Before I begin, I need to clarify something that, sadly, needs to be clarified. When I write “pharmaceutical companies,” I don’t mean all pharmaceutical companies. Just like when I write “people,” I don’t mean all people. In the following paragraphs, I’m trying to reason through the actions (and words) of pharmaceutical companies and the systems in place to encourage some very questionable decisions by them. So buckle up, let’s go down the rabbit hole…
Even before I got swept up in the “Vaccine Wars” in 2009, I had heard people complain about the perceived power and greed of pharmaceutical companies. The conspiracy theorists, in particular, were very quick to accuse “Big Pharma” of wrongdoing whenever there was some drug recall or warning. “See,” they would say, “they bought off the FDA.” (The FDA being the government agency in charge of regulating medications, medical devices, and treatments claiming to be for medical conditions.) This as it was the very FDA that recalled the dangerous drugs.
Not that conspiracy theorists make sense to me, anyway.
When I started dating my wife, she had just started working as a healthcare provider. One of our dates involved a dinner sponsored by a pharmaceutical company. (They don’t do them [as much] anymore.) It was at a nice restaurant next to the small airport near where we lived. You wouldn’t know that the dinner was sponsored by a pharmaceutical company because the “host” was a local physician. He was the one being paid to talk about his experiences with a drug.
The physician gave a quick, 20-minute presentation about his experience in prescribing a certain drug, the outcomes he saw in his patients, and then a summary of the evidence presented for the approval of the drug. Then we had a very nice dinner and talked about all sorts of stuff. During the talk, the pharmaceutical rep stepped out. My wife (then girlfriend) told me that it was to not have the appearance of impropriety, but we both agreed that it was just a game. We knew why we were there. The “host” knew why he was there (and how much he got paid), and anyone who didn’t know should probably not be taking care of patients.
In all of those events, one of the things that I have noticed is how well-dressed and just plain pretty the sales reps have been. “Sex sells,” my brother told me when I told him of my observations. (He has a business and an education degree… And, if I may quickly boast about my brother, he’s also working on a PhD.) “Most physicians are men (though that trend is changing), and the pharma companies know that. So they send cute girls — and boys — to catch their attention,” he said.
True. Sex sells.
At the talk the other night by Dr. Paul Offit, someone in the audience complained about the money that he made through his contributions to the development of a rotavirus vaccine. His response was more or less that people need to be paid for their work, and pharmaceutical companies for their investment toward developing a product. This makes sense to me, especially since we live in a capitalist economic system. While companies can’t price gouge, especially during an emergency, they certainly are allowed to set a price for their own product. Market forces then determine the way that price goes.
Unfortunately for many people who need certain medications, there might be only one or two manufacturers that can provide said medication. So there is not a lot of competition for something that is in high demand, leading to higher prices. And, while there are some things our elected officials can do to help alleviate this problem, they’re hesitant to do so because we also live in a system where lobbying efforts (which I call “legal corruption”) invest a ton of money into keeping legislators from fixing things.
Then there is the whole thing with patents. Pharmaceutical companies will use some pretty “interesting” tactics to extend the patents they hold on the medications they develop. If they manage to hold on to the patent, then generic forms of the medication are not developed and there is less competition to drive prices down. While completely “sleazy,” it’s not criminal.
Does all this make pharmaceutical companies evil? And what, exactly, is evil?
In the economic and legal system we live in, they’re very much operating under the laws and regulations under which other businesses have to operate. The difference is the pharmaceutical companies’ ability to influence what is legal, and even who regulates them. (Look at how much money pharmaceutical companies have given to both political parties in this election cycle.) Even worse, but just as legal, people in authority have moved back and forth between government jobs and pharmaceutical jobs, or consultant firms that consult with companies and/or the government.
At the same time, the federal budget doesn’t have nearly enough money allocated toward drug development as the pharmaceutical companies have as cash-on-hand. And what is allocated often changes threats of cuts. So who is left to develop life-saving and life-improving drugs but the pharmaceutical industry? (One could argue that they may or may not lobby for those budget cuts as well… If you really want to go down that particular rabbit hole.)
