Editorial Note: This post is from Sally MacGregor. In depositions and lectures I commonly state that I have had more support and information from colleagues working for industry than from clinical colleagues.
I loved the analysis of the derailment of medicine and research through the comparison between a Republican and Empire structure, and the take-over of the former by the latter (See Data Wars & Minions No Longer). It highlighted a moral/ethical dilemma that I thought about throughout the riveting unrolling of Study 329 and its re-write. How do good people become corrupted?
Unless you buy into the idea that every one of the million or more people who have ever worked for a drug company is inherently lacking any moral compass, then it is imperative to wonder what happens such that one giant corporation can ruthlessly and without any expression of regret kill people in the interests of profit. Corporations aren’t some weird, otherworldly entity, a life form that has developed somewhere in the outer reaches of the galaxy, like the Daleks that terrified me at the age of 8. Corporations are people. From the chief executive down to the people who make the products on a factory line – they are all human.
One might attribute hubris, overweening greed and psychopathy to those at the very top but not, I think, to all the tens of thousands of employees. Thoughts of Nazi Germany spring to mind – the millions of ‘ordinary’ Germans who kept quiet, or turned a blind eye to the persecution of the Jewish people and the Holocaust. Maybe there is something similar at work, but it doesn’t quite fit the whole picture for me.
I can describe the last throes of Republic and the transition to Empire from a personal perspective: when my husband was offered his first job after university in the early 1980s, with a now defunct American pharmaceutical company, we thought he was going to be putting his biochemical training to good, practical purpose – albeit in animal medicines. Dealing with problems like enteritis in pigs or finding better ways of managing flea infestations in cats and dogs. It wasn’t exactly noble – but it seemed a useful way of earning a crust.
At that time, in the early 1980s, the animal health division was headed by a veterinary surgeon and many of the older scientists at American HQ were exiles from Nazi Europe. One, Irv, long since dead, had escaped from Germany in 1939, and met and married a fellow escapee who had got out on the Kindertransport scheme, here in the UK. They’d settled on the East Coast of the US, near the company’s research HQ in Philadelphia when Irv began work for the company as a chemist. They stayed there for 50 years. He was a scrupulously honest person who sometimes drove his colleagues mad with his meticulous attention to small detail. He was a Democrat through and through, and utterly horrified by the corporate dishonesty revealed during the Enron scandal. Music was his first love but he was always ready to talk politics, books and the theatre. He and his wife were humane, cultured people. They were also deeply grateful and loyal American citizens. The only time we ever differed was when they were both shocked to the core by a spate of flag burning in the early 1990: some protest or other in the US, which seemed perfectly low key, and quite amusing to us but really shocked them both. I wish I could discuss what has now emerged about the embedded corruption of Big Pharma with Irv.
During the 1990s the pharmaceutical industry sank into turmoil: Rob’s company was, I think, the first to be the subject of a hostile take-over by another US giant. It wasn’t a pleasant way to lose your job: there were over 3,000 people working at the UK base alone. The managing director and division heads in the US knew about the bid from AHP and had been fighting secretly for the company’s survival. They lost.
Rob and everyone else turned up for work one Monday to be met by personnel (as Human Resources used to be known) and representatives from the invading forces. All the managers were asked for their car keys, escorted to their desks and watched while they collected the photos of the kids and any other personal items. Then they were escorted rapidly off the site and sent home. Rob was back by 10 am. They were watched as they cleared their desks, in case angry and upset (now ex) employees scooped up papers with data and information that could be used in revenge against the invading Empire, or those with IT know-how might bugger the computer system with a rapidly inserted virus.
Redundancy the American way was a humiliating experience. And nothing was ever the same again. No one ever felt secure from that point onwards.
The UK site was raped and pillaged by the invading hordes, its commercial assets split and sold off to other companies in a frenzy of ‘reorganisation’. The UK base had been the second biggest employer in a large area, which has never recovered, economically. The site was gradually torn down; the land sold piecemeal for housing and where Rob’s office building stood there is now a Drive-Thru Kentucky Fried Chicken outlet, which employs 30 people on zero-hours contracts.
Some like Rob found another job, some never did. Rob went to work for a Swiss company that, within 6 months had merged with another to make, at that time, in 1996, the biggest pharmaceutical company in the world. We’d faced redundancy twice within a year. At the time we had two children about to go to university, our house like many others in the UK was in negative equity due to soaring interest rates and a collapsing housing market. We were financially vulnerable – like everyone else. When he was offered a job at HQ we had little real choice, despite the fact that it was in Switzerland.
