This chapter is very different than any other in this book because it has more general discussions and more nonpharmaceutical examples. The goals of this chapter are to present various ways to
structure one’s thoughts and approaches to creating strategies, developing negotiation positions, and solving problems. To do these things, one has to sometimes identify the individual components of one’s issue or situation in a different way. For example, instead of creating a development plan for a “drug,” perhaps you can view the product as an antidote, enzyme replacement (the product does not have to be an enzyme to replace one), part of a chemo-preparative regimen, essential nutrient, physiological replacement, and so forth. Clearly, the scope of the plan one creates is likely to be different for one of these products than for a “drug.” This is due to the greater medical need of one of these products and the anticipated greater safety involved in a benefitto-risk assessment.

The focus of this chapter is the many facets of reality. When one’s product or problem is seen as the many facets of a gemstone, you can decide how each of these is to be presented. The “how” involves questions of whether to be a “splitter” or a “lumper” and which of the following techniques often (or others) to apply:

A person’s view of reality is strongly influenced by his or her perceptions, values, biases, and beliefs; and reality is, therefore, a relative term. Truth can be thought of as either a relative or an absolute concept. Assume that there are several eyewitnesses to an event such as an automobile accident involving several vehicles and pedestrians. Each witness will swear that certain things happened and in a certain sequence. Because it is likely that each person will report seeing something different or recall a different sequence of events, this frequently observed situation also suggests that truth is relative, since one can rarely ever know who is correct. In the pharmaceutical industry, people’s overall perceptions of the product they are developing will vary widely based on their training, experiences, and personality.

The “absolute” truth of what occurred may be considered as a moving-camera version of the events of the automobile accident taken from a building with an unobstructed and total view of the scene or, in the case of a scientific experiment, as the real-time output of scientific apparatus measuring the sequence of changes that occurred in the experiment. These film or other objective records may be quite different from what any of the eyewitnesses observed. But even film versions cannot be relied on to always show the truth. For example, instant replays of sports events on television often cannot determine the exact sequence or nature of an event, and often, we get to view the same event from numerous cameras, some of which seem to show a different picture than do others. Likewise, it is best not to adhere to only one image of viewing a drug or even its target disease or condition. Many diseases can be presented in multiple ways, and the focus or focuses one chooses can help one re-evaluate one’s approach to seeking treatments or explaining what the specific treatment does. For example, while most people think of diabetes as a sugar disease, many physicians view it as a disease of small blood vessels, particularly arterioles, and looked at in that way, the orientation one uses to interpret data often differs.

Another example is a filmed version of a magician that does not show all components of the tricks. Thus, even a perfect camera or recording device cannot capture sufficient information to be 100% certain of reality, and thus, the absolute objective truth may never be known about many accidents or experiments. Also, recall that Harry Houdini fooled the best scientists in the Royal Society of England about the truth of what they observed when he made a sensitive balance move erratically from a significant distance merely by waving his wand. The illusion depended on microscopic baby fleas that were cast from the wand through an opening that then closed and some of the fleas settled on the highly sensitive scale causing it to wobble. The fleas then returned to the wand when it was waved again, opening the other end exposing a powerful pheromone inside.

Religious views are an example of absolute beliefs to many people that admit no possibility of debate. Others see religious questions as relative matters without absolute answers to fundamental questions.

Many people believe that the reality of the external world may be objectively measured and assessed, and they define reality in terms of what they broadly observe and assess with their senses. Others believe that the assessment and understanding of reality must focus on a more detailed level of organization or underlying factors. The former group of people is often called “lumpers” and the latter group “splitters.” Lumpers try to tie many aspects of a drug or issue together to present an overall view or assessment. They may find the lowest common denominator of an issue to summarize their views. Splitters tend to divide each larger point or aspect into its components.

Even the ability to determine the reality of a drug through objective instruments and measures is limited. Pathologists and radiologists sometimes differ about what they see when looking at the same photographs or other data. Everyone sees the same “thing” that is out there in the environment (i.e., it is not literally something in the mind that they are looking at), so the “thing” itself is not different. The way that people describe it is influenced by their training, experience, and expectations.

Most people accept the principle that there is not a single absolute reality about an event but, instead, many descriptions of a reality that depend on the perceptions of the observer. One’s perceptions may be strongly affected by drugs or personal biases. People who have taken drugs such as lysergic acid diethylamide (LSD) or other hallucinogens report that reality occurs on multiple levels and that most people are living on, and experiencing, a single and sometimes superficial level of reality.