Purdue, OxyContin, and the Perils of "Our New Ruling Class"

The Pharma Giles blog is best known for its satirical take on the pharmaceutical industry. So when its anonymous blogger chooses to drop the tongue in cheek approach and get serious, you know something is up.

This week, the subject was whether the punishment of those responsible for the deceptive marketing of OxyContin fit the crime. We noted here that this case was unusual in that some of the corporate leaders involved actually had to face some negative consequences, in addition to the usual fines levied against the company. However, there is an argument that even paying millions of dollars in fines is not that much punishment for extremely well-paid health care corporate executives.

ED Silverman, on PharmaLot, has chronicled the campaign by , an intrepid lady whose daughter died after taking OxyContin, to have "Howard Udell, Purdue’s top lawyer, disbarred, and Paul Goldenheim, formerly Purdue’s medical director, to have his medical license revoked." (See our post here.)

Much of Pharma Giles' rant is worth repeating:

Anyone who comes here regularly might know that beneath the froth and silliness that are my chosen sticks for poking Big Pharma with, one of my recurrent themes is the lack of accountability of Big Pharma executives. One could argue that there’s not a lot funny about people dying as a result of the misdemeanours of our big pharma companies, but I’d like to think that any reasonable person could see that the victims aren’t my targets, despite the hate mail I sometimes get. On the Purdue case, for example, I compared fictitious executives with Tom Lehrer’s “Old Dope Peddler”, which seem to strike a humorously ironic chord with some people, as intended.

Drugs like Vioxx, Oxycontin and possibly Avandia have all recently been launched onto an unsuspecting public in the quest for billion dollar profits, and have gone on to harm tens of thousands, even though there is evidence to suggest that the companies behind them had a pretty good inkling of the potentially lethal hazards and side-effects from data they chose to selectively ignore during trials.

People have needlessly suffered or died, at best because of complacency and at worst because of corporate greed, and as a result public trust in the pharmaceutical industry has never been lower. And because of public mistrust, the regulatory environment has become so tight that it is now much harder to launch new medicines of any sort – a situation which is a constant cause of whining by the pharma CEOs who are, ironically, ultimately responsible for creating the hostile regulatory climate in the first place!

Pharma industry wonks talk about the “risk/benefit” of new drugs, and yet it seems that these days it’s the public who take the risks and the CEOs and shareholders who get the most benefit.

Executives hide behind the line that they cannot be aware of every little thing that goes on their companies and therefore cannot be responsible for any illegal actions of their underlings. Sorry, guys, but just what do you get paid six, seven or even eight figure "compensation packages" for? By and large, it certainly isn’t for your personalities or good looks, is it?

I certainly believe that, given the magnitude of suffering caused by (at the very least) their inability to control the actions of their underlings, million dollar fines for multi-millionaires aren’t really much of a punishment. Or, indeed, much of a warning to other CEOs to keep a closer eye on what their minions are doing and saying in their name. I wrote a comment along such lines to Ed’s post on the issue, hence the e-mail I got from Ms. Skolek.

There’s a wider issue here, of course. Executives hide behind the superficially reasonable excuse of not being able to constantly monitor illegal activities by their underlings. Yet when employees actually try and tell them, well, we all know what happens to pharmaceutical industry whistleblowers, don’t we? Dr. Rost wrote quite a good book about his experiences. Pharmafraud recently recounted his. There are a host of other similar such tales out there.

If CEOs knew that as a condition of their multi-million dollar salaries, they would be held absolutely accountable for the actions of their companies, then maybe, just maybe, whistleblowers might be treated with much more esteem than they currently are at the moment. And I’m sure that CEOs would have a much greater incentive to ensure that their companies would actually operate in a much more ethical way than they do now.

But perhaps it is too much to ask of our new ruling class that they fully accept the risks as well as the rewards of their multi-million dollar lifestyles…

Hat tip also to the Clinical Psychology and Psychiatry blog. If we do not make sure that the governance of health care organizations is representative, accountable, transparent, and ethical, woe to us all. But on Health Care Renewal, we have documented far too many examples of how our "new ruling class" can be self-interested, unaccountable, opaque, and corrupt. Maybe the last thing we need in health care is a "ruling class."