Don’t blame Big Pharma, blame our economic system.

To (possibly) quote Joseph Stalin, “one death is a tragedy, a million deaths are a statistic”. This is the reason why our society is frequently exercised by a single preventable fatality that becomes a cause célèbre (especially if they are a white female child born to respectable middle class parents), whereas meanwhile innumerable equally preventable deaths of other “less important” people can pass us by without registering. It is with this in mind that I often read World Health Organization or United Nations statistics reporting the millions of babies, children, mothers, AIDS patients or elderly in developing countries that die needlessly due to inadequate access to medicines or because inadequate funds are allocated by our economic system to develop cures for such diseases. I say “needlessly” because these deaths are generally not due to a lack of medical knowledge, but due to economic reasons. The medicines or treatments could easily have been supplied if the will was there, however unfortunately our economic system judged these people to either own or be capable of producing insufficient wealth to exchange for them. Thus, treatment was denied and the individuals died.

Pharmaceutical companies control the development, production and distribution of the majority of medicinal-therapeutics (drugs, vaccines, biologics, etc.). They are therefore the mechanism by which these treatments are made available to individuals suffering from disease. Periodically, there is outrage at the ethical nature of some decision that one or all of the major pharmaceutical companies has taken, whether it is denying poor people life-saving medication, overzealous enforcing of drug patents, bullying researchers and academics, or burying negative drug trial data and suppressing the evidence of harmful side effects. Notice that such outrage criticizes the companies’ behaviour as though they have been naughty, and not criticizing, say, the disgusting way we organize our society so that drug development and distribution is left to private enterprise and so left to the caprice of the market.

Formulating criticisms in this way misses the point. Pharmaceutical companies are both capitalist enterprises and public limited companies. Their raison d’être is financial and business orientated, not humanitarian. They are big players in the grand capitalist game of which we all know the rules and a majority of us, we are told, favour organizing the economic activity of society according to these (“free market”) principles. This is, so the flag bearers of capitalism say, because it is the most efficient method of organising economic activity known to man. Presumably the parents of children who die due to lack of medicine take comfort in knowing this.

By understanding that their aim is simply to turn a profit and not to save lives, the actions of the pharmaceutical companies start to make more sense. If an organisation is led by a board of directors or team of executives who owe their position and career development to the demands of shareholders and the performance of the company on the stock market, it will be the demands of shareholders that will be prioritised, not the health of children in developing countries. Occasionally these different incentives can overlap, for example when drug companies occasionally decide to distribute drugs in developing countries for free in order to improve their public record. This tends to be rare however, and again, cold economics lies at its heart (the potential for greater profits later), for it is impossible for such organisations to act differently.

Of course effective regulation can provide the necessary incentives to produce a greater focus on the health and lives of both current and potential consumers. However this relies on strong, impartial regulators able to collaborate and enforce their decisions internationally, and also willing to prioritise constituents health over potential personal gain. Capitalism being capitalism, in any sector a number of smaller companies compete to become a few large, powerful companies, which then have the incentive to act oligopolistically. Unfortunately in many modern capitalist markets it is often more efficient for companies to focus on financial ingenuity or lobbying government and regulators to ensure financial success, rather than on product development. For all their talk of the necessity of high drug prices to recoup and fund the costs of world-class drug development, in reality the major pharmaceutical companies have recently spent more on share buybacks to artificially inflate their share price than on original drug research.

This is also the problem with solutions that focus simply on efforts to improve regulation or increase awareness of the problems. Whilst these are obviously worthy pursuits, we should realise that the levels of regulation and public awareness of these problems are low by design. It assumes that everybody shares enlightenment values based on helping people and believing that the world operates according to what is most equitable for everyone scientifically. Unfortunately it doesn’t. Even in the 21st century, simple power struggles dominate our society.

It’s difficult to envisage comprehensive solutions to these problems that don’t involve a complete reorganization of our economic system. Large numbers of people will continue to die and suffer everyday due to lack of affordable medicines. Whilst it is easy and tempting to diagnose the problem as being due to a lack of morality in the pharmaceutical industry, they are ultimately just businesses responding to economic incentives. In that respect, the plight of citizens in developing countries is no different from the other problems they regularly face due to their economic disadvantage. The actions of pharmaceutical companies aren’t just a threat to the citizens of developing countries however. Anybody who takes one of their products is potentially at risk from pharmaceutical companies burying trial data or suppressing reports of harmful side effects, not to mention the cost of drug company profiteering on national health care systems such as the NHS. Whilst drug development and distribution remains under the control of private enterprise, this is simply what will continue to occur.

Like so many things, if we wish to achieve better results we will have to look deep into the fundamental way our society operates and decide if we wish to continue to judge the worth of human beings simply according to narrow economic criteria. Many of us wish that the distribution of drugs could be based on individuals’ need rather than their ability to pay, and that drug development could be organised so that improving human well-being was regarded as a worthy aim in itself, rather than the requirement to turn a profit. However until we can put forward a convincing proposal of how to achieve this, we are left with the capitalist system of drug development, and as such the obscenities that are its inevitable consequence.