The Next Tyranny to Collapse: Could It Be Big Pharma?

The Fall of Mubarak, illustrated by Thomas James (

See how they run, the deposed dictators, brought down by their formerly subjugated populations via Facebook Power: the new social-networking tools of information exchange.

The old despotic attitudes of top-down hierarchical leadership have been laid bare through a new transparency, born of the Internet. In this new light, the old methods of leadership, accurately described as “command-and-control,” are seen for what they are, tools of oppression. Now the tyrannized have risen up; the silenced have discovered their voice. Decades of accumulated injustices must now be accounted for.

These phrases apply to the ousted regimes that once ruled the nations of Tunisia and Egypt, and to the unravelling rule of strongman Muammar Gaddafi in Libya. The trend is clear: In the age of Wikileaks, Facebook and Twitter, crude authoritarianism will be starkly revealed and repudiated by a public empowered by free access to information. And so, absolute-rulers such as Zine El Abidine Ben Ali and Hosni Mubarak (to be followed by Colonel Gaddafi, and others) belong to the past, and their grip on power and treasure are artefacts of memory.

That seems to be the 21st Century fate of those who cling to the past-century notion of command-and-control. The emerging question is, however, will this popular uprising against top-down hierarchies continue to be directed against governments, or will private-sector institutions soon become subject to the same forces?

It’s a question with a pre-determined answer, since the lines that separate public and private interests have become largely illusory, in the wake of the 2008 crises in the banking, investment and automotive sectors. And perhaps nowhere do the intersections between public and private interests become as blurred as when you examine one business, the business of healthcare.

Worldwide governments and healthcare. They have, with steadily increasing intensity since the UK brought forth the National Health Service in the late 1940s, played the role of bed-mates who refuse to come to terms with, or even acknowledge the true nature of their relationship.

And what exactly is the relationship? Public health agencies determine which pharmaceutical agents may be marketed — and where, and to whom, and when, and how. Public formularies decide which products are acquired for patients, using the common purse. In most nations (with the United States, until very recently, as a defiant partial-exception), public funds directly pay practitioners for health services. So, let’s not fool ourselves. Stripped of the dignity-saving pretence you read in annual shareholder’s reports, the healthcare industry works for the government — unless (as Michael Moore and others might argue), it’s vice-versa.

These are legitimate questions for today’s empowered information-seekers to ask: Who works for whom? Where does the accountability lie? Mubarak famously held popular elections, but his actual constituency was the officer-class of the Egyptian military. Those in the healthcare sector like to talk about “putting patients first,” but there exists the equivalent of a tiny, enabling power-base, in the form of Wall Street securities analysts, and (with declining enthusiasm) local regulatory agencies. There can be little doubt that these traditional working relationships between investors, institutions, regulators and the Life Sciences industry have worked admirably to serve and improve the public health, but there are signs that the fastening is coming undone.

In the United States, where one agency of the federal government, the FDA, is tasked with approving new therapies for use, effective this year, a second agency, the NIH, has been assigned the duty of discovering new drugs to treat problematic conditions.

The brand new National Center for Advancing Translational Sciences, which is likely to be funded by a billion dollars of taxpayer’s money, is a response to what NIH director Dr. Francis S. Collins says is a 15-year decline in the drug industry’s research productivity, which, he adds, “certainly doesn’t show any signs of turning upward.”

This marks a fundamental change in the equilibrium between Big Pharma and Big Government. The implications may be viewed several different ways, but one thing is clear: It’s the end of the era when the branded pharmaceutical industry was able to justify its outsized margins based on the need to accumulate multi-billion dollar war chests to deploy in the hunt for new medicines. Now that government has assumed a greater portion of the risk in developing new drugs – essentially telling Big Pharma, “You don’t know what you’re doing” – the private sector’s economic rationales and assumptions are undermined.

What is the next domino to topple? Intellectual property protection is already being assailed by proponents of the “open source” approach to developing pharmaceuticals, whereby group-effort research takes place on the Internet, leading toward public-domain discoveries. The right to communicate the therapeutic advantages of products to prescribers is being potentially challenged by initiatives such as the Cochrane project, which promote supposedly objective “best practices” via the Internet. Similarly, new laws in several states require the disclosure of all payments offered to practitioners by commercial enterprises – once again using the Internet.

It is tempting to emphasize the parallel between how the Internet led to the lightning-fast downfall of the Tunisian and Egyptian regimes, and how private corporations may quickly face similar consequences.

However, more than one factor beyond social-networking technology led to the collapse of the political entities in question. It may be said of the fallen dictators that they were reluctant to listen to the people, overly dependent on sloganeering and symbolism, too reliant on the scale and size of their infrastructure and field forces, fixed on the monomaniacal necessity of maintaining the status quo, and unduly influenced by weak counsel. Their arrogance and obliviousness directly resulted in a loss of their legitimacy. It’s a good thing that the management of the multinational pharmaceutical industry has recognized the need to eschew the principles of top-down hierarchical leadership, and has embraced the democratization of knowledge.

Oh. Hang on a minute.

They have done that, haven’t they?

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