I have a background in science (biochemistry), have worked in the pharmaceutical industry, and am currently reporting on the industry full time. At the same time, I live in a very liberal college town where hippy lifestyles and alternative medicine are very popular. That means I am quite frequently doing a conversational tango of tact around people’s various strongly held beliefs about health and healing. Many people I know are scientists or doctors, or strongly align with science and conventional medicine. Many others have been let down by conventional medicine and are distrustful of science and of the motives of the health care and pharmaceutical industries, and have embraced alternative medicine theories like homeopathy, traditional chinese medicine, yoga, and more.
Quite often, directly or indirectly, people seek my opinion on these issues. It can be difficult for me because I have mixed feelings. I recognize that medicine and science have real limits, and that the practice of medicine is just as fallible as the human being in the white coat. Medical science can’t fix everything that’s wrong with you, and sometimes it will make things worse.
At the same time, I don’t agree that the pharma industry is an evil industrial complex pushing poisons on us purely for profit. I’ve been inside it too much to buy into that. It’s true that the pharmaceutical industry is huge and very influential in medicine. In fact, I have often noted that it seems like doctors view patients as buckets of water into which they dump medicines until they get what they think is the right balance of chemicals.
There’s a good reason for that. It’s because historically many of our biggest medical breakthroughs have come in the form of medicines–generally small organic compounds that can be taken orally or injected, diffuse through the entire body, fix whatever is broken, and are metabolized relatively harmlessly out.
Drugs have been revolutionary for many diseases, and patients like the idea of them so much (“take a pill and you’re cured”) that much of the practice of medicine seems reduced to handing patients a wad of prescriptions and hoping or assuming that they’ll be better in time. Sometimes the doctor even has samples provided by pharma companies to give to patients directly.
I believe there are many reasonable alternative therapies completely overlooked by science because of the pill/bucket paradigm, and in that sense I harbor a healthy skepticism of the pharma industry.
In addition, there are some business practices and scandals that are inarguably evil. For example, the pharma industry is often penalized for “off-label marketing” of drugs. That means marketing drugs to patients for indications for which the FDA has not approved them. It is completely legal for doctors to prescribe medications off-label, and there are many excellent off-label uses for drugs. But that is a decision for a trained medical professional to make.
Marketing off-label drugs directly to patients, and then having them come into a doctor’s office pressuring the doctor to prescribe it, is a situation the FDA frowns on. Drug companies have been punished with huge fines, on the order of hundreds of millions of dollars, but it hasn’t stopped the practice of off-label marketing, and probably never will. It seems pharma companies have come to view those fines not as a disincentive, but as a business expense, along with the lawyer’s fees that go with them. Unless the government comes up with a fine that hits the pharma companies on the bottom line, it’s likely they will continue to push the envelope of off-label marketing.
That’s kind of evil. And I could go on at length about ways in which for-profit pharma business conflicts with patient health.
At the same time, the pharma and biotech industry depends on a commitment to fighting and curing terrible diseases. Yesterday I wrote an article for BioWorld Today about a new drug combo for cystic fibrosis. Exceeding all expectations, in a Phase II trial, the drugs, made by Vertex Pharmaceuticals, showed a big benefit for a group of cystic fibrosis patients with two copies a mutation called f508del. That accounts for about half of all cystic fibrosis patients. It’s a huge breakthrough, and it’s thrilling for me as a writer to have a front-row seat when these things happen.
While my mother was in the ICU, one of the other rooms was occupied by a man with cystic fibrosis. We struck up an acquaintance with the family, and learned that he was 40 years old, and that he’d had a sister who died of the disease at the age of 16. At 40, he has already survived longer than almost everyone with the disease. Seeing him fighting for his life in the ICU was incredibly moving. ICUs are moving toward as much physical therapy as possible, to the tolerance of the patient. Each day they got this intubated and ventilated patient out of bed, and with a parade of therapists, nurses, and aids holding all of the bags, tubes, and equipment that was keeping him alive, he went for a walk with his ventilator clicking and whooshing as it pushed air into his diseased lungs the whole way.
I prayed like crazy for him. No one should have to live with such a terrible disease. No family should have to lose two children. No one as young as forty should be spending that much time in respiratory ICU.
He had a tough battle, but each day he seemed stronger. Eventually, the tubes came out, and he disappeared from the floor. I hope and believe that he is somewhere, safe and alive. I hope and believe that he is a candidate for Vertex’s new drug combo, and that he can hold out until it’s ready.
There’s no effective homeopathic treatment for cystic fibrosis. There’s no effective traditional chinese medicine for it. Yoga may alleviate some of the symptoms, but it’s not a cure, either. Nature can be harsh. The natural remedy for cystic fibrosis is death. We want to do better than that.
The pharmaceutical industry is the army we have for fighting diseases like cystic fibrosis. Medical science is the only hope when nature turns against us, when nature wants to kill us and get us out of its gene pool, and that’s not evil. That’s a profound good.
And, in fact, in my interactions with the industry, and the scientists and business people who run it, true believers seem to outnumber profit-mongers. That’s probably because the industry is so inherently risky. If you just want to make money, go invest in a tech startup or trade commodities or something. The pharma industry is for people who want to change the world, and possibly make some money at the same time.
I know many people are upset at the profit motive, but that is an unchanging fact of the world we live in. It costs roughly $600 million to invent and develop a new drug to the point of marketing. Those costs have to be covered by drug revenues, and for pre-revenue companies, investors have to front hundreds of millions of dollars before they see a return. The government does offer some research grants and support, but these are barely adequate to get a small company through some early animal studies. In order to have a totally non-profit drug industry, we would have to have a completely different society. We would have to want to invest our tax dollars heavily in drug research and development, and the will is just not there.
In a weird kind of way, the government does provide much of the funding, because Medicare and Medicaid pay a huge chunk of the costs of new drugs on the market for patients. That’s probably a blog post for another day.
So what does all of this mean? Can you trust your doctor and the pharma industry to take care of you?
My take on it is this. The sicker you are, the more you need to trust in science, because, honestly, that’s your best shot. If reasonable natural healing alternatives are available, yes, definitely try them. But do it with the knowledge and blessing of your doctor. If your doctor says, “No, that’s too risky, you need to be on this treatment now to save your life,” then believe her. If your doctor sends you home with a prescription, and you choose not to take it, then let her know. You have already paid her for her very best advice, so give her a chance to counsel you on your decision. The investment in a medical education and advanced training is non-trivial, and can’t be replaced by unsourced information you find on the internet.
Natural healing will not save you from everything. Nature gave you an amazing immune system and the ability to heal from a huge number of injuries and illnesses. Your body’s healing capacity is awesome. But Nature does not have your back. In the event that your body can’t heal or repair itself, Nature’s Plan B is other people. Yeah, sucks, don’t it? So give medical science a chance.
I also caution people to be a little extra careful of new drugs. They are tested as thoroughly as possible before market, but the first year or so is sort of a final test. If you can safely do so, maybe wait to try it until several hundred thousand other suckers have tried it. If it passes that first year, you can feel more confident that the drug is truly safe.
This doesn’t apply, of course, to lifesaving drugs for dangerous diseases. If this is your best and only shot, and it’s a new drug, and your doctor thinks it could help you, then go for it. Again, because Nature’s cure for cancer and other serious disease is to breed more people. It works well on a population level, such as it is, but Plan B is not that helpful for you.