Socially Acceptable Druggies

Alcohol is, without a shadow of a doubt, our society’s commonly acceptable drug of choice; no matter that one third of people admit to smoking cannabis at some point in their lives, or that smoking kills tens of thousands more people every year, neither can touch alcohol for its prevalence and importance within western civilisation. It’s everywhere; for most polite social gatherings it is fundamentally necessary as an icebreaker, every settlement from the biggest city to the tiniest hamlet will have a bar, pub or other drinking venue and many people will collect veritable hoards of the stuff, sometimes even in purpose-built rooms.

Which, on the face of it, might seem odd given how much it screws around with you. Even before the damage it causes to one’s liver and internal organs was discovered, it had been known for centuries that alcohol was dangerously habit-forming stuff, and it was generally acknowledged that prolonged use ‘pickled’ the brain. It also leaves those who imbibe it severely confused and lacking in coordination, which has proved hideously dangerous in countless scenarios over the years (even contributing to several assassinations), and can be almost guaranteed to result in personal embarrassment and other decisions you’re really going to regret when sober. If it wasn’t for booze’s noted enhancing of promiscuity, it might be surprising that drinking hadn’t been bred out of us simply thanks to natural selection, so much does it generally screw around with our ability to function as proper human beings

Like many drugs, alcohol has its roots in the dim and distant past when it felt quite nice and we didn’t know any better; a natural product when sugar (usually in the form of fruit) comes into contact with yeast (a common, naturally occurring fungus), it was quickly discovered how to make this process happen efficiently and controlledly by putting both sugar and yeast under water (or in some other anaerobic atmosphere). All raw materials were easy to come by and the process didn’t require any special skill, so it was only natural that it should catch on. Especially when we consider that alcohol is generally considered to be the single best way of making the world feel like a less crappy place than it often appears.

However, the real secret to alcohol’s success in worming its way into our society is less linked to booze itself, and has more to do with water. From our earliest infancy as a species, water has been readily available in the world around us, whether it be from lakes, rivers, wells or wherever. Unfortunately, this means it is also available for lots of other things to use and make their homes in, including a vast array of nasty bacteria. As can be seen with the situation across swathes of Africa and the Third World (although this problem has been reduced quite significantly over the last decade or so), access to water that is not fetid, disgusting and dangerous can be nigh-on impossible for many, forcing them to settle for water containing diseases ranging from cholera to dysentery. And that’s where alcohol came in.

The great advantage of alcohol is that its production can be very carefully controlled; even if the majority of an alcoholic drink is water, this is generally a product of the fruit or other sugary substance used in the brewing process. This means it is a lot purer than most ‘fresh’ water, and in any case the alcohol present in the fluid kills off a lot of bacteria. Even for those that can survive that, alcoholic beverages are far more likely to be bottled (or at least they were, before someone discovered the sheer quantity of suckers willing to buy what you can get out of the tap) than water, keeping any more invading bacteria, parasites, insects and other crap out. All of this was, of course, not known before Louis Pasteur first came along with his Germ Theory, but the facts stayed the same; historically, you were far less likely to die from drinking alcohol than drinking water.

Still, come the 20th century most of our sanitation problems in the developed world were sorted, so we didn’t need to worry about all that any more did we? Surely, we would have been fine to get rid of booze from our culture, throw out a feature of our lives that ruins many a night out, body or family? Surely, we’d all be far better off without alcohol in our culture? Wouldn’t we?

In many cases, this kind of question would prove a purely theoretical one, to be discussed by leading thinkers; however, much to the delight of all champions of evidence over opinion, the USA were kind enough to give banning alcohol a go way back in the early days of the 20th century. A hundred years ago, campaigns from the likes of the church and the Anti Saloon Bar League painted alcohol as a decidedly destructive influence, so successfully that from 1920 to 1933 the sale, production and consumption of alcohol within the United States became illegal.

At the time, many people thought this was a brilliant idea that would yield great social change. They were right; society as a collective decided that the law was more like a guideline anyway, and through their lot in with the mob. This was the golden age of organised crime, the era of Al Capone and others making fortunes in dealing bootleg alcohol, either dangerous home-brewed ‘moonshine’ liquor or stuff smuggled across the Canadian border. Hundreds of illegal speakeasies, clubs whose drab outsides hid their gaudy interiors, and in which were housed illegal gambling nests, dancers, prostitutes and a hell of a lot of booze, sprung up in every major American city, and while the data is inconsistent some figures suggest alcohol consumption actually rose during the Prohibition era (as it was known). Next to nobody was ever imprisoned or even charged with their crimes however, because the now-wealthy mob could afford to bribe almost anyone, and in any case most police officers and legal officials were illicit drinkers themselves; even Al Capone wasn’t taken down until after he was suspected of ordering some rival gangsters gunned down in what became known as the St Valentine’s Day Massacre. Eventually a group of supremely dedicated policement known unofficially as ‘The Untouchables’ managed to pin tax evasion charges on him, and even had to switch a bribed jury to ensure he went down (a film, The Untouchables, was made about the story- give it a watch if you ever get the charge). By the time Franklin D. Roosevelt repealed prohibition upon coming to power in 1933, the message was clear: America loved alcohol too much, and it wasn’t about to let it go.

Alcohol is, in its effect at least, not a special drug; many others can be used to forget the bad times, enjoy the good times and make the world feel like a better place. But there’s something about, something about its cultural imagery, that makes it timeless, and makes it an immovable feature of our world. It could be that it’s probably the cheapest recreational drug, or maybe that it’s the oldest, but to me the real secret to its success is its weakness, combined with the way it is almost always served very dilute. Most illegal drugs give an instant hit, a huge rush followed by crashing downer, and this makes any use of it a brief, wild experience. Alcohol is more mellow; something you can spend an entire night slowly drowning your sorrows in, or casually imbibe whilst chatting and generally functioning like a normal human being. It’s slow, it’s casual, a feature of an evening that does not necessarily have to define it- that is the cultural secret to alcohol’s success.

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.