Pharmaceutical ethics?

though-or because-they raise more questions than they answer. This multi-authored book is not among them. Early on we are told that its authors are outstanding leaders and thinkers from all segments of health care who will provide a fair and balanced view of the troubled relationship between the pharmaceutical industry and society. Puzzling, I thought: leafing through the list of authors I hadn't noticed the names of leading critics of the pharmaceutical industry, namely John Abramson, Surely, I thought, some of their well-documented examples will show up later, but both they and their ethical concerns are missing in action. There is virtually no mention of the pharmaceutical industry's major ethical lapses, such as hiring ghostwriters to write favourable journal articles, rigging study designs to produce favourable results, hiding unflattering results, failing to publish negative findings, promoting off-label drug use, giving bribes and kickbacks in return for promises to prescribe, and intimidating researchers whose results counter a company's interests. There is also little mention of shameless attempts by manufacturers to extend their monopolies, to block the production and sale of generic drugs, to put undue influence on the US Food and Drug Administration (FDA), to buy off large cadres of doctors, to promote drugs to treat social conditions, and to spend more money on marketing than on research-and, at the end of the day, to produce a shrinking list of truly innovative, clinically useful drugs. Inexplicably, with minor exceptions, most of the chapters have little relevance to the ethics of pharmaceutical companies. There are many "primer" chapters (some first class) on the implementation and ethics of clinical trials, research involving children, drug-prescribing practices, the role of the FDA, direct-to-consumer advertising, intellectual property rights, the influence of activists on the industry, and the application of cost-effectiveness analysis. These discussions bear mostly on the ethics of researchers and doctors, not on the ethics of companies. Eventually it becomes clear that the sole ethical issue addressed in this book is the disjunction between the profitability of drug companies and the vast health needs of the public; that is, between a profit-seeking corporate culture and societal responsibility. Industry has little interest in developing drugs to treat serious illnesses in large populations when there is no market with the capacity to purchase those drugs. The ethics of corporations demand that their activities maximize shareholder profits regardless of whether those activities also serve genuine societal needs; hence …