In this article I’ll give you a mostly materialist analysis, utilizing my education in life science, on why drug development works the way it works and what kind of medicines are being denied to the public because of that. In the latter half of the article I’ll sketch out the beginning of a solution, for a drug development which is more optimized to benefit public health.
In a capitalistic ecosystem, the corporations which survive and dominate the market are mindless beast operating on the primary imperative of maximising profit. Often, this imperative corresponds pretty well to giving the consumers whatever goods they want and need but this is far from the case in drug development. In the pharmaceutical industry, the profit imperative results in drug development being skewed from drugs and other medical technologies which cures diseases, towards addicting drugs which treat the symptoms of chronic illnesses, since the latter class of drugs sells more and create a steady revenue stream. This skewing is further enhanced by how prohibitively expensive the American Food and Drug Agency and the European Medicines Agency have made drug development. The bureaucracy, all the licenses which must be bought, the massive phase III and IV studies which are needed (Most often you need to test the drug on thousands of people before it hits the market) it all adds up. The pharmaceutical companies need the revenue from patented drugs in order to survive and afford to develop new drugs. The ideal scenario for the pharmaceutical corporation, from a strictly materialist standpoint, is a dystopia where everyone suffers from ten different chronic diseases requiring each and every one of us to eat ten different pills a day, for the rest of our lives. The behaviour of the pharmaceutical industry is an emergent phenomenon which arises due to several factors:
In part it’s a result of the class interest of the life science academics employed in the corporations, these people want to keep their jobs, feed their families and keep their line of work expanding, just like everyone else. However, I think it’s important to also view sociology through an evolutionary lens. Our species is inherently tribal and so people are first and foremost inclined to help the Dunbar’s number of people they see at their workplace (About 150), secondly their tribe, (The corporation), and thirdly, the world.
Now I’d like to state for the record that people in the pharmaceutical industry are not the greedy, cynical caricatures I often see depicted in degenerate “left-leaning” media. I’ve socialized with several of them and I can confirm that they’re good people. They tend to be quite idealistic and very hard working. A course mate of mine went to work for AstraZeneca and she tells me that it’s a completely different atmosphere from working at university. At our universities people are constantly competing with each other for a limited pool of grants, it gets Machiavellian, the labs are rife with backstabbing and stolen research data. Meanwhile, at AstraZeneca, where people don’t have to apply for their own salary every 6 months, everyone actively seek out collaboration with their co-workers in order to ensure the survival of the corporation. So the employees aren’t evil, if there ever was such a concept, however, the people in power in drug development are trapped in the rat wheel of making addicting drugs to treat chronic illnesses in order to acquire funds to afford new studies so they can make more addicting drugs and so the circle goes on and on. It’s rare that they get the time or funds over to create drugs which actually cure people.
So because the regulatory agencies have made drug development so prohibitively expensive, particularly by requiring large phase III studies, a stratification in the corporate ecosystem has occurred. At the top you have the humongous transnational corporations such as AstraZeneca and Pfizer. They specialise in drug manufacturing, phase III studies and quite crude high-throughput studies on an industrial scale. Essentially they do dumb, brute force research and bureaucracy, they throw money at the problem until a pill manifests. They use methods which no one else can afford on a large scale, wielding their capital like a club to reach a competitive advantage. It’s not very inspiring at all, so if you want to do creative work, you start a smaller, high risk, life science start-up. Often the entire business model of the start-up is to produce and patent a promising drug candidate, take it from preclinical to phase I or II and then sell out to one of the transnationals. It happens that the transnationals buy a patent to scrap it, because it threatens one of their existing revenue sources. So essentially, very much of the power to make or break a drug is concentrated to about 20 board rooms of quite conservative corporations, who have no financial interest in selling less drugs to anyone.
Yet another problem with drug design is the issue of American law, because you want to be able to push your drugs on the US market if you’re want to make a profit. America, land of the free, where it’s every man’s god given right to attempt to get rich by suing a corporation for a couple of million bucks. This is one of the reasons for why corporations can’t afford serious 1 in 10 000 side effects, even though the net effect on public health is beneficial. Many promising drug candidates have been scrapped because of this. Here we see how the difference between individualist and collectivist values shape drug design. In stark contrast to the American idea world, the Soviet Union invented bacteriophage therapy behind the iron curtain. It’s essentially a way to attack bacterial infections by using viruses which has evolved using bacteria as hosts. It works great, most of the time. When it doesn’t work it provokes dangerous inflammatory reactions from the immune system of the patient. A side note:
Bacteriophage therapy is also much more specific than antibiotics which can be a problem since you often don’t know exactly which species of bacteria you’re fighting. The communists were willing to sacrifice a few individuals to save the collective. Regardless of idea world, I suspect we’ll soon see a return to bacteriophage therapy, what with the rise of super-resistant gonorrhea and tuberculosis. One million white people just have to succumb to a pandemic first. A striking example of the non-utilitarian individualist zeitgeist in the west is that many countries have paused the administration of the AstraZeneca vaccine due to a few dozen cases of dangerous blood-clots, even though millions of doses have been administered and that vaccine has drastically decreased the death toll of the pandemic in several countries.
