Danger: pills for profit

The government is worried, the police are pretty much baffled but nobody really knows what to do. We hear of spectacular police ‘busts’ where they come across huge amounts of drugs with a street value of millions of pounds but it doesn’t seem to make much difference to the overall picture. Apparently this is a problem that has no solution. In a probably futile attempt to control it the government in Britain is considering making some drugs such as cannabis, legal or rather partially legal. One question that never seems to get asked though is – why?

“Why?” of course is a question spectacularly lacking in politics, and the reason for this is simple – they dare not ask it because the answer would lie in the nature of capitalist society. And of course there is the point that a very workable diversion exists to keep workers’ minds off their real problems. Capitalism is content, or has to be content, with a good many expensive circuses to maintain itself in existence.

However there are other aspects to drugs that never get mentioned. These are the problems of the other sorts of drugs – the legal ones. One may come across an odd mention of a particular drug that is having “side effects” (an outrageous euphemism if ever there was one). Scandals such as Thalidomide made the headlines, but there is no sustained coverage in the media such as is given to Ecstasy where one death will make the headlines, especially if it happens to a young girl. Legal drugs, that is drugs prescribed by doctors to treat disease are never described as a problem. Yet problem it is, because legal drugs kill far more people than the illegal ones.

This is a shocking statement. Yet it is true, as records published in the USA and the UK show. According to the prestigious Journal of the American Medical Association at least 106,000 Americans die every year as a result of some adverse reaction to a prescription drug. A further 7,000 die from an error relating to a drug such as a wrong dosage or a wrong mix (drugs which do not combine). This finding was only for drugs administered in hospital. The Institute of Medicine, which carried out this survey, admitted that its findings did not include drugs consumed outside of hospital as a result of GP or consultant prescription.

In the UK, according to a study by University College London, estimated medical errors, which include unwanted drug reactions, kill 40,000 people every year. This again only applied to hospitals, and did not take into account the many more fatalities that occur at home. Figures taken from Secrets of the Drugs Industry, by Bryan Hubbard, suggest that the monitoring system used to test new drugs for efficacy and “adverse reactions” (the name given to unwanted effects) is far from foolproof, and can be pretty sketchy. Children and the elderly are not often included in the tests though many drugs may be aimed at just such people. The real test comes when they are put on the market.

To cover this, doctors are expected to report the side effects that they come across, that is, that are reported to them by patients. In the UK adverse reactions to prescription drugs should be monitored by the Yellow Card system, whereby if a doctor suspects a drug has caused a reaction not intended by the manufacturer, he or she notes it down and sends it to the Medicines Control Agency. They oversee the safety of drugs once they are licensed but the system has many loopholes. It is estimated by Dr Bill Inman, the man who initiated the system, that only about ten percent of all reactions are ever reported, either because a link is not suspected or because GPs are overburdened with paperwork. In France researchers estimated that doctors report only one in 24,000 adverse reactions. And if the adverse reaction is not already noted, many doctors will tend not to believe the patient.

So far one could conclude that all of these are unfortunate results due to human error from over-worked doctors under a lot of pressure. The true picture is far more sinister than that and has to do with drug companies, profits and the nature of the social system we are all living under, capitalism.

Why is this? Most drug companies admit to making massive profits but seek to explain this away by pointing at the costs of research, which, they claim, is necessary to put new drugs on the market and keep up with the increasing demands of modern medicine. New research is very costly and does seem at first glance a valid justification. A closer look at the marketing habits of drug companies will reveal a very different story. While the money required for completely new formulations is indeed massive, there are not as many completely new research discoveries as they would like us to think. Whilst the cost of producing an entirely new drug can rise to £350 million and can take from ten to fifteen years to bring on to the market, the reality is not quite so clear cut. Many “new” drugs are not new as far as involving new chemicals but are re-formulations of existing drugs. A study in America discovered that, of all the drugs approved during the 1990s, only 15 per cent contained new active ingredients.

But for the drug companies launching a new product on the market is a matter of vital importance because that’s where they make their money. Prices charged for a new product are substantially higher. In America in 2000 the average price per prescription for the most innovative new drug was $91.20 compared to an average price of $37.20 for older drugs that were approved before 1995.

