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The pharmaceutical industry needs to rehabilitate its image. Moral foundations theory can help.

Over the course of a career spent in the industry, I have felt disapproval, mostly from liberal friends and acquaintances, regarding the work I do. At first, I didn’t know what to say in those circumstances, and even questioned whether I was in the right career.

But I came to realize that most people are unfamiliar with the care the pharmaceutical industry takes in discovering and developing drugs. Few outside the industry know how hard and expensive it is, in both time and money. Fewer understand the failure rate for drugs in development, or the concern the industry must have for product safety.

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Learning to reframe my conversations about the pharmaceutical industry using arguments based on recently formulated ideas about the basis of conflicts called moral foundations theory has abated the criticism of my career choice among my liberal-leaning friends and family. Although this theory, formulated by Jesse Graham and Jonathan Haidt, was created to explain why religion and politics have become so divisive, it also provides insight into consumer attitudes about other areas.

I wondered if this theory might help uncover if there was something else beyond lack of knowledge behind the negative attitudes towards the industry. So I conducted a study of consumer attitudes towards the industry, which I presented at the 2018 Intellus conference for market research executives in health-related industries and later incorporated into my first book.

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I found that the major image problem with the pharmaceutical industry comes from a conflict at the moral level among liberals. The issue for conservatives was different but also morally based.

This finding related to the fact that, in general, liberals place more importance than conservatives on the care/harm moral foundation, which is based on humans’ inborn tendency for empathy. Because the pharmaceutical industry is about saving, extending, and improving lives, this moral foundation lies at its core. Given that, liberals should be the greatest supporters of the pharma industry — and liberals were more positive toward it than conservatives.

But because business is about trade-offs made for money, and moral foundations theory doesn’t deal with that, I added other questions to the survey. Not surprisingly, I found that costs are the major factor that get in the way of liberals approving of the industry. People — especially liberals — dislike making trade-offs because of money.

In the open-ended comments from survey respondents, I repeatedly saw pharmaceutical executives labeled as “greedy.” I have heard an anecdotal comment that “Chief executives of pharma companies could lower prices if they did without their third yachts.” That is emblematic of the perceptions the industry should want to shed.

Liberals particularly abhor monetary trade-offs that result in people getting hurt, especially people who are disadvantaged. In my survey, the attitudes of those who described themselves as liberals didn’t relate to their own abilities to afford drugs. Instead, these attitudes were based on beliefs about poor people not being able to afford the drugs they needed. This hits on both the care/harm moral foundation related to empathy and the equality form of fairness, which is rooted in the belief that everyone should be treated equally. Both of these are quite strong among liberals.

On the other side of the aisle, conservatives expressed more concern about Americans getting the same or better prices than other countries, not surprising given their greater importance on the moral foundation that drives patriotic values. Thus, both sides are concerned about prices, but their concerns have a different focus partly because of differing moral foundations.

Another part of the challenge to the pharma industry that isn’t well-understood is that, as a culture, Americans have become spoiled by low-priced generics. That leads many to believe that all drugs are easy and cheap to make. This calls into question the high prices charged for innovative new drugs, and the public doesn’t quite believe the industry when it talks about how much money it spends on early-stage drug development and clinical trials.

Despite the concern over high prices for innovative drugs, the news stories that reverberate in the public’s consciousness, getting recycled over and over again, are those that relate to generic or old drugs. When I talk to people, they bring up the same anecdotes. Martin Shkreli’s astronomical price increase for Daraprim, which had been on the market for more than 40 years as an inexpensive branded drug, and Mylan’s quintupling of the price of the EpiPen, a delivery system for generic epinephrine, are the stories often recalled and repeated at family suppers and in lunchroom banter.

The focus has recently switched to insulin, discovered in 1921 and not patented, which has raised the question of why does insulin cost so much today? It is a still-important old drug that’s taken for granted as cheap to produce. Companies that violate the paradigm of “we love our generic drugs at low prices” outrage us. More than that, these price increases don’t seem to be justified by product improvements. That violates the fairness moral foundation in another way.

The coronavirus pandemic has shone a new light on how hard it is to develop vaccines and new therapies, and how much our world relies on the pharmaceutical industry. The opportunity for the industry to rehabilitate its image is ripe because the pandemic has increased the need for new drugs to treat the disease and has increased awareness of the complicated process for testing new drugs.

But the rehabilitation needs to be done in a way that overcomes the difficulty some people have with trade-offs about money. Vows to not profit from vaccines help, but the industry needs more to overcome years of being ranked at or near the bottom of trust among industries.

This poor perception of the industry has another downside: Because of it, some people with the right skills for working in the industry, and who could make great contributions to it, never consider this line of work.

The focus of this rehabilitation effort should be primarily on how the industry helps care for people and efforts it is taking to protect people from harm. That is, after all, what the pharmaceutical industry does: it designs, develops, and manufactures safe drugs that increase health at great expense and effort. And that is why pharmaceutical professionals go into the business.

I recently told someone about a drug that was shown to be effective in its Phase 3 trials, but there was a safety problem. It wasn’t a major problem, approximately similar to the safety profile of Tylenol. But because of the greater concern we have now about safety, much greater than when Tylenol was developed, the sponsor company jettisoned the new drug. This kind of story is unknown among the general public, largely because the industry hides its rejects.

But there is another potential angle of this story. Because the industry works against the odds to develop new drugs and continues to try new ways to do it, perhaps it can feed into a story of an archetype that people love, the hero’s journey. Everyone adores a hero who succeeds against the odds.

Think about the story of the industry’s many and continued attempts to conquer Alzheimer’s disease despite repeated failures. It’s a hero’s journey without the happy ending … so far. That would be using the fairness moral foundation in still another way, that when great effort is expended, rewards commensurate with the effort are accepted.

If you are having a challenging conversation with a skeptic or critic of the pharmaceutical industry, try to reframe it using moral foundations theory and see if it changes the conversation. For example, you could use the idea that the industry is investing lots of time and money in overcoming Covid-19 even though companies know that many of these therapies will fail.

Every good conversation can help rehabilitate the industry’s image.

Karen Tibbals worked in pharmaceutical marketing at Novartis, Merck, and other companies. She is the author of two books applying moral foundations theory: “Marketing Landmines: The Next Generation of Emotional Branding” (2019) and “Persuade, Don’t Preach: Restoring Civility Across the Political Divide”(2020), both published by Ethical Frames.

  • I’m a fan of moral foundations theory so I was intrigued by this article. Thanks for writing it.

    One piece of feedback: I was surprised that someone who has studied marketing would call the audience for their idea as “spoiled”, specifically “spoiled by low prices” I found myself more defensive and less receptive to your ideas after reading this. I’d suggest that Americans who base their views about pharma prices on the prices for generics have an incomplete view of a reasonable price for a drug pre-patent expiration, but they are not “spoiled.”

  • Gobbledygook! Pharma spends more on advertising then R and D. The Sackler Family won awards at the Medical Advertising Hall of Fame.
    The Golden Rule does not mean not have a good life. It means treat every new or old drug treatment as if your mother or father or spouse or child life depended on it. That says it all sweetie!

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