Here follows a list of some types of drugs which we don’t see developed in any larger extent because of the capitalist yet over regulated nature of the system we’ve built for ourselves:
· Antibiotics: Drugs which actually cures people. Their manufacture, prescription and distribution is heavily regulated by law in many countries, like they should be, in order to prevent bacterial resistance. This makes them very unprofitable to develop and it’s pretty much only done if nation-states or the EU funnels large amount of money into the project.
· Vaccines: Effectively prevents disease after the administration of one to two doses every 5–15 years. Almost worthless as a revenue source. The only reason we have COVID-19 vaccines today is that the nation-states and the EU guarantees that they’ll buy them and is funneling taxpayer money into the corporations developing them.
· Psychedelics: Extremely effective treatments for depression, PTSD and a range of other psychological ailments. They work almost like a vaccine for the psyche, or with therapy more like surgery for the psyche. They work miracles in therapy, so often you only need a few sessions. A serious threat to the anti-depressant market. I wouldn’t be surprised to see Big Pharma funding an anti-hallucinogen lobby in the near future for that exact reason.
· RISUG: There’s an amazing contraceptive for men which has been under-development for four decades in India. It’s a plaque injected into the vasa deferetia (the sperm tubes), behind the testicles. Upon ejaculation, RISUG rips apart the sperm by generating an electromagnetic field. The plaque is effective for up to ten years but can be washed out at any time by the injection of a special solvent. Obviously this is a serious threat to the entities manufacturing both birth control pills and condoms.
I’ve saved one of the most pressing inefficiencies of the current system to last. Most of the budget of the big transnational pharmaceutical companies is actually spent on advertisement for their drugs. In the USA this advertisement is carried out by pharmaceutical sales representatives, most of whom lacks formal education in life science. These barely legal drug pushers target medical doctors with various predatory manipulation campaigns:
Misleading drug information, expensive dinners, gifts, consulting fees, etc. etc. This lies on the border of, and sometimes passes the border to, downright bribery. Nevertheless, this profession is not solely destructive. There’s some justification for its existence since pharmaceutical sales representatives have an important role to play in getting health care providers to adopt new treatments, rather than continuing on with the outdated techniques they were taught in med school. Here I’d like to quote the Nobel prize winning physicist Max Planck:
”A new scientific truth does not triumph by convincing its opponents and making them see the light, but rather because its opponents eventually die and a new generation grows up that is familiar with it. . . . An important scientific innovation rarely makes its way by gradually winning over and converting its opponents: it rarely happens that Saul becomes Paul. What does happen is that its opponents gradually die out, and that the growing generation is familiarized with the ideas from the beginning: another instance of the fact that the future lies with the youth.”
— Max Planck, Scientific autobiography, 1950, p. 33, 97
Sadly, this statement also holds some truth for the adoption of new treatments by medical doctors.
So, dear reader, are you fundamentally depressed yet? It’s solution time. Because there’s too much whining in the blogosphere and far too little constructive proposals to solve the important issues of our time. I’m going to capitalise the solution market. Like, share, subscribe and so on and so on.
Entities exist which holds an interest in the long term health of their taxpayers. I’m talking of course of the nation-states and super-state organizations such as the EU. Their cold, hard, materialist interests lies in ensuring the long-term flow of tax revenue into their coffers. Here I’m talking about the abstract entities of states as if they had a consciousness and will of their own and this is of course not the case, the states are made up by many classes and people with different, often opposing interests and agendas. In fact, many nation states, my homeland Sweden in particular, are led by scheming politicians who mostly think about getting re-elected and are not very good at large national projects nor at building anything. People whose plans at best stretches to the end of their terms of office. That is why the deep state exist. I’m not talking about an illuminati shadow government here, I’m talking about the army of civil servants, technocrats and administrators who’re publicly employed to provide expert advice about their specialized fields, to implement laws and budgets and to push the long term interest of the nation. Of course, this class has its own class interest and like every other class, strives towards class reproduction (administrators have a tendency to generate more of their kind), therefore they must be kept in line and constantly be forced to function cost-effectively, sadly this is not done nearly extensively enough in the public sector of Sweden and maybe I’ll get back to that in a separate post. Regardless of their economically inefficient tendencies, I still land in the conclusion that if anyone should set the agenda for a drug development which benefits the people, this class is our best hope.
