[e-drug] Pharmageddon?

E-DRUG: Pharmageddon?
---------------------
[Pharmageddon?? Those of you who have seen "Armageddon" in 1998 might ignore this as yet another (rather bad and unlikely) Bruce Willis movie, in which the world was saved by a few cowboys. But...

"Pharmageddon?" is far more serious. Pharmageddon has been defined as, "the prospect of a world in which medicines and medicine produce more ill-health than health, and when medical progress does more harm than good".

Charles Medawar of the British NGO "Social Audit" (see www.socialaudit.org) is calling for abstracts or descriptions of "Pharmageddon" in 350 words. He is planning to host a "Pharmageddon?" conference somewhere in 2008. There are prizes of GBP 1000 to be won for the best abstracts or suggestions. But, it has to stay within 350 words, so no long essays, but to-the-point analysis of "Pharmageddon?".

Obviously, "Pharmageddon?" is just a hypothesis, although a nasty one. Corporate social responsibility staff of big farma are also invited - to tell why the hypothesis should be rejected. The main issue at stake is that Charles Medawar wants to tackle the indifference, and just taking for granted that benefits hugely outweigh the harms.

Have a look at Social Audit's excellent website, consider the issue, and let your pen or word processor flow! Send your thoughts to Charles at mail@socialaudit.org.uk E-Drug will cover the conference in 2008! Wilbert Bannenberg, E-drug moderator]

Social Audit News: http://www.socialaudit.org.uk/6040000.htm#New
Pharmageddon? The background: http://www.socialaudit.org.uk/60700716.htm

---
Pharmageddon? Call for abstracts:
http://www.socialaudit.org.uk/6070716-ABSTRACTS.htm#PHARMAGEDDON?

PHARMAGEDDON? – first CALL FOR ABSTRACTS

Pharmageddon: "the prospect of a world in which medicines and medicine produce more ill-health than health, and when medical progress does more harm than good". In line with the Precautionary Principle [1], we see the need to investigate and explore that risk and to identify the factors and features that describe it.

What are the risks of Pharmageddon and what harms might be involved? Health Action International, Social Audit and friends are in the early stages of planning a conference on Pharmageddon? We want to develop understanding of the threat, and a better model of what it might be.

We are now making this first call for abstracts/summaries of papers/presentations that you might want to give or hear. We invite submissions from all quarters that signal the nature of risk - including the lack of it, in relation to the benefits felt.

The conference is neither sponsored nor yet scheduled, but we are aiming for the Summer of 2008. We see this conference as a first step in developing the signalling and monitoring systems needed to keep Pharmageddon at bay. If the risk is real, we should be thinking about the process needed to collect and classify reports of signals, indicators, manifestations and portents of Pharmageddon, including the relative lack of them.

To explore this, and by way of stimulating consultation, we are introducing an element of competition in this call for abstracts on Pharmageddon? People who submit the best entries will be invited by Health Action International to attend and present at the conference. In addition, Social Audit is offering at least eight prizes of at least €1,000 each, for any submission published on the Social Audit website. We welcome submissions from all quarters, certainly including those sent in by anyone who is (or has been) closely connected to the pharmaceutical industry.

Cash for seekers after truth? Some might think it inappropriate or vulgar to offer cash prizes in a serious ‘call for abstracts’ but we are convinced it is justified – and now seeking prestigious and appropriate sponsorship for prize money of at least €15,000. We are thinking in terms of a 1st 2nd and 3rd prize, plus as many €1,000 awards as there are outstanding contributions. See UPDATE, October 2007).

The cash is partly to reward effort and excellence, also a stimulus to critical peer-review and deeper consultation. Beyond that, it is intended as an incentive to all-comers, from wherever, to pool the thoughts and meanings that Pharmageddon? brings to mind. The prizes on offer will be well worth having, but not too generous as compensation for the work that might be involved: condensing elaborate evidence, thoughts, stories, or ideas into a 350-word text demands effort and time.

Try it yourself, and/or invite your students or colleagues to try it – and then see if you feel like communicating your ideas. The Social Audit website is not a bad place to start: it now gets over 1,000,000 visits a year, and rising.

This is an open competition, with absolutely no strings attached or implied. Prize money may, if you wish, be taken in the form of an ‘unrestricted grant’, with no further commitment to develop thinking about Pharmageddon?

Clearly, we cannot award prizes for completely anonymous submissions – but we will sympathetically consider any request not to publish an author’s name or affiliation. We prefer signed submissions, but would not think it necessary to disclose either payment or receipt of any cash award as some possible conflict of interest.

All submissions should include the name(s) of principal author(s), and email address, and it would help to give some indication of your perspective, experience and/or affiliation(s). You may propose a pseudonym if you wish, and all requests for anonymity will be strictly honoured, (though you would need to provide an address, or nominate some bank or other recipient for any payment to be made).

