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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Well, last week’s solution didn’t work…

As I did last weekend, I am feeling like a sad, depressed, lonely bugger for no identifiable reason. Last week this lead to the disjointed and distinctly odd post on the subject of death, murder and assorted weird things, and as a method of letting out emotion it failed truly spectacularly. So today, I thought I might as well instead talk about depression.
I am not, incidentally, going to talk about this in a strict medical sense- I am neither qualified nor able to do so. But just-being-bloody-depressed-and-unhappy-half-the-time is something I have had to cope with for a large proportion of my life, and it is not something I have found to be well understood or, especially, appreciated.
Depression can arise from a wide variety of causes. For some people it’s  getting too philosophical and deciding there is no actual point to life, for others it’s an alternative to anger with the way their life is working out, and for some it’s just loneliness and boredom. The latter is actually an especially interesting scenario- people are generally only depressed when their mind is not occupied. A case in point is Robbie Williams, who for years suffered terribly with offstage depression whilst onstage having the time of his life. One thing, however, crops up when the matter is given thought- depression does not happen to anyone. Some people will never have a reason to, some will always be surrounded by friends, some will spend their entire lives kept too busy to really get depressed, but many simply don’t have the personality for it. Depressives tend to be people who think a lot- they may not necessarily be intelligent, but they will almost certainly be introverted to an extent and self-reflect a lot. The trouble is, bouncing ideas off yourself is not the same as bouncing them off friends, and it is unhealthy for a normal human brain.
The big problem with this is that the kind of people who get depressed are, therefore, those least likely to seek help. If you are an introverted person, you may have an unimpressive social life, perhaps be bad in the company of others or had some embarrassing rejections, and you are often unlikely to feel that opening up is going to help you. Plus… there is something delightfully selfish in wallowing in your own misery. It feels good. While everyone passes by and doesn’t help you, you feel better than them, which for a depressive is often a rare and satisfying feeling (Many depressives have major self-esteem issues; the irony is that these are often completely unfounded, and often caused by obsessive perfectionism or overambitiousness). The natural instinct of a depressive is to revert to their lifelong tactic and turn in on themselves, and it can take a seriously analytical and critical mind to realise that this is what is causing all the mental damage. Some people will never get out of this cycle, and will go to their grave with the same depressed tendencies that have dogged them all their lives, never telling a soul. These people are few- after an extended period of time, only the strongest-willed of depressives will not have thought of suicide, and it’s an option far too many have taken. Herein lies the issue- depressives hide from the rest of the world to prevent it from helping them, but often refuse to help themselves.
I must interrupt the flow here- if anyone who ever ends up reading this suffers from depression, make a beeline for your nearest counsellor. This can feel incredibly defeatist, like you’re giving up on yourself, but some things cannot be handled on your own. Counselling does not mean you are some psycho with mental issues, and counsellors are not psychoanalysts or quacks. Think of a counsellor as a professional friend- someone who you can talk about stuff to with no fear that it’s going to get spread, and who knows the best way to help you. If you really can’t persuade yourself that you should be getting counselling, or just want another tactic, throw yourself into your social life. Focus on a group of mates you’re sure you can trust (disloyal friends are killers to your self-esteem (and possibly wallet), as well as being amoral scum), and focus all of your efforts into enjoyment. Buy the first round, have an extra beer or two, be as wild as your inhibitions will let you. It may not work, but it’s worth a try, and if you manage to get yourself a stable social circle then the fight is as good as won.
However, there is one almost sure-fire way to help a depressive, and that is to break  their idea that introspection is a good tactic- to show them that the world is, actually, a good place full of good people. This not uncommonly happens by accident- the stressed-out worker with entering a spiral of depression receiving a rise and getting back on top of his rent. Many new parents may find coping with a new baby incredibly hard, and start getting depressed after the third night in a row that their little bundle of joy has woken up at 1am screaming their eyes out, and for them the release may come when such episodes stop becoming a nightly occurrence- circumstance too can be a saviour. But for many circumstances may not simply fall their way again, and this is where other people come in. I can speak from experience when I say that nothing cheers up a depressive more than somebody coming up to ask them what’s wrong, and persisting past the initial mumbled ‘Nothing’ or ‘I’m fine’ (although be warned anyone who tries this- make sure you know when to back off, because people who happened to just be staring vacantly that day may not take kindly to you asking deep questions about their mental fragility).  Somebody who genuinely wants to hear your problems and help you out is manna from heaven for a depressive, and there is also something deeply satisfying about knowing you’ve helped somebody else out. Depressives can sometimes be hard people to like- some have a tendency to be clingy while others demonstrate that there is clearly a reason they were out of the social loop. But if treated properly and pointed in the right direction, they are generally as nice enough people as the rest of us.
A little while ago, I heard a story about a schoolboy that I thought I could leave you with. He missed the bus home after school and, since he didn’t live too far away, decided to walk home. On the way back he met a guy in his year who was walking the same way- he didn’t know him well, only really as a face and name (I believe he was new to the school), but he seemed like an OK guy. They got talking, in the way schoolboys do, and spent most of the way back talking about football. It was a Friday, and as they parted the first boy asked his new mate if he wanted to come for a kickabout in the park over the weekend- he’d already arranged it with a few of his mates, and thought they could use an extra player to make up the numbers. The guy agreed, they parted, and met the next day at the football.
About a year later, the two having become pretty close friends, they got to talking about the day they first met. The second boy said that, for all the time he had been going to that school, that was the first time he’d had anyone to talk to on the way home. He also said that in his schoolbag that day had been a length of rope and, for but a missed bus and a few friendly words, he would have hung himself that evening.