For nearly all of human history, across different cultures and governments and moral and faith traditions, medicines have been considered a public good. It was both immoral and illegal to treat medicines as a commodity to be monopolized and used to price gouge sick and desperate people.
And yet here we are, with a system in which people suffer and die because they can’t afford their medicines. Pharmaceutical corporations are making obscenely high profits off the back of this deadly system, thanks in large part to charging prices that are hundreds of times what it cost to make the medicines, but even when we discuss solutions, a for-profit system is taken for granted.
It shouldn’t be. If we want to truly solve this crisis, it can’t be. But saying so doesn’t have to be radical; just the opposite. We can find a better future for affordable medicines in large part by simply looking to what worked for centuries.
Insulin and the polio vaccine: no profit motivation, no problem
Let me begin by asking a question: Do you know anyone who did not get the polio vaccine when they were a kid because they couldn’t afford it?
Probably not. That’s because the inventor of the polio vaccine, Jonas Salk, refused to take a monopoly patent on it. And patents are the platform for our current plague of medicine price-gouging. To Dr. Salk, it was a ridiculous idea to have monopolies on life-essential goods: “Can you patent the sun?” he asked.
The inventors of insulin won the Nobel Prize for discovering the medicine that allows millions of people with diabetes to live. Those inventors sold their insulin patents for $1 each, just so it could be distributed as quickly and widely as possible. When Dr. Frederick Banting was asked why, he said, “Because insulin does not belong to me. It belongs to the world.”
These inventors’ attitudes were not exceptions: until the later half of the 20th century, very few countries even allowed individuals or corporations to have exclusive rights over medicines. In our hearts and minds, we — meaning regular people, not Big Pharma CEO’s — still think this way. Public opinion polls and human rights treaties show that most of us still consider medicines to be something far different from a consumer item like a smart phone or flat-screen TV. With those items, we can walk away from a purchase if the price is set too high. When it comes to medicines, sick people don’t have that choice–and we know it.
The overnight hijacking of a centuries-old system
For decades, massive multinational drug corporations have deployed armies of slick lobbyists using piles of political campaign dollars to hijack for profit a system that we have always treated as a public good.
Sadly, they have gotten their money’s worth. The proof is in the relatively recent, pro-pharma changes in international law like the TRIPS Agreement and national law like the Bayh-Dole Act; more visibly, the proof is in successive presidential administrations that have obediently done the industry’s bidding.
The result of these multimillion-dollar lobbying and marketing sprees is corporations being allowed to insert themselves as middlemen into our medicines process—a process that is funded by taxpayers at both the front and back end. Worse yet, we hand those corporations patent monopolies—on government-funded discoveries, believe it or not—that they gleefully exploit to siphon off billions of taxpayer dollars in profit.
Big Pharma PR: an expensive, bitter pill we shouldn’t swallow
One way to look at all this is that we taxpayers have been turned into venture capitalists, but particularly dim-witted ones: we pay marked-up monopoly prices at the back end for the medicines we funded in the beginning.
For Big Pharma, this makes for a sweet business model. Take-it-or-die leverage over life-essential goods has allowed pharmaceutical companies to become more profitable than any other industry in the world, with banking their only real competition for the honor.
Pharma corporations claim that they need those massive profits to fund research and development for newer and better medicines. Since we all want vigorous medicines research, it’s an argument that makes for powerful videos and slogans.
We must never lose sight of the fact that it is you and me, through our government, paying for the most critical stage of the most critical research on the most critical drugs: that means cancer medicines, vaccines, mental health drugs, you name it. Of the 210 new drugs approved from 2010 through 2016, every single one traces its origins back to taxpayer-funded research.
So, with the industry leaning on us taxpayers to fund so much of the research, where are the drug companies’ massive profits going?
It turns out they spend much more money marketing their drugs, which are often profit-seeking copycats of other medicines already available, than they do on research. When pharma companies do conduct research, it is usually laser-focused on dollars, not public health. A lot more corporate lab time is spent on erectile dysfunction drugs than on a malaria vaccine.
Then you add in breathtaking CEO salaries—as high as $47 million per year. Mix in the lobbying and campaign dollars, and buybacks to shareholders. Now, we can see the full picture of what our high medicines prices are subsidizing.
Never forget: this is not normal
It’s easy to forget that this whole system is a relatively modern invention, while the system we had for so long, the one motivated by public health rather than private profit, is the one that gave us access to many of the most critical drugs we have today. We can go back to the approach that worked for generations, and kick the monopolist price-gougers out of the middle of our medicine process. Just a few years ago, a global movement of people affected by HIV did just that. They stood up to Big Pharma and the lawmakers it had paid for, and broke the patent monopolies on antiretroviral drugs, saving millions of lives as a result.
The same kind of victory is waiting for us with cancer medicines, insulin, and every other drug. Economists like Dean Baker of the Center for Economic Policy Research have crunched the numbers, and found that eliminating patent monopoly markups would save us enough to replace every penny the private companies spend on their own research–and replace it with better research focused on health, not profits.
That leaves us with plenty of money we can devote to proven methods to spur innovation, like government-funded grants and prize funds and open-source innovation. Since medicines are almost always very cheap to produce—some companies are charging $1,000 per pill for medicines that cost pennies to make—we can have generic-level affordability from day one. It’s not that complicated.
For generations, we had a medicines system that worked for people, not corporations. Let’s do it again.