Dr. Pal, why do you love Big Pharma so?

Aug 24 2011 Published by under Medicine, Uncategorized

After my recent post attacking the journal Cancer which published a horrid piece on quackery, a twitterer asked me question: "Why do Sci writers go in harder on quacks than pharma?"  (I think this begs the question; I don't believe that we neglect abuses among Pharma, but let's pretend that there is data to support her assertion). She continues, "My problem with selectively trashing these studies is we presume pharma studies better-so our audience does, as well. All quackery should be pilloried yet we selectively pillory the faith healer & homeopath. Why? B/C they're easier targets."

Assuming, once again, that her assertion is true, there are a number of good reasons to focus on blatant quackery above corporate malfeasance.  The pharmaceutical industry, while motivated primarily by profit, is required to go through extensive scientific testing of plausible drugs and devices.  This process is long, expensive, and is frequently successful at actually fighting disease.  There have been many infamous cases of burying data, of inappropriate promotion of drugs, but in general, science has won; sometimes it takes years, and sometimes there is harm done, but eventually, ineffective drugs, or drugs whose risk/benefit ratio is horrible tend to die.  There are of course exceptions, but not many.  The very fact that drugs have been given post-marketing black box warnings or have been withdrawn from the market (sometimes despite the work of bad actors in industry) is a marker of the ultimate success of the system.

This happens because science and medicine is designed to look for faults. Sure, the system can be gamed by dishonest players, but the scientific community is more than willing to toss out a modality that proves itself wanting.  Medical science, while influenced by ideology, is not ruled by it.

So-called alternative medicine and quackery works in a completely different way. Rather than asking a question and accepting an answer good or bad, altmed comes up with an answer and no amount of data will  cause it to be abandoned.  Despite hundreds of years of ineffectiveness, homeopathy is still used.  Despite its utter implausibility and proven inutility, reiki is still practiced.  There are very few if any altmed modalities that have been abandoned because of unfavorable data.  They are ideologies rather than science.

It is science and plausibility that separates quackery from real medicine.   Pharmaceutical companies develop and test hypotheses.  Sometimes they behave badly, but generally they have been successful at helping us live better and  longer.  There is an entire legal infrastructure in place to prevent them from doing ill, and to punish them when they are caught.  This system is far from perfect but it does work.

No system is in place to regulate or punish those who sell snake oil, and since patients are often "true believers" they are unlikely to sue quacks.

It's not a matter of choosing to go after quacks rather than pharmaceutical malfeasance.  We do speak out about it; there is a regulatory structure in place to monitor pharmaceuticals, as imperfect as it may be; and pharmaceutical science is science, whereas quackery is simply immoral, made up practices profiting off the hope of people who hurt.  It deserves every smack-down we can deliver.


3 responses so far

  • Mary says:

    The other thing that I can't understand about the complete discrediting of pharma is: where do you think medications are going to come from if we abandon this system? Do you really think academic labs are going to be able to produce enough of a certain compound to treat everyone on a large scale?

    But hey, if they want to abandon all pharmaceutical + synthetic products, and encourage their friends and family to do so, I guess there would be more....

  • Michael says:

    I think that you're missing the tweeter's point. or at least manipulating it with a rhetorical flourish to suit your needs. It seems pretty clear that the comment regarding quackery was not an effort to say that medical science is bad, or wrong, or quackery, and that we should abandon it with the same gusto that we abandon the quackery of holistic medicine studies.

    It seems pretty clear that the tweeter was trying to say that quackery is quackery is quackery; that medical science is guilty of it too, and that we should treat all quackery equally.

    As a statistician who works closely with medical researchers and also serves on an IRB, I see as much good science as I do hackery. Actually, I see more hackery because many researchers don't understand the statistical tools they use and often draw conclusions that are not valid or supported by the data. Despite peer-review, these studies still get published and still enter the canon.

    The idea that we should scrutinize all science with the same fine-toothed comb is valid, and not nearly as threatening as your post seems to assume.

  • jre says:

    Great post, and a bonus gold star for your correct use of the phrase "begs the question." Your twittering correspondent was indeed assuming that "Sci writers go in harder on quacks than pharma" without showing that this is so. I share your view that writers interested in medical science do criticize abuses by "pharma" -- but I think that criticism is different in nature from criticism leveled at pseudoscience. Corporate sleaze is distinct from woo in style, substance, motivation and the potential for correction. Pace Michael, abuses by "pharma" are not the same as quackery. They are violations of legal, ethical and scientific standards shared by the medical science community. When they come to light, they are rightly condemned both inside and outside that community and, when justice is done, they are punished. Quackery, on the other hand, is immune to condemnation for violating the standards of its own community, because that community has no standards of honesty. When was the last time you heard of faith healers or homeopaths bringing up one of their own on charges of making false claims? That is the reason quacks are criticized, and it is the critical difference between quackery and science. As a great man once said:

    ...I'd take homeopaths and I'd put them in a big sack with psychics, astrologers & priests, and I'd close the top of the sack with string, and I'd hit them all with sticks. And I really wouldn't worry who got the worst of the belt of the sticks.

    - Dara O'Briain