I was struck by this recent Guardian article, in which Ben Goldacre showed how pharmaceutical companies systematically manipulate the evidence that reaches doctors and the general public about the efficacy or otherwise of their products, cherry-picking good results, suppressing bad or neutral ones.
It tells you something about the immense power of these companies that they can get away with this even in a country like the UK, where their dominant customer is single giant nationwide organisation, with a £100bn budget, and the power of the state behind it. (The English NHS is said to be the fifth largest organisation on Earth, but even so it apparently lacks the clout to say to its suppliers, ‘Either you’re transparent with us or we won’t buy your drugs.’)
For many years now, we have been fed a neo-liberal orthodoxy about the virtues of the unfettered market in which the free choices of consumers will reward efficiency and drive out mediocrity, and for years we have been told that state intervention is stifling and bad. But what stories like this one seem to demonstrate is that big companies actually work very hard to stop consumers making rational choices, and they work pretty hard too to avoid free competition (as the recent LIBOR scandal illustrated). Far from being the enemy of a free marketplace, heavy state intervention looks to me the only possible means of maintaining such a fragile, delicate and deeply artifical entity as a free and fair marketplace.
Without it, ultimately, you don’t get Adam Smith’s Utopian hidden hand. You get the Mafia.
A friend posted the link to the article on my Facebook page, hoping that I would see it. I read it carefully, was dismayed but not surprised, and reposted it. The article is important. It supported whilst not proving the correctness of a decision I took several months ago, not to take a certain med. I already knew that its side effects could be dangerous, had contacted medical agencies in three countries, heard some stories from doctors, dentists, and chemists in two countries, and decided that caution was called for. I was right. One national agency is being cautious, two others have approved it for use. All this while the manufacturer has, since 2010, refused to supply sufficient trial evidence and data about side effects to satisfy the cautious agency. It will investigate the med until at least November 2013. Several weeks after I took my decision I read Dr Goldacre’s article. It strengthened my resolution.
A good post. The extent of the dodgy relationships between the industry and the peer-reviewed journals that are supposed to scrutinise them is only just coming to attention. Bioethics too is having something of a dark night of the soul in this regard.
The difficulty lies in exposing this sort of practice without playing into – and driving people into – the hands of the equally dodgy elements like the anti-vaccination movement and some parts of the (multi-billion dollar) CAM industry. Ben G does a wonderful job of striking a balance in this regard.
And yes, you’re dead right about the ‘free market.’ Even where it is a desirable thing, we must remember that it is a product of human artifice, not a naturally occurring state. As such, it will often need active protection, rather than a hands-off approach.
Thanks for the comments, George and Colin. I’m been struck lately by the thought that the idea that the ideology of the free market is essentially UTOPIAN. It has posed so successfully for so long as tough and realistic.