*One vial of insulin cost $21 in 1996, compared to $320 in 2018. The cost of Big Pharma’s outrageous greed is American lives. If they will not end their greed, then we will end it for them.* —Bernie Sanders
Corporations are bundles of rights. The most important right is a shield from liability. Corporation rights used to be contentious–in particular, a lot of capitalists thought that it was wrong for corporate officers and owners to not be liable for wrongdoing and debts.
Corporations are given their special rights because it is assumed to be in the best interest of the public. Corporations exist, thus, to make the public better off. When they do not do so, they should be put down. (I would argue corporations have too many rights. Certainly they should not have personhood.)
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So, they’re murderers. Mass murderers. They take actions they will know will kill many people.
The sane response, beyond the simple, “Get them out of the business and have government take over drug research and manufacture,” which would lead to better, cheaper drugs relatively quickly, is to throw them in jail. They kill people in large numbers, and they know they are doing so.
And, in death-penalty states, well, hang them high.
That said, again, it is stupid to run drug research and manufacturing privately. The promotion budgets are larger than the research budgets, and the incentives are all wrong, leading to palliatives rather than cures and insufficient research in important drug classes like antibiotics.
There are things markets do well, but drug research isn’t one of them. (And, in fact, a vast amount of the money still comes from government and flows through universities, but the profits are privatized.)
Lock up the murderous executives, break up their companies, and move the research to public bodies.
nihil obstet
Corporations started as a means to raise a lot of money for expensive projects, like mining ventures or building railroads. They turned into bundles of rights because you could get very rich if a project worked, and then you could buy yourself rights. It’s pretty much been corruption all the way.
The worst financial abuse was the law removing publicly funded research and development from the public domain. If you’re looking for proof that “Property is theft”, that’s it.
Linda Merrill
Ian, First, THANK YOU!! Your amazing essay finally pushed me right over the edge to share a video I find comforting on days when feeling a little extra traumatized by our world.
“TIME FOR GUILLOTINES” – Trevor Moore – from High in Church
https://youtu.be/TMHCw3RqulY
DMC
The figures on relative gross expenditures by Pharma companies that I recall were 14 or 15% for research and 28 to 30% on marketing. That tends to shut down any of those “well, they need all that money for research” arguments pretty quick. That and the tale of Taxol, publicly researched and then sold back to the public for $10K per annum.
Hugh
How about Dennis Muilenburg president, chairman and CEO of Boeing and all its C level execs who decided they could and should be allowed to build planes on the cheap?
How about the Sacklers of Purdue Pharma and Oxycontin fame?
How about all the banksters who blew up the financial system back in 2008, and walked? How about Greenspan and Bernanke who let them?
How about all the politicians who enabled and protected all these crimes?
We live in a society where people in suits blithely kill hundreds, thousands, tens of thousands a year and are heavily rewarded for doing so.
I think corporations should serve the social good. If they don’t, they should not exist. I think that the size of corporations should be limited to preserve competition and prevent monopolies. Some of the current monopolies and oligopolies could be broken up (media, banking, Amazon), nationalized, or run as public utilities.
I agree we need a public US producer of generic and orphan drugs. Also if we had a real universal single payer healthcare system, we would have a monopsony (single buyer) to control other drug costs.
I agree there is something wrong with government financed research turning into lucrative private patented drugs. I would add there is another layer to this scam where universities either set up their own corporations to profit off government funded research or at least get their cut of the action. As I have said before, we also need to look at how copycat drugs (all the cephalosporins, statins, SSRIs, etc.) and reformulations are treated,
Paul Harris
Same goes for any public utility: energy, transportation, housing, health, education, food, water and so on. Let them earn their money from flogging crap that we can decide not to buy if we so choose.
StewartM
I have a dear younger friend who was recently diagnosed with Type II diabetes (probably a genetic risk for him, given his family history), so I hear his rightful complaints. As Ian has said, Pharma is more in the business of shutting down drug research than conducting it. It is far, far, more profitable to use the moola instead to lobby the government to extend their patents.
One of the reasons why both antibiotics are overused (sub-therapeutic usage on just making animals fatter is where 80 % of antibiotics goes) and why there are little in the way of new antibiotics being developed is that there’s little profit in making a drug that should not be used (read: sold) often–ergo, for profit and profit alone either we develop antibiotics and fritter them away them in order to prop up sales, allowing bacteria to adapt, or we don’t waste them and there’s no profit incentive to develop new ones. This is a NUTTY way to do medicine.
And a world without antibiotics would be a world where most parents would see many of their children die in childhood, and routine operations would be too dangerous to do. All being frittered away for the next quarterly profit report. This is also a NUTTY way to run an economy.
bruce wilder
it is the meta-issue that troubles me most. for-profit pharma and its gravitational attraction toward addictive drugs is kind of an obvious hazard. why aren’t “elites” — the most prominent economists, say — more plain-spoken about this public policy hazard and more supportive of measures to address it? (rhetorical question, of course — i kinda know why as almost every one reading this does — ka ching)
the most conventional and orthodox analysis, derived straight from textbook economics, would lead any honest person to conclude that for-profit pharma — absent considerable constraint — will focus on producing and marketing addictive drugs because that is the profitable strategy. how much money is spent on research is not the point; the research, however much is funded, will be focused and shaped to serve profitability
another strategy that works in pharma in the absent of constraint is to produce snake oil. do not do any research or fake the research you do, and just sell some concoction with the usual advertising lies or actual fraud there’s a lot of money to made in aspirin and antacids which have some effectiveness and are also very mildly addicting, as well as well as placebos with a bit of alcohol, caffeine or other stimulants or sedatives for a kick.
of course, at least in theory, the state can place restraints and constraints on the system and historically at least some economically advanced nation-states created regulatory regimes of various character and effectiveness for pharmaceuticals (as well as many other industries).
actually hanging malefactors, once established as a precedent, might serve as a kind of restraint — and maybe if we dampened the profit potential in other ways, it might be sufficient for practical purposes. (though I agree with Ian that things have gotten plain enough in practice in some cases that resort to severe judicial punishment is warranted, my “meta” concern leads me to think ideally, we’d want to be in a place where governance was not relying primarily on judicial violence in cases so plain and unambiguous that they can be narrated in primary colors.)
it is the regulatory regime in place in the U.S. and a few other countries that is the constraint that requires that research be done to establish efficacy to some scientific standard. it is the regulatory regime that turns pharma from (addictive?) snake oil toward a wide variety of more sophisticated or esoteric medical interventions. and it is the degeneration of that regulatory regime under assault by for-profit banditry that turns pharma toward ever more questionable strategies. it isn’t just that a few aggressive pioneers go directly to fentanyl; it is also shading, say, vaccines (which have been traditionally an example of cheap and effective prevention of dread conditions) into more and more questionable, risky (to the patients) and expensive strategies.
which brings me back to my “meta” concern: why has the American polity in particular lost the ability to critique its system and to press for reform in furtherance of the general welfare and public good.
things have gotten pretty bad, pretty extreme that there isn’t even much subtlety in addiction to pain-killers or inflating the prices of life-saving (and basically cheap to produce) treatments. and, yet, the willingness to press political reform or even to criticize this degenerate state of affairs is not — as i see it — widespread nor has it penetrated very deeply the public discourse as carried in mass media.
nihil obstet
A new or changed drug does not have to show that it is better than other drugs — only that it is better than a placebo. There appears to be a lot of drugs which have been “improved” enough to get patent extension but in fact are less effective than the previous version.