On bridging the gap between public health and big pharma, or, why we would all benefit to see the world in more varying shades of gray

I come from a non-profit background. Actually, backing up even further, I come from the background of sober living throughout college in no small part so that I could spend every hour that I wasn’t working or attending class focused on my volunteer work at a smattering of local organizations. I wanted to make a difference. I wanted to be part of change. Part of a solution.

When I moved to Albany to pursue a graduate degree 23 years ago, I thought I had a reasonable path mapped out to realize my dreams of being the change I wanted to see in the world. One or two semesters in I realized that as much as I loved my field of sociology, studying systemic disparities and addressing systemic barriers were two very different things.?

Two years later I entered the professional workforce highly motivated, but also wildly unsure of how I was, in fact, going to be the change. There was so much that needed to change. And so few of us who seemed interested in changing it. At some point I realized what everyone over the age of 30 had probably been impatiently waiting for me to realize all along: change doesn’t happen through some grand, sweeping motion. It happens incrementally through an ongoing series of small actions. You find a network of good folks, and you, and each one of those good folks do your best to bring the best into the world, one small step at a time. And eventually, there may be change. And even if it’s not visible on the large scale, it impacts the individuals you interact with. And that may just be all there ever is. And maybe that’s enough.

Dreamers, doers, and change-makers?

My work in homelessness gave way to work in food insecurity which gave way to work in public health. And really I suppose that could have been the beginning of this post. But I wanted you to understand how deeply connected I feel to the world of wanting to do good. How integral those values are to my sense of self and sense of purpose.

Public health, it turned out, wasn’t all that different from social work. You examine societal challenges - many of which probably don’t even register as “health issues” to folks outside the field- and look for multifaceted approaches to improving the well-being of the community as a whole. In a sense, housing insecurity, food insecurity, racial, economic, and sex or gender-based disparities - all the areas I’d previously focused on through a social work lens - were also public health issues.?

And the field of public health is made up of dreamers and doers who are committed to being the change.?

Studying and practicing health has the potential to be a financially rewarding career. But not usually if you go into public health. Public health is to the practice of medicine what Legal Aid attorneys are to the practice of law. (Would it surprise you to know that my second job out of graduate school was working at a Legal Aid Society with some of the most brilliant lawyers I’ve ever known?) It is change-making work. It is critically important work. It can be rewarding work when the reward isn’t overshadowed by the exhaustion. But it’s not lucrative. You go into public health knowing you can make one of two things: Money, or a difference. And you consciously choose “difference.”

Improve maternal mortality rates. Reduce the burden of preventable disease in lower-income communities. Eliminate racially disparate health outcomes of people living with diabetes. Increase access to nutritious food. Reduce pain. Reduce harm. Improve health outcomes, and by extension, quality of life.?

Profiteers, exploiters, money-grabbers

Ultimately, when I was in my 30s, not partnered, and struggling to pay my mortgage, pay for my medication, and save for a car that was less than 12 years old, I left the non-profit world for government work. Marginally better pay with significantly better benefits meant that for the first time in my adult life, I could think beyond my next paycheck. And after a successful career in government with limited opportunities for advancement during the financial (public health) crisis of the Covid-19 pandemic, I ultimately left government for a job in the private sector.

It was still working in learning and development. And it was still aligned with my idea of being part of a change. Was it wrong to want to not only pay my bills, but also save for retirement? (Note that the topic of compensation for those in non-profit and public sector deserves a much greater acknowledgement than fits within the scope of this post).?

I expected that my biggest struggle was going to be finding myself in meetings with senior leaders in overpriced suits making overtly racist, sexist, and homophobic comments while lauding extremist republican ideals that inflicted harm on the communities I’d worked so hard to serve. I feared that while I could do the work, I wouldn’t fit in culturally, and would have to do a lot of “game-facing.”

I was shocked at how wrong I was. The folks in the private sector used unfamiliar words like, marketing, revenue, innovation, C-suite and high-performers. But beyond the new lingo, they weren’t all that different from me. Or my former colleagues in the worlds of the public and non-profit sectors. They were looking for learning solutions to support their employees. They wanted to improve employee engagement, provide opportunities for skill development, develop more effective leaders, provide better experiences for their customers- and yes, of course, also make a profit.?