Share prices
The launch of a new drug can also have remarkable affects on the share price. For example, shares in Cambridge-based drugs firm Alizyme rocketed from 34.5p to 114.5p after second-stage trials of the anti-obesity drug ATL-962 dramatically aided weight loss without the damaging side effects of its rivals. “This will definitely be a blockbuster drug” said Finance Director Tim McCarthy. “We would anticipate sales of at least $1bn a year once it is fully approved.” The Daily Mail commented: “The £110 million company’s future is virtually guaranteed. On top of a hefty one off fee, it is likely to secure a double digit percentage of any future royalties” (20 September 2003.)

Once a “new” drug is approved pharmaceutical companies can usually look forward to a rosy future. They have a patent, which usually extends to 20 years, and no other drug firms may produce that drug. However other companies may produce what is called a generic drug, given permission from the parent company. That is a drug containing the same ingredients but not entitled to use the same name. These can be produced much more cheaply and there is, for example, a long-running dispute between companies producing anti-aids drugs and governments in Third World countries over permission to produce generic drugs. The nascent drug industry of Pakistan would like to build on the production of generic drugs but a big demand from South Africa is being blocked by the parent companies, who see their profits threatened. Needless to say both parties are on their moral high horse. In this connection it is worth noting that most drug companies spend twice as much on marketing and advertising as they do on research.

Enormous amounts are also spent on lobbying governments especially in the United States. “Overall, drug companies spent $78.1 million on lobbying in 2001 bringing the total lobbying bill for 1997-2001 to $403,071,467. The companies employed 623 different individual lobbyists in 2001 – or more than one lobbyist for every member of Congress”. (source. Public Citizen, 12 June 2002: http://www.citizen.org/congress/reform). The reason for this is that after such huge amounts have been paid out on research the costs have to be recouped by an aggressive selling campaign. Development of a new drug can take up to fifteen years after its initial licensing, leaving a mere five years before the patent runs out. And since these are prescription drugs that are dependent on doctors to administer, the main promotional target must be a doctor. Doctors, who, after all, we must believe have their patients’ interests at heart, have to be persuaded that a new drug will be more efficacious than one they have previously relied upon. It must be pointed out that development in drugs moves at such a rapid pace that within a few years from graduating the average doctor will be heavily dependent on outside sources for any knowledge of their usefulness. And the companies concerned do their level best to ensure that such knowledge comes from the producer.

How is this done? The short answer is bribery, but this is carried out in such subtle ways that doctors themselves are unaware that they are being wooed. Expense-paid ‘holidays’ to seminars in foreign locations are one such, but there are many other methods pursued to persuade doctors. Articles in medical journals are heavily influenced by biased reports from company funded research. Drug companies are very powerful entities and they use every method they can to sell their products. Remember, to them drugs are a commodity, and a commodity is something that is put on the market to make a profit for the shareholders.

That the pharmaceuticals industry is way up there as one of the more unpleasant features of capitalist society does not need much proving. To degrade what should be an honourable attempt to alleviate the ills suffered by humankind, (many of them caused by capitalist society itself) into a sordid scramble for wealth should be sufficient indictment of the capitalist system, but what is the solution? All those who consider that state regulation is an answer should look closely at other attempts by the state to regulate some of the ‘unacceptable faces of capitalism’ such as the arms trade. They should also perhaps reflect on the fact that in Britain up to one third of MPs receive some funding from drug companies to help pay for administrative expenses etc.

Will drugs be as big a menace in socialism? As far as legal drugs are concerned there should be no problem. Without the commercial pressures of today and the drive for profit it would be possible for researchers to behave in a responsible manner and pool their findings. What is now called the problem of illegal drugs might not be so easy to solve. One prime factor, however, would immediately disappear in a socialist system – the monetary incentive to produce such drugs. We believe that socialism would fill up the gaps in people’s lives making it less likely (if not completely unlikely) that they would turn to drugs to fill an empty life or escape from an intolerable one. One thing is for sure that there is no solution within capitalism. The consensus of opinion is that the problem is growing.

But the question has still to be asked – why is it that the terrible death toll from prescription drugs is so under-reported in the media?