Is Big Pharma Ethical in Effectively Controlling Medication Affordability by a Nation's Populace?

FrankGSterleJr

Whenever Canada’s federal government promises universal medication coverage (the last such promise was made following the last election, October 2019) the pharmaceutical industry reacts with threats of abandoning their Canada-based research and development (R&D), etcetera, if the government goes ahead with its ‘pharmacare’ plan. Why? Because the universal medication coverage would negatively affect the industry’s plentiful profits. Of course profits would still be great, just not as great, which apparently bothers the industry greatly.

Once again promised universal medication coverage was conspicuously yet quietly missing from the federal budget, released a couple weeks ago. Thus we continue being the world’s sole nation that has universal healthcare but no similar coverage of prescribed medication, however necessary.

Recouping R&D costs is typically cited by the powerful industry to justify its exorbitant prices and stiff resistance to universal medication coverage public plans, the latter which it's doing in Canada. However, according to a Huffington Post story (“Pharmaceutical Companies Spent 19 Times More On Self-Promotion Than Basic Research: Report,” updated May 8, 2013), a study conducted by the British Medical Journal found that for every $19 dollars the pharmaceutical industry spent on promoting and marketing new drugs, it put only $1 into its R&D.

A late-2019 Angus Reid study found that about 90 percent of Canadians — including three quarters of Conservative Party supporters specifically — champion universal medication coverage. Another 77 percent believed this should be a high-priority matter for the federal government. The study also found that, over the previous year, due to medication unaffordability, almost a quarter of Canadians decided against filling a prescription or having one renewed. Not only is medication less affordable, but many low-income outpatients who cannot afford to fill their prescriptions end up back in the hospital system as a result, therefore costing far more for provincial and federal government health ministries than if the medication had been covered. So, in order for the industry to continue raking in huge profits, Canadians, as both individual consumers and a taxpaying collective, must lose out huge. And our elected representatives, be they federal Liberals or Conservatives, seem to shrug their figurative shoulders in favor of the pharmaceutical industry — yet again.

Considering it is such a serious health affair for so many people, impressed upon me is the industry lobbyists’ potent influence on our top-level elected officials — manipulation that our mainstream news-media apparently fail to even try to fully expose, let alone condemn — for the sake of large profit-margin interests.

BC

"Is Big Pharma Ethical in Effectively Controlling Medication Affordability by a Nation's Populace?"

Is the Pope a Buddhist?

On the one hand, pharmaceutical corporations have, over the years, developed a lot of drugs which are curative or palliative, and that is good. On the other hand, the small number of major drug producers, coupled with patent law and avid lobbying, enables Big Pharma to keep everyone suspended over a barrel, or maybe over a casket.

It's standard capitalist behavior: Maximize profitability.

The ethical angle casts very dark shade on the business. Companies put much more research effort into drugs for diseases which are controllable, but not curable: high blood pressure, arthritis, mental illness. They also focus on diseases which are more rapidly fatal -- heart disease and cancer in particular. Companies tend to spend little on effective preventative drugs or short-term curable diseases like infections. Why spend a lot on a new approach to an antibiotic which people will take for 2 or 3 weeks when you can make statins or bp meds which people will take for decades?

Cancer is a difficult class of diseases to cure, or even control sometimes. Drugs like monoclonal antibodies are complicated to make, may need to be administered in clinic, and so on. Yes, they are expensive. Some drugs for some diseases may cost around a $1,000,000 a year. Granted, a lot of research went into the new drug that may save patients otherwise without hope, but one suspects that the profit motive had a larger role than the milk of human kindness.

Some of the drugs for PReP--HIV prophylaxis--which make transmission of the virus extremely unlikely, even with discordant (positive and negative) couples, are charged as if the drugs were new. They are not -- they've been in use since the late 1990s. The application is new; the drug is not.

A utilitarian cost/benefit analysis would suggest that the most effort should go into drugs which will prevent the most disease first. Another approach is to ask whether a drug a) extends life significantly, or b) improves the quality of life significantly. Some drugs achieve those ends, some do not.

None of this matters, unless governments gain the upper hand over the health care industry, including Big Pharma.

javi2541997

↪FrankGSterleJr

I do understand your point/argument from an ethical point of view but sadly, pharmacies and overall pharmacology are lobbies which create a lot of money to politicians or at least to the leviathan (Hobbes’s leviathan )

Here we have an interesting ethical dilemma about how the role of pharmacies could change:
A) the government control the prices of medicines. Somehow this method or criteria will be thought as “communist” rule of law. So most of the entrepreneurs and lobbies will not accept it.
B) pure savage capitalism. Can’t you buy a medicine or COVID vaccine? Sorry is your fault… we are not guilty of your poverty (they would think…)
C) sorry but it is not third way. We can’t get a middle pattern where both pharmacies and citizens win. Can we here agree that pharmacies are important lobbies who act silently?

