Prejudice and Pride

Nick Broughton

pharmaceuticalethics.com

It was about 2am and I was tacking up Oxford Street in the peculiar manner universally adopted by those who have had one over the eight. Dressed in a dinner suit, my posh watch gleaming in the orange hue of the streetlights I could have done little more to advertise myself as a potential mugee. In my peripheral vision I became aware of two persons paying me close attention and blind prejudice came unerringly to my rescue.

Prejudice gets a bad name. Give it a Google and all manner of negativities are described or implied, ‘an unjustified or incorrect attitude (usually negative) towards an individual based solely on the individual’s membership of a social group’ to give but one example. For myself I prefer to view prejudice with less…err… prejudice…for like all common human emotions both ‘good’ and ‘bad’ it must surely have a basis in evolution unless we are to descend for an explanation to the realms of mysticism or to considering the human condition as somehow special.

"Articulated lorry running out of control towards two people an eighty year old lady and a six year old girl. You can save only one and the other will surely die. Who will you save?"

My Oxford Street encounter whilst not quite a momentous evolutionary event did at least provide me with a glimmer of an explanation for the evolutionary basis of prejudice, one which subsequently I found is described in academic literature. Viewing the youthful hooded figures behind me I drew several conclusions about their character that could best be described as featuring a strong thieving git motif. My prejudice led me to turn down a side-street and hide (in a very manly sort of way). When they followed and then doubled back on to Oxford Street on seeing me doing the same they were no longer gits but bastards and rapidly aspiring to unprintable realms. I hailed a cab, if I’m going to get robbed I’d prefer it to be by someone with a licence to do it.

I may have been unfair to those two young gentlemen of course. They may have been pursuing me with concern for my obvious incapacity or to ask what o’clock it be but my prejudice didn’t give them chance. I drew conclusions and made decisions rapidly on a very limited amount of information to lessen the threat to myself. My prejudice (probably) saved me as it has countless humans through antiquity by driving rapid action on limited information. Prejudice is a survivor and the instinct to reach conclusions rapidly and act when under pressure is hardwired into each of us.

That a capacity for making judgements on limited information has been an evolutionary advantage and is instinctive (but not exclusive) to humans as a species seems to me to be self-evident but this is not to say that prejudiced behaviour is always ethically acceptable in modern society, it clearly isn’t. Many human instincts have a time and a place where they are necessary and a time and a place where they are just plain wrong, lust would be a pre-eminent example but prejudice no less. Rather than analyse clearly immoral prejudice such as that based on race or sexuality let us look rather at the prejudices society seems to equivocate on, prejudice in favour of the medical profession, prejudice against the pharmaceutical industry and, as a kick-off, age prejudice.

"...someone somewhere (actually a lot of people in a lot of places) must be acting uncaringly, unethically towards elderly patients."

Age prejudice? What’s that doing there? Surely this isn’t equivocal but a slam dunk immorality? Well you might think so but try this thought experiment on for size. Articulated lorry running out of control towards two people an eighty year old lady and a six year old girl. You can save only one and the other will surely die. Who will you save? You may post rationalise with talk of a good innings but let’s stop flannelling, we have a prejudice to youth and the audiences where I’ve presented that scenario recognise it although a bit of seat squirming is involved. To me being age prejudiced is not the immoral act, the immorality is not recognising it and actively countering it. The mark of a moral society is not that it doesn’t carry natural human prejudice but that it recognises and overcomes it and treats all, particularly the elderly, with equality and with kindness. Which brings us in a roundabout sort of way to ‘Dignity and Nutrition’, car salesmen, the healthcare professions and pharma.