Scientists and department heads were replaced by people with backgrounds in ‘business management’, and PhDs gave way to MBAs as the gold standard qualification for employment. Pressures grew to maximize profits: it would be foolish to pretend that loyalty to the company hadn’t always been a requirement, and that the profit margin had always came first – but from the mid 90s onwards the moderating influence of people like Irv just evaporated. The atmosphere at work became highly focused on meeting targets, deadlines, and budgets. There was simply no room for skepticism or questions: once you were perceived as awkward you knew you were likely to be kicked out.
The people who had to go out and sell the products on the frontline – the sales force – were probably subject to the most intense pressure of all. And were most vulnerable to being sacked. I read the Eli Lilly internal documents posted on Mad in America, detailing operation Viva Zyprexa! The Empire was out to conquer new lands – primary care physicians. The crib sheets detailing how the sales force were to lie about the fact that Zyprexa caused diabetes make grim reading (particularly grim for me maybe, as I developed diabetes and lipid dysregulation after years of Zyprexa/olanzapine). But as sickening is the appalling cheerleading at the ‘product launch’ meetings, the crude offsetting of one team against another and the psyching up of the reps to ‘Go out there and kick ass!’ OK, maybe reps aren’t the brightest people in the world but they were being groomed for aggressive selling, just as 16-year-old lads are groomed to kill when they enter the army. A macho, bullying environment where you either sink or swim. No room for people who might have qualms about the morality of what they are being asked to do and who have families to care for and mortgages to pay every month.
I asked Rob whether his company would have launched an internal damage limitation exercise like GSK/SKB did around the Panorama programs about paroxetine: Of course he said – and that it would have probably been successful. Employees would have been reassured that the company – their company- would never have deliberately harmed children. Success of the exercise would have been sustained partly through loyalty to the company but mainly because no one could afford to think too closely about whether it was true. Ask too many questions and you would be out on your ear with no chance of getting a reference for a future job.
If this sounds like an apologia for those working in the pharmaceutical industry – it isn’t. Some people do very bad things in any arena which are simply unforgiveable on any level: it’s hard to forgive the doctors and nurses who propped up a failing, abusive hospital in Mid Staffs by ignoring the pain and distress of patients. It’s very hard for me, remembering some of the casual brutality to which I was subjected as an inpatient in several mental hospitals. Even harder to think that the industry which bought our food and paid the bills wreaked such appalling damage on our family.
But unless you dig under the surface and wonder how such things happen, think about the context: the atmosphere of fear engendered by bullies who are probably being bullied themselves, then it’s too easy just to be angry. Anger is good – but not enough on its own. I think it’s important to put Study 329 in its cultural and economic context; try and peel away the layers of the onion and get at some understanding of why what happened, happened. Saying ‘oh that’s just capitalism in action’ is true, but in the end offers no chance of doing things differently at some point.
Empires fall, eventually, however powerful. I hang on to Abraham Lincoln’s words (although I prefer Bob Dylan’s version)
“You can fool all the people some of the time, and some of the people all the time, but you cannot fool all the people all the time”
Thank you for such an interesting account Sally; there is nothing better than a ‘true life’ account from someone who has suffered the awfulness of a situation. I admire the way that you are able to look at the whole picture despite your experiences being , more or less, on one side of the fence. I truly believe that, unless we’ve been there, it’s almost impossible to be sure how we would react if we were to be one of the workers in a large company with ideals that are abhorrent to us. How can we be sure that we would not comply? Are we sure that we are strong enough to become a whistleblower, disregarding the financial loss that would follow? I think not. Of course, being an onlooker, we can safely say that what we see is totally wrong and that we SHOULD shout from the rooftops when we hear of the wrongdoings. Unfortunately, ‘should’ and ‘would’ are two very different concepts!
What, then, can we, the outsiders, do to bring about change? In my opinion, the first step is to make sure that we inform as many people as possible of the drastic state of the workings of pharma companies. (The practises are not restricted to those companies alone but they have the greatest effect on the lives of ordinary human beings in my opinion). Also, we should never shy away from sharing our experiences of these companies with others – not only on forums of like-minded people but face to face with people we meet, particularly those who see ‘capitalism in action’ as being ‘the way of the world’ and quite acceptable. If people hear a message often enough, they just might stop to think about its relevance to their lives. Advertising seems to work for the big companies – let’s copy them and see if it works for us!
