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Ethical Pharma's Code of Ethics

What's the difference between 9% and 400% and 5000%? Unfortunately, the easy answer is that two of those percentages get you on the front page of mainstream news, and a whole lot of Twitter abuse, and the other gets you adulation and admiration from the 'moderates' in the industry.

But who decided that Brent Saunders' 9% rises per year (I'm guessing that's what 'single digit' means...) is OK and Martin Shkreli's 4000% isn't? We didn't discuss it. We did have a lot of people hoping that the spotlight wouldn't turn to them during all of the recent noise. But, that spotlight is getting bigger (whichever President the US may have, come November, they're bringing big torches). Shkreli may be hard to like, but he's not all wrong: he makes the point that when a certain German large pharma company realised what he was planning to do with the drug he wanted to buy at Retrophin, they stopped the sale. And then immediately increased the price themselves by 400%... And, if we're not more ethical than he is, we have a problem.

With a distinct sense of unease that we seem to generate our positions and our defences on the fly when we hit the front page, I started (25 years too late, to my shame) to look for our industry's Code of Ethics. And, it turns out, there is none. Of course there are Codes that touch on what we do: medical ethics, bioethics, etc., that are deeply rich disciplines and that we import to guide behaviour in studies (for example on adaptive trial design). We have legal frameworks so we can self-police before anyone puts us in jail. But a Code, the Code? Nope...

And I struggle when I see bodies like PhRMA, BIO, ABPI, EFPIA et al holding a 'defend at all costs' approach (unpleasantly akin to the NRA), in case anyone upset our 'innovation'. Well, I'm sorry, but our 'innovation', in good years, amounts to some 40-50 new products, and we're charging the world for the 50,000 that it took us to get there, with a plan only to increase that number.

So, I've had enough. When I received a lifetime achievement award at PharmaVOICE100 last week, I wanted to review what I'd done, and hadn't done, with that 'lifetime'. I had already polled quite a few folks to see what they thought about this idea: let's develop a Code of Ethics for the industry. Every single person agrees we should have one. They had questions, of course. Their questions fell into these themes:

  • Don't we have one already?(In a shocked voice.) No, we don't.
  • Won't it get co-opted by the industry groups? No, it won't. I am going to invite them to participate, and hopefully align to, but it won't be theirs. It will be ours. Same with the companies.
  • Can I help? Yes.
  • What will it cover? Well, to start, there's pricing and price rises. There is trial inclusion/ exclusion, trial designs, data transparency, promotion, developing world access, IP, generic competition, and a hundred other areas that I can already think of.
  • Won't this seem negative? I don't think so. I want to be proud to work for pharma. I want to know that we have decided as an industry that some of what we do is OK, and some of it isn't. And then stand behind that view when it is both inconvenient and when it is convenient. (Oh, and by the way, if we think that anyone thinks what we're currently doing seems positive, they're not watching...)
  • What makes you think you're the right person to do this? I am very sure I am not (I have no training in ethics, despite reading a lot in that space). But I am the person who is going to start it.
  • How are you going to do it? I am not sure yet. This isn't an IDEA Pharma initiative - bless them, they've enough on! So, I am inviting support, offers of research, and mass participation from everyone. I don't have the answers - I don't expect any one of us does.
  • When will there be a Code? I hope, by this time next year, we'll have a draft. I don't expect that to be the final draft, but I do hope, every year, we have a Code that is not 'in progress' but a working document for us to stand behind.
  • What will it look like? I don't know yet, but I do know that we should have simple headline principles (maybe 10-12 main points) and supporting chapters.

We all want to feel proud to work for pharma. And I bet each and every one of you is sick of being concerned about mentioning that you do work for pharma, in polite dinner party conversation. We have no defence. Yet, I have never met anyone (on the R&D side, particularly) who didn't come to work to make great medicines, and a reasonable profit. We need the world to know that we have debated, and discussed what we do, and that we believe we have an ethical position.

We will have a Code of Ethics.

If you'd like to help me figure out our first (or our second) steps, email me or message me via LinkedIn. Are you in?