Transparent Moment

No one can pinpoint the precise instant it happened, but the dull cloud of our universe suddenly cleared. About a half-billion years had gone by since the Big Bang, finally giving the condensing proto-stars and quasars enough time to sweep a veil of dust from the young cosmos. Their light then penetrated the darkness and, along with that of countless other spawning suns, has traveled the skies ever since.

So it is with many a defining moment-though long in the making, its arrival seems sudden, as if it came out of nowhere. In a single blink, the eyes close on one world and open on another. But only in retrospect can we see the roots of the earthshaking change. That is how quickly the pharmaceutical industry has transformed from a black box, mysteriously opaque to all outsiders, into a glass house, transparent to anyone's view.

In just a few turns of the earth around the sun, pharma companies have run, walked, crawled, been dragged, or by whatever means entered into a new pact with the public. "You can advertise to us and try to educate us if you want to," the public says, "as long as we get to kibitz about your every move."

If only there were as many insiders looking out as outsiders looking in. Sad to say, the more companies merge, purge, and otherwise concentrate on restructuring their inner workings, the more often they appear to ignore those outer voices. That shows in their typical message to consumers: "This is what we do for you," rather than, "What can we do for you?" Ending the sentence with a question mark would mean a drastic turnabout in how companies interact with outsiders. A question invites dialogue. It implies a willingness to listen, not just speak to the public.

I envision the following TV spot. A spokesperson in nonthreatening business attire looks viewers "straight in the eye" and, in an open and calm manner, begins: "I represent the pharmaceutical industry [or a company], and I want to talk with you about how you perceive us, how we can improve on that, and how we can help you with your own healthcare. Please call the number or go to the web address on your screen for an anonymous survey of your opinions, ideas, and suggestions for making our products work better for you. At the same time, you can receive information about free programs already geared to your needs. In the coming weeks, I will return to air your responses and address the issues they raise." Then, as promised, subsequent spots would "talk turkey" with viewers about those issues, which would undoubtedly include some thorny ones such as affordability, safety, marketing practices, and even research direction.

What would follow such a brazen invitation? Anything from a deafening silence to a riot in the zoo, I suppose. It could turn out as the most naive or the most valuable thing the industry has ever done. But this much is true: The survey's value would not depend on the number of respondents but on the content of their responses-and on how seriously the spokeperson takes their concerns.

Once companies learn to enter a dialogue with outsiders they may also rediscover a treasure trove of ideas by listening to their insiders. Top-down restructuring can bury people and their talents. All the trendy management tools in the world-performance measurement, incentives, and the like-work well only when companies build them from the ground up. That begins with giving people on the ground a fair hearing.