In this call for abstracts on Pharmageddon? we are looking for submissions with a pithy title and text of <350 words. But you do not need to write a paper to enter: we are now looking simply for relevant evidence, skeleton arguments and ideas: clarity, brevity and cogency are at a premium, as is the ability to capture the imagination. Any focus and all perspectives are welcome: Pharmageddon should be regarded as a hypothesis, no more.

There is no limit to the number of entries, nor to the number of grants made to each entrant. The closing date: 31 December 2007.

Please send submissions in good time to Charles Medawar at Social Audit, copied to Tim Reed at Health Action International.

Charles Medawar
July 2007

---

2nd call for abstracts:

This is the second ‘Call for Abstracts’ for the inaugural conference on Pharmageddon? The concern that prompts it is "the prospect of a world in which medicines and medicine produce more ill-health than health, and when medical progress does more harm than good".

The Pharmageddon hypothesis needs close examination; that is the rationale for offering upwards of eight awards of €1,000 each for Abstracts posted on this website (>one million visits per year). The rules are simple: in <350 words, write an Abstract (not the paper) for a presentation that you would want to give or hear at the inaugural conference on Pharmageddon? Closing date: 31 December 2007.

Four weeks have passed since the first ‘Call for Abstracts’ and already ten have come in. It is good to see them – but in the interests of keeping a level playing field, we cannot enter into any correspondence or dialogue about submissions proposed or received. Sorry if this seems standoffish but, in the interests of fairness, everyone gets the same unadorned note of thanks:

Thank you very much for responding to our Call for Abstracts for the planned 2008 conference on Pharmageddon? This is a quick note to acknowledge, with many thanks, receipt of your submission; we very much appreciate your interest in this enquiry.

As mentioned in the original Call for Abstracts, the closing date for submissions is 31 December 2007. Between now and then, we do not expect to post any submissions on the Social Audit website. There could possibly be exceptions, but there are three main reasons for this general rule:

It will help to maintain a level playing field: making judgements about the best submissions will be feasible only when we have seen them all. At present, we are able to guarantee only eight awards of €1,000 each – though we are now actively seeking sponsorship for more, including handsome prizes for the best three. We expect to be able to report more on this in November 2007.
We deliberately left this long lead time to encourage submissions of Abstracts from people who are less familiar with the broader issues, and/or who need time to develop and refine their ideas. Meanwhile, we reserve the right to mention and/or quote briefly from Abstracts sent in before the end of 2007. This would be by way of narrative of ‘the story so far’: as submissions come in, we are likely to reflect more on the questions implied by Pharmageddon and the response they get. We will advise you of relevant website updates on, or shortly before publication.

Abstraction

Pharmageddon is shorthand for a worst case scenario that may or may not happen - a notional end-point, a yardstick of where we don’t ever want to be. It implies that, in spite of progress, we are losing sight and sense of health. The relationship between drugs and health may in future prove a disaster, just as Climate Change may be.

The parallels with Climate Change seem strong. Pharmageddon is another gold-standard paradox: the threat arises because of progress, not in spite of it, and is compounded by natural resistance and blindness to risk. The time-scale fits too: Pharmageddon implies that our children and grandchildren will feel the worst effects.

The investigation of Pharmageddon cannot depend on measurement of physical change; nor is it linked to images of crashing icecaps and stranded polar bears. Still, there is writing on the wall and the point of the inaugural conference should be to depict and decipher it. So many big questions are in the air:

In relation to health output, could a viable pharmaceutical sector perform at least twice as well as it does now? To what extent do ‘conflicts of interest’ mark the course of Pharmageddon? In terms of health returns, do present levels of investment in drug innovation make sense?
Does the style and thrust of drug regulation promote lack of productivity in
drug innovation?
What is real and what is imaginary in relation to drug ‘safety’ and ‘effectiveness’?
Has humanity reached some point of diminishing health returns?
Is there a future for a contract between patient and drug prescriber?
Is personal health possible when community health is not?
But what do all such questions add up to? Do they point to different issues,
separate problems running in parallel? Or is there a sum of these parts: Pharmageddon?

The underlying question is simply whether it is prudent, relevant, timely and realistic to be asking this question at all? Hence our emphasis that we welcome any thoughtful Abstract, including those that seriously challenge the notion that Pharmageddon is a real risk. Heaven forbid that all signals should point in one direction.

Charles Medawar
13 August 2007

---

3rd call for abstracts

PHARMAGEDDON: DYNAMICS 101

The Pharmas face a critical problem, "declining productivity in drug innovation" (‘DPDI’), and operate under intense and increasing pressure because of it. The continuing existence of the Pharmas depends on their solving and/or adapting to the DPDI problem – at the same time emphasising that they are key to cracking the health problems we face.

