…but some are more equal than others

Seemingly the key default belief of any modern, respectable government and, indeed, a well brought-up child of the modern age, is that of egalitarianism- that all men are born equal. Numerous documents, from the US Declaration of Independence to the UN Bill of Human Rights, have proclaimed this as a ‘self-evident truth’, and anyone who still blatantly clings onto the idea that some people are born ‘better’ than others by virtue of their family having more money is dubbed out of touch at best, and (bizarrely) a Nazi at worst. And this might be considered surprising given the amount of approval and the extent to which we set store by a person’s rank or status.

I mean, think about it. A child from a well-respected, middle class family with two professional parents will invariably get more opportunities in life, and will frequently be considered more ‘trustworthy’, than a kid born into a broken home with a mother on benefits and a father in jail, particularly if his accent (especially) or skin colour (possibly to a slightly lesser extent in Europe than the US) suggests this fact. Someone with an expensive, tailored suit can stand a better chance at a job interview to a candidate with an old, fading jacket and worn knees on his trousers that he has never been rich enough to replace, and I haven’t even started on the wage and job availability gap between men and women, despite that there are nowadays more female university graduates than males. You get the general idea. We might think that all are born equal, but that doesn’t mean we treat them like that.

Some have said that this, particularly in the world of work, is to do with the background and age of the people concerned. Particularly in large, old and incredibly valuable corporate enterprises such as banks, the average age of senior staff and shareholders tends to be on the grey end of things, the majority of them are male and many of them will have had the top-quality private education that allowed them to get there, so the argument put forward is that these men were brought up surrounded by this sort of ‘public schoolers are fantastic and everyone else is a pleb’ mentality. And it is without doubt true that very few companies have an average age of a board member below 50, and many above 65; in fact the average age of a CEO in the UK has recently gone up from a decade-long value of 51 to nearly 53.  However, the evidence suggests that the inclusion of younger board members and CEOs generally benefits a company by providing a fresher understanding of the modern world; data that could only be gathered by the fact that there are a large number of young, high-ranking businesspeople to evaluate. And anyway; in most job interviews, it’s less likely to be the board asking the questions than it is a recruiting officer of medium business experience- this may be an issue, but I don’t think it’s the key thing here.

It could well be possible that the true answer is that there is no cause at all, and the whole business is nothing more than a statistical blip. In Freakonomics, an analysis was done to find the twenty ‘blackest’ and ‘whitest’ boy’s names in the US (I seem to remember DeShawn was the ‘blackest’ and Jake the ‘whitest’), and then compared the job prospects of people with names on either of those two lists. The results suggested that people with one of the ‘white’ names did better in the job market than those with ‘black’ names, perhaps suggesting that interviewers are being, subconsciously or not, racist. But, a statistical analysis revealed this to not, in fact, be the case; we must remember that black Americans are, on average, less well off than their white countrymen, meaning they are more likely to go to a dodgy school, have problems at home or hang around with the wrong friends. Therefore, black people do worse, on average, on the job market because they are more likely to be not as well-qualified as white equivalents, making them, from a purely analytical standpoint, often worse candidates. This meant that Jake was more likely to get a job than DeShawn because Jake was simply more likely to be a better-educated guy, so any racism on the part of job interviewers is not prevalent enough to be statistically significant. To some extent, we may be looking at the same thing here- people who turn up to an interview with cheap or hand-me-down clothes are likely to have come from a poorer background to someone with a tailored Armani suit, and are therefore likely to have had a lower standard of education and make less attractive candidates to an interviewing panel. Similarly, women tend to drop their careers earlier in life if they want to start a family, since the traditional family model puts the man as chief breadwinner, meaning they are less likely to advance up the ladder and earn the high wages that could even out the difference in male/female pay.

But statistics cannot quite cover anything- to use another slightly tangential bit of research, a study done some years ago found that teachers gave higher marks to essays written in neat handwriting than they did to identical essays that were written messier. The neat handwriting suggested a diligent approach to learning, a good education in their formative years, making the teacher think the child was cleverer, and thus deserving of more marks, than a scruffier, less orderly hand. Once again, we can draw parallels to our two guys in their different suits. Mr Faded may have good qualifications and present himself well, but his attire suggests to his interviewers that he is from a poorer background. We have a subconscious understanding of the link between poorer backgrounds and the increased risk of poor education and other compromising factors, and so the interviewers unconsciously link our man to the idea that he has been less well educated than Mr Armani, even if the evidence presented before them suggests otherwise. They are not trying to be prejudiced, they just think the other guy looks more likely to be as good as his paperwork suggests. Some of it isn’t even linked to such logical connections; research suggests that interviewers, just as people in everyday life, are drawn to those they feel are similar to them, and they might also make the subconscious link that ‘my wife stays at home and looks after the kids, there aren’t that many women in the office, so what’s this one doing here?’- again, not deliberate discrimination, but it happens.

In many ways this is an unfortunate state of affairs, and one that we should attempt to remedy in everyday life whenever and wherever we can. But a lot of the stuff that to a casual observer might look prejudiced, might be violating our egalitarian creed, we do without thinking, letting out brain make connections that logic should not. The trick is not to ‘not judge a book by it’s cover’, but not to let your brain register that there’s a cover at all.

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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.