I would like to exorcise the demon represented by industry and assure you that we have several other demons, just look through our door...
The fact is that without the drug companies, we would not have many of the drugs that have allowed some more years on our life expectancy. However, the health of people in different countries does not necessarily depend only from drugs. Much of the population still die from problems like hunger, lack of sanitation, violence, accidents, etc...
It should be keep in mind that the logic of a pharmaceutical industry is the logic of any other industry, it must produce drugs with high potential to the market, in which case, is extremely competitive. The industry point of view, that is correct, does not consider the analysis of public policies in each country (only for profit), and how healthcare is, only how big is the market, the profits to be reached. The industry wants to sell too much to the highest number of people.
I have great friends working in the pharmaceutical industry, including some graduated from our institution, and I respect them very much. They work with high quality products and sell extremely well in our country. They do the job. Their industries pay the fees and taxes like any others but, do not promote the development of any of their drugs in Brazil, only the sale, and obviously they have a good profit. They are happy and believe strongly in their living model, continually criticizing Brazil's creeping bureaucratic system and we all know what that means...
Brazilian pharmaceutical industries have only recently benefited due to expiration of some patents, due to the use of reverse engineering processes and due to our biodiversity potential. We are walking a promising way in biologics products. Our economy is changing and after the global crisis of 2008, we still have a reduced market. We are lagging behind, slowly evolving...
Now, whose responsibility is it to coordinate public health policies? Who should invest in domestic industry? How often does the private sector come to the university for drug development projects? Who should decide whether or not a particular drug enters our country? What are the necessary medicines for our people? Who should know what is right or wrong for each patient? Questions? Problems? Thousands of them? Which are summarized in low government investment, low innovation, poor infrastructure, few cultural and social resources...and much corruption.
Obviously, the pharmaceutical industry lobby is immense. But which segment is not? How do you guys think U.S. congressmen or senators and congressmen in Brazil are elected? With cash savings? Millions of dollars of pharmaceuticals, armaments, oil, high tech and other industries feed politics. In Brazil, it is even worse... Our population ignores the facts.
In every field of human action this problem will occur, whether motivated by money or another motivator for conflict. This is inherent to the human race.
When I present the data about misconduct or interest conflict in class, I share the same surprise I had the first moment that I read it, however, I know the difficulties of fighting for a better and more humanistic world. I dare say that it borders on impossible, and always has been.
What to do? Cry, rebel, go to the Himalayas?
No!
I firmly believe that change occurs with knowledge. The oldest and acculturated civilizations have greater power than us to influence policies and decisions on all aspects of citizenship in an emerging and developing country.
Thus, we doctors, teachers, students, have a duty to multiply our knowledge, create and disseminate best practices of our professional practice and act as citizens to our patients, trying to give them the best and scientifically correct knowledge. We have an obligation to maintain our honesty and combat practices that are known to harm our fellow people. I think that EBM needs this focus.
When we are facing a big problem, almost always the solution can be quite simple. Faced with this immense problem related to conflict, money, politics, influence, lobbying, corruption, lies, etc., is not the solution the simple exercising of our best practices, carefully, with more and best knowledge, with criticism?
From a reading of Kant about moral reflection: "I should never act except in such a way that I can also will that my maxim should become a universal law."
Competing interests:
No competing interests
31 January 2014
Carlos A Caramori
Associate Professor
Fac Medicina, UNESP - Univ Estadual Paulista, Campus Botucatu, Departamento Cl Medica
Rapid Response:
Re: Evidence based medicine is broken
I would like to exorcise the demon represented by industry and assure you that we have several other demons, just look through our door...
The fact is that without the drug companies, we would not have many of the drugs that have allowed some more years on our life expectancy. However, the health of people in different countries does not necessarily depend only from drugs. Much of the population still die from problems like hunger, lack of sanitation, violence, accidents, etc...
It should be keep in mind that the logic of a pharmaceutical industry is the logic of any other industry, it must produce drugs with high potential to the market, in which case, is extremely competitive. The industry point of view, that is correct, does not consider the analysis of public policies in each country (only for profit), and how healthcare is, only how big is the market, the profits to be reached. The industry wants to sell too much to the highest number of people.
I have great friends working in the pharmaceutical industry, including some graduated from our institution, and I respect them very much. They work with high quality products and sell extremely well in our country. They do the job. Their industries pay the fees and taxes like any others but, do not promote the development of any of their drugs in Brazil, only the sale, and obviously they have a good profit. They are happy and believe strongly in their living model, continually criticizing Brazil's creeping bureaucratic system and we all know what that means...
Brazilian pharmaceutical industries have only recently benefited due to expiration of some patents, due to the use of reverse engineering processes and due to our biodiversity potential. We are walking a promising way in biologics products. Our economy is changing and after the global crisis of 2008, we still have a reduced market. We are lagging behind, slowly evolving...
Now, whose responsibility is it to coordinate public health policies? Who should invest in domestic industry? How often does the private sector come to the university for drug development projects? Who should decide whether or not a particular drug enters our country? What are the necessary medicines for our people? Who should know what is right or wrong for each patient? Questions? Problems? Thousands of them? Which are summarized in low government investment, low innovation, poor infrastructure, few cultural and social resources...and much corruption.
Obviously, the pharmaceutical industry lobby is immense. But which segment is not? How do you guys think U.S. congressmen or senators and congressmen in Brazil are elected? With cash savings? Millions of dollars of pharmaceuticals, armaments, oil, high tech and other industries feed politics. In Brazil, it is even worse... Our population ignores the facts.
In every field of human action this problem will occur, whether motivated by money or another motivator for conflict. This is inherent to the human race.
When I present the data about misconduct or interest conflict in class, I share the same surprise I had the first moment that I read it, however, I know the difficulties of fighting for a better and more humanistic world. I dare say that it borders on impossible, and always has been.
What to do? Cry, rebel, go to the Himalayas?
No!
I firmly believe that change occurs with knowledge. The oldest and acculturated civilizations have greater power than us to influence policies and decisions on all aspects of citizenship in an emerging and developing country.
Thus, we doctors, teachers, students, have a duty to multiply our knowledge, create and disseminate best practices of our professional practice and act as citizens to our patients, trying to give them the best and scientifically correct knowledge. We have an obligation to maintain our honesty and combat practices that are known to harm our fellow people. I think that EBM needs this focus.
When we are facing a big problem, almost always the solution can be quite simple. Faced with this immense problem related to conflict, money, politics, influence, lobbying, corruption, lies, etc., is not the solution the simple exercising of our best practices, carefully, with more and best knowledge, with criticism?
From a reading of Kant about moral reflection: "I should never act except in such a way that I can also will that my maxim should become a universal law."
Competing interests: No competing interests