The Price of Life
James Porter again, this time on drugs
![[A bottle of pills]](price.jpg)
Photo: freefoto.com
If one thousand people are going to die and you can do something about it, do you: “a) Do something,” or “b) Look away”? What if it is ten thousand people? What if it is one million people?
Around 13 million children and young adults[1] died last year of infectious illnesses. Around 13 million will probably die this year of infectious illnesses. That’s the equivalent of every child in the UK dying in one year. These are illnesses which, although not unheard of in the West, are rare. Why do we not do anything about the situation?
Perhaps that’s unfair. Don’t some pharmaceutical companies donate drugs to poorer countries? Don’t some charities supply drugs? Yes. This is true. They supply some drugs. They do some provide some help. But only on their terms. Often the drugs supplied are older, less effective drugs. Often they are the cheaper drugs. You may be thinking at this point “but you can’t expect these companies to lose a lot of money — they need to make a profit or at least be able to cover the costs of production.”
Unfortunately the price of manufacture of a drug is not reflected in the price at which it is sold. This is mainly due to the patenting system where a company is given sole ownership of some intellectual property. Essentially they are the only ones who can make a certain type of drug. The majority of drugs can be manufactured at an extremely low cost (perhaps a few pence or less per unit in some cases), yet are sold for hundreds of times that cost. Why? Because people need the drugs to survive and pharmaceutical companies set the price. For those of you who know a trivial amount of economics, you probably know that when there is anything resembling a monopoly the consumer gets screwed. Yes, there are counterarguments to this statement. But these rely on specialised market conditions like significant regulation or a situation where the market can only support one company. The underlying principle of market based economics is profit maximisation. Basically this means that when a company is motivated mainly by profit, they want to maximise this profit. How do they do this? By selling the drugs for the highest price possible. This doesn’t necessarily mean the highest price per unit, but thanks to massive disparities in wealth between the ‘North’ and ‘South’, pharmaceutical companies, in seeking to maximise profit, will set a high unit price for their drugs. This is easily seen in the real world, by the extortionate prices that these companies charge.
Simply put, pharmaceutical companies put a price on peoples’ lives. A price many in poorer countries (and even some in some richer countries) simply cannot afford. To defend pharmaceutical companies is to defend the pricing of peoples’ lives. A practice I think most people find morally repugnant.
When reading Samantha Power’s book America and the Age of Genocide recently, I was struck by how the only way anyone convinced politicians to do anything was by arguing for their self-interest. It sickens me to think someone could not be satisfied by the moral arguments alone. But just in case someone like that is reading this I will provide a ‘self-interest type’ argument. First go and look at how much your health service spends on drugs. Then look at the figures for revenue that your government collect in tax from pharmaceutical companies. Do these figures add up? I very much doubt it. What if the cost per unit of each drug could be vastly reduced? It can be.
The second argument I present is that of retaliation. Let’s say someone in a poorer country sees their family die of illnesses that could have been prevented if an American (or British or Dutch or…) company had not set prices on drugs at too high a level. Are they likely to be happy? Of course not! One of the reasons for terrorism (I emphasise that it is only one) is almost certainly the way in which drugs are restricted only to rich people. If we only let white people have drugs it would be considered (by most) to be abhorrent. If we only let rich people have drugs — is that okay? (If you answer yes to this question, place yourself in the position of someone in a poorer country. Do you agree with this policy now?).
So how can we reward innovation? How can we create a new generation of drugs without the current system? What I am about to propose is such a system. First I would like to make a few things clear. Firstly we aren’t really rewarding the innovators (to the extent they deserve) now. The real innovators are the scientists who work for the pharmaceutical companies. Who do we currently reward? The shareholders and the executives of the pharmaceutical companies. The second point I would like to make is that the research that is currently carried out is that which the ‘market’ demands. For example the major pharmaceutical companies are collectively spending hundreds of millions on developing seven independent weight loss drugs[2]. Wouldn’t one be enough? Few companies are investing in the development of vaccines, the generally accepted best way to halt the spread of disease. Why? Because these drugs are mainly required in the developing world. The spending on vaccines cannot approach that of the main pharmaceutical companies just on weight loss drugs.
So how should research be funded? I apologise to any ardent neo-liberal supporters reading this[3] but I suggest it should come out of the public spending of first world countries. This could actually save money! In 2002 the NHS spent £6.1 billion just on prescriptions. At a rough guess the development of a major drug costs around £100 million. With some it can be up to about £400 million[4] over a typical timescale of fifteen years. So the NHS could, taking the more expensive estimate, fund the development of about 200 major drugs simultaneously and still have £1 billion per year left over for the necessary manufacturing processes[5]. Factor in countries like the USA, Japan, Germany etc and take into account the improvements in efficiency brought about by the sharing of progress and techniques between groups, and you can easily see the potential for a drastic improvement in the current situation.
The second alternative I propose is a compromise. Let things continue as they are in the West but allow poorer countries to manufacture generic copies[6] or if they are not able to do that provide the drugs for free. This unfortunately would not solve the problems of research but it would still be a vast improvement on the current situation. This action alone would save the lives of millions and spare many from severe suffering.
I remember on 11 September 2001, I was driving home from school with my brother. I knew something major had happened. Details continued to emerge from the car radio. I was in a state of shock. I could barely concentrate on driving. Thousands dead? When we arrived home we switched on CNN. There we witnessed the horrible events of the Twin Towers collapsing. We saw people jump out of windows in a desperate, but hopeless effort to escape. Around 3000 people died THAT DAY thanks to the deliberate actions of a few people and the world was in shock. Around thirty five thousand people die EACH DAY thanks to the deliberate actions of a few people [7], and the world doesn’t seem to care. At least not enough to do something about it.
The majority of this article was written in a general way as I wanted it to be accessible to as wide an audience as possible. As I am submitting it to Christis I should probably have some ‘Christian’ opinions. I think it is clear to see what is going on is wrong. That it is evil. And that it is sinful. I also think we should do something about it. Proverbs 31:8–9 says:
“Speak up for those who cannot speak for themselves, for the rights of all who are destitute. Speak up and judge fairly; defend the rights of the poor and needy.”
I would argue against a world-view that accepts the doctrine of the fall or the inherent sinfulness of man and from that constructs a fatalistic ‘we can’t do anything about it’ view. Perhaps alone we can’t, but you might want to reflect on this:
“Now to him who is able to do immeasurably more than all we ask or imagine, according to his power that is at work within us, to him be glory in the church and in Christ Jesus throughout all generations, for ever and ever! Amen.”
Ephesians 3:20–21
What good is it, my brothers, if a man claims to have faith but has no deeds? Can such faith save him? Suppose a brother or sister is without clothes and daily food. If one of you says to him, “Go, I wish you well; keep warm and well fed,” but does nothing about his physical needs, what good is it? In the same way, faith by itself, if it is not accompanied by action, is dead.”
We can’t achieve perfection in this life; but with God’s help we can get a lot closer than we are now. We can make a real difference for the right reasons. Jesus teaches us to love our enemies. The people who are dying and suffering because of lack of drugs aren’t our enemies. If we can’t even love them enough to help them, then loving our enemies is going to be pretty much impossible.