I distinctly remember the first time I told a friend and former colleague about work I was doing for a client that was a pharmaceutical company. It may have been my first “Big Pharma” client. I hadn’t even shared much information when my friend responded saying, “Wow! You’ve really sold out, huh? You can’t possibly stay in a job like that that’s so misaligned with your values! What are you going to do?”?

Yes, that’s right. The once change-maker had sold out to the profit-hungry, greed mongers of Big Pharma (please read the words Big Pharma in a deep, booming, vaguely threatening voice. That’s how they’re intended to be read). We all know about, and love to hate, Big Pharma. I was in deep with the devil. Working for the man. Screwing over the little people left right and sideways to help the rich get richer and hopefully carry me along for the ride. How did I get here?

The humans in the room

If this was an audiobook, there would be the scratching sound of a tonearm being pulled unexpectedly across a record in play. But it’s not, so I’ll ask you to imagine it.?

How did I get here? Where is here, exactly??

My first Big Pharma client contact was a Black, lesbian woman who was shared her openly critical perspectives on systemic racism within the United States, and also shared her enthusiasm in the efforts her company was making to improve the quality of life for those most impacted by the policies she’d referenced. I probably had more in common with her than I did with the men I'd worked for in government.

My second pharma contact was a European woman who engaged me in deep, thought-provoking conversations about healthcare, climate change, and universal income.?

And the first time I found myself in a room full of Big Pharma employees, it felt like I was in a room full of academics. Or social workers. Or public health practitioners. And the second time, it felt the same way. And the third time as well. And, frankly, every time thereafter.

What do I mean by this? Ask people to tell you about their work. What motivates them. How they chose their career path. Why they are in this very specific field.?

Their mom had an extremely rare form of cancer, and they had no options for treatment. Watching their mother die before the age of 50, and the devastation it had on their entire family motivated them to want to find a better way.

They went to school with someone who suffered from a degenerative bone disease that dramatically decreased their quality of life over the years, till they ultimately withdrew from all of their prior activities because they were too painful. They don’t want anyone else to go through this pain.

They are a member of the LGBTQ community and watched as their friends, family, and lovers died during the height of the AIDS epidemic. While it is great that people can now live with HIV, they want more than just “living”. In the memory of all those who are lost, they want to find a way to help those not only live, and survive, but thrive.

They grew up in a community where access to fresh, healthy food was scarce and the prevalence of obesity and Type 2 Diabetes was much higher than surrounding communities. They want to improve quality of life for those who are currently living in situations that don’t allow them to access healthy foods.

They work long hours. And face high pressures. And repeatedly pick themselves back up and try again after failures. Because they want to be the change they want to see in the world. Because they want to reduce pain. Reduce harm. Improve health outcomes, and by extension, quality of life.

The messy truth?

We all want things to be black and white. Simple. Defined by straight lines with clear margins. We want things to be good or bad.

Non-profits = good.

Corporations = bad.

The actual diverse populations of people in each system - left undiscussed.

You’re either fighting for good, or you’re contributing to bad. And there is no room for anything in between.

Except that in my experience, almost everything - and everyone - is somewhere in between. In my experience, the narratives of the folks at the public health conference aren’t actually that different from the folks at the pharmaceutical conference.?

I could write a novel on the many mistakes I made and many ways I unintentionally caused harm during my career regarded as noble because I was a professional dreamer, doer, changemaker. I could also probably write a novel about all of the good that has been done by some of those regarded as profiteers, exploiters, and money grabbers based on their type of employment.

And the inverse is true as well. And likely every variation that could fall in the middle.?

I started my career wanting to be part of a solution - even though I wasn’t sure what exactly that solution was. It’s taken me about a quarter of a century, but I've gotten much closer to defining what is that solution that I want to contribute to - to be the change I want to see in the world. I want to facilitate conversation and connection. And to reduce the barriers - the artificial lines and labels we use to simplify the things that are inextricably human, and therefore inherently complex. To welcome people from the black and from the white to enter and explore this delightfully messy, delightfully honest, uncomfortable and unquantifiable, world of gray.?

I’m still committed to bringing my best into the world, one small step at a time. And eventually, there may just be change. Even if it’s not visible on a large scale, maybe it will impact the individuals I interact with. Both the public health professionals and the pharmaceutical company employees. The non-profit workers and the private sector workers. The folks in the black, and in the white, and all of the endless shades of gray. Maybe that's my best solution. And truthfully, that may be all there ever is. And indeed, it will be enough.