A recent article in the journal Science described a significant gene-therapy based advance in the treatment of two boys with adrenoleukodystrophy (ALD), a rare and lethal genetic disease. This was wonderful news for those who have affected family members. This devastating affliction was the focal point of the beautifully crafted movie “Lorenzo’s Oil.” The film chronicled the true story of Augusto and Michaela Odone’s desperate search for a cure for their afflicted son Lorenzo.
One of my favorite scenes from the film portrays a British scientist, Don Suddaby, who is in the twilight of his career. Six months away from retirement, Don takes on a special challenge at the request of the Odone family: purify a special oil for testing as a possible treatment for the disease. As he drives himself to synthesize the oil, the scientist’s young supervisors fear that he will collapse from overwork. Ultimately, they resist the urge to interfere with his efforts. After a career spent working on face creams and cosmetics, it is apparent to everyone that he is having the time of his life working on this potentially life-saving task. At the end of a long night spent completing the purification drop by drop, Don announces he is going home, asks his supervisors to ship the finished oil to Lorenzo’s parents, and slowly shuffles down the hall into retirement. It is a beautiful portrait of a scientist ending his career on its highest note. Fittingly, Don was recruited to play himself in the film.
Don Suddaby’s character in Lorenzo’s Oil stands in marked contrast to the megalomaniacs that often show up as scientists and doctors in the movies. Recent examples include Gene Hackman’s warped doctor in “Extreme Measures” and Kevin Bacon’s deranged scientist in “Hollow Man.” In these and countless other sci-fi films, it’s usually a single individual who takes the deep dive into the insanity pool. As a scientist working in the biotech industry, I’m always interested in how people in biomedicine are portrayed in the movies.
Since 1992, when “Lorenzo’s Oil” was released, I’ve noticed a more disturbing portrayal of pharma and biotech companies cropping up in films. For the industry, the images are not good. Greed, corruption, mendacity, and murder seem to be the emerging elements in cinema’s portrait of corporate misdeeds in biotech and pharma. My sense is that the blame is going more toward the corporations than the individuals, but I worry that these portrayals really make all scientists look like bad guys. Let’s review some recent renderings of pharma in film:
“Coma” (1978) brings us to a hospital in which young, seemingly healthy patients emerge from minor surgery in comas, leading to their transfer to a long-term care facility. One young doctor becomes suspicious after a friend of hers suffers this fate. Her sleuthing reveals a conspiracy: patients have deliberately been put into comas by corrupt physicians and their accomplices seeking to profit by selling off the patient’s organs to the highest bidder. The doctor manages, at great personal risk, to expose the evildoers at the film’s conclusion.
In “The Fugitive” (1993), corrupt drug executives of Devlin MacGregor Pharmaceuticals alter clinical trial data to remove evidence of serious liver side effects that would prevent their drug from being approved by the FDA. This leads to the murder of a doctor’s wife, for which he is blamed. A fugitive, he undertakes a frantic search for his wife’s killer before he can be imprisoned for her murder. He successfully exposes the corrupt drug company leadership in the movie’s climax. The rationale for the murder was unique to the film; malevolent pharma execs played no role in the original TV series on which the film was based.
In the thriller “Deep Blue Sea” (1999), a team of biotech scientists is working to develop a cure for Alzheimer’s disease. Under pressure from their financial backers to get results ASAP or have their project shut down, they undertake the illegal (as well as ill-considered) approach of using gene therapy techniques to enhance the brain size of mako sharks. Of course, this makes the sharks smarter and eventually leads to a murderous rampage that involves munching most of the unscrupulous scientists and their financial backers.
In the 2005 film “The Constant Gardener” (based on John Le Carre’s novel), the Swiss pharmaceutical company KVH and it’s African partner ThreeBees go to great lengths, including murder, to cover up the severe side effects of a new tuberculosis medicine being improperly tested in Kenya. The conspiracy involves not just the pharmaceutical company and its distributor, but corrupt politicians in Africa and England. At the film’s end the conspiracy is uncovered through the efforts of the title character, the diplomat husband of the murder victim.
All of the films above diverge from earlier portrayals of doctors and biomedical researchers engaged in the search for new drugs and treatments. Have any of you seen Edward G. Robinson in the title role of “Dr. Ehrlich’s Magic Bullet” (1940), detailing the discovery of a treatment for syphilis? How about the 1936 film “The Story of Louis Pasteur,” which recounts the discovery of vaccines for anthrax and rabies? Heroic biomedical scientists also make appearances in other films, such as “Awakenings” (1990) “Medicine Man” (1992) and “Outbreak” (1995). Sure, there have been movies about scientists trying to play God (and receiving their comeuppance) nearly as long as there have been films, “Frankenstein” (1931) being a classic example. But the more recent trend of corrupt biotech and pharma companies is relatively new.
How is it that pharma’s reputation has fallen so badly that it is now demonized in the movies? What have they done to deserve this? A search of my archives revealed numerous recent examples of questionable, if not outright illegal behavior that may not have spawned this cinematic trend, but certainly continue to show the industry in a bad light. Some recent illustrations:
Pay-for-Delay Agreements. This is the anti-competitive practice by which pharma companies pay off potential competitors to NOT make cheaper generic drugs that will rival their own, more expensive brand-namemedications. For example, Bristol-Myers Squibb paid a $2.1 million fine as well a $125 million shareholder settlement over the company’s failed attempt to negotiate a favorable drug patent settlement with the generic manufacturer Apotex. While not currently illegal, the Federal Trade Commission is trying to curb this egregious practice and has estimated it would save consumers some $3.5 billion annually.
