If Pharma Made Cars

If Pharma made cars, the seat-belt warning signs would be removed, and the beeping noise if you moved without a seat-belt on would be silenced, as the start of a gradual process that would result in seat-belts being removed or made non-functional. The safety-bags would be removed or made ornamental. The car would be turbo-charged. The accelerator would be re-engineered so that the only options were travel at the upper end of the speed limit or faster.

The car would come with a Driver (Dr.). You could not get one without this option. The law would be adjusted so that in the case of any untoward event, legal liability falls on the Dr. rather than the manufacturer.

You would have no real choice of car, your Dr. would choose it for you. There are 4 types of Dr. but depending on the country you were living in you might have little or no choice of type of Dr.

One type of Dr. is the Speedy Gonzalez model, who is programmed/trained to put experience over adherence to speed-limits and other regulations, who is likely to attempt exciting maneuvers in the course of travel, and who is imbued with what you might regard either as confidence or foolhardiness. If you voice nervousness at the driving this Dr. is likely to increase speed.

A second type is the Standard Model, who is most concerned with keeping things uncomplicated. Driving is a matter of getting from A to B – she is less interested in the onboard gadgets. She keeps an eye on the routes her colleagues take and follows these rather than taking short-cuts or other off-piste options in the face of traffic snarl-ups. This is not done with an eye to liability but it makes her legally invulnerable should anything go wrong.

A third type is the Guidelines-Based Dr. This Dr. has become more popular lately as cars have come with GPS installed to offer the Dr. advice on standardized driving. These computers are supposed to have Ruse Controls installed to manage the “tricks” that Pharma get up to but the computers are programmed by Pharma. Rigid adherence to the GPS often leads these Drs the wrong way up one way streets – once you start paying heed to the onboard voice it’s difficult to stop.

Finally there is the Traditional Model but this is being phased out, despite being celebrated in Dr. textbooks and routinely invoked by politicians and others.

The key personnel in terms of sales at the Trade Fairs, or in the showrooms, have more extensive training than the Drs. These are highly professorial staff whose brief it is to cover different company products but never mention any other form of transport such as bicycles or walking, even though their earlier training included exposure to these other forms of transport. They are central to company efforts to get over two messages – one that cars are the way to go – what other form of transport comes with a Dr? And at the same time a Dr. is no good without the latest car.

Companies are legally obliged to answer the question “Can cars kill?” with a “Yes”. They can usually evade this by answering instead the question “Will this car kill me?” or “Did it kill him?” with a “No – absolutely not – if things went wrong it was the Dr’s fault”. But ultimately they depend on their professors (who are carefully managed independent contractors under no legal obligation) to deliver the message “Cars Cannot Kill”.

If Philip Morris made medicines, all available drugs would come with prominent Black Box warnings that this product can kill consistent with the traditional medical view that Every Drug is a Poison, and the Art of Medicine lies in finding the right dose.

There would be a ban on all advertising including Direct to Consumer Adverts. The use of drugs for children would be severely restricted, and exceptional rather than common.

As company products are available over-the-counter rather than on prescription-only, doctors would be openly skeptical of the claimed benefits and would fully support ongoing research to demonstrate the risks. Somewhat more puritanically perhaps some doctors might be expected to attempt to get Philip Morris sponsorship of university activities banned.

Unlike doctors, pilots have to take the same flight that those in their care take. As a result safety is a real issue for them; if the passenger is injured, the pilot is likely to be also. If American Airlines made medicines, doctors would have to sample all of the medicines they gave to patients. More generally doctors would need extensive retraining on safety issues.

Doctors would have to liaise with colleagues regarding near misses and other events that happen ‘in therapy’. The current Adverse Event Reporting System (AERS) would be replaced by something closer to the Airline Safety Reporting System (ASRS). Not such a big change in reporting – but a world of difference in the way the reports are handled by regulators. AERS reports now dismissed as anecdotes would, like ASRS reports, be taken seriously by regulators – “Often, such lower-bound estimates are all that decision makers need to determine that a problem exists and requires attention.”

If the case of a drug disaster, the regulatory agency responsible for letting a drug on the market would not be one charged with investigating the problem. An independent Drug Safety Board would be set up.

The emphasis placed at present on the efficacy of drugs would be replaced by a focus on their safety. Airlines do not compete on the basis of who can get me to Kansas 30 minutes earlier. If an airline is perceived as being less likely to get me to Kansas safely – it goes out of business.

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