In the aftermath of 9/11, Newsweek did a cover story on the roots of Islamic hostility to the U.S. That story was titled “Why They Hate Us.” As 2007 begins, the same unsettling question can be asked of the life sciences. Why does the public hate pharma? There are no glib, facile answers. It’s time to assess the problem without flinching.

Late last month, as it happens, there was a new poll from Harris Interactive. It shows that the public’s estimation of the pharmaceutical industry has continued to drop. News reports and lawsuits over missing data about painkillers, anti-depressants and drug-coated stents have taken their toll. No doubt there will be new revelations in 2007.

There is only one industry that Americans think is in more urgent need of regulation than the drug business: Oil and petrochemicals. Guess how many people think the pharmaceutical industry is “generally honest and trustworthy”? Seven percent, according to Harris. It works out to one American in 14.

The Goat

For reasons that remain mysterious, medical device, biotech and drug companies have allowed themselves to become the scapegoat for everything that is wrong with the U.S. health care system. Perhaps this is misplaced corporate chivalry, allowing other blameworthy parties in the health care landscape (with which the industry works closely) to escape public criticism. We really don’t know.

But it is clear that if the industry mounts a rigorous self-defense, a real self-defense, it could come to be seen as a more ethical and reasonably profitable trade—just not perfectly ethical or grotesquely profitable. If a rigorous and serious defense is not made, pharma will be viewed as it is now. In denial. Sinister. Callous. That future is not pretty. The drug industry will come to be regulated even more tightly than it can imagine now, and perhaps not by the FDA but by a new body of less friendly individuals from God knows where in the federal bureaucracy.

Ironically, the Harris pollsters say the public’s view of the tobacco industry is softening, with fewer people thinking it is in urgent need of regulation. No comparison stings the pharmaceutical industry more. For better or worse, the public perception is that Big Tobacco has done its penance, paid astronomical fines, and is moving forward. For better or worse, the public perception of Big Pharma is that it is arrogant and rolling in dough, unregulated and unapologetic.

Risk Ahead

The slide in pharma’s reputation is bad for business. It also poses a significant and immediate danger to scientific progress. The industry’s failure to address its own declining status in the public mind baffles us, we must confess. Perplexes us. And no, the industry’s reputation will not be redeemed in an unmarked conference room in some Maryland hotel with a few amiable friends from Congress and the FDA. No such luck. It will happen on CNN, Fox News, and USA Today.

Call it the demonization of pharma. Scapegoating the drug industry for everything that is wrong with the U.S. health care system and society.

There are two acute consequences to demonization.

1) With every year, the industry will find it more difficult to enlist patients and physicians into participating in research. It is a fallacy to think the problem will be solved by moving trials to developing countries. These populations, too, can be quickly turned against U.S. and European research companies. (If you don’t believe this, you may want to read up on what’s happened to Coke in India, where pesticides have turned up in the cola.)

2) Unable to think for themselves, and adept at reading polls, a new crop of Washington politicians is poised to tap into demonization for the sake of grabbing a few headlines or bolstering its own poll ratings.

Over the long haul, however, it is the chronic consequences of the industry’s mismanagement of its reputation that are far more sobering.

An Analogy

To understand the long-term risks here, consider nuclear power. Nuclear power is a somewhat regulated industry. A slightly subsidized industry. An industry fraught with societal potential and risk. A wee bit of thought goes into the design, construction and operation of a nuclear power plant. The nuclear industry’s overall safety record is outstanding, unblemished. Dedicated, highly skilled engineers deserve some credit for that. (Does any of this sound familiar?)

And yet the nuclear power industry is basically dead. Why? Simple. One big mistake. One bungled media circus. Three Mile Island, a partial reactor meltdown in Pennsylvania in 1979. We’re coming up on the 30th anniversary of that accident, and the nuclear power industry is ... still dead.

For the benefit of younger readers, let’s review what happened after Three Mile Island.

Getting Nuked

After a certain amount of debate about nuclear power, a collective, unofficial national consensus formed. An unspoken decision was made collectively. It took shape as Americans watched the news, sat in bars, chatted at the water cooler. The U.S. population (and their elected representatives) more or less came to the conclusion: Wow, we don’t trust these nuclear power people. We’re done with atomic power. The nuclear industry was cooked at that juncture.

There was no federal judge that rendered this decision. No amount of lobbying could overcome this decision. After hearing about the pros and cons of nuclear power, the public simply decided anti-nuclear activists were more credible than pro-nuclear activists. It was in the zeitgeist. At that point, any money or sweat spent on behalf of nuclear power was wasted. Game over.

The relevant question: Has pharma already had its Three Mile Island? Is the stack of books attacking the pharmaceutical industry evidence that the best days of the industry are behind it? ClinPage doesn’t think so. But we’ve already rambled on, for which we apologize. We’ll wrap up our thoughts on pharma’s demonization tomorrow.