Ethics Hero, Corporate Division: Merck

Sometimes, though their implacable foes would refuse to acknowledge it, big corporations do the right thing even without a metaphorical gun at their heads. This week’s Economist magazine relates an amazing example that the public needs to know about, especially since it challenges popular stereotypes about Big Pharma.

The Economist begins by horrifying us with a deadly aspect of life in third world countries that are hot and wet: “neglected tropical diseases,” or NTDs. These are neglected because the populations that suffer from them are poor and far away, but they affect more than a billion people. Among the scourges, all parasitic, are Buruli ulcer, Chagas disease, guinea-worm disease, leishmaniasis, river blindness, trachoma and yaws. There are 18 pernicious maladies currently listed as NTSs.

In the 1970s, mega-pharmaceutical firm Merck developed the drug ivermectin after tests on animals with parasitic infections. William Campbell, one of the firm’s parasitologists,told company executives that the new drug might be effective against the parasite that caused onchocerciasis, or river blindness, which  afflicts populations in in parts of Africa, Latin America, and  Yemen.  He was given the green light to find out.

The first human trial of ivermectin as treatment for river blindness took place in Senegal in 1981, on patients who had the early stages of the disease—itching, rashes— but no damage to their eyes yet. The results were encouraging,  indicating that ivermectin was safe for humans and highly effective at stopping the disease before it blinded its victims.  Merck, however, now faced the problem that has impeded cures for all the neglected tropical diseases: those who needed ivermectin were too poor to buy it, and so were the nations where they lived. Big corporations are not charities; they have investors, stockholders and a bottom line. They are not accustomed or programmed to give away their products.

Yet Merck made a corporate decision that Bernie Sanders and Elizabeth Warren say is impossible. Starting in 1987, it made an open-ended commitment to distribute as much ivermectin as was needed to eradicate the river blindness worldwide. In the next ten years, it swallowed the cost of 100 million doses. The biggest hurdle, however, was not finding a cure but getting it to the afflicted.  The treatments had to be sent to remote areas.  Health care workers  had to be trained in regions where medical personnel were scarce. Victims of the disease had to be found and persuaded to accept treatment, and protocols for surveillance and follow-up had to be developed and followed, or the disease would come back.

To accomplish all this, Merck developed partnerships with charities, foundations and international health groups. Meanwhile, its example spurred other drug companies, such as GSK, Pfizer and Novartis,  to donate their medicines on a large scale for other  NTDs.

In 1999 the Gates Foundation began funding efforts to eliminate  lymphatic filariasis (elephantiasis) and schistosomiasis, another horrible disease caused by a parasitic worm transmitted by freshwater snails. Efforts to eradicate guinea worm were led by the Carter Centre, the foundation set up by Jimmy Carter in 1982. A public-information campaign about the need to filter drinking water and keep sufferers away from water sources, where they might pass on the infection, brought new cases guinea worm down from an estimated 3.5 million a year in  1986 to just twenty five in 2016.

The Economist makes it clear that the battle against NTDs will be a long one, and that the proposed cuts to the Trump State Department budget would be serious setback. Read the whole article, which is about a a lot more than Merck. Still, it was Merck that cut the Gordian Knot of economic reality blocking any chance of successfully fighting these 18 dread diseases.

The article emphasizes that Merck’s 1987 decision to donate ivermectin for river blindness was pure altruism. The firm’s scientists  felt it was the right thing to do, and management agreed. I am obligated to point out that there was probably some ulterior economic motive in the executive suites: the vilification of drug companies is a serious problem for companies like Merck, so stories like this can be extremely useful. Then again, if the idea was to get Merck good publicity and provide PR magic bullet to counter the accusations of critics, why don’t I know about the river blindness saga? Why don’t you?

Whatever the answer, Merck earned its Ethics Hero status.


Pointer: Tom Fuller

17 thoughts on “Ethics Hero, Corporate Division: Merck

      • There was and is tons of publicity about it. Read the NYT’s original article about it

        Just so you’re clear that the 40-year old example has its limits, here’s a current article about the WHO pleading with pharma companies to do more in this area:

        I’m sure you can find examples of left-leaning press trying to suppress the do-gooder work by corporations, but believe me, this is not one of them.

        • Thanks, Charles.

          I sure missed it at the time, and the vital question is: was it covered on broadcast news? I have done ethics programs for Big Pharma, met with executives, ran a health care non-profit largely funded by one, and what they say is that the vilification of the industry is based on a one-way narrative that rigs the debate. What’s your guess: is Bernie aware of this story?

          • You’re hearing corporate paranoia. This is an industry–cone to think of it, preciseley this company– that once censored one of my slides from a presentation about trust. The slide had three words in 96 point font : TELL THE TRUTH.
            The lawyers insisted it be redacted because it might be used against them in future lawsuits.
            Note this is an industry where lawyers review speeches by outside experts like me–and determine what’s fit for their management to hear!
            It’s an industry that long ago list the ability to distinguish between “compliance” and “ethics.” Ethics to them is simply not violating the letter of the law.
            This is not an industry with dishonest, lying people. Every pharmaceutical employee I ever met is a decent, upstanding person. But the industry itself is structurally compromised on many dimensions. And the situation where people can at the same time believe that they are upstanding ethical people – and yet contribute to unethical behavior.
            Remember when the industry paid hundreds of millions to doctors to act as “thought leaders?” They would wine and dine them and expensive resort, and pay them but loads of money. Everyone of those doctors insyated their ethics were not compromised, the money did not influence their opinion. Right. Why do you think the companies kept on spending the money?

