I was 22 at the time, about to embark on the brand new adventure of medical school, when my mother sat me down and informed me of difficulties I would soon encounter as a doctor in the dating world.
The years have proven the wisdom of her words. (They always do.) Now, ten years later, I have whittled down the list of potential soul mates to definitively exclude the following: ambulance chasers… male nurses… Christian scientists… self-proclaimed gluten intolerants… supplement junkies… proponents of the thimersol-causes-autism campaign… hypochondriacs… anyone who likens my job to Gray’s Anatomy… and of course pharmaceutical sales reps.
I just know that I wouldn’t be one bite into the delicious foie gras at the Merck-sponsored dinner, before I would blurt out, “How do you feel about working for a morally reprehensible organization that profits from denying patients necessary medications?”
This is why I’m single.
The pharmaceutical industry, perhaps more than any other private organization, underscores the ethical quandaries that occur at the interface of economic incentives and health provision. Entangled within a complicated web of intellectual property rights and patent protections, they have waged a ruthless campaign against the production of generic medications in underdeveloped countries, many of which could be used to treat deadly diseases such as HIV/AIDS at a fraction of the cost. It is no wonder that over the past several decades, the pharmaceutical industry has emerged as one of the most nefarious actors on the global stage
An interesting solution has emerged over the past several decades in the form of public-private partnerships between pharmaceutical companies and various non-profit organizations. Embraced by the financially strained public sector as a means of increasing revenue as well as encouraging research and development, the partnership allows pharmaceutical companies to create a guise of corporate social responsibility, while in many ways carrying on with business as usual.
In 1987, Merck announced its decision to donate Mectizan (ivermectin) as part of a collaborative effort with the WHO to combat onchocerciasis. The company announced that it would donate “as much as needed for as long as needed” in order to eliminate onchocerciasis as a leading preventable cause of blindness worldwide.
Laudable? Perhaps not. Conveniently omitted is any reference to the decade or more between the initial discovery of the drug and its distribution to those afflicted with the disease. What happened in that twelve-year span? Multiple attempts by Merck to sell the drug at market and below-market prices. Only once the drug was deemed not to be profitable was it donated to low-income countries under the guise of philanthropy.
Twenty-five years later, Merck touts the MECTIZAN Donation Program as a “groundbreaking public-private partnership that has been influential in the development of a number of other drug donation programs.” It is the longest-running drug donation program to date, and its impact on the prevalence of river blindness worldwide cannot be overstated.
Has Merck benefitted from the positive publicity? It’s impossible to say with any degree of certainty. However, in the most recent Fortune 500 Rank, Merck ranked #57, just below Amazon.com. Merck’s total revenue was $48 billion, with $6.3 billion in profits, a staggering increase of 628.5% since 2010.
Are public-private partnerships a sustainable answer to global health problems? They are certainly a means of raising large revenues. But the imposition of private agendas on the public sector, the discordant priorities of economic interests and human rights, the prioritization of external aid over national solutions, make it highly unlikely.
Perhaps it’s not a match made in heaven…
*This blog is dedicated to my mom, who forever reminds me not to settle. You are always my inspiration.
 Birn A-E et al (2009). Textbook of International Health, 3rd edition.