These may be tiny steps but, possibly, if we take enough tiny steps we might end up completing a marathon.
Best wishes, Sally, and thanks again.
It s’official..
Sir Andrew Witty to retire from GSK in March 2017
17 March 2016
Issued: London
http://www.gsk.com/en-gb/media/press-releases/2016/sir-andrew-witty-to-retire-from-gsk-in-march-2017/
https://twitter.com/GSK
At the end of my comment, I have put up a talk by Sir Andrew Witty, given yesterday, and, I, for one, was captivated……
It might help to answer this question by providing a little more background knowledge and to realise that the Pharmaceutical Industry is in a unique position to develop new products like Paroxetine and price them high and either end up as a Shkeli or as a possible ambassador on the speaking circuit and possibly a senior advisor to hm guv..
David Healy
19 hrs •
In the latest post on dhblog.wpengine.com, Sally MacGregor asks ‘How do good people become corrupted?’
10 of the Worst Big Pharma Company Rip-Offs — and Their Plan to Keep the Gravy Train Rolling
Mar 17, 2016 12:34 pm | By Martha Rosenberg, The Influence
http://www.alternet.org/drugs/10-worst-big-pharma-company-rip-offs-and-their-plan-keep-gravy-train-rolling
Witty’s future has been in doubt for some time amid flagging sales and profits and questions over his focus on consumer health products such as headache pills and toothpaste.
http://www.thisismoney.co.uk/money/markets/article-3497753/Glaxo-confronts-break-threat-Boss-Sir-Andrew-Witty-quits-Investors-urge-firm-focus-selling-developing-drugs.html?ITO=1490&ns_mchannel=rss&ns_campaign=1490
“…plots, intrigue and manoeuvring.
http://www.theguardian.com/business/nils-pratley-on-finance/2016/mar/17/glaxosmithkline-gsk-andrew-witty-neil-woodford-break-up
“…were the chief corporate bogeymen a decade ago.
Just sayin’…
“…to curate
http://www.alltrials.net/news/american-medical-association-joins-alltrials/
https://pbs.twimg.com/media/CdwUsi6WwAAXlJ7.jpg
***WATCH ‘LIBERATED’ SIR ANDREW WITTY***
Sir Andrew Witty
Center for Strategic & International Studies
The Bio-Pharma Industry and Society
17 March 2016
Introduction….”he is such an outlier”
http://csis.org/event/bio-pharma-industry-and-society
GSK Retweeted
Smart Global Health @SmartGlblHealth 18 hrs18 hours ago
.@GSK Sir Andrew Witty: data transparency doesn’t stifle innovation, it encourages it. #CSISlive
The moderate tone of this piece on the heels of the pharma rape series is perfect. Blaming and shaming those we see as responsible for our injuries is only natural, but this post really sheds light on the utter complexity of the situation.
Perhaps an important thing to note about the cogs in the system is that they’re still sitting ducks. Ours was a rude awakening but hey, we’re awake.
The Fundraised US Flim brought to you from SenseaboutScience
The US version of the AllTrials video is now live! Thanks to your support, we were able to make this hugely important video to help US supporters spread the word, and encourage people to become campaigners themselves. Two patient advocates, AnneMarie Ciccarella and Gregg Gonsalves, explain exactly why the campaign for clinical trial transparency matters. Watch the video to hear their stories, and please share it with your friends, colleagues and networks in the US.*
Congratulations to our team in the US who made all of this happen. And a huge thank you to everyone who has supported the campaign in so many ways. Without you, none of this would be possible.
Best wishes
Steph
* If you’re not in the US and you want to share the original AllTrials video, you can find it here.
Campaign resources in other languages will be announced very soon – watch this space!
—
Dr Stephanie Mathisen
Campaigns and Policy Officer
1.20….in
GlaxoSmithKline (GSK)
https://www.youtube.com/watch?v=UCCYEdBrtTc
Published on 17 Mar 2016
Why patients and patient advocates like AnneMarie Ciccarella and Gregg Gonsalves support AllTrials, a patient-led campaign seeking to have all clinical trials registered, and their results reported.