The Dignity and Nutrition Inspection Programme was conducted by the Care Quality Commission and reported in October 2011. The report was initiated by the Secretary of State for Health in response to concerns raised by charities about the poor care being experienced by some elderly patients within the NHS and was based on the results of 100 unannounced inspections of NHS hospitals. Despite there being some ‘good and excellent care’ there was in the report ‘a great deal…to give cause for alarm’, principally that one in five hospitals inspected weren’t meeting minimum standards required by law. This was top billing on the morning news but by teatime was drifting and by the next day was gone. Expunged from public consciousness more likely than not by a celebrity mishap, an outstanding example of the selective memory positive prejudice towards the health professions can engender.

For one in five hospitals to be delivering elderly care which is breaking the law someone somewhere (actually a lot of people in a lot of places) must be acting uncaringly, unethically towards elderly patients. The report names institutions but people are involved, yet the cleansing power of positive prejudice towards the health professions has a purging quality. Consider how a report would be received that stated one in five pharmaceutical companies was breaking the law and putting patients at risk – the hullaballoo would persist for years but this is the nature of prejudice. Bad behaviour by those you are prejudiced against you see as ‘typical’ another example of a wider malady, bad behaviour by those you are prejudiced in favour of is ‘exceptional’, an outlier, something to be explained away or forgotten.

I’ve just bought a car but as usual I didn’t really enjoy the process although I’m happy with the car in question. The reason I’m sure is a pervading suspicion of car salesmen that I share with a large part of the population. A recent online pole put car salesmen as absolute bottom of the list in types of people you trust, telemarketers being second worst. The car salesman I had was fine, a nice chap but my prejudice won’t recognise this in my wider appreciation of his ilk. He was an exception, the person I remember is the guy who sold me that clapped out Polo in 1989 – typical car salesman he was.

"The unethical trial, the non-transparent sponsorship, the incentive to prescribe the selective reporting of results, all are referenced in outraged polemics."

I don’t feel too sorry for car salesmen for after all the same injustice is perpetuated on pharma and probably always will be. The natural public suspicion of profit driven corporations is compounded for pharma by the fact profit is gained from poorly people at public expense. I can accept prejudicial viewing of pharma by the public but I have less patience with our gainsayers in the medical ranks when they fail to recognise the disorder in their own house. High profile speakers from medical journals and bloggers on the science arts have become adept at identifying and outing the failings of industry. The unethical trial, the non-transparent sponsorship, the incentive to prescribe the selective reporting of results, all are referenced in outraged polemics. It is right to out bad ethics in pharma but more questionable to portray it as typical and wrong to ignore the powerful positive benefits the pharmaceutical industry brings to the world, at best such behaviour is selective reporting, at worst it is bigotry and hypocrisy.

The healthcare professions and the pharmaceutical industry are not on different moral planets. Both must have the safety and care of the patient as their primary consideration, both bring benefits to the world and both fail from time to time (sometimes spectacularly) in providing the care they should. Prejudice in favour of health professionals has the potential to hide some serious issues within healthcare and prejudice against the pharmaceutical industry is unjustly perpetuated by some within the medical world who fail to see the problems in their own glass house. The former point is important but something for healthcare to deal with, the latter point of little real consequence to the wider world. What is important to me is that we who work in pharma don’t let ourselves adopt an ethical position that is secondary to that of the healthcare world – creation, development, production and promotion of medicines is a difficult complex process, let’s take pride in that and make the ethical case for it in the face of those who would have it otherwise.

About the author:

Nick Broughton is Managing Director at Pharmaceuticalethics.com.

Dr Nick Broughton qualified at Nottingham University Medical School and worked in hospital medicine and primary care for a period of seven years before joining the pharmaceutical industry.

His first role was as a clinical research manager in phase II and III at studies Sanofi Winthrop before moving into a medical adviser role at MSD UK.

The majority of his pharmaceutical career has been at AstraZeneca where he was UK Medical Affairs Manager before becoming UK Head of Medical Affairs. He then gained over 2 years international experience as European Director of Regulatory Affairs.

Nick is co-founder of Pharmaceuticalethics.com a company that provides ethics and compliance audit, education and consultancy services to pharma and allied agencies.

Is it time to actively combat prejudice against pharma?