Sunday, February 19, 2012

On skeptical priorities: CAM and Big Pharma

I’ve been thinking for a while about the priorities of the skeptical movement in general, including the importance of addressing sexism and racism, and specifically about differences in the respective treatment accorded to CAM on the one hand and Big Pharma on the other. This includes not only the overwhelming focus on CAM amongst skeptics, but the hostile and dismissive replies to criticisms of Big Pharma. There are skeptics – such as Ben Goldacre, Marcia Angell, and myself - who write about problems with both, but in the skeptical blogosphere generally serious skepticism concerning the claims and products of pharmaceutical corporations is minimized and very often met with derision, while jokes implying that “Big Pharma” itself is a silly and illusory invention are ubiquitous. Furthermore, the same sorts of evidence that are rightly rejected when coming from CAM advocates are often accepted (or at least not challenged) when presented in favor of Pharma’s products.

So I’d like to sketch out the various harms and benefits of the two, as a means, I suppose, of thinking through my own priorities and explaining my choices. Both Big Pharma and CAM cause extensive direct damage to humans and nonhuman animals, misshape our understanding of the causes of suffering, warp the scientific process and people’s understanding of what science is, misdirect energies away from more productive and just actions, waste valuable resources, and contribute to a view of ourselves which is damaging and inaccurate. I won’t be providing illustrative links for the items listed, but many examples can be found here or in the materials I’ve recommended (OK, and one new reference below).

Pharma, most obviously, makes drugs and devices that are ineffective and that harm or kill, sometimes in large numbers. They market and sell products that are ineffective, encouraging false hope. The development of their products – beneficial, neutral, and harmful; necessary and frivolous – often involves the exploitation and suffering of humans and other animals on an immense scale, both as research subjects and as the providers of needed materials.

The profit motives of pharmaceutical corporations lead to several profoundly negative effects on science. The companies prioritize the research that will benefit them, which is that which appeals to or is useful for the rich and powerful. They draw attention away from the social causes of, and responses to, suffering and illness. Both of these lead to the squandering of resources, as do the huge sums spent on marketing. They pathologize wide swaths of human thought, behavior, and suffering in order to sell treatments, in the process stigmatizing people and altering their self-conception and vision of society in the companies’ own interest, which has political ill effects.

They corrupt the scientific process, at every stage, in a huge variety of ways. They "fix" and suppress research. They work against practices of scientific sharing and openness. They corrupt medical researchers, physicians, educational institutions, scientific journals, and even ethicists, and in doing so corrupt the very foundation of medicine. They influence government in their interests. They work effectively to silence critics and to criminalize protest of their actions, enhancing corporate power and promoting a culture that is both authoritarian and insufficiently critical of human, animal, and environmental abuse and damage if it’s claimed to be in the service of medical goals. Finally, they promote a culture in which corporate science is seen as science per se, making it more difficult for science-based skepticism to get a fair hearing.

On the benefits side, pharmaceutical companies do produce useful and life-saving drugs (though the number of new ones has declined significantly over the past couple of decades). But this needs to be seen in historical context. I don’t think the argument that a system of medicine and public health dominated by corporations, given all of the negatives listed above, has been a boon to well-being in comparison to a system not based on profits and ownership but on research and production in the public interest is supportable. A system in which the power of these companies is drastically reduced would be a better one for science, medicine, and human and animal welfare and rights, and one in which they ceased to play a role altogether in favor of public control would be, in my view, best.

CAM, too, develops and uses treatments that harm humans and animals both in their development and in their use. Further, its proponents harm people by steering them away from needed effective treatments when these exist and are accessible. Though smaller in scale, the harms have to be weighed against the far smaller benefits offered by any CAM treatments. They provide false hope to suffering people, and make claims about the causes of illness and suffering that are false and distort people’s image of themselves and others, sometimes in profoundly harmful ways. Like Pharma, they ruthlessly go after and attempt to silence critics. Contrary to the self-presentation of many practitioners, CAM is big business, and economic gain is a major motive. They also corrupt scientific institutions and political agencies, though, due to their relative size and influence, to a far lesser degree than Pharma.

They cause severe epistemic damage, actually promoting practices that are not just unscientific but antiscientific. Much of CAM is not simply unsupported, but ludicrous. They promote a culture in which not corporate “science” but science itself is rejected, and in which people are led to view CAM as the sole alternative to Pharma-dominated medicine. This leads to false paths and misdirected energies amongst people with real concerns, problems, and criticisms, and to wasted resources. CAM is often racist and essentialist, both in its specific substantive claims and in its self-promotion as the alternative to “Western” science. It leads people, tragically, to see antiscientific movements as progressive, when this is the opposite of the truth. It makes the work of science-based progressive activists more difficult by encouraging the notion that there is a fundamental association between challenging the claims and actions of Pharma and challenging science, and between social justice and woo, and by misleadingly appropriating scientific criticisms for its antiscientific ends.

CAM treatments can ameliorate the suffering of people with conditions that can be genuinely helped with placebos, and its proponents do on occasion provide criticisms of corporate medicine and priorities that are accurate (though usually not original, and often set in a context of other, dubious assertions). But this amelioration pales in comparison to the harms, and their half-baked, antiscientific skepticism is used to steer people away from actions that would be productive.

So it seems criticism of both - Big Pharma and CAM – is urgently necessary. Really, the two feed each other, causing harm to human and nonhuman animals, promoting regressive politics, and weakening medicine and science. The solution isn’t a half-hearted acceptance of some aspects of each, but a rejection of both in favor of a solid science and system of public health that serves real needs and values rather than profits.

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