In my previous post (The Pharmaceutical Industry: Bad Apples and Blights – March 2020), I referred to a book “Pharmaceuticals, Corporate Crime, and Public Health” by Dukes, Braithwaite, and Moloney. The authors, with experience working in the pharmaceutical industry, in international regulation, and in public health, diligently mined content from all the right peer-reviewed journals, court cases, and government/health/justice agency investigations, over a half century. They described illegal and unethical conduct at no less than 64 pharmaceutical companies in no less than 31 countries, across all populated continents. In the previous post, I left it at that. This post will list examples of the misconduct so we can consider, more specifically, the full extent of the inhumanity that pervades the culture of this industry. I would encourage anyone interested in drug policy to read the book for the full, and despairing, story. I would recommend that you avoid reading the book in the evening. The contents will disrupt your sleep.
Below are the types of conduct that were perpetrated on multiple occasions by numerous companies. I ask you to resist the inclination to read through the list quickly. Instead, I hope you will pause on each one and imagine the scenario as it may have unfolded. Then consider the depth and breadth of the suffering that might ensue. Here is the dizzying list of malfeasance.
• ignoring and withholding evidence of harm to subjects in test trials
• agreeing to follow specific testing protocols and then ignoring them
• intimidation of researchers
• suppression of uncooperative investigators
• manipulation of research practices and findings
• testing new drugs in countries with weak regulations, exposing vulnerable populations to harm
• deaths of infants and children resulting from the conduct of illegal trials in which parents were pressured into providing uninformed consent
• non-payment of court-ordered settlements to parents whose children died in the trials
• recruitment of unemployed vulnerable subjects onto research subject panels
• use of prisoners as subjects
• testing of experimental drugs without informing subjects of the availability, at no cost, of similar products already established as safe
• fabricating research data from nonexistent patients
• ignoring consumer complaints
• falsifying reports
• forcing less-senior executives to take the blame for CEO decisions
• workplace safety infractions during manufacturing
• environmental infractions
• animal rights violations
• use of offshore havens to avoid taxation
• use of advertising content that is not evidence-based
• overly aggressive, misleading, and illegal advertising and marketing practices
• imposing restrictions on the availability of drugs to countries that are not industry-friendly in their regulation
• various tactics of manipulation of drug supply chains
• untruthful “public awareness” campaigns
• tampering with court proceedings and legislative processes
• abuses of international conventions
• selling drugs to publicly funded Medicare programs at inflated prices
• failing to keep promises made to governments to increase research and development and create new employment in the sector
• circumventing competition law and patent law
• misleading patent offices to secure patents
• circumventing safety laws
• bribery of government officials
• collection of tax breaks from donations of expiring drugs that were useless or likely to do more harm than good for the recipients
• use of patent protection to prevent promising research
• creation of exploitive monopolies
• engagement in anti-trust activity
• price-fixing
• insider-trading.
With such a long and diverse list of legal infractions and public health incursions, one would think that government regulators would be vigilant and responsive to such misconduct. And yet, Dukes and colleagues also detailed repeated failure of government regulation to prevent industry perfidy and effectively hold it accountable. These failures included:
• allowance of high-risk, highly profitable drugs on the market
• insufficient fines to act as deterrents
• lack of administrative or legal action on unpaid fines
• not enforcing requirements for ethics review
• industry whistleblowers were not protected and were sometimes prosecuted by the state
• complicity of regulators with companies in the commission of infractions.
This leaves us with a two-fold problem. Not only does this industry appear to have little regard for public health protection or the law, but the governments of the world appear to have little interest in containing the first problem in anything more than a performative manner. Perhaps the dilemma was best summarized by a World Health Organization spokesperson who noted:
“Market power readily translates into political power. Few governments prioritize health over big business.”
As we ponder the broader implications of this legacy of corporate misconduct, we can turn our attention to the current covid-19 pandemic. Pharmaceutical companies are producing vaccines that are preventing illness and deaths and will hopefully facilitate a return to a less encumbered life for us. We can be grateful for that. But a historical perspective should also make us wary of the industry’s larger playbook for this and future pandemics; and of how confident we can be that governments will ensure that these game plans will serve their citizens as faithfully as they serve the industry’s financial interests. For a provocative and timely treatment of this topic see this article published just yesterday in The Nation.
Mike DeVillaer
Hamilton Ontario Canada
June 1, 2021