Over the past decade, the Pharmas have responded to the DPDI problem mainly by increasing investment in marketing, lobbying and public relations:

The introduction of Direct-to-Consumer drug promotion in 1997 underlines the present trend - more aggressive and intrusive emphasis on products, brands and ‘health needs’
At the same time, the Pharmas have invested massively to secure systematic
and forceful involvement in professional, governmental and public affairs. This has led to the creation of a new health climate in the Pharmas’ main markets, especially the USA. The result is overmedication; it stands for three distinct threats to personal and public health. The first is iatrogenesis – personal, social and cultural – resulting from the spread of ‘health anxiety’. The second is unsustainable demand leading to breakdown of national health services, and divisive inequity in access to them.

The third problem is that, as richer countries succumb to overmedication, they strengthen a drug establishment that necessarily perpetuates health deprivation elsewhere. Undermedication is the main problem for the two billion people worldwide who cannot get the essential drugs they need; improved access to medicine could save 10 million lives a year. What a waste of the talent, energy and commitment that medicine should mean.

No-one should count on immunity from Pharmageddon. Even in the richest countries, personal health seems overwhelmingly predicted by the health and well-being of others – by their action, example, attitudes, traditions and behaviour. We are all in this together: everyone is affected when other people feel ill or are impoverished, desperate, miserable or insecure.

The drug establishment, on its own, is no more able to contain the threat of health climate change, than energy companies can protect the physical environment. The definition of remedies is a matter of public interest, mainly in our hands.

Charles Medawar
24 September 2007

---
4th call for abstracts:

PHARMAGEDDON - €15K ON OFFER NOW

The Allen Lane Foundation has just awarded Social Audit a grant of £10,000 to explore Pharmageddon. This is specifically to allow us to offer attractive prizes/grants for the best submissions (Abstracts) for the inaugural conference on Pharmageddon?

The competition rules are simple and unchanged, but the prize money has now doubled. Please send us up to 350 words on Pharmageddon, by 31 December 2007. If the response merits it, we will award a first prize of €5,000; second prize, €3,000 and third Prize €2,000, with five further awards of €1,000 each. Otherwise, we shall offer up to 15 prizes of €1,000 to the best Abstracts received.

This grant supports a project that aims to grow sufficiently to establish whether or not the risk of Pharmageddon might be real, and whether the reality is capable of being understood, in the face of perhaps implacable and overwhelming resistance.

Do you doubt, or can you believe in, "the prospect of a world in which medicines and medicine produce more ill-health than health, and when medical progress does more harm than good"? Either way, please let us know.

The offer of prizes/grants reflects these thoughts:

The issues are vital and deserve attention: Pharmageddon implies the drug equivalent of Climate Change – or not

The prize money is recompense for hard work, for condensing and honing words, and thinking beyond your usual box

Competition should stimulate participation, and make the challenge equal for passionate believers and disbelievers alike

It feels appropriate that Sir Allen Lane was the founder of Penguin Books, and that one of his Foundation’s main aims is to support work that "encourages or enables unpopular groups to share in the life of the whole community".

The Foundation’s grant underpins this as an enduring project: perhaps a book will emerge and/or pharmageddon.org might develop as website accessed by subscription or invitation. This would partly depend on Abstracts received but, with a fair wind, there will be more prizes to come. The main prize would be to stimulate wider appreciation of these vital issues, but contributors might earn royalties too.

Charles Medawar
22 October 2007

---

Pharmageddon in 350 words? Is that all?

In our Call for Abstracts for the inaugural conference on ' Pharmageddon? ' we asked for submissions of no more than 350 words – but, especially since announcing the grant from the Allen Lane Foundation, we have had second thoughts.

A few otherwise good submissions have exceeded that length. Moreover, we don't want this restriction to penalise submissions written in/translated from languages other than English. Thus, a 350 word count in English might translate as more in French, or many more in Japanese – though the 17 syllables in Haiku can go a long way ...

More recently, we have been asked if we can accept a submission in the form of a short film. As the point of this competition is to inform and support a conference, all our instincts were to say yes, a short film would be fine. However, even if the storyboard / commentary kept to the word limit, there would be two obvious complications – both to do with keeping a level playing field.

We wouldn't want to give a film-maker any competitive advantage over a wordsmith. Moreover, we want to keep the judging 'blind' - and a film among written entries stands apart. So where do we go from here?
We are still searching for the best solution, but part of it has to be some relaxation of the rules. There was and still is a good reason for asking for submissions of <350 words. But we accept the need to be flexible and intend to interpret the rules in a generous spirit, rather than to the letter.

The main reason for originally proposing that strict word length was simply to promote quality and not to over-burden readers. There's too much verbiage as it is and most people can't/won't/don't want to read much more than one page.
However, we are looking for submissions that capture the imagination. Clarity, brevity and cogency matter hugely, but think of the 350 word limit as a target, not a tripwire.

In short, we're looking for the Big Picture. If it can be captured in a film, still, cartoon or other medium, we'll welcome it.

Charles Medawar
26 October 2007