Whenever we argue about ethical dilemmas always appear a pharmacy issue where related to controlling medication.

frank

"Is Big Pharma Ethical in Effectively Controlling Medication Affordability by a Nation's Populace?"

Is the Pope a Buddhist? — Bitter Crank

:lol: The whole thing is a racket, from McDonald's to Merck.

Protagoras

:lol: The whole thing is a racket, from McDonald's to Merck.

This is truth! @frank

Isaac

↪FrankGSterleJr

Seems a bit contrarian to posit an industry whose R&D departments are so noble that they do nothing but tirelessly produce medicines of the greatest benefit to human welfare, but whose sales department are so evil that would withhold such panaceas from humanity nonetheless. What kind of schizophrenic CEOs do you imagine are in charge of these organisations?

BC

What kind of schizophrenic CEOs do you imagine are in charge of these organisations? — Isaac

The "schizophrenia" concerns the kind of drugs that are sought in R&D laboratories and how these drugs are priced. First, the drug companies favor drugs that are taken for long periods of time over short periods of time. Bacteria, viruses, fungi and parasites pose the greatest threat to human health and well-being (apart from global warming). There are no new antibiotics in the pipeline of drug development, and the existing ones are gradually losing their effectiveness. The demands of investors drive the search for the multi-billion dollar jackpot that will cost $50,000 to $100,000 a year, or cost much less but will be taken over decades.

Antibiotics are missing from the R&D program because they won't yield as much profit -- pure and simple. They are generally taken for 2 or 3 weeks, and then are no longer needed.

Pricing of drugs isn't "schizophrenic"; from their POV, it makes perfectly good sense to extract the cost of development and profit-potential as rapidly as possible. What that means is that many of the humanity-benefiting drugs will be far too expensive for most of humanity to afford.

I benefit from several old drugs that are long-term cash cows. I am grateful for their place on the pharmacy's shelves. But these old drugs I am taking are still remarkably expensive (in the US). They are priced at the highest level the market will bear because they are allowed to get away with it. In most developed countries they are not.

Isaac

the drug companies favor drugs that are taken for long periods of time over short periods of time. Bacteria, viruses, fungi and parasites pose the greatest threat to human health and well-being (apart from global warming). There are no new antibiotics in the pipeline of drug development, and the existing ones are gradually losing their effectiveness. — Bitter Crank

Interesting point.

Pricing of drugs isn't "schizophrenic"; from their POV, it makes perfectly good sense to extract the cost of development and profit-potential as rapidly as possible. — Bitter Crank

Indeed. Though what I actually meant by the term was simply that the OP presumes drug companies are making drugs which are sufficiently beneficial that we'd want them to be available at lower cost.

My point was really why would anyone make that assumption. Having established the dug companies are willing to hold their community's health to ransom for a fast buck, why would we simultaneously assume their work in R&D is motivated by any lesser a greed?

Having corrected that assumption, we no longer have good reason to believe these drugs benefit the community and so have no cause for concern about their cost.

Pharmaceutical companies paid for 6,550 trials out of 7,598 in 2014.

Same year that the Cochrane report found Tamiflu had little to no benefit in preventing the flu or shortening the duration of flu symptoms, yet had a chance of life-threatening side effects, including suicide.

It's now so lucrative for pharmaceutical companies to get an anti-cancer drug approved that could make a profit from absolutely any chemical at all and simply run sufficient trials for one to have a positive effect by chance alone.

So basically I'm questioning the assumption that these drugs are useful in the first place, expensive or otherwise, when compared to other potential therapies.

BC

↪Isaac

All good points.

Scientists in big pharma's labs are probably much more motivated by the potential for human benefit than the executives. My guess is that they are salaried and have no share in the patents.

It's now so lucrative for pharmaceutical companies to get an anti-cancer drug approved that could make a profit from absolutely any chemical at all and simply run sufficient trials for one to have a positive effect by chance alone. — Isaac

That is how a lot of early-stage drug research is done. Colonies of cancer cells are cultivated in many petri dishes, then exposed to one chemical after another to find one that is harmful to the cancer cells. Same thing with AIDS drugs back in the 1980s and 90s -- lots of lab techs in universities testing one chemical after another.

Sometimes a given chemical's effect on tissue is known, but there are so many different chemical compounds, (hundreds of thousands, at least) for which the effects on tissue are not known. That in itself is another problem, because we end up getting exposed to many of these chemicals.

Pharmaceutical companies paid for 6,550 trials out of 7,598 in 2014. — Isaac

That's a problem. Another problem is that drug trials are not what one would call 'thorough'. The real drug trial often starts after a drug is approved for use. Drug companies collect "adverse results" to see whether too many people are getting sicker. Non-drug-company-research is done (not often enough) to determine whether drugs work at all. Fairly often the result is "not that much" or "no better than existing drugs".

