Big Pharma

The pharmaceutical industry is (some might say amazingly) the second largest on the planet, worth over 600 billion dollars in sales every year and acting as the force behind the cutting edge of science that continues to push the science of medicine onwards as a field- and while we may never develop a cure for everything you can be damn sure that the modern medical world will have given it a good shot. In fact the pharmaceutical industry is in quite an unusual position in this regard, forming the only part of the medicinal public service, and indeed any major public service, that is privatised the world over.

The reason for this is quite simply one of practicality; the sheer amount of startup capital required to develop even one new drug, let alone form a public service of this R&D, would feature in the hundreds of millions of dollars, something that no government would be willing to set aside for a small immediate gain. All modern companies in the ‘big pharma’ demographic were formed many decades ago on the basis of a surprise cheap discovery or suchlike, and are now so big that they are the only people capable of fronting such a big initial investment. There are a few organisations (the National Institute of Health, the Royal Society, universities) who conduct such research away from the private sectors, but they are small in number and are also very old institutions.

Many people, in a slightly different field, have voiced the opinion that people whose primary concern is profit are those we should least be putting in charge of our healthcare and wellbeing (although I’m not about to get into that argument now), and a similar argument has been raised concerning private pharmaceutical companies. However, that is not to say that a profit driven approach is necessarily a bad thing for medicine, for without it many of the ‘minor’ drugs that have greatly improved the overall healthcare environment would not exist. I, for example, suffer from irritable bowel syndrome, a far from life threatening but nonetheless annoying and inconvenient condition that has been greatly helped by a drug called mebeverine hydrochloride. If all medicine focused on the greater good of ‘solving’ life-threatening illnesses, a potentially futile task anyway, this drug would never have been developed and I would be even more hateful to my fragile digestive system. In the western world, motivated-by-profit makes a lot of sense when trying to make life just that bit more comfortable. Oh, and they also make the drugs that, y’know, save your life every time you’re in hospital.

Now, normally at this point in any ‘balanced argument/opinion piece’ thing on this blog, I try to come up with another point to try and keep each side of the argument at an about equal 500 words. However, this time I’m going to break that rule, and jump straight into the reverse argument straight away. Why? Because I can genuinely think of no more good stuff to say about big pharma.

If I may just digress a little; in the UK & USA (I think, anyway) a patent for a drug or medicine lasts for 10 years, on the basis that these little capsules can be very valuable things and it wouldn’t do to let people hang onto the sole rights to make them for ages. This means that just about every really vital lifesaving drug in medicinal use today, given the time it takes for an experimental treatment to become commonplace, now exists outside its patent and is now manufactured by either the lowest bidder or, in a surprisingly high number of cases, the health service itself (the UK, for instance, is currently trying to become self-sufficient in morphine poppies to prevent it from having to import from Afghanistan or whatever), so these costs are kept relatively low by market forces. This therefore means that during their 10-year grace period, drugs companies will do absolutely everything they can to extort cash out of their product; when the antihistamine drug loratadine (another drug I use relatively regularly, it being used to combat colds) was passing through the last two years of its patent, its market price was quadrupled by the company making it; they had been trying to get the market hooked onto using it before jacking up the prices in order to wring out as much cash as possible. This behaviour is not untypical for a huge number of drugs, many of which deal with serious illness rather than being semi-irrelevant cures for the snuffles.

So far, so much normal corporate behaviour. Reaching this point, we must now turn to consider some practices of the big pharma industry that would make Rupert Murdoch think twice. Drugs companies, for example, have a reputation for setting up price fixing networks, many of which have been worth several hundred million dollars. One, featuring what were technically food supplements businesses, subsidiaries of the pharmaceutical industry, later set the world record for the largest fines levied in criminal history- this a record that persists despite the fact that the cost of producing the actual drugs themselves (at least physically) rarely exceeds a couple of pence per capsule, hundreds of times less than their asking price.

“Oh, but they need to make heavy profits because of the cost of R&D to make all their new drugs”. Good point, well made and entirely true, and it would also be valid if the numbers behind it didn’t stack up. In the USA, the National Institute of Health last year had a total budget of $23 billion, whilst all the drug companies in the US collectively spent $32 billion on R&D. This might seem at first glance like the private sector has won this particular moral battle; but remember that the American drug industry generated $289 billion in 2006, and accounting for inflation (and the fact that pharmaceutical profits tend to stay high despite the current economic situation affecting other industries) we can approximate that only around 10% of company turnover is, on average, spent on R&D. Even accounting for manufacturing costs, salaries and such, the vast majority of that turnover goes into profit, making the pharmaceutical industry the most profitable on the planet.

I know that health is an industry, I know money must be made, I know it’s all necessary for innovation. I also know that I promised not to go into my Views here. But a drug is not like an iPhone, or a pair of designer jeans; it’s the health of millions at stake, the lives of billions, and the quality of life of the whole world. It’s not something to be played around with and treated like some generic commodity with no value beyond a number. Profits might need to be made, but nobody said there had to be 12 figures of them.

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The Price of Sex

This is (probably, I might come back to it if I have trouble thinking of material) the last post I will be doing in this mini-series on the subject of sex.  Today’s title is probably the bluntest of the series as a whole, and yet is probably most descriptive of its post’s content, as today I am going to be dealing with the rather edgy subject of prostitution.

