Leopards and spots

Conferences have changed over the years. Back in their heyday, conference delegates would be showered with expensive enticements, gifts and so on. Rolex desk clocks, Gucci conference bags, Mont Blanc fountain pens. That sort of thing. Okay, I exaggerate but there was still a culture that regarded expensive desk paraphernalia as a the way to a physician's prescribing of their medicines.

I was a scientist rather than a clinician in those days. And even then there was a caste system. I remember a medical congress in Venice couple of decades or so ago where I was presenting some data from a study sponsored by a drug company. The basic scientists flew cattle class and stayed in a B&B on one of the more stagnant canals while the clinicians, arriving first class, were wined and dined at the Cipriani. A fleet of water taxis took them to and from the Congress. We were given a weekly ticket for the vaporetto.

 Nowadays it's different. So tightly regulated is the industry today that pharmaceutical representatives cannot speak to their target audience without first obtaining the kind of security clearance associated with piloting nuclear bombers or attendance at a White House dinner.

A friend of mine (and I digress here) once went to a White House dinner or Capitol Hill reception -- I forget. His overwhelming memory was of the sunglassed security guards and the overwhelming sense that all they wanted to do was shoot you. They were just waiting for a cue, any cue, that would allow them to empty the magazine of a submachinegun into you.

Times have changed. And I for one think it's for the better. But it's amazing how long the old perceptions of pharmaceutical companies persist. There is still somehow the notion that a leopard cannot change its spots. The perception that, left unregulated, the industry would revert to the old ways.

I don't buy that. Not only are those practices gone, so are their proponents. And this coincides, in my opinion, with the rise of patient power. Patients are the new opinion leaders. We may not yet be on equal footing but that will come. And patients are no mugs. As the ultimate stakeholders, our opinions cannot be bought by carriage clocks, cases of wine or sides of smoked salmon. We want treatments, pure and simple. And, as so often, the patients have been the catalyst of that change.

Ironically, patients are in many ways the most adversarial group, the lobby least likely to acknowledge its success. Many still remain unable to recognise that pharma has cleaned up its act and persist in bleating the same old "four legs good, two legs bad" dogma. We are perhaps our own worst enemies when we cannot recognise our own successes. The words 'pissup' and 'brewery' come to mind.