They are legal drugs. These pills, injections, tablets and infusions help determine both the quality of life and the proximity of death. They are the difference between sickness and health.
Prescription drugs have become an enormous social issue for our time. No other subject illustrates more profoundly humanity’s greatest triumphs and failures.
Triumphant in that scientists and physicians continue to achieve a better understanding of the body and mind. Every day, there is new potential to effectively treat a host of ailments. But human weakness is evident in this pursuit too. Society continues to allow people to die of easily-treated sicknesses for the simple reason that they don’t have the money to pay for medication.
Quoted in sources from CNN to the New England Journal of Medicine, pharmaceutical industry analysts say that Americans alone spent $200 billion on prescription drugs in 2002. It’s a figure that has been rising by 12-18% every year since 1980. Total world spending on pharmaceuticals is $400 billion, making the pharmaceutical industry one of the three most profitable business sectors in the global economy.
It’s an elephantine industry dwarfed by surrounding ethical controversies.
- Over the past five years, many US sources have featured reports about American seniors who must choose between purchasing their medications and buying food. Even more commonplace are news reports of seniors’ bus trips over the Canadian border, where brand name prescription drugs are up to 20% cheaper. A study conducted by the PRIME Institute at the University of Minnesota in 2000 predicted that the average American senior will spend $2,810 a year on prescriptions by 2010.
- In the developing world, controversies over the costs of drugs spiral and intertwine with deadly consequences. The AIDS epidemic, in particular, is prone to issue entanglement surrounding antiretroviral (AVR) treatments. In sub-Saharan Africa, where 28 million people suffer from AIDS, the ability of nations to provide even basic governance is being challenged as an entire generation of parents, teachers and healthcare professionals die.
- While the political and emotional hotbed of drug access rages, medical care and cosmetic procedures compete for attention and expertise. Some of the most deadly tropical diseases and TB are already losing the battle for attention.
In this series of articles BustedHalo explores the social issues of big pharma and attempts to understand how treating diseases seems to spread injustice.
Part 1 (below): The costs of drugs is directly related to the costs of research, the pharmaceutical companies maintain, it’s a view that has been challenged by The Truth About Drug Companies How they Deceive Us and What to Do About It by Marcia Angell. We start the series with a review of her controversial book.
Part 2: The drug companies dropped their patent infringement challenge against providing generic ARV treatment to AIDS victims in Africa. In part 2, in an interview with a German priest/AIDS worker on the frontlines of the epidemic, we’ll look at what effect, if any, this has had on the fighting AIDS deaths.
Part 3: We’ll look at new threats to access to medical care and what situation the profit-motive has created in the developing world where NGOs have created cause for hope.
Part 4: In the final part of the series, we’ll look at how the Church and Catholic agencies are involved in prescription drug issues both locally and globally.
Chasing the Money: The True Cost of Drug Research
A Review of The Truth About Drug Companies, How They Deceive Us and What to do About It, by Dr. Marcia Angell: 2005 Random House Trade Paperback Edition, reviewed by Kate Baggott
Drugs are just products. The cost of research is directly proportional to the cost of a cure.
Or is it? According to The Truth About Drug Companies, How they Deceive Us and What to do About It by Dr. Marcia Angell, the central tome in the legal drug wars canon, the answer is a resounding no.
Central to Dr. Angell’s argument is the belief that “the cost of research” is merely a deception in a form of blackmail the drug companies have been holding over citizens and governments. “If you want drug companies to keep turning out more life-saving drugs, you will gratefully pay whatever they charge,” she writes.
An internist and former editor in chief of the New England Journal of Medicine, Angell puts drug company profits into a broader social context. Drug prices, she believes have less to do with the cost of research than with a shift in morality that occurred with the election of Ronald Reagan in 1980.
“Before then,” the author says, “there was something faintly disreputable about really big fortunes. You could choose to do well or you could choose to be good, but most people who had any choice in the matter thought it difficult to do both.”
Making money for its own sake, as opposed to earning a living, became the central to that status consciousness of individuals. This ethos affected medical professionals in terms of how and why both patient care and research were conducted.
If You’re So Smart
Angell quotes her grandmother, to explain what medical professionals began to ask themselves: “If you’re so smart, why aren’t you rich?”
Drug companies dismiss this profit motive, claiming that research costs are behind the high cost of medication. It is a myth, Angell says, that drug companies accept any cost for research that will not be rewarded.
To cure a disease, to understand its behavior as molecular or genetic level is long term research. This is what Angell refers to as “the most creative and the least certain part of drug research.” During this stage millions of dollars are invested in the hopes that eventually, understanding a specific disease will teach researchers how to target treatments for that disease. This risky stage of research can go on for decades. It is not commonly supported, at least financially, by pharmaceutical industry.
“Contrary to industry propaganda, it is almost always carried out at universities or government research labs, either in this country or abroad. In the United States most of it is supported by the National Institutes of Health (NIH),” says Angell’s research. Presumably, donor-supported foundations designed to raise money for disease research also play a role in funding these activities. In other words, the international public is paying high prices for drugs their tax dollars helped to discover. The most famous example of this phenomenon is AZT, the first drug developed in the treatment of AIDS.
Better Deal, Better Health
The drug company, Burroughs Wellcome, which was acquired by the giant GlaxoSmithKline, profited from the manufacture and sale of the drug. The two years of initial research that identified AIDS as a retrovirus, the primary step in developing a treatment, was conducted by the NIH and The Pasteur Institute in France.
Further complicating the industry’s claims the research expenses explain high drug prices, is the fact that marketing costs generally surpass R&D expenditures. Angell takes the argument a step further, claiming that much research may actually be marketing in disguise. The doctor refers to some late-stage clinical trials as “ways to introduce doctors and patients to a company’s drug by playing clinicians to use it and then report some minimal information back to the company.”
“People have grown angry about the high and rapidly climbing prices for prescription drugs,” Angell says in her book. “They no longer believe that big pharma has to charge stratospheric prices to cover the costs of research and development.”
Angell’s book provides those angry citizens with the facts, figures and illustrations of research practices they need to fight for a better deal and better health.