            I worked with the marketers who trained the “expert” position to be influencers. They too believed that because they were adhering to the letter of the law, there was nothing unethical going on.
            I’m telling you, this is an industry which when they consultant main about being persecuted, you need to take with an ocean of salt.

            • Ugh…I should not try typing long responses on iPhone while eating lunch in the car. Sorry about all the typos…

              At the risk of over-stating my point: the caricature of liberal media out to castigate the honest pharma is just as absurd as the caricature of pharma as bloodsucking evil people. Both are far from the truth.

              The truth is that pharma is nearly all composed of people who are good, thoughtful, educated, largely socially liberal, and far from being unethical individuals.

              At the same time, they operate in a system that is ethically challenged in a myriad of ways, including research funding, sales techniques, publications, opaque cost estimates, and lobbying.

              Can you find ethical people in an unethical system? This is Exhibit A for “yes.” And the whole bit about River Blindness is true, there are HBS cases about it, it gets talked about in Conscious Capitalism programs – it’s hardly been hidden under a basket. Merck itself does a darn good job of making sure it’s not forgotten, as you realize when you walk in the front door of their corporate HQ.

              Finally, the Merck that offered up the cure for River Blindness was the old Merck, run by a genuinely product/people driven CEO. He wouldn’t make it anywhere near the C-Suite today, because pharma is run today by people from finance, marketing, PR and compliance, aka “ethics.”

  1. My guess, our “oh, so fair and balanced media news” (sarcasm intended) are so sold on the “evil pharma corporations” that they will no more report anything good that they do than they will become civil to President Trump. All Merck can do is send out press releases…it’s up to the reporters to actually,,,you know…REPORT.

    • Your prejudice is blinding you in this case, Dragin. See my notes elsewhere. This was in no way covered up, it’s well known (in large part because Merck does a fine job of letting everyone know what they’ve done), and because it is a legitimate example, it’s often used to blow smoke in the eyes of the beholders because it is an exceptional example. As in, it’s an exception for the industry.

  2. It’s a big problem that most of the countries in sub-Saharan Africa are such a mess economically due to massive corruption and socialism following the colonial era. The Foundations have done a pretty good job in helping treat some ot these awful diseases. They couldn’t do it without big phama involvement however and Merck is only one of the corporations involved in these efforts, albeit a star player.

  3. Let’s go ahead and cut State Department foreign aid on this. Let ISIS and al Queda step up in places like Yemen and Sub-Saharan Africa.

    • Yep, I wish some of the jerks in The Resistance would take a look at the list and perhaps change their opinions about evil corporations. Most of them won’t though I’m sure.

      • Very much afraid you’re right. The “evil corporations” make their money on the backs of their “wage slaves”. Wonder where I’ve heard that before?

  4. It looks like the NYT reported on this back in 1987 but there has certainly been minimal focus on this example as compared to say the Mylan EpiPen price issue. I think one of the reasons it has not been as big a news item despite such a huge positive impact on world health is that it is about people “over there”. Americans looking at the news here just don’t respond to issues about diseases they’ve never heard of affecting people in Africa the way they respond to issues like how much they have to pay for their kid’s EpiPen. Whatever the reason for their decision, the Merck executives did the right thing and as a result millions of people will not go blind.

  5. Contrary to what you suggest, this is very well known in business. There’s a statue in the front entrance of Merck’s headquarters, it’s been taught in business schools a lot. Believe me, the pharma industry knows how to publicize a good story.

    And it is a good story, legitimately. Even a great story, and definitely worthy of your approbation.

    But it’s important to recognize this grew out of the days when Merck was run by an amazing CEO, Roy Vagelos. His autobiography is truly inspiring, and a wonderful read; a medical research guy, a guy who was devoted to what pharmacology could do for the world, he was the Last Stand of the researchers over the marketers.

    Big Pharma has since his time been seriously dominated by marketers, and as a gross generalization, I would say the pharma industry is as ethically compromised today as any industry except financial services. There are structural conflicts as far as they eye can see.

    Think about what’s called “reach and frequency” sales. This is the industry term for carpet-bombing doctor’s offices with ex-cheerleaders sporting cleavage and carrying free drug samples – this is what became of the once-respected profession of pharmaceutical reps, a potentially very valuable role which has been basically turned into legalized drug-pushers.

    Or think about the compromised role of medical research publications, how they select articles to be published, who funds the research, and the web of conflicted cross-referrals.

    It’s an industry desperate to trumpet its days of glory past. Which is what the River Blindness story is. A great story, and true, and worthy of honor: but the best honor would be to live up to the spirit that founded it.

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