To advance even a solid idea requires, ideally, close communication between industry and outside experts: university researchers, who often developed the
science and understand it the best; practicing clinicians, who can describe where the medical needs are the greatest, and what properties an ideal
therapeutic would have; and patients, of course, who understand better than anyone else what they need, and where existing approaches may fall short.
We should strive to cultivate, not demonize, these sorts of interactions.
The signaling problem that's developed is especially unfortunate: we're taught to distrust the physicians and university researchers who consult the most
with industry, yet it's often these experts who are the smartest scientists or the most experienced clinicians -- that's why companies seek them out. In
essence, we're stigmatizing (and increasingly, seeking to exclude) experts who are arguably the most worthy of our admiration.
It's true that industry has seen its share of bad actors; so has academia; yet in
both cases, we should be careful about generalizing from sensationalized examples to condemn everyone who works in pharma -- or in universities, for that
It's also true that drug companies seek to turn profits, which many seem to regard as fundamentally incompatible with wanting to do good. But Whole Foods
CEO and "Conscious Capitalism" champion John Mackey
has it right when he explains
, "Making high profits is the means to the end of fulfilling Whole Foods' core business mission. We want to improve the health and well-being of everyone
on the planet though higher quality food and better nutrition, and we can't fulfill this mission unless we are highly profitable." I enjoy farm-raised
salmon and oven-roasted kale as much as any Californian, but I'd like to think that the pursuit of new medicines represents at least as worthy an endeavor.
Looking ahead, many worry that increased focus on cost will further fray doctor/industry relationships, but I see a far more hopeful future.
Increasingly, everyone in health care -- providers as well as medical products companies -- will be asked to demonstrate the value of their goods and services, asked to prove that they
are really making a difference.
Doctors who are paid based on quality metrics, or who are "accountable," and own some of the risk, will be highly motivated to think especially critically
about their therapeutic choices, and are likely to discover many instances where a powerful new medicine turns out to provide the best, most economical
option -- when total costs are considered.
Medical products companies will also be under tremendous pressure to
deliver medicines capable of rigorously demonstrating value
. To understand what would be worthy of use, drug companies will need to speak to clinicians; rather than stick their heads in the sand, Kaiser physicians
should engage with medical product companies, participate in this dialog, and help increase the chances that they'll be able to prescribe better medicines
to patients in the future. Participating experts also deserve to be compensated for their time, as Kaiser can both well appreciate and precisely calculate.