My first job out of college was as an entry-level research associate at a health care consulting firm. I wrote glossy briefs for CEOs and COOs of hospitals, pharmaceutical companies, and insurance firms, answering their questions on wide-ranging issues from how to alleviate emergency department overcrowding to how to cut costs with disease management programs. Usually, I had two days to scour the Internet and interview sources before producing a memo of highlights that could be skimmed by a busy executive between meetings.
At my first performance review, my manager told me that my analysis and writing were excellent; but I “wasted” too much time looking for references. I would be more productive if I filled out the templates without trying so hard to validate new data. Time is money, she emphasized.
I left that job in less than 6 months. I couldn't accept that money should wield so much power, especially in health care, which I thought was about taking care of sick people. My short stint in the for-profit world taught me that business is never personal and always about the bottom line.
I returned to academia to study health care policy. I remember attending a debate between Professor Jeffrey Sachs, the leading international economic advisor of this generation, and the vice president of marketing from PhRMA, the pharmaceutical industry’s lobbying group. The debate was about providing AIDS medications to developing nations at lower cost. The audience was predominantly sympathetic to Dr. Sachs’ position that it was the moral responsibility of wealthy drug companies to lend a hand in the AIDS crisis. We were all there to watch a brilliant mind squash a greedy corporate entity.
Unexpectedly, the VP stole the show. Stunningly beautiful and flawless in a gray tailored suit, she started off with a self-deprecating joke and a string of accolades for Dr. Sachs, which made him smile. She deftly parried his arguments with her own research and talking points. The VP knew how to communicate to an audience unfamiliar with the industry’s inner workings. She broke down technical ideas and told stories; tied her points to basic principles like merit and fairness; and reframed all the classic human rights arguments in such a way that her clients’ position seemed reasonable. Without ever attacking Dr. Sachs, she made him seem like an out-of-touch academic who didn’t know how things really worked outside the ivory tower. The performance was impressive. After the debate, the won-over audience crowded around the VP to get her business card. It was the 1% charming the 99%. For a moment, I wondered if I could affect more change in the health care system if I returned to the private sector…despite my former experience preparing slapped together briefs that probably was the core of the VP’s presentation.
Instead, I moved further away from the corporate world and became a doctor. From this new angle, I watched the practice of medicine and the pharmaceutical industry grow increasingly interdependent. Industry has the resources. Scientists have the techniques. Doctors have the network of colleagues and the patient base. They all relied on each other in essential ways to make medical progress. Furthermore, with managed care, malpractice insurance, and student loans cutting into physician income, industry’s generous honorariums for “educators” and “consultants” to help shape product development became more attractive to doctors. I worried about my profession being seduced by the slickness of business, and by the money. I had seen how easily it could happen.
Last year, I attended a professional conference replete with bottomless coffee pots, sit-down lunches with silver utensils, free Wi-Fi on the premises, schedule and program apps, multimedia presentations, and a golf tournament. Corporate signs lined the hallways, not advertising any specific product, but with colorful logos announcing the companies that gave “unrestricted educational grants.” Some of the most well-attended symposiums featured a panel of top researchers in the field, sharing their latest findings. The sponsoring company’s reps hovered over the attendees, chatting pleasantly, making their business cards abundantly available. I remember the very nice lady who made me her project. We spoke about the weather and where I was from before she seamlessly transitioned to whether I knew my district’s rep and what brands my hospital used in the operating rooms. I was on guard, but she was decidedly friendly, attentive, and professional. The interaction made me feel so uncomfortable that I left my filet mignon unfinished and skipped dessert.
Rather than boosting my ego, this lavish display reinforced for me that the problem with our health care system isn’t scarcity of resources. It's that we have a lousy way of distributing what we have. Cancer patients are on waiting lists for chemotherapy drugs restricted due to a national shortage. Uninsured patients can’t get indicated diagnostic tests in a timely manner. Outdated equipment in public hospitals provide substandard care. Yet, industry invests so much time, money and effort to entice doctors to develop loyalty to their brand or win over policymakers by appealing to their sensibilities. It felt so obvious to me that money, flattery and luxury were being used to obscure my mission – to care for the sick.
Having experienced both sides of the game, I no longer question money’s seductive power in health care. I am wary as I pick through the minefield.