Biopharma’s Racial Justice Work is a Start. But More Needs to Happen

Stewart Lyman, biotech consultant

Stewart Lyman

Biopharma leaders have pledged to make their companies more diverse and inclusive. MassBio created an open letter on culture, recruitment, development, sustainability and accountability that has been signed by presidents and CEOs of more than 200 member companies.

Large and small companies have described some of their specific efforts in public. Bristol-Myers Squibb aims to double the number of executive roles for Black and Latinx employees; Biogen has said it will be increasing minority participation in clinical trials, and Sutro Biopharma is working hard to increase diversity within company ranks.

The work to fight racism is showing up in clinical medicine as well. American Society of Clinical Oncology President Dr. Lori Pierce has made “Equity: Every Patient. Every Day. Everywhere” the theme of her Presidency. The American Medical Association has released a plan for ending structural racism not just within medicine, but also within the organization itself.

A pledge won’t transform an industry where BIPOC and Latinx employees are historically underrepresented, but it’s a start. We’re living in a time when many people, especially young people, expect corporations to do more than just maximize the bottom line.

I’m hopeful that these companies and organizations follow through on their words. But the industry could do one thing above all to attack racial disparities in healthcare.

It could make drugs more affordable. Especially for members of the BIPOC community.

As discussed here by Patients for Affordable Drugs Now, a patient advocacy group, the high price of prescription drugs helps to perpetuate systemic racism.

I want to applaud the industry for stepping up and taking pledges to do better to address racial inequities in hiring, career development, and representation in clinical trials. This is important work. But it’s simply not enough.

What’s going to have more impact: doubling the percentage of BIPOC employees at your company from three to six percent, or helping tens of millions of BIPOC people obtain the drugs you make?

Let’s not dream small. Why isn’t it possible to do both of these things?

BIPOC Communities are Marginalized by Biomedicine

There are many ways that Black people and other minority groups have been marginalized by the biomedical industry.

Here’s just a partial list of the disparities exposed and amplified by COVID-19 in the past year:

  1. Black people ages 35 to 44 were dying at nine times the rate of white people the same age from COVID-19.
  2. Neighborhoods that have higher COVID-19 hospitalization rates should have higher rates of COVID-19 testing, but if they’re majority Black neighborhoods, they don’t.
  3. Life expectancy in the U.S. fell in 2020 by the largest amount measured since WWII. Life expectancy for white people fell by a full year; for Black Americans it fell by 2.7 years.
  4. Racial bias was found in a major health care risk algorithm that is used for determining patient needs.
  5. Pulse oximeters used to measure blood oxygen levels, a quick and easy test to determine the severity of disease for a given patient, don’t work as accurately for many Black people.
  6. The number of kids being diagnosed with SARS-CoV-2 induced Multisystem Inflammatory Syndrome in Children (MIS-C) is growing in the U.S. Though MIS-C is rare, the majority of kids who get it are Black or Latino.
  7. In Palm Beach, Florida, COVID-19 vaccines intended for rural Black communities were instead given to wealthy white Floridians, and in general Blacks and other minority groups lag whites in getting the COVID-19 vaccine.
  8. In emergency departments at children’s hospitals in the U.S. from 2016-2019, Black children were 18% less likely and Hispanic children were 13% less likely than white children to receive X-rays, ultrasounds, CT scans, or MRIs.
Unfortunately, We’ve Seen This Movie Before

Some of the racial problems in healthcare are outside the control of the biopharma industry. But when the issue turns to race in biopharma, the industry tends to fall back on knee-jerk defenses that do nothing to solve longstanding racial inequities.

Biopharma has some movies I’ve had to watch far too many times. Three examples with comments:

  • Patients testifying in public that they can’t afford their drugs, or how unaffordability led to the death of a loved one.

The unaffordable price of drugs has been raised as an issue at least as far back as the Eisenhower administration and the Kefauver-Harris hearings that transformed the FDA in 1962. The industry managed to avoid price controls back then, and it’s beaten back every similar effort since. Our former President promised many times to lower drug prices. He broke that promise.

  • Drug prices can’t be cut because that would remove the incentive for innovation.

Venture capitalists are quick to point out that cutting prices would slow the development of new drugs. All of us would love to see a continuous stream of new and truly useful medicines. But what good are medicines, old or new, if patients can’t get them?

  • Listening to the CEOs of biopharma companies, healthcare insurers, and pharmacy benefit managers explain why they bear no responsibility for high drug prices, and why it’s always “the other guy’s fault.”

People are tired of these finger-pointing, blame-shifting exercises. Each of these special interest groups is there to protect itself, and each controls a small army of highly effective, well-paid lobbyists. Their combined forces would make a worthy opponent to those rampaging legions of Orcs in the Lord of the Rings movies.

The connections between these three industries are deliberately constructed to be opaque and hard for those on the outside to review and understand. For example, “rebate walls” have been set up between drug companies and PBMs. This term refers to contractual arrangements that control the placement of certain drugs on formularies that are used by most healthcare plans. Drug makers can offer higher rebates to the PBMs for any given medicine, or bundles of different medicines. This allows them to “wall off” other drug makers from getting favorable formulary placements for their drugs.

All of these groups should spend a lot less time offloading blame and focus instead on solving the problems of increasing access to medicines, reducing healthcare costs, and improving health outcomes. Mud slinging just promotes the growth of a swampy ecosystem of missed opportunities and wasted money. Everyone’s reputation gets bogged down in the muck and mire.

Reputation Resuscitated?

Life-saving COVID-19 vaccines were produced in record time, along with new and repurposed drugs for combating the pandemic. Many people are grateful for this work. Polls have shown that biopharma’s reputation is trending upward. That’s good news for the industry. Whether this will be sustained is an open question.

This positive movement in favor of biopharma is being counterbalanced in real-time by anti-vaccine forces, most of which are anti-pharma and anti-science. The anti-intellectualism and misinformation promulgated by these groups lingers like a bad cough, even as biomedicine successes continue to pile up.

Biopharma scandals continue, with large fines levied for all manner of offenses. Purdue Pharma is on the hook for $8B for driving the opioid crisis. Novartis agreed to pay $678M for making improper payments to doctors (i.e. kickbacks). Even after admitting this, Novartis was forced to walk back comments made by its chairman, who inaccurately insisted that the company had done no such thing.

Gaslighting is never a good look for an industry leader. Congressional testimony about drug pricing from the CEOs of AbbVie and Amgen was embarrassingly bad, wilting under the tough questioning of Rep. Katie Porter with her “whiteboard of truth.” This confirmed what many in the public already suspect, and which helps drive the anti-vaccine movement: the industry can’t be trusted.

Just as coal, oil, and gas companies need to change their business models because of the threat of global climate change, biopharma companies need to work much harder to ensure their medicines will be available to all those who need them.

It’s a reasonable request for an industry that continues to oppose state drug pricing boards, Canadian drug imports, and Medicare negotiations on drug prices.

The industry’s stance on those issues hasn’t changed in the past decade. But the industry can and must change.

The shifting position on racial diversity, equity, and inclusion is a sign that industry can do better. We need to hold it accountable. Let’s make sure the industry follows through on its promise by doing everything in its power to ensure that the poor, the disadvantaged, and BIPOC and Latinx folks gain access to the treatments and medicines that will enrich and prolong lives.

Stewart Lyman is a biopharma consultant based in Seattle.

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