CONSPIRACIES OF GOODWILL?
I believe my father coined this term in 1979. He was emphasising the need for treatment evaluation "on a genuinely objective basis, uninfluenced by the physician’s wishes, or the patient’s". Note that he did not refer to the wishes or influence of the pharmaceutical industry."Exaggerated claims for the efficacy of a medicament are very seldom the consequence of any intention to deceive; they are usually the outcome of a kindly conspiracy in which everybody has the very best intentions. The patient wants to get well, his physician wants to have made him better, and the pharmaceutical company would like to have put it into the physician's power to have made him so. The controlled clinical trial is an attempt to avoid being taken in by this conspiracy of good will".
I added the capital letters, 25 years later, wanting to underline what seemed to be the general relevance of this model of destructive commitments and collaborations. Conspiracies of Goodwill (CoGs) seem to pump the heart of pharmaceutical medicine, and to be vital to the development of human perspectives, relationships and organisation.
The "Conspiracy of Goodwill" model also lends historical insight, providing some measure of rates of change, direction, and perspective. CoGs define the equilibrium between competing self interests, and therefore help to explain how the landscape of medicine changes over time, as well as providing glimpses and visions of possible futures.
The Pharmageddon? hypothesis proposes that exaggerated claims for the efficacy of a medicament are no longer the exception, but the rule. They are probably only rarely the consequence of individual malevolence, or concerted and knowing commitment to deceive. Conspiracies of Goodwill still seem to be the main driver of misunderstandings about the relationship between drug benefit and harm, medicines and health.
At the turn of the 21st century, we feel close to a turning point. We need to understand the role and impact of well-organised, attractive deceptions, that indulge and exploit the most natural of impulses – including survival instincts, the triumph of power over dependence, obedience to authority, and the impulse to promote personal and corporate self-interests, above all.
Charles Medawar
Medawar PB: Aspects of Scientific Life and Manners, in Advice to a Young Scientist, (New York: Harper & Row, 1979), p. 50
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