The unraveling of the “grand bargain”

Perhaps no business engages the worlds of science, medicine, economics, health, human rights, government, and social welfare as much as the pharmaceutical industry. As the twenty-first century begins, however, there is growing controversy and even hostility in the relationship between the pharmaceutical industry and the public. The millions of individuals, families, and communities throughout the world that have been stricken by the scourge of AIDS offer the most tragic human face to this controversy, but it is no overstatement to say that the pharmaceutical industry impacts the life of virtually every person in the world.

What we are witnessing is the unraveling of a “grand bargain” between the pharmaceutical industry and society. This grand bargain was a complex, implicit social contract that allowed the modern global pharmaceutical industry to emerge in the second half of the twentieth century. Although the industry prospered immensely, society also enjoyed a bountiful array of life-saving and life-enhancing drugs. As the twenty-first century begins, however, this grand bargain is in tatters and public mistrust and resentment of the industry run feverishly high. Many feel that the enormous industry profits are not sufficiently matched by contributions to the common good. What factors are behind this growing tension between the pharmaceutical industry and society?