A drug dealer’s paradise
August 31, 2012 § 3 Comments
Let me describe for you the perfect business.
The purchase decision makers (PDMs) are relatively small in number, so you can spend a lot of marketing money segmenting them, figuring them out, and telling them (individually if necessary — the message will vary with the PDM segment) just what they want to hear. It doesn’t matter if a particular PDM is a ruthlessly scientific idealist, a heat-seeking innovator, a corrupt greaseball, or any other permutation of characteristics. The fact that the population of PDMs is small means you can spend money equivalent to multiples of their personal incomes just figuring them out and telling them, through various credible organs, precisely what you want them to hear. Your overall market of consumers is enormous; but the market of purchase decision makers is quite small in comparison to your marketing budget.
The actual consumers of your products are not the PDMs, so the consequences of using your products are not born by the same people who decide to purchase your products. (In fact, the consumer is not permitted to purchase your products without an order from a PDM). Contrast this to the pilot-passenger relationship, where everyone is along for the ride together. The PDMs are the expert decision makers, and when problems arise from your products which are not part of the current scientific consensus those problems will typically be attributed to something independently wrong with the consumer himself. The usual response to problems created by your products, then, will be to add on an additional one of your products to address this new problem. Furthermore, when a consumer ceases using your product that will sometimes in itself cause a whole cascade of new problems. (This is often enough the case even when your product was doing nothing beneficial for the consumer in the first place). Frequently these new problems would in fact resolve on their own if things were just left alone long enough after (carefully) ceasing use of your product; but instead what usually happens is that this class of problems is attributed to your product “working” (even if it wasn’t), and to ceasing its use as imprudent; so its use is resumed in order to avoid temporary difficulties involved in ceasing its use. In general the notion that ceasing use of your products is itself a source of (temporary, but often lasting for quite some time) problems is outside of the scientific consensus: those kinds of notions are generally considered “alternative”, that is, not serious, as are alternatives to your products. So once consumers start using your products it often becomes extremely difficult for them to stop using them, even though they may be getting little benefit from them and are often gravely harmed by them.
It also turns out that the all-important “scientific consensus” is something over which you have a great deal of control.
The regulatory agencies for your business require that your overt marketing claims must be evidence-based, but they don’t require you to make all the evidence public. The great majority of the evidence is produced by you, or by those funded by you, and it is considered proprietary commercial data which you have no obligation to share — not even with the regulatory agency. You get to pick and choose from the evidence in your secret files to support whatever thesis you are trying to defend, whether in the domain of legal disputes, marketing, regulatory approval, or what have you. The gold standard for this evidence is “statistical significance”, which is arguably statistical but is certainly not significant, unless by “significant” we mean “begging whatever question you want begged“. Actual consumer experience with your products is considered “anecdotal”, and rests on the very bottom of the evidence heirarchy — when it is reported and believed at all.
The regulatory agencies don’t permit you to market uses of your products unless those uses are scientifically demonstrated and pass regulatory approval (keeping in mind what “scientifically demonstrated” means above). However the PDMs can use your products for whatever they choose to use them for: so this not-so-stringent regulatory requirement boils down to labeling restrictions. Your marketing departments can (and do) commission ghost written papers supporting whatever uses you want to market. This includes inventing new “needs” for your products which do not exist in reality, and backing up those new “needs” with question-begging scientific measurements you have designed with the result in mind, again passing through your selective data filter to get the results you want. Because of the diversity of academia and your pervasive presence there as a funding partner you can always find prestigious academics willing to sign their names to your ghost written papers, not because they are corrupt but because doing so comports with how they as individuals actually view things; and besides it helps advance their careers and uses their time efficiently. Things like bribes and wining and dining may be in the game from time to time, but they aren’t where the real action is. There is no advocate quite like the true believer, and when you feed the true believer just what he wants to see the results can be far more potent than any bribe. The fact that you do the same thing with diametrically opposed academics depending on your own purposes – much like you cherry pick the scientific data to suit your own purposes – goes largely (though not completely) unnoticed. As a result, the great bulk of the “scientific” literature is marketing copy written by you and your competitors, with just enough distance to (mostly) keep you out of legal trouble. Any actual objective science in the domain is insignificant: the consensus is a constructed consensus over which you and your competitors have control. This works not as a conspiracy but because your industry can easily outspend (and out-litigate), by orders of magnitude, any points of view you find less than amenable.
The public at large has a very different perception of how things work: a situation you have carefully cultivated. The public falsely thinks that when you come out with “improved” products, you have to have actually shown that those products represent improvements over previous generations of products which have now fallen off-patent. In actual fact your new products are frequently less effective and more dangerous than previous generations of product; but you only have to show that they “work” (in the sense of “statistical significance”) compared to doing nothing at all in order to get regulatory approval. At the same time, when you show that they “work” along some scientific measure (which you get to select) you can ignore any negative effects they may have, both by preselecting what data you want to use and because the studies and their data are, by design, not intended to bring bad effects to light. You don’t have to show that your products actually improve things for consumers. The public falsely thinks that regulatory agencies will not approve your products for sale unless your products have been demonstrated to be safe. The public falsely thinks that there is lots of independent study of your products which ensures their safety and effectiveness. The public falsely thinks that your industry is heavily regulated, when in fact the regulatory structure is something to which you have fully adapted and now use to your advantage: the false appearance of tight regulation is better for business than no regulation at all. The list goes on.
Finally, the fact that problems are usually attributed to the consumer rather than your product creates a moat of social stigma and institutional ignorance around your business. When someone has trouble getting rid of one of your products it is typically attributed to a character flaw (or some other flaw) in the person, and our social institutions are designed only to deal with people with those flaws, not with innocent victims. The consumer-victim is typically either categorized as an abuser or as a psychiatric case: there is no institutional support of any kind for unwitting victims.
Neither you nor the PDMs want the category of unwitting victim to exist as distinct from character-flawed or mentally ill individuals. This also happens to comport well with hypocritical modern liberal non-judgmentalism: there is no such thing as character flaws because that would imply that there is such a thing as character, which means that “tolerance” goes out the window. But as with white flight, what we say and what we do are different things: I still wouldn’t be caught dead as one of those flawed people.
The institutional approach to dealing with abusers and psychiatric cases is wildly inappropriate and ineffective in actually helping consumers deal with problems caused by your products, but it has the advantage of making it impossible for them to find the right kind of help. Most of the PDMs don’t understand issues that arise with your products and will refer consumers to “experts” – “experts” who will treat the consumer as an addict or as mentally ill. As a result of this moat of social stigma and ineptitude, consumers are far more likely to remain a customer of yours for life than they are to escape from the chains you’ve sold them. The only real downside is that your products shorten your customers lives, so the annuity stream doesn’t go on quite as long as you might prefer.
That perfect business is, as I’m sure you’ve guessed by now, the modern pharmaceutical industry.