- BIOETHICS FORUM ESSAY
Walk it Off, Crybaby
On a recent installment of This American Life, Ira Glass asks this pressing question. Why are rich and powerful people so often the world’s biggest crybabies? Exhibit A: the whining of Wall Street bankers and brokers, who have worked themselves into a frenzy of self-pity over the cosmically unfair manner in which they are being treated by the Obama administration.
Never mind that these people are making record bonuses and profits. Never mind that the Obama administration bailed out Wall Street with a massive federal spending package last year, rescuing them from having to pay the price for their own arrogance and failure. Never mind that many people in the rest of the country are unemployed and struggling to pay the bills for the bail-out. Not only is Wall Street not grateful for the rescue, it is convinced that it is the victim of an historic injustice.
The mood on Wall Street this summer was captured perfectly by the CEO of the Blackstone Group, one of the wealthiest private equity funds in the country, who compared Obama’s plan to raise taxes on his company to Hitler’s invasion of Poland in 1939. When one banker was asked by This American Life why Wall Street doesn’t seem more grateful for the federal bailout, he seemed offended by the very question. “I mean, survival of the fittest!” he said, explaining that his wealth has nothing to do with aid from the federal government. Why is he rich? “Because I’m smarter than the average person!” he said. “The fact that I benefitted from that is because I’m smart.”
If anyone in America ought to be saying a silent prayer of thanks for the arrogance of Wall Street bankers, it is pharmaceutical industry executives. Finally, someone has taken their place alongside tobacco and oil industry executives as the most vilified businessmen in America. Yet consider the indignant letter posted recently in PLoS Medicine by an attorney for Wyeth Pharmaceuticals. Apparently, Wyeth is upset about an article by Adriane Fugh-Berman titled “The Haunting of Medical Journals: How Ghostwriting Sold ‘HRT’.” Drawing on internal documents made available to her when she testified as an expert witness against Wyeth, Fugh-Berman describes how the company used ghostwritten journal articles to promote Prempro, its hormone replacement therapy.
So what is the crime Wyeth is so worked up about? That Fugh-Berman – who writes in her introduction that she got access to the documents through her work as a paid expert witness in litigation against Wyeth, and also discloses that fact in her competing interests statement – did not specifically state that she is still working as an expert witness. Yes, that’s the crime. Not the breast cancer, not the heart disease, not the strokes or emboli linked to Prempro. The crime is using the incorrect verb tense.
Wyeth, of course, is the company that became notorious in the 1990s for covering up the lethal side-effects of its diet drug, Fen-Phen, which was linked to valvular heart disease and primary pulmonary hypertension. The bill for the Fen-Phen disaster is currently $13 billion and counting. In 2009, Wyeth was acquired by Pfizer, a three-time felon which paid out $2.3 billion last year to settle criminal and civil allegations that it illegally marketed Bextra, Geodon, Zyvox and Lyrica. The Pfizer settlement was the largest health care fraud settlement in U.S. history and the largest criminal fine of any kind. And now that Wyeth is being sued yet again – this time, by 14,000 patients who developed breast cancer while taking Prempro – it has apparently decided to take a lesson from Wall Street. Not only is Wyeth upset about Fugh-Berman’s expert testimony, it is angry that PLoS Medicine joined with The New York Times to force the company to make the ghostwritten documents public.
It is worth remembering exactly what we owe to people like Fugh-Berman, and to organizations like PLoS Medicine. Most physicians are terrified of the pharmaceutical industry, and most medical journals are financially dependent on it. As a result, the extent of industry wrongdoing was largely hidden from the public for years. That began to change when expert witnesses who had testified against the pharmaceutical industry began to make their findings public.
If not for David Healy’s work as an expert witness against Pfizer, for example, we would never have known that over half of all medical journal articles published on Zoloft during the late 1990s had been produced by a single medical communications agency working for Pfizer. If David Egilman, an expert witness against Eli Lilly, had not leaked internal documents toThe New York Times (for which he was fined $100,000 in a legal dispute) we might have never known about Lilly’s fraudulent marketing of Zyprexa. If not for Seth Landefeld and Michael Steinman at the University of California, San Francisco, who testified against Warner Lambert (now part of Pfizer) in the Neurontin litigation, we would not have the Drug Industry Document Archive.
The same could be said for what we know about the deceptive marketing of Vioxx, Paxil and Seroquel. Of course, expert witnesses are well-paid for their work. But the fact that so few physicians are willing to testify against the industry, despite the payment, suggests the extent to which the pharmaceutical industry is feared.
In a just world, the complaints of Wyeth about its unfair treatment at the hands of a single academic physician would be met with the ridicule that they deserve. Instead, these complaints will probably just frighten physicians even more. And that, I suspect, may be the real purpose of the letter: to intimidate anyone who might be thinking of testifying against them.
Carl Elliott, a professor at the Center for Bioethics at the University of Minnesota, is author of the new book, White Coat, Black Hat: Adventures on the Dark Side of Medicine. He is a Hastings Center Fellow.