Imagine a world where the EU, neither offers nor recognizes any new patents for pharmaceuticals. Instead of pharmaceutical companies gaining revenue from patents, each EU-member state commits to dedicating a certain base percentage of their GDP for financing drug development. Each member state forms its own government agency, hiring experts from the universities and the pharmaceutical industry. An agency whose mission it is to fund most drug development. Ideally, this agency consists of many different work groups with different and overlapping areas of expertise to prevent that too much power is concentrated in any one group, this system would ensure that a wide variety of drug-candidates are developed and reaches the consumer market. The corporations and start-ups can then apply to the newly employed technocrats for funding to develop their medicines. Let the most beneficial, best pitched ideas win. Lets earmark the majority of the funding, perhaps 70%, solely for drug development, so that the industry doesn’t spend it all on advertisements and dividends for their shareholders. Another government agency, let’s say Läkemedelsverket in the case of Sweden, gets a significant budget increase and an expanded mission:
The mission of actively seeking out the relevant medical doctors and supporting them with the latest advice and education on which new drugs are the best to use in which situations, as well as newly discovered applications of older drugs. In reasonably functional democracies, government agencies should be reasonably objective with this advice, after all, it’s in the interest of the state.
Do you want to know the best thing about this system, dear reader? After the initial years of investment it would come to no extra cost to the Swedish taxpayer, in fact it would likely be cheaper in the long run since the taxpayers today collectively pays the brunt cost of patented drugs already. In Sweden, once you pay over 2000kr (slightly less than 200€) for prescription drugs, the rest of your drug consumption is funded by the public health insurance. My system would likely induce a shift from symptom-treating drugs to curing drugs so we wouldn’t need to buy as much drugs. Furthermore, Läkemedelsverket probably doesn’t have to spend as much on informing health care providers on novel treatments as the pharmaceutical industry already spends on targeted advertisement to them. Of course, the pharmaceutical companies would still get revenue from production of the drugs which they do cost effectively enough, the drugs would just become much cheaper, now that each company has to compete with every other company in drug production, in a freer market without monopolies. They might even develop a drug or two of their own, even without patent revenue. I see no reason to change pharmaceutical production more than this. I’m not an unreasonable communist. Except that I’m of the opinion that the state should use whatever means necessary to keep as much of the production of essential medical supplies as possible inside Sweden’s border. These means include subsidies, tax-breaks and in worst case scenario other legislative measures. You don’t have to go full Juche about it, but it is a matter of national security to keep drug production local. See my earlier post about vaccine nationalism. Once the nation-states finances drug development directly, they will realise fairly quickly how expensive and time consuming their own governmental bodies have made drug development. With the right, educated and wise political leadership, backed by an enlightened public opinion, the EMA will be forced to deregulate and de-bureaucratize.
-“But what about the rest of the world?” I hear you say, “Surely they’ll punish the EU for not respecting intellectual property anymore?”
Actually, China and India really doesn’t like the current patent-legislation hitching up the prices for essential medicines. They used to pirate medicines for years, for humanitarian reasons. Only a dedicated effort by the international community strong-armed them into partially accepting intellectual property. As I mentioned in my post on vaccine nationalism, a large proportion of the world’s early production steps of pharmaceuticals has been outsourced to those two countries, while the EU has specialized in the latter steps of the production. If the EU was to change opinion about patents, and if we put aside other geopolitical considerations for a moment, there’s room for a mutually beneficial trade and research agreement here. I believe these three geopolitical giants could build a functional medical industry together. The USA wouldn’t have a lot they could do about it, it’s not like their trade war against China is going very well as it is. Eventually the USA might come around, by convenience, and drop their own medical patent legislation. After all, they’d be liberating their own market from monopolies, making trade freer.
I mentioned above that a wise leader would deregulate and de-bureaucratize drug development, however, our leaders aren’t wise and they’re woefully uneducated in STEM. The social democratic government has a crippling tendency to select high level CEO:s for government agencies on the basis of party loyalty rather than competency, see the case of Dan Eliasson for a harrowing example. The Swedish meritocracy has seen better days. The government’s poor judge of character and poor leadership can be seen most strikingly in the interaction between former welder, now prime minister, Stefan Löfven and chief epidemiologist Anders Tegnell. Together they carry the responsibility for thousands of preventable deaths and a pandemic so out of control that they’ve been forced to shut down society. Clearly, the top of the tree is rotten, and the rot spreads downwards. Since our democratically elected representatives would select the top CEO, having Folkhälsomyndigheten take over the responsibility for drug development under the command of this government would be a dystopian nightmare scenario and I have no hope that the opposition would resolve the matter with more competence.
That is why you need to vote for more STEM-educated people in Riksdagen and the European Parliament. A lot of the political establishment needs to be replaced in a very short time to destroy the toxic, backstabbing, petty culture of those particular snake-pits. The media-trained, post-truth doublespeak needs to go if government is to become a place where scientifically literate people actually want to work. After the political establishment has been renewed and rejuvenated the technocrats needs to lobby for an EU-wide stop to all new patents and the creation of the funding government agencies. This solution is not an ideal solution, the road will be long and there will be many missteps on the way, yet it’s the only solution I see to get us the next generation of vaccines and antibiotics, which we’ll need to deal with the coming plagues of totally resistant killer-bugs.