2.31….in
GlaxoSmithKline
https://www.youtube.com/watch?v=Kto5vuiS5rA&feature=youtu.be
Clinical trials
For my next trick…
http://www.economist.com/news/science-and-technology/21695381-too-many-medical-trials-move-their-goalposts-halfway-through-new-initiative
End..or…sing Robert Frost on #alltrial.
https://twitter.com/hashtag/AllTrials?src=hash
Apparently my last comment was un-publishable..
anyhow, that’s ok, I respect that blogs have to be moderated etc…
I would just like to say, I don’t really buy into the premise of this article…
That’s not to say that i don’t understand it, and it’s not to say that it’s not a valid perspective… it is, and it is well written, and genuine…
It’s just , I am not convinced..
Zypreza and Seroxat didn’t happen in some ancient historical time-frame where everyone was so afraid of losing their job in the pharmaceutical industry that they had no choose to keep quiet about dangerous side effects…
These are very much current scandals…
And the internet has documented everything.. so there’s no excuse now for anyone in the industry or anyome thinking of joining Big Pharma a career- not to know the nature of the beast they ‘choosing’ to assimilate into…
The culture in pharma (and big business in general) is to maximized profits- this has not changed… we live in a capitalistic greedy world- what is to stop future Zyprexa’s or Seroxat’s happening again?
Unless the drug reps, and other workers in the industry demand a sea-change- things will stay the same…
This takes courage..
I was very dismayed experiencing the *brain dead* phenomena that seemed to inflict ALL of my nursing colleagues — whenever I tried to engage around topics one would naturally associate with a leading academic medical center’s interests, I saw that *light’s on, but nobody’s home* look one might also see on the face of a child who is hoping to escape notice for his/her *pranks*.
Are there really reasons for willful avoidance of academic discussion and debate amongst professionals earning a good living in the health care/pharma industry? I don’t find myself looking for a reason–, as I don’t think there is justification for *irrational* behavior by the educated elite we place our trust in.
I do not think it is even a good idea to approach this scourge from a *why or why*? perspective–. We desperately need, a WHEN do we act decisively?- position, and a plan.
Really? Really.
There is no *reason*– hence NO excuse. IF you receive a pay check working in the industry that is directly connected to people, YOU are obligated to give a damn about the effect your work (in whatever capacity) has on -PEOPLE.
Who is in peril today because so many *professionals* have lost their voice along with their conscience?
Better to be poor as you contemplate an honest means for making a living, than to collect a dime from an industry that exploits vulnerable people for profit; an industry that harms, even kills innocent children– .
I speak from experience. Poverty is a circumstance one can change. Moral bankruptcy is a condition far more serious with a much worse prognosis..
How I wish now that I’d just poured it down the sink.’
http://www.dailymail.co.uk/health/article-3503456/Weeks-Prozac-Jake-14-took-life-aren-t-parents-warned-suicide-risk-children-anti-depressants.html
‘The link between suicide and Seroxat is the best known,’ says Professor Gøtzsche, ‘but Pfizer (which makes Lustral) and Eli Lilly (the makers of Prozac) have also hidden suicides and suicide attempts.’ The latest findings have provoked the ire of psychiatrists. ‘There’s no evidence or data from this . . . or previous published trials of an increase of actual suicide in young children who take antidepressants,’ declared the Royal College of Psychiatrists. ‘The possible risks of harm always have to be balanced against the benefit of treating depression effectively.’
There is a place for antidepressants, adds Professor David Healy, a psychiatrist from Bangor, North Wales, who first raised concerns about SSRIs more than 20 years ago. ‘They are valuable drugs when used carefully — I prescribe them to my own patients — but we can’t just rely on what the trials say.
‘It would help if doctors were more ready to listen when patients tell them about the side-effects. However, their tendency is to believe the claims contained in flawed trials that side-effects are rare and my patients tell me that often the response is to advise a higher dose.’
In 2003 a BBC Panorama programme revealed that GlaxoSmithKline had hidden trials showing that children who took the SSRI Seroxat were more at risk from suicide.
The trials showed that 6.5 per cent of children prescribed the drug suffered ‘emotional lability’ compared with 1.4 per cent of those taking a placebo. In 2012 the company was fined a record £2 billion by a U.S. court, in part for wrongly promoting Seroxat as a treatment for childhood depression between 1997 and 2004. By 2005 authorities in the U.S. and UK had banned Seroxat’s use in children.”
