John Abramson: Big Pharma | Lex Fridman Podcast #263

The jury found Pfizer guilty of fraud and racketeering violations.

How does Big Pharma affect your mind?

Everyone's allowed their own opinion. I don't think everyone's allowed their own scientific facts.

Does Pfizer play by the rules?

Pfizer isn't battling the FDA. Pfizer has joined the FDA.

The following is a conversation with John Abramson, faculty at Harvard Medical School, a family physician for over two decades, and author of the new book, Sickening, about how Big Pharma broke American healthcare, and how we can fix it. This conversation with John Abramson is a critical exploration of the pharmaceutical industry. I wanted to talk to John in order to provide a countervailing perspective to the one expressed in my podcast episode with the CEO of Pfizer, Albert Bourla. And here, please allow me to say a few additional words about this episode with the Pfizer CEO, and in general about why I do these conversations and how I approach them. If this is not interesting to you, please skip ahead. What do I hope to do with this podcast? I want to understand human nature, the best and the worst of it. I want to understand how power, money and fame changes people. I want to understand why atrocities are committed by crowds that believe they're doing good. All this ultimately because I want to understand how we can build a better world together, to find hope for the future, and to rediscover each time through the exploration of ideas just how beautiful this life is, this, our human civilization, in all of its full complexity, the forces of good and evil, of war and peace, of hate and love. I don't think I can do this with a heart and mind that is not open, fragile, and willing to empathize with all human beings, even those in the darkest corners of our world. To attack is easy. To understand is hard. And I choose the hard path. I have learned over the past few months that this path involves me getting more and more attacked from all sides. I will get attacked when I host people like Jay Bhattacharya or Francis Collins, Jamie Metzl or Vincent Racaniello, when I stand for my friend, Joe Rogan, when I host tech leaders like Mark Zuckerberg, Elon Musk, and others, when I eventually talk to Vladimir Putin, Barack Obama, and other figures that have turned the tides of history. I have and I will get called stupid, naive, weak, and I will take these words with respect, humility, and love, and I will get better. I will listen, think, learn, and improve. One thing I can promise is there's no amount of money or fame that can buy my opinion or make me go against my principles. There's no amount of pressure that can break my integrity. There's nothing in this world I need that I don't already have. Life itself is the fundamental gift. Everything else is just a bonus. That is freedom. That is happiness. If I die today, I will die a happy man. Now, a few comments about my approach and lessons learned from the Albert Bourla conversation. The goal was to reveal as much as I could about the human being before me, and to give him the opportunity to contemplate in long form the complexities of his role, including the tension between making money and helping people, the corruption that so often permeates human institutions, the crafting of narratives through advertisements, and so on. I only had one hour, and so this wasn't the time to address these issues deeply, but to show if Albert struggled with them in the privacy of his own mind, and if he would let down the veil of political speak for a time to let me connect with a man who decades ago chose to become a veterinarian, who wanted to help lessen the amount of suffering in the world. I had no pressure placed on me. There were no rules. The questions I was asking were all mine and not seen by Pfizer folks. I had no care whether I ever talked to another CEO again. None of this was part of the calculation in my limited brain computer. I didn't want to grill him the way politicians grill CEOs in Congress. I thought that this approach is easy, self-serving, dehumanizing, and it reveals nothing. I wanted to reveal the genuine intellectual struggle, vision, and motivation of a human being. And if that fails, I trusted the listener to draw their own conclusion and insights from the result, whether it's the words spoken or the words left unspoken, or simply the silence. And that's just it. I fundamentally trust the intelligence of the listener. You. In fact, if I criticize the person too hard or celebrate the person too much, I feel I fail to give the listener a picture of the human being that is uncontaminated by my opinion or the opinion of the crowd. I trust that you have the fortitude and the courage to use your own mind, to empathize, and to think. Two practical lessons I took away. First, I will more strongly push for longer conversations of three, four, or more hours versus just one hour. 60 minutes is too short for the guest to relax and to think slowly and deeply, and for me to ask many follow-up questions or follow interesting tangents. Ultimately, I think it's in the interest of everyone, including the guest, that we talk in true long form for many hours.Second, these conversations with leaders can be aided by further conversations with people who wrote books about those leaders or their industries, those that can steel man each perspective and attempt to give an objective analysis. I think of Teddy Roosevelt's speech about the man in the arena. I want to talk to both the men and women in the arena and the critics and the supporters in the stands. For the former, I lean toward wanting to understand one human being's struggle with the ideas. For the latter, I lean towards understanding the ideas themselves. That's why I wanted to have this conversation with John Abramson, who is an outspoken critic of the pharmaceutical industry. I hope it helps add context and depth to the conversation I had with the Pfizer CEO. In the end, I may do worse than I could have or should have. Always, I will listen to the criticisms without ego, and I promise I will work hard to improve. But let me say finally that cynicism is easy. Optimism, true optimism is hard. It is the belief that we can and we will build a better world, and that we can only do it together. This is the fight worth fighting. So here we go, once more into the breach, dear friends. I love you all. This is the Lex Fridman Podcast. To support it, please check out our sponsors in the description. And now here's my conversation with John Abramson. You're faculty at Harvard Medical School. You're a family physician for over two decades, rated one of the best family physicians in Massachusetts. You wrote the book Overdosed America and the new book coming out now called Sickening about how big pharma broke American healthcare, including science and research, and how we can fix it. First question, what is the biggest problem with big pharma that, if fixed, would be the most impactful? So if you can snap your fingers and fix one thing, what would be the most impactful, you think?