40 years of cheers and jeers

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MM&M's 40th anniversary called to mind that one of my first articles for the magazine–not quite 40 years ago but close–was about the emergence of accredited CME and how it not only provided a new communications channel for the industry but was making a major contribution to better patient care. Now CME is again in the news, but these days it's all about how the “good guys” have to make sure that anything industry pays for isn't disguised promotion.

Forty years ago I was proud to consider myself one of the good guys. When I would tell an acquaintance that I worked for a medical advertising agency, the response was apt to be one of intrigued admiration.

How the ground has shifted. That was brought home to me in a conversation this summer with someone I respect for his intellect, his honesty and his grasp, as an epidemiologist, of healthcare issues. To illustrate the growing consensus that head-to-head comparisons should replace placebo-controlled studies as the gold standard in clinical testing, I mentioned that when I interviewed the medical affairs SVP of a major pharma company for an article on this subject in our August issue even he agreed.

“Of course he would,” was the rejoinder. “He's on the company payroll.”

“Wait a minute,” I interrupted. “Placebo studies are easier, cheaper, and less risky. Why would....”
But he wasn't about to listen. If this physician worked for the industry he had to have an ulterior motive, a secret agenda. He had to be corrupt.

 What a sad reversal. My own opinion is that 40 years ago there were ethical transgressions that would in no way be tolerated today. Consider this: the head of the agency I first worked for also published a clinical journal devoted to anti-infective therapy. Agency clients bought lots of reprints of favorable articles about their products, and the editor—who happened to be the chief of the FDA's antibiotic division—received a generous share of reprint charges.

Today such a cozy relationship would rightly be the subject of headlines and Congressional hearings. Our critics to the contrary, standards today are considerably tighter, and multiple watchdogs challenge every move the industry makes, with some critics calling for “reforms” that would gut basic marketing practices.

What happened?

There's no denying that there have been industry mistakes, but that's not new. Look up the story of the Dalkon-Shield if you want to be reminded of past transgressions. But they didn't blacken the entire industry's image.

By coincidence, at the time of my summer conversation I was reading Saturday, a novel by Ian McEwan. In it, the lead character ruminates about the fashionable cynicism about progress that demeans what he, as a neurosurgeon, is able to accomplish. So perhaps that's the problem: that we're caught in a cycle when the public, having been lied to all too often, has come to believe that all that shines must be fake.

We can't avoid such cultural bias, but let's not internalize the steady drumbeat of criticism. As a corrective, just consider how promptly HIV infection was turned from an almost certain death sentence into a chronic (though still tragic) disorder. For that achievement, the pharmaceutical industry is due much of the credit... and that achievement alone justifies our still saying proudly: Yes, I work for this industry.

Warren Ross is MM&M's editor at large

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