As you can see, this all is not a simple concept to think about. On the one hand, we have a system that allows an industry to influence who regulates it and how. On the other, we have a people who keep electing representatives who don’t want to fix the problem or are ignorant of it. And on another hand, we have a healthcare and public health system that doesn’t prevent diseases and conditions as well as it should, so we’re left trying to play catch-up through chemistry, through drugs.
I know several people who work for or with the pharmaceutical industry. They are very good people who seem genuinely interested in making a difference in the world. They’ve dedicated their lives to becoming true professionals in science, mathematics, engineering, and other disciplines. They’re morals and ethics are in the right place, and, if they saw anything wrong or evil going on in and around their jobs, I’m almost 100% sure they would do something to make things right.
They’re troublemakers, basically.
But then comes news this week that Merck, a pharmaceutical company, has decided to not sell/give its RotaTeq vaccine to poor African countries anymore. Instead, Merck has decided to shift its sales to China:
“Merck’s decision means it will fall short of its commitment to supply its rotavirus vaccine, RotaTeq, to four low-income countries in 2018 and 2019, according to Gavi, the Vaccine Alliance. By 2020, the company will completely stop delivering its vaccine.
“This was difficult decision for us, which did not come lightly,” Merck wrote to NPR in an email. “We would like to express our deepest regret to all of the parties involved and have offered to assist and work with UNICEF, Gavi and affected countries through the transition to alternative images [versions] of rotavirus vaccines,” the email added.
Merck said in the email that “supply constraints” were preventing it from fulfilling its agreement to the West African countries.
In April, Merck’s agent in China received approval to start selling the vaccine there, where the price per dose will likely be more than 10 times the amount Gavi pays for the vaccine for low-income countries.
As a result of Merck’s decision, more than a half-million children in West Africa may not receive the vaccine in 2018 and 2019, Gavi told NPR in an email. And more than 2 million may go without the vaccination in 2020.”
Again, this is perfectly legal. If we were talking about trucks or steel, I bet the President of the United States would heartily approve. It’s all business, and making a profit is what business is all about. In our society, helping people comes second or third to profits. Our economy is structured that way. Our legal system is structured that way. We like making money. I like making money.
The frenzy of Powerball and Mega Millions ticket buying the other week? Because we like money.
We think we’re going to be rich here soon, so we oppose everything and anything that might prevent that from happening, even if there is little to no chance that we’ll be millionaires in our lifetime. During the 2016 election, people were okay with Mr. Trump not releasing his tax records because they themselves would not want their taxes to be put out in public. They were okay with him making money in some “questionable” ways because they themselves hope to be able to use those same questionable-yet-legal ways to become millionaires. (Not that they will, but — just like with the lottery — they hope to be.)
Likewise, the stock owners and investors in pharmaceutical companies like money. Many if not most of them like money so much that they don’t care (or don’t want to think about) if children in Africa will die from dehydration from what is an otherwise very preventable disease through a very safe and very effective vaccine. As long as the money keeps flowing, everything is okay in their view, it seems.
But that’s the way it is for all businesses. You didn’t see investors flee oil companies when they artificially increase prices every time someone looks funny at a Saudi Arabian monarch, or when the theocracy in Iran decides to re-interpret their religious mandates. We get outraged for a little bit at fast food companies that are run by religious zealots, but then we go back to eat their delicious fried food. You know what I mean.
So, yeah, there are things that pharmaceutical companies — like all companies — do that seem “evil.” But they’re operating well within the limits of the law and the regulations. If we don’t like what they’re doing, we have the power to change their behavior through not investing in them, through electing people who will hold them accountable, and by raising awareness of the problems that come with some of their business decisions… We achieve nothing with blanket statements about the intentions of people and groups we don’t know, and we cannot make judgments without a sober, balanced view of the things they do.
René F. Najera, DrPH
I'm a Doctor of Public Health, having studied at the Johns Hopkins University Bloomberg School of Public Health.
All opinions are my own and in no way represent anyone else or any of the organizations for which I work.
About History of Vaccines: I am the editor of the History of Vaccines site, a project of the College of Physicians of Philadelphia. Please read the About page on the site for more information.
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