I don’t usually think of private companies as institutions but they really are; historically, the Hudson Bay Company was private but was an important institution for the settling of western Canada by Europeans. In this posting, I look into large pharmaceutical companies (Big Pharma) as an institution and consider if they have failed us over the past several years. My take on Big Pharma is that they failed big time because they failed to fulfill their social contract.
All corporations have responsibilities to their shareholders, their employees and their customers. For the first two, the responsibilities are financial and binding because investors rightly expect to reap some return for financing the company’s operations and employees expect to be paid for their labour.
Customers are different. They have a social contract with the corporation. People pay the corporation and in return expect a benefit. In the case of drug manufacturers, customers expect a product that cures/prevents a disease or provides relief from an ailment.
The COVID-19 (C19) pandemic has shone a bright light on how Big Pharma has ignored its social contract with the Canadian and other national publics. Pfizer, Moderna and other companies enthusiastically collected payment from the public through contracts with our governments. In return the public received an inadequate product at best and a lethal injection at worst.
Was this just an unfortunate accident or was it this part of a pattern of corporate strategy that has been in development for years. I suspect that it’s the latter because it has become increasingly challenging for Big Pharma to create a new “blockbuster” drug. They had to develop new lines of income and one opportunity was vaccines because they can be prescribed/recommended for everyone, even those in good health. We know the script: change the World Health Organization into an ally, curry the favour of national political and regulatory leaders, advertise heavily to the public, silence critics and denigrate any competition, such as re-purposed generic drugs.
We have seen many descriptions of the tragedies associated with mRNA vaccines; an excellent analysis was recently published by Mead … McCullough (https://www.cureus.com/articles/203052-covid-19-mrna-vaccines-lessons-learned-from-the-#!/authors ). Almost immediately, the paper was retracted by the editors. Considering that the paper had been reviewed by eight referees and then accepted for publication by the editors, a skeptic might suggest that the retraction was instigated higher up the ownership chain. Interestingly, Cureus is controlled by the Nature Portfolio, and the board membership includes those with various associations with major pharmaceutical companies.
This retraction would be funny if it weren’t a serious attack on scientific integrity. The abstract concludes with “Given the extensive, well-documented SAEs (serious adverse events) and unacceptably high harm-to-reward ratio, we urge governments to endorse a global moratorium on the modified mRNA products until all relevant questions pertaining to causality, residual DNA, and aberrant protein production are answered.”
To this observer, C19 mRNA vaccines have not been effective and they have not been safe. By marketing such a product to government and hence the public, who paid for them, the manufacturers have broken the social contract.
In short these pharmaceutical companies have failed their responsibility to the public.
Vaccines have been one new line of income; what are the others? Did I hear invention of a disease? Or was it creation of a dependence? Would these qualify for failing to live up social contracts?
Opioid crisis. Big Pharma promoted some newer opioids as being effective for pain management while having significantly lower risk of dependence and abuse. This resulted in a progression of opioid abuse that in turn resulted in three waves of opioid associated deaths as described by the USA CDC (https://www.cdc.gov/opioids/basics/epidemic.html . The first wave was attributed to the increase in prescription opioids that started in the 1990s; the second wave was attributed to heroin starting 2010; the third wave was attributed to synthetic opioids, such as fentanyl, and started in 2013. According to NPR (https://www.npr.org/2022/02/25/1082901958/opioid-settlement-johnson-26-billion ), Johnson & Johnson, AmerisourceBergen, Cardinal Health and McKesson will pay $26 Billion to settle lawsuits. Purdue Pharma has filed for bankruptcy and the Sackler family will pay up to $6 Billion to settle lawsuits.
While the manufacturers have not admitted responsibility, the financial settlements are tacit admission of selling opioids while knowing that they would do considerable harm and offer significantly less benefit. A further example of breaking the social contract.
Cholesterol and the statins. According to ourworldindata.org, citizens of Canada, Denmark and UK were taking over 300 defined daily doses of statins per 1,000 population in 2020. The revenue generated by the statins has been impressive. Thus “$141bn of revenues racked up over its lifetime by Lipitor for US drug giant Pfizer,” according to Simon King, executive editor of FirstWord Pharma.
These sales have occurred despite the data showing a minimal benefit of statins on CV deaths. An example of this can bee seen in Diamond and Leaverton (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10153768/ ), which shows a 54% relative benefit derived from a 0.41% absolute benefit. The benefit herein was not dying from myocardial infarction.
Could this have been due to the reduction in cholesterol synthesis induced by Crestor/rosuvastatin? Perhaps, but having worked in the world of hemeoxygenase and the anti-inflammatory effects of its products, carbon monoxide and biliverdin/bilirubin leads me to suggest that induction of heme oxygenase-1 could be the mechanism underlying this small benefit. If this were found to be true, one could suggest that any heme oxygenase-1 inducer, such as curcumin, might be effective at lower financial and adverse effect costs.
The pharmaceutical future:
It’s time for Big Pharma to recognize that they have harvested all the low hanging fruit that gave them “blockbuster” drugs.
But what happens when the gullible politicians “get it” in the way that many ordinary citizens “get it”. Judging by the low uptake of C19 boosters, citizens have become skeptical of mRNA-based shots. They took the shots and still got C19, and then they saw the adverse effects; so much for “safe and effective”. Big Pharma, governments and public health have all lost credibility among the public.
Do I dare suggest a new social contract? What about one in which the benefit to consumers is maintenance of health and prevention of disease?
Regulatory Agencies. Perhaps it’s time for them to embrace integrity and/or develop a backbone.
Summary. The pharmaceutical industry has not delivered the benefits expected by their customers. They have failed to maintain their end of the social contract.