Additional Reporting by Jerome Burne
22 Mar 2016,
Prozac is the safest drug for depressed children. Why this is a myth.
By Jerome Burne
“GlaxoSmithKline had been discovered hiding trials that showed Seroxat wasn’t effective for children and raised their risk of suicide.
http://healthinsightuk.org/2016/03/22/prozac-is-the-safest-drug-for-depressed-children-why-this-is-a-myth/
“It might be relevant to point out that the scientist who did both of these Prozac licencing trials was Dr Graham Emslie of University of Texas-Southwestern Medical Center. Emslie was also one of the authors on the infamous Study 329 which claimed that another SSRI – Seroxat – was safe and well tolerated for use on children when it found nothing of the sort.
A later analysis found there were ‘clinically significant increases in harms, including suicidal ideation and behaviour’. The company GSK was eventually fined three billion dollars for fraudulently promoting Seroxat. There are more details on Study 329 here.
Time for an independent review
Sharp intake of breath, did Sir Andrew Witty really say this:::0
“Limited Market Life of doctor-prescribed medicines………
GSK Retweeted
Bloomberg Business @business 9 hrs9 hours ago
Toothpaste is helping Glaxo’s investors to clean up on dividends http://bloom.bg/1PqA0DT
Glaxo’s Generous Dividend Policy Boosted by Twice-a-Day Brushing
Ketaki Gokhale
March 23, 2016 — 5:00 AM GMT
The success of such over-the-counter products, which don’t face the patent cliffs and limited market life of doctor-prescribed medicines, mean that the consumer division can generate a steady cash flow to pay the dividends, according to Witty.
http://www.bloomberg.com/news/articles/2016-03-23/brushing-twice-a-day-bolsters-glaxo-s-generous-dividend-policy
“…..pain and erosion.
Sense oh Die n
I agree with Truthman. But I also understand that somewhere in the article lies the “middleground” or “mix” of events that has made a whole pharmaceutical branch toxic.
That include the local secretary, the mid-management, the regulatory people, the doctors, governments and CEO’s.
We (who visit DH’s blog) would like to change things, but it’s unlikely to happen, since all mentioned above are OK with the way things are..
And, as Truthman says, money flows good in pharmaceuticals, so who on the inside would wanna stand up against the tide of cash?
I’m facing up to the fact that I am just going to be remembered as an a**wipe, no one will know I was an “a**wipe” because of Paxil/Seroxat.
Looks like Avoiding Apocalypse nearly have a David Healy, although to be fair it is quite a good title:)
Sunday 29 May
3:00pm
Doctors and The Danger Industry
Philosophy Session
David Healy.
For the first time in a century, today’s treatments may be less effective than before. Outspoken Psychiatrist David Healy reveals the market forces that threaten our health.
“An enfant terrible and a very brave man” TLS
Sunday 29 May
5:30pm
Venue: Spiegel Tent
Event [177]
After Doctors
Philosophy Session
Stephen Dorrell, David Healy, David Nutt. Mary Ann Sieghart hosts.
Most of us still think doctor knows best. Yet troublingly a third of all hospital beds are filled with conditions caused by medical intervention. With sophisticated diagnosis just a websearch away is it time to rid ourselves of medical authority? Or do we need doctors more than ever in the chaos of information?
Psychiatrist David Nutt, former Secretary of State for Health Stephen Dorrell, radical GP David Healy envisage the future of medical authority. Mary Ann Sieghart hosts.
………..Durham political theorist David Held
Would the real DH please stand up….happy teaser:)
Avoiding Apocalypse
Philosophy Session
Frank Furedi, David Healy, Patricia Lewis. Matt McAllester hosts.
Fifty years on from the Cuban missile crisis we are so used to living with nuclear weapons that we feel strangely safe. Yet with the end of US dominance and the likelihood of proliferation the future looks precarious. Is a nuclear crisis at some point inevitable? Or can we avoid catastrophe, and if so how?
Nuclear physicist and Chatham House international relations director Patricia Lewis joins Durham political theorist David Held and author of The Politics of Fear Frank Furedi to take the apocalypse seriously.
https://howthelightgetsin.iai.tv/programme-page/?utm_source=Institute+of+Art+and+Ideas&utm_campaign=a08a5dcc15-HowTheLightGetsIn+Newsletter+IAI+Version+24%2F03%2F16&utm_medium=email&utm_term=0_33593fe9fa-a08a5dcc15-47027401