Social and individual perceptions dictate the discourse surrounding illness, diagnosis, prognosis, and treatment options. Stigma, stereotypes, and assumptions determine the quality of care one receives not only in the medical field, but more generally in society. Public opinion and public relations mold the ways in which health care functions. The role outlets such as the media play in swaying public opinion is immense. Carl Elliot’s piece titled “Pharma Goes to the Laundry: Public Relations and the Business of Medical Education” exposes the nearly synonymous nature of medical education and pharmaceutical public relations. Indeed, medical education’s relationship to public relations renders medical education a product of a large industry seeking to maximize profit. Anne Pollock’s article “Transforming the critique of Big Pharma” discusses the “ misplaced priorities and corruption inherent in a business model that funds both research and regulators” (Pollock, 2010). Both articles magnify a growing global issue: health care is determined by health insurance and pills rather than providing the best possible care to a patient.
In essence, when it comes to pharmaceutical companies, public relations are the primary signifier of the success of a drug. A good relationship with the public is more conducive to economic success on the part of the pharmaceutical company than the actual effectiveness of a drug. This intense reliance on the media then connects physicians and other medial professional who are, more or less, paid off to endorse a drug. According to Elliot, physicians will ghostwrite articles endorsed by large pharmaceutical companies in exchange for money. In 1998, 11% of articled published by six major American journals were ghostwritten (Elliot, 2004). These ghostwritten articles are then used more widely than works conducted and published by actual physicians; a warped sense of truth, then, prevails in a field that prides itself on objectivity and hard science. Money here is the determining factor. Money determines what drugs are offered to the public, not the potential health benefits (or in some cases, lack of benefit). When randomized control trials fail to support a given drug, data is destroyed, as if to erase the human lives that will be affected by such a decision. Money given to physicians allows favorable medial portrayal of drugs. Too, money has become synonymous not only with the power of pharmaceutical companies, but with the health; that is, money sets the standard for which drugs are marketable. Elliot eloquently writes “the cost of that betrayal is being paid in human lives” (Elliot, 2004). In a sense, the problem of physicians taking money from big pharma is a kind of collective action problem. As Elliot discusses, though doctors offer different explanations for the reasons behind why they take the money (whether because they remain objective or for the cause of “social justice”), all begin with the phrase “I take the money.” Herein lies the problem: until all physicians find the actions of big pharmaceutical companies unacceptable, they will mostly find the actions of big pharma a standard within the plane of health care and medical education.
It has been difficult for me to come to terms with the bureaucratic and manipulative nature of these pharmaceutical companies when examined from the perspective of basic human well-being. The desire to make economic and monetary gains at the sake of an ill individual is not only reprehensible, it is criminal. Yet, such finagling of the system, or even transformation of a system designed to offer reliable and credible health care into one that supports only large corporate industry, continues.
Pollock further deals with the pharmaceutical industry’s obsession with money over concrete medicine. She writes, “prices are not set by production costs, but by willingness to pay.” It becomes apparent that pharmaceutical companies cater to the rich, those who are most likely to pay for expensive drugs. I found it morally reprehensible and disgusting to find how much drugs for terminal illnesses cost. Pollock discusses the mindset behind these pharmaceutical giants who have realized that those close to death will do almost anything to try and prolong life. In particular, Pollock offers one example of a drug that was found to increase lifespan by only 12 days, but which sold for approximately $3,500 a month. In the face of death, rationality becomes obscured, and pharmaceutical companies have seized this opportunity. Pollock explains, “as long as the price can be whatever the drug company demands, with indeed a higher price threshold for a shorter duration regimen, there is little financial incentive for the drug to actually work” (Pollock, 2010). Moreover, the argument that pharmaceutical companies and high-level members of society are engaging in charitable “pro bono” acts and therefore not just concerned with profit falls flat in the face of the hard reality that “charitable approaches do not necessarily lower the cost of the drugs, which is to say the revenue of the pharmaceutical companies” (Pollock, 2010). In fact, in many ways these “charitable approaches” only further bolster a company’s public relations image; in this world superficiality reigns. Philanthropy should be seen “as part of [pharma’s] global pricing strategy rather than the unmitigated good that their ‘corporate citizenship’ public relations would suggest” (Pollock, 2010).
Additionally, the social bifurcations that are established as a result of companies like Pfizer catering to the rich establishes “trade-offs between a commitment to equity in health care for all versus access to potentially life-prolonging medicines for some” (Pollock, 2010). Unfortunately, those with money are those guaranteed to receive the highest level of care. More unfortunate is the dismissal of diseases of the “poor” such as HIV/AIDs and malaria. For pharmaceutical companies, treatments are offered to those illnesses in “profitable areas.” Pollock concisely states the issue of big pharma in the following statement “pharmaceuticals are part of a postwar boom in techno-science that has created both increased control over bodies and widening global inequalities and created dissidents” (Pollock, 2010). In short, big pharmaceutical companies are able to initiate and end the dispersal of pills and by extension health care (as health care is now defined by medication). It is important to realize the termination of a pill is not always because it is ineffective, often times the financial revenue it brings in outweighs the health effects (whether good or bad). Health in relation to big pharma and their influence on medical education and dispersal is about economic capital.