Prostitution is famously quoted as being the world’s oldest profession, and it’s not hard to see why. Since men tend to have physical superiority over women they have tended to adopt overlord roles since the ‘hitting other people with clubs and shouting “Ug”‘ stage, women have, as previously stated, tended to be relatively undervalued and underskilled (in regards to stuff other than, oh I don’t know, raising kids and foraging for food with a degree of success often exceeding that of hunting parties, although that is partly to do with methodology and I could spend all day arguing this point). In fact it can be argued that the only reason that some (presumably rather arrogant) male-dominated tribes didn’t just have done with women as a gender is purely down to sex- partly because it allowed them to father children but mostly, obviously, because they really enjoyed it. Thus the availability of sex was historically not a woman’s most valuable asset to her male peers, but since it was something that men couldn’t/would rather not sort out between themselves it took on a great degree of value. It could even be argued that women have been ‘selling’ sex in exchange for being allowed to exist since the earliest origins of a male-dominated tribe structure, although you’d have to check with an actual anthropologist to clarify that point.

Since those early days of human history, prostitution has always remained one of those things that was always there, sort of tucked into the background and that never made most history books. However, that’s  not to say it has not affected history- the availability of pleasures of the flesh has kept more than one king away from his duties and sent his country into some degree of turmoil, and even Pope Alexander VI (a la, among other things, Assassin’s Creed II) once famously hired 50 prostitutes for a party known as the Ballet of the Chestnuts, where their clothes were auctioned off before both courtesans and guests (including several clergymen) crawled naked over the floor to first pick up chestnuts, and later compete to see who could have the most sex. In fact, for large swathes of history, prostitution was considered a relatively popular profession among lowborn women, whose only other choices were generally the church (if you could afford to get in), agriculture (which involved backbreaking toil, malnourishment and a generally poor quality of life), or serving work if you were lucky. It was relatively well-paid, required no real skill, was more exciting than most other walks of life and far less risky than a life of crime. Even nowadays sex workers are held with a degree of respect in many countries (such as The Netherlands and New Zealand) as being people stuck in a difficult situation who really don’t need the law trying to screw over (if you’ll pardon the pun) what little they have.

However, that doesn’t mean, and never has done, that prostitution is just some harmless little sideshow that we should simply ignore. The annual death rate among female prostitutes in the USA is around 200 per 100,000, meaning that over a (say) 10 year career one in fifty are likely to be killed. Compare that to a rate of 118 per 100,000 for America’s supposedly most dangerous profession, being a lumberjack. Added to this is the fact that prostitutes, many of whom are illegal immigrants, runaways or imported slaves, are rarely missed or even noticed by society, so make easy victims for predators and serial killers. Prostitution is often seen as a major contributory factor in the continued spread of STD’s such as HIV/AIDS, and is often targeted by women’s rights groups as being both degrading to women both directly involved and indirectly associated as well as slowing the decline of chauvinist attitudes. Then there is sex tourism (aka travelling to somewhere like Thailand to hire prostitutes because at home people might see you coming out), which is rapidly becoming one of the most distasteful, as well as dangerous & counter-productive, aspects of 21st century tourism. And then, of course, there is sex trafficking, perhaps the lowest of the low as far as all human activities go. Sex trafficking is the practice of abducting young women to sell into slavery as prostitutes, both within a country and across international borders, which would be morally repugnant enough if it wasn’t for the fact that a significant proportion of those trafficked are children, sometimes sold even by their own families. Around three-quarters of human trafficking today, the largest slavery operation in the history of the world, is concerned with the global sex trade, and is the fastest growing criminal activity on the planet. Much of it is connected to other aspects of organised crime, such as the drugs wars in Mexico, and can therefore be directly linked to large-scale theft, murder and smuggling, amongst other crimes. In India & Bangaladesh, some 40% of prostitutes are thought to be children, many of whom use a highly addictive drug linked to diabetes and high blood pressure to make them seem older & fatter (research suggests that men find fuller physiques more attractive when under stress or hardship). Looking through some of these figures & reading some of the stories surrounding them, it’s hard not to be struck by how low humanity has the potential to stoop when it ceases to think or care.

Over the last 100 or so years, as life has got less hard for the average woman and job opportunities have expanded, prevailing attitudes towards, and the prevalence & amount of, prostitution have declined heavily, and it is now frequently seen more as a rather distasteful sideshow to modern living that most would rather avoid. But to contrast against this we have the fact that the industry is both very much alive across the world, but could even be said to be thriving- the ‘labour’ of slave prostitutes is worth tens of billions of dollars worldwide. The trouble is, because it is an inherently seedy sideshow, it is impossible to get rid of, with legislation usually causing it to merely go underground and leading to further degradation in living conditions and welfare of sex workers, and regulating it is similarly tricky. Thus, it’s very hard for governments to know what to do about an industry that they recognise will always be there but is immensely prone to crime, human rights abuse and health issues. Unless the world, in a rather unlikely twist learns to live largely without prostitutes, a black stain is unfortunately likely to remain on our pride and dignity as a race. Exactly how this should be dealt with is still a little unclear.