Learning from Science in an Age of Marketing

“It was widely believed thalidomide would be useful to control morning sickness. It did – but it did other things, too.  We need evidence, but unregulated marketing does not help us get needed data.” –A colleague at UCSF

The epidemic of reductionism that has swept throughout science leads us to rely on ersatz measure for the real thing. For example, in public health, instead of looking at holistic outcomes, how well someone is doing both short- and long-term after the intervention, we increasingly rely on biomarkers of harm or health as predictive models. These molecules act as snapshots of the larger phenomena researchers wish to investigate. Biomarkers, however complex the portfolio of them, are by definition only valid insofar as they can be abstracted in a vacuum, not taking into account the other interactions of hormones, environmental stimuli, genetic specificity, and latent versus blatant (or known versus unknown) effects and interactions of a given encounter.

The very existence of individualized medicine may warn us against biomarker essentialism. In the distribution of effects of a given pharmaceutical, for example, which end of the spectrum will we end up on? We know that while most people (whatever that meant for the pharmaceutical trials involving a geographically limited and probably age limited population), most products that make to the market (in an ideal world) are tested to be benign at worst, and helpful at best. But what about for those other people who have chemical sensitivities, are near the tipping point for severe reactions to additional stimuli, or simply have extreme adverse reactions to whatever happens to be in the drug?

We may aim at treating X (e.g., morning sickness), and be successful at it, while causing a much more severe Y (e.g., retardation in babies). While there is no failsafe method to avoid any sort of side-effects, prohibiting marketing of pharmaceuticals to doctors or directly to consumers may be one way to avoid hasty clinical trials, falsified information, and widespread corruption (deliberate and unintentional) in science. Another possibility would be setting up medical companies as B-Corporations so that they have no incentive to cut corners. Otherwise, the side-effects game, where people start piling up medications to deal with the side-effects of the previous one ad infinitum, makes them poor and the corporations rich. Certainly, this is not a happy ending for the majority, and is an unsustainable, parasitic business model.