Millions of people take antidepressants for a long period of time. Do they work? To some extent, they may. They probably help people put up with bad situations. It would be much better if people changed their life circumstances, but that is far easier said than done.

Same year that the Cochrane report found Tamiflu had little to no benefit in preventing the flu or shortening the duration of flu symptoms, yet had a chance of life-threatening side effects, including suicide. — Isaac

Public health measures (vaccination, social distancing, masks, frequent hand washing, staying home when sick...) are effective in reducing the incidence of influenza and Covid 19 and some other diseases. We should depend on public health rather than pills to deal with viral disease.

Trey

Medical care, pharmaceutical research, etc should never be capitalized! It’s unethical. It’s more unethical than cutting welfare (at least you won’t die if you get less welfare)

Isaac

It's now so lucrative for pharmaceutical companies to get an anti-cancer drug approved that could make a profit from absolutely any chemical at all and simply run sufficient trials for one to have a positive effect by chance alone. — Isaac

That is how a lot of early-stage drug research is done. Colonies of cancer cells are cultivated in many petri dishes, then exposed to one chemical after another to find one that is harmful to the cancer cells. Same thing with AIDS drugs back in the 1980s and 90s -- lots of lab techs in universities testing one chemical after another. — Bitter Crank

Yes, but the fear being expressed here (it's John Ioannidis's calculation, not mine) is not that the chemical gets randomly tested in vitro, it's that they don't get tested in vitro at all. In other words, they actually have no demonstrable effect on cancer cells whatsoever. Clinical trials have to show an effect to 95% confidence. One in twenty such trials would theoretically show an effect by chance alone - ie the drug did not help the people in the trial in the slightest bit, they just happened to get better for other reasons, but in coincidentally disproportionate numbers in the cohort compared to the control. A new drug trial is extortionately expensive so running twenty in the hope of getting such an effect has been unviable. Only recently, cancer drugs have become sufficiently lucrative that running twenty trials in the hope of hitting a randomly good looking one to market literally any chemical at all is now viable. To be clear, no one is suggesting that this has actually happened, but it's would be hopelessly naive not to take the situation seriously.

Non-drug-company-research is done (not often enough) to determine whether drugs work at all. Fairly often the result is "not that much" or "no better than existing drugs". — Bitter Crank

Famously (though perhaps not famous enough) the Cochrane trials only recently found most common paracetamol to be largely ineffective for the majority of people.

___

What intrigues me most in all this is how the pharmaceutical companies managed to pull of this trick. they are the largest industry in the world, spend four times more than the next biggest spender on lobbying, have an absolutely appalling track record on transparency and social welfare... yet somehow they are the darlings of the political left, immune to criticism, seen as nothing but knights in shining armour whose motives are beyond repute.

If the tobacco industry tells us some additive in it's cigarettes is totally safe because they tested it in house and found it to be fine, we'd throw the report in the bin without a second glance. When the pharmaceutical industry do the same, the report is not only treated with earnest reverence, but to even suggest it might be less than the whole picture is to be lumped in with the Proud Boys and Qanon. It's despicable for sure, but definitely gets my grudging respect - what an astonishing piece of long game PR they've pulled off.

BC

Famously (though perhaps not famous enough) the Cochrane trials only recently found most common paracetamol to be largely ineffective for the majority of people. — Isaac

Interesting result, because Tylenol/paracetamol/acetaminophen (all the same compound) are sold OTC. It seems very unlikely that people would buy it by the billions of pills IF it had no effect?

I have osteoarthritis which causes a lot of mid-level pain and limits mobility. I prefer ibuprofen (Advil in the US, Anadin®, Brufen®; Calprofen®... in the UK) to acetaminophen which seems to have more negative long-term or large-dose consequences.

Some of the drugs used to treat cancers do seem to work well, at least in the medium run. Some kinds of lymphoma, for instance, can be controlled for a few years, though in the end the cancer proves fatal. But 2 or 3 years of survival is a good result, I think. Some drugs, many of which are very expensive and/or have serious side effects, may control a cancer for only short periods of time (months), which seems like a dubious achievement.

I'm 75; I currently take 6 Rx medications for chronic conditions -- none of them new. Do they work? Yes; but not a cure. That's OK; at my age some things don't need to be cured, just tolerated.

DuPont's advertising logo used to be "Better Things for Better Living... Through Chemistry." A lot of people count on chemistry to solve their life-style generated problems caused by smoking and drinking; too many calories, not enough exercise; too much time in the sun; too much fried fish and meat cooked on open fires or charcoal (loaded with polycyclic aromatic hydrocarbons); too much striving after a high-consumption life style, etc. etc. etc. Never mind pollution from chemical plants producing better living through chemistry,

Is Big Pharma Ethical in Effectively Controlling Medication Affordability by a Nation's Populace?

Welcome to The Philosophy Forum!

Categories

More Discussions