How Pharma’s Checks and Balances Can Help Fight Its Public Perception

Daniel Rehal, President, Vision2Voice Healthcare Communications

Talking about ethics isn’t exactly exciting. Leaders don’t usually jump at the chance to emphasize following rules or exceeding standards—it’s much more appealing to focus on growth than on problems. But what if we built our organizations around hiring the right people, fostering the right culture, and creating an environment that encourages and rewards ethical behavior? Many companies have systems in place to support doing the right thing, even though challenges still arise. The key to success lies in following the "law of the farm" — understanding that regular, disciplined effort is what really makes a difference.

This article explores the critical role of ethics in the pharmaceutical industry, emphasizing the importance of cultivating a culture rooted in integrity and accountability. It examines how ethical missteps tarnish public perception, and the processes in place to prevent such failures. The discussion extends to actionable best practices and how to embed these principles into organizational culture, so that we can ensure the industry thrives on trust and delivers meaningful value to patients and society.

Unscrupulous behavior

Let’s start with an example from my own experience. Years ago, I was called into a high-rise tower in New York City to help a start-up BioPharma company launch a healthcare education initiative. As time went by, I slowly learned that these borderline strategy and planning discussions were being led by a man who had little regard for improving the lives of patients; his motive was profit. As he purchased a life-saving product for sepsis and increased the price from $12.50/tablet to $750/tablet, he was rebranding Deraprim which had been on the market for 70 years and was long generic. Martin Shkreli, who was a founder of three hedge funds, came from Wall Street to seek his financial fortune in healthcare. Years later, he was convicted of security fraud and conspiracy and sentenced to prison.

In BioPharma, future leaders who have good intentions are typically selected. During the early years of my career at Merck and Takeda, I never had the need to question someone’s commitment to the greater cause. Now as a MedComm agency leader, my team walked away from the opportunity to work with Mr. Shrkeli because it didn’t align with our values.

Another well-known case is Elizabeth Holmes, the biotech entrepreneur who dropped out of Stanford to establish the blood-testing start-up Theranos. The company achieved a multi-billion-dollar valuation based on her claims of revolutionizing blood testing, purportedly enabling over 250 biomarker tests with just a small volume of blood. These claims, however, were false. In reality, Theranos had approval for only one test. Consider the impact on patients — such as someone who received a false negative for a breast cancer test, unaware they were living with the disease.

Following a tip from a whistle-blower and an extensive investigation, John Carreyrou, a reporter with The Wall Street Journal, published a bombshell article exposing Theranos that ultimately helped to land Holmes in jail, where she was sentenced to 11-1/4 years. Several members of our Vision2Voice team and I met with Mr. Carreyrou when he was a guest speaker at a Better Business Bureau luncheon. When I asked Mr. Carreyrou about his beliefs on the pervasiveness in our industry, he responded,

“As Silicon Valley and healthcare come closer together and as more and more people in Silicon Valley come to solve healthcare challenges, they need to bear in mind that stakes are higher. Healthcare is peer-reviewed with scientific publications and that has always been the way that discoveries and innovations are aired out, and there is a reason we have things like clinical trials and peer reviews before publications in top journals.”

The rigors of our processes used in healthcare cannot be understated. Double-blinding our trials, randomizing patients, stratifying results, using placebo controls, ensuring statistical significance, and differentiating between the way the statistics pan out and the way patients are clinically assessed, all measure the effectiveness of discoveries in pharma. At the end of the day, people within the scientific community must agree and show that results are replicable.

Five ethics-focused best practices

How can we prevent reputational damage from occurring in an industry that so many of us deeply value? A key step is to uphold the checks and balances established through the scientific methods that form the foundation of product development. Beyond that, we must foster a culture of accountability, ensuring that individuals and organizations are held responsible for the commitments they make.

Here are five checks and balances we should uphold in our own organizations:

1. Hire people with values and character. When we hire principle-centered people, leaders and organizations succeed. The best predictor of future behavior in the workplace is past performance. Assess their patterns from the past and recognize that they are probably going to act in the same way in the future. Spend time reviewing their online profiles, their social posts, and listening to their words to really know their history. Find employees who match the character of your culture.
2. Keep your team focused on patient care. It’s rather simple: each of us in the industry needs to take accountability for an unwavering focus on what is best for patients. Like a litmus test, make decisions based on whether or not the decision will ultimately improve the lives of patients for which we serve. In 2025 we celebrate the 75^th anniversary of George Merck famously saying, “We try to remember that medicine is for the patient. We try never to forget that medicine is for the people. It is not for the profits. The profits follow, and if we have remembered that, they have never failed to appear.”
3. Reward good execution of your core values.
   There are many ways to celebrate excellence within an organization. Most companies focus on rewarding significant achievements, which is typically expected. However, the most effective organizations also recognize and reward how employees approach their work. This can be highlighted during staff meetings or annual gatherings, where leaders share stories about employees demonstrating honesty in challenging situations or leading with ethics and empathy under pressure. When leaders set this example, imagine the impact of colleagues sharing similar stories about one another, showcasing how they uphold the company’s values in the face of adversity.
4. Develop a mentor and protégé culture. People coming into the organization can learn from those who are experienced. An established mentorship program provides a forum for new employees to make a connection with someone more senior who is outside of their manager. Not only does this benefit the new individual, but it offers a refreshing opportunity for a more seasoned team member to reflect about things through the eyes of someone new. Going inward from top to bottom (and from bottom to top) propels an organization from good to great.
5. Create an ecosystem of ethics.
   Beyond your own organization, cultivate relationships with business partners, suppliers, and clients who align with your company’s mission, vision, and values. These external collaborators are an extension of your team and should reflect the same commitment to integrity and a patient-first approach. I recall a moment when a prospective pharmaceutical client interrupted us on the very first slide of our new business presentation. As we outlined our agency’s core values, she remarked, “We are so aligned on values; we’ll find a way to work together.” And we did — continuing a strong partnership that has lasted seven years and counting.

As people working in healthcare, our cultures guide our corporate tolerance, and our values help us determine the decisions we make. Those values drive ethical standards of behavior and should be woven into everything we do — from how we treat others to the processes we execute. Measure these carefully, because when times get tough, we should always lean on our values and company cultures. Just like the law of the farm, what we reap we sow.

Daniel Rehal, President, Vision2Voice Healthcare Communications