accounts of its actions do to the industry and to science?
Here we shall go through some of the more notable pieces depicting pharma and biological science, and see what the world thinks of the industry, and how it can change its image.
Frankenstein
The first book of modernity to tap into these fears is, of course, Mary Wollstonecraft Shelley’s Frankenstein, or its more apt title The Modern Prometheus. The tale is of man – in this scenario a natural science student called Victor Frankenstein – taking on the role of God by creating the abomination that becomes Frankenstein’s monster.
Much in the same way that Prometheus gave fire to humanity in order for them to create for themselves – earning Aeschylus’s anti-hero banishment with only a rock and vulture for company – Victor, using the skills given to him by a 19th century God, makes an entirely new creation from a rather grisly source.
As soon as this creature is shocked into life, Victor, disgusted by his project, runs in fear, only to be chased down by this rather complex, brutish but also decidedly sentimental ‘monster’.
The early 19th century fear of science is palpable in Shelley’s novel, but after nearly two hundred years, have we become more accepting of science?
A brave new world?
Perhaps not: Over a century after the publication of Frankenstein, in 1932, Aldous Huxley’s Brave New World put the remit of medicine under the microscope.
In one of a string of dystopian novels in the 20th century, Huxley – grandson of Thomas Huxley, the prominent defender of Charles Darwin’s theory of evolution – described how a new society functioned under the spell of the pleasure drug known as Soma, created by the industry to eliminate emotional extremes, creating stoic neutrality, interspersed with pleasure.
The idea – and one very much borrowed in the more recent film Equilibrium under the same premise – is that the industry has created a drug that removes the threat of war, and makes contentment the ultimate emotion, above and beyond the harsh reality of life.
“Christianity without tears – that’s what Soma is”, as Mustapha Mond explains to the rebellious ‘John the Savage’, the main character who eventually kills himself as he cannot live in this new world.
The fear here is that drugs will be used to dampen, if not even quash, humanity’s emotional state in order to create a more malleable society. And it is the industry that creates the lubrication for this dystopian nightmare.
Addiction
If we fast forward a few decades, we come to a new problem – that of prescription pill addiction. There are a number of novels and films that deal with this issue, but one of the best – and starkest – is Hubert Selby Junior’s 1978 work Requiem for a Dream.
The entire novel deals with addiction, but it is with Sara Goldfarb, a lonely widowed mother, that we see pharma’s influence. Her entire life revolves around television and when she is offered the chance to be a TV quiz show contestant, she begins popping diet pills in an effort to slim down for her appearance.
Mentally she begins spiralling mentally out of control as her addiction to the pills take hold.
One of the more recent films to hit out directly at pharma is the 2008 film Max Payne, based loosely on the successful gaming franchise of the same name. Payne, as his ominous name may suggest, is beset by tragedy after his wife and baby are killed by men addicted to a new and highly addictive drug called Valkyr.
Payne’s wife once worked for a pharma company, but discovered the firm was developing Valkyr, and as it turns out was in fact killed by the firm’s chief executive, because she inadvertently came across incriminating documents.
The entire piece, set in a film noir setting, depicts pharma executives as ruthless, surreptitious and murderous villains, willing to do anything and everything to maintain a profit.
The sales rep
The 2010 film Love and Other Drugs also shows the 1990s drug rep as a rather arrogant, intentionally charming male who uses this ability to help sell medicines.
In fact the film directly name-drops Pfizer as the firm the main character Jamie (played by Jake Gyllenhall) works for, and it takes the love of the free spirited Parkinson’s sufferer Maggie (Anne Hathaway) to stop him pursuing a career rife with bribery and a ruthless need to increase drugs sales.
All of these examples paint the picture of corrupt and ruthless pharma scientists, or prescription pill-addled patients, and puts into the public imagination an almost entirely negative view of pharma.
Some of these examples may seem frivolous, but the industry is so keen to work in the shadows, it is difficult for the public to see any side other than those portrayed in popular fiction.
Bad karma?
There are, however, elements of truth that these fictitious accounts have used to describe the industry, and a number of more academic pieces of non-fiction have sought to bring those elements to light.
Dr Ben Goldacre’s Bad Pharma is the most well-known and contemporary titles broaching the subject of pharma’s role in society. It’s been discussed by us at great length here so there is little to add, except to say that off the back of the book the AllTrials campaign was born in the UK, showing just how deeply literature can penetrate its readers.
Ray Moynihan’s 2006 work Selling Sickness: How the World’s Biggest Pharmaceutical Companies are Turning Us All into Patients, was the forerunner to Bad Pharma, and explains in occasional strong terms the dodgy marketing practices of pharma, including its use of celebrities to endorse products.
Many in pharma say that these two books are intentionally shrill in their prose and are designed to gain as wide a readership as possible by presenting information in an exaggerated fashion. They also argue that many of these examples are now very old, and represent a different era for the industry.
Ethics
Unfortunately however, a lot of this still going on. In fact currently in the news is the story of the type 2 diabetic TV chef Paula Deen, who was until recently a celebrity spokeswoman for the Danish diabetes specialist Novo Nordisk.
She was dismissed from this role in June after it emerged she made racist and disparaging comments about some staff in her restaurants.
But the reasons behind her becoming a spokeswoman are just as unethical, as she is notorious in the US for her highly calorific meals and was recently diagnosed as a type 2 diabetic.
Novo took her on to promote its type 2 medications in the US, which includes its relatively new drug Victoza. Many question whether a woman who promotes such bad eating should be allowed to work for a company that is ostensibly working to end the disease, and indirectly obesity.
Elizabeth Wurtzel’s Prozac Nation: Young and Depressed in America – A Memoir, is the most damning of all these books and films, written in a first-hand account it strikes right at the heart of the pharma and how it is changing society.
Just one quote from his work sums up its message neatly: “I start to get the feeling that something is really wrong. Like all the drugs put together – the lithium, the Prozac, the desipiramine and Desyrel that I take to sleep at night – can no longer combat whatever it is that was wrong with me in the first place.
“I feel like a defective model…I start to think that there really is no cure for depression, that happiness is an ongoing battle, and I wonder if it isn’t one I’ll have to fight for as a long as I live.”
There is a belief, nurtured by pharma and promulgated by doctors, that taking medicines can help cure or control mental health issues, but as this memoir testifies, people need more than medicine to combat such a complex disorder as depression, if in fact they need medicine at all.
Lessons
So what does all of this tell us? In short, that the industry and science is, in the eyes of fiction and through the lens of more academic research, a dark underbelly of society: ruthless, willing to create evil and misery in the name of innovation and profit, and desperate to medicalise almost anything in order to sell more pills.
Some of this is simply from the mind of a writer and not based in reality – but much of the fears in fiction and the investigations in non-fiction have turned out to be true. This should be troublesome for the industry as it is not keen to open itself up to the public, but that which lies in the shadows is often the most feared, and misunderstood.
Pharma and science in general should be more willing to accept its failures and engage more with its customers, if it is to become a positive force in the public’s imagination.
Much of this revolves around its marketing practices – Novo’s hiring of Paula Deen was always questionable from a moral standpoint, and simply opens up pharma to greater scrutiny.
Fundamentally the attitude of reps and pharma executives have changed over the decades, with many sales reps now being highly educated and acting more professionally – although they are still prone to bad behaviour.
Pharma must be willing to admit to both its past and its ongoing mistakes: no industry is perfect, but the morality of pharma should be beyond reproach, given that it literally has its customers’ lives in its hands.
Ben Adams
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