Off-Label Drug Marketing. This is the practice of marketing drugs for uses they were not approved for by the FDA. This happens so often, it is clearly considered a cost of doing business in the industry. Recent settlements with the government include Pfizer ($2.3 billion dollar fine), Eli Lilly ($1.4 billion), Cephalon ($425 million), and Otsuka ($4 million). Part of what Pfizer paid ($1.19 billion) constituted the largest criminal fine in U.S. history.
Corrupt CEOs. This is certainly not exclusive to the pharma industry, but where do they find these guys? In the past few years, we’ve seen CEOs canned amid accusations of insider trading (ex-ImClone CEO Sam Waksal), sexual harassment and income tax fraud (ex-Astra CEO Lars Bildman), generating bogus data (ex-Sequenom CEO Harry Stylli), and wire fraud (ex-InterMune CEO W. Scott Harkonen), for distributing a press release that falsely portrayed clinical trial results.
Ghostwritten Science Articles. These are papers that are written for scientific journals by drug company employees, not the independent academics who were listed as authors. They are generally crafted to show the company’s drugs in a positive light, and are supposed to carry weight because of the credibility of the named authors. This apparently widespread—and deceptive—practice has led scientific journals to respond with (what else?) “ghostbusting.”
Fake Medical Journals. In was revealed this year that in 2003 Merck paid Elsevier, the publisher of many peer-reviewed scientific journals, to print several issues of The Australasian Journal of Bone and Joint Medicine, which was not peer reviewed and was not a legitimate medical journal. This was simply an advertising vehicle for Merck in the disguise of a real publication. Hooking up with a legitimate publisher of biologic journals helped to sell the illusion.
Serious Prescription Drug Pollution. Drug levels in treated wastewater from a plant where Indian drug companies dump their residues were 150 times higher than the highest level detected in the US. Be thankful you don’t have to drink this stuff. This problem is hardly unique to India. In the US, antibiotics, anti-convulsants, sex hormones and other pharmaceuticals have been found in the drinking supplies of at least 41 million Americans.
Raising Drug Prices. In 2009, pharma companies have raised drug prices an average of about 9% at a time when the Consumer Price Index—a common measure of price inflation in many consumer goods—has fallen 1.3%. This was the highest increase in drug prices in years.
Attempting to Fix Company Mistakes Via Legislation. The Medicines Company mistakenly filed some patent extension paperwork one day later than it should have. The mistake will cost the company four years of patent protection on its drug bivalirudin (Angiomax), and potentially hundreds of millions of dollars in revenue. To fix this, the company has spent millions of dollars on lobbyists working to draft a bill that would retroactively rectify the mistake. The Patent and Trademark Office’s director has said that the legislation, if enacted, would apply to only one drug. Guess which one?
Tax Evasion. Several companies have paid huge fines for practices in which they funneled money offshore to hide cash from US tax authorities. Schering-Plough lost a $437 million tax case in New Jersey for parking money in Ireland, and Merck has to pay $2.3 billion to the IRS for tax avoidance in Bermuda.
Putting Words in Your Politician’s Mouths. Portions of speeches given by lawmakers debating healthcare reform that found their way into the Congressional Record have been traced to lobbyists working for Genentech. The company estimated that 22 Republicans and 20 Democrats picked up on language crafted by their lobbyists. While some of these politicos received contributions from the company or were beneficiaries of fundraising efforts, according to Genentech “there was no connection between the contributions and the statements”.
Bribing Foreign Officials. This can certainly facilitate selling drugs in their countries. The US Justice Department has promised to crack down on pharma providing foreign officials with cash, gifts, travel, meals, entertainment, etc. This is an extension, of course, of good old-fashioned domestic bribes. Biovail Pharmaceuticals agreed in 2009 to pay nearly $25 million in criminal and civil fines for compensating doctors to prescribe or recommend one of their drugs.
Failure to Complete Clinical Studies. Between 1992 and 2008 the FDA asked drug makers to complete 144 clinical studies in support of 90 drug applications, according to the Government Accountability Office. These applications were part of a program intended to speed drugs to patients with life-threatening illnesses. Fifty-two of the studies remain uncompleted, with 15 pending for more than five years and several others by more than eight years.
Hiding Payments to Doctors. This is another widespread industry practice that has forced a number of companies to recently change their practices. The Institute of Medicine recently issued a report about the need to adopt “conflict of interest policies” to avoid perceptions that would serve “to undermine public confidence in medicine”.
A 2007 survey by the marketing research firm Ipsos revealed that only about one-third (35 percent) of Americans had a favorable opinion of the pharmaceutical sector. Does the industry acknowledge that it has not only an image problem, but an ethical problem as well? Both Pfizer CEO Jeff Kindler and Merck CEO Richard Clark have given speeches in the past year recognizing the need to regain the public trust. It would seem that the first step in such a campaign would be to curtail the corrupt practices detailed above.
Whether the industry is capable of reforming itself remains to be seen, and, given the examples cited above, would clearly be a huge undertaking. Huge amounts of money are at stake, the industry isn’t monolithic, and the companies are spread out over a large number of countries. Reining in the excesses of all of its members is unrealistic. However, they need to seriously examine their actions and put in place industry-wide reforms if they hope to regain the public trust.
In the meantime, I’ll get the popcorn popping in anticipation of next month’s release of Extraordinary Measures, a film (inspired by a true story) that stars Harrison Ford as a researcher enlisted by desperate parents seeking to cure their children’s rare disease. Sound familiar? Harrison Ford may be a fine actor, but I’m betting he’s no Don Suddaby.
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