Some prompts are more challenging to
find a personal connection to. This was one of them. Even though it is a week
late, I have just recently watched a movie that I believe ties perfectly with
this topic of the triangle principle-agent model. The movie is called “The
Constant Gardener” and it made me think about the pharmaceutical industry and
the principle agent model.
The movie talks about the
principal-agent conflict with new drugs research and new drugs testing. It
shows the conspiracy of the Big Pharma using African people to test drugs which are destined to become
huge profit-earners in the West. These drugs were never tested in people and
therefore there is no knowledge the side effects or the efficiency of the drug
in humans. The movie is of course a piece of fiction, but it made me think
about the role of the researcher in the principal agent model.
I see the
researcher as the agent having to satisfy both the pharmaceutical company as
well as the patient. It is in the best interest of the researcher to develop a
new drug that may cure or help certain diseases. The interest the patient is,
of course, to get access to the drug that will help with the disease. The
interest of the firm is what causes a conflict. The firm is seeking profit,
therefore it does not want to spend a huge amount of money on research and
development, and it wants a revolutionary drug fast. The longer it takes for
the researcher to develop the drug, the costlier to the firm it is. There is
also the threat that the competition will come up with a cure first.
My dad and
my stepmom both work for a pharmaceutical company, Abbott and AbbVie, respectively
and I remember them usually bringing up two separate issues on the news. The
first was related to the Trovan developed by Pfizer. In 1996 Kano in Africa had
an outbreak of meningitis and Pfizer decided to start a trial with their new
drug on the children in the community. Desperate parents, who were not really
informed of the risks of the drug trial because of language barriers, ended up enrolling
their kids on the trial without being aware of the risks of joint pain etc… I
remember them discussing the dilemma faced by the researchers who wanted to
help those kids, and were expected to succeed on this trial versus the ethical
dilemma of getting an informed consent and accurate results.
The second
case was with the pharmaceutical company Apotex. Dr Nancy Oliveri of Toronto’s
Hospital for Sick Children was assigned to take part on the trial for a new
drug, Deferiprone, to treat iron build-up in patients with thalassaemia. During
the trial, she noticed worrying liver problems on the trial patients and raised
her concerns to the principal, Apotex. Shortly after she was dismissed and the
drug was passed in more than 24 countries. On this case, she stood with the
patients as the principal and sued the company.
There are
many more examples of Big Pharma trying to skew trial results or cover up
negative side-effects in order to release a new drug into the market. It comes
to the agent, to either release information of malpractice or stand by the
pharmaceutical and potentially hurt the patient.
Another
potential source of conflict is related to drug prices. The pharmaceutical
company holds a patent over new drugs to cover all the research and development
costs incurred over the years, this offers them a monopoly which allows them to
charge a premium. This is not necessarily the goal of the agent since many of
the patients will not have enough money to access the drug and therefore will
most likely be able to get cured or “better”. This was the case with Antiretroviral
drugs in the 90’s which cost from $10,000 to $15,000 a year per patient per
year. After a great deal of joint mobilization developing countries started
developing generic drugs against much pressure from wealthy nations to tighten
patent protection.
In this case
the triangle principle-agent problem involved the drug manufacturer, the
civilians and the government.
I didn't quite understand why this post is coming in now. However, you've earned some goodwill from me. So I will treat it as if it is on time. I hope you you will also get in the final post....very soon.
ReplyDeleteI read the novel The Constants Gardener by John LeCarre. It's better than movie and has a bunch of different issues, before the ill doings of Big Pharma enter the story.
I do want to note that in the U.S. even trials on animals (laboratory mice) are scrutinized and monitored. So there is the question of how to test a new drug and whether there is an ethical way to do this. I don't really know the answer to that question, but I will suggest a procedure that might make sense to you. This is to do limited trials on animals first. If there are adverse consequences in a high fraction of outcomes stop. If not, expand the trials and repeat the idea. Do this a few times. Only if there are very limited bad outcomes do you go to human subjects, and then you use a staged approach there as well. This will lengthen the time to when the drug might be deployed.
There is a flip side to this, written about many years ago in a book called Arrowsmith by Sinclair Lewis. (There is an old movie about it that stars Ronald Coleman.) The issue there is whether if you think the drug is quite potent against a horrible disease, is it ethical to withhold it from people to test its potency, by comparing those who have received the treatment from those who haven't.
Then there is the movie The Insider, which is based on a true story, where it is Big Tobacco rather than Big Pharma that wants to manipulate the information. A big part of that story is that the researcher had signed an NDA with his employer, so making the information public was a breach of contract. I wonder if that was also trued in the case of the Big Pharma examples that you described.
Let me add one other point for you to consider. In class we talked about the quality assuring price. If you think that is doctors who are the customers of Big Pharma, because they are the ones who write the prescriptions, you wonder why some of the stories you told don't come back to bite the companies in their other drugs, which would be a mechanism to prevent them from promoting bad drugs. But that doesn't seem to happen. So you might consider why that is.
The previous comment seems to have been published with white font. I wonder if you can change that without deleting the comment.
ReplyDeleteI haven't seen the movie, "Constant Gardener", but I would be sure to add it to my must see movie list for winter break.
ReplyDeleteI think pharmaceutical companies and hospitals are a great example of the Triangle-Principal Agent problem. The hospital is principal one, and the patients are principal two. One of the main aims of principal one is to make profit for the hospital while keeping its reputation high. Principal two wants to save as much money as possible especially if her insurance company does not provide full coverage. The agent is the pharmacist or doctor who serves as the middle man working to help both parties reach their goal. Thus, your example very well explains my concept as the hospital did not want to waste time, money and resources doing research when they can easily test the drugs on others to see the effect.
Both of your examples are really sad, and it is just unfortunate that people in need end of being vulnerable. Dr Nancy Oliveri did the right thing, but not everyone can act as a good citizen and not be opportunist. Indeed, cases like this keeps me wondering how we can eliminate triangle principal model problems that has adverse effects on others.
This reminds me of an episode of Royal Pains that I watched where they talked about people with uncommon diseases or conditions and how since that condition isn't common enough, there aren't any drug companies putting any effort or research into finding a cure because it won't be profitable. It honestly kind of opened my eyes on the issue of people with rare conditions because they don't get enough funding to find a cure for those conditions. Any disease is bad but it's really sad to think of the possibility that some of these rare conditions might be simple to cure, but it doesn't get enough recognition for pharma companies to put money into finding treatment.
ReplyDeleteI can imagine the internal conflict many pharmacists and researchers feel when having to choose between doing good for the patients and following the directions of their employer (Big Pharma). It is ridiculous how expensive medication is in this country.