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This is not about profits and
patents; it's about poverty and a devastating disease." That
statement did not come from AIDS activists struggling to provide
sub-Saharan Africa's 25 million HIV-positive people with access to
life-extending medications. It came from the executive vice president
of Bristol-Myers Squibb, which recently announced it would slash
prices on its two AIDS drugs and forgo patents on one of them. A week
earlier, Merck & Co. said it would lower prices on its two AIDS
drugs not just in Africa but, pending review, in other heavily
affected countries as well.

What's going on is not a
change of heart on the part of "Big Pharma"--which John le
Carré describes in this issue as a group of
"multibillion-dollar multinational corporations that view the
exploitation of the world's sick and dying as a sacred duty to their
shareholders." Far from being a humanitarian action, the price
reductions represent an attempt to preserve patent rights by
diffusing international pressure for generic manufacturing.
Revealingly, neither BMS nor Merck has withdrawn from a suit against
the South African government brought by thirty-nine pharmaceuticals
seeking to prohibit importation of generic drugs, which they claim
would violate their patents.

The Indian generic
manufacturer Cipla announced in February that it would sell the
entire AIDS triple-therapy combination at $350 per person, per year,
and other generic manufacturers, in Thailand and Brazil, currently
offer AIDS drugs at a fraction of multinational prices. By
comparison, the Wall Street Journal reported that a
combination of AIDS drugs from BMS and Merck would cost between $865
and $965 per person, per year. If those prices were multiplied by the
number of AIDS patients in, say, Zimbabwe, a relatively prosperous
country by African standards, the total would come to about 20
percent of its GDP. And that sum doesn't include the investments in
healthcare infrastructure needed to distribute and monitor the drugs'
use.

But even if poor African countries could somehow find
the money to pay the high patent-protected prices of the drug giants
(the $26.6 billion a year it would cost to provide all Africa with
AIDS drugs is no more than about a third of what Bush's tax plan
would give to America's wealthiest 1 percent), that would not be the
end of their problems. Rather, such a course would lock them into
exclusive trade agreements with multinationals and put them at the
continual mercy of Western foreign aid budgets. As new treatments are
developed, Africa would have to negotiate new price reductions,
country by country, company by company.

If the solutions
lie with generic manufacturing (not just for AIDS medications but for
a slew of vital drugs for malaria and other ills), then circumventing
existing international patent regulations is a necessity. The trial
in South Africa over compulsory licensing is one crucial test of the
viability of this option. Another potential plan would be for the
National Institutes of Health to give patents owned by the US
government on publicly funded AIDS drugs to the World Health
Organization, thereby licensing it to oversee generic manufacturing.
Why not, in fact, let governments underwrite the entire cost of drug
research--rather than, as now, underwriting substantial amounts of
the research, which drug companies then exploit--and do away with
patents altogether?

Whatever the recourse, and despite the
well-publicized gestures by multinational pharmaceutical companies,
the solutions to Africa's AIDS epidemic lie in sustainable
competitive drug production, not momentary self-interested
charity.

I have eaten more than my share of Whoppers in my forty-one years. As a teenager I liked them so much I'd worry about whether I could afford another one while still eating the first. As I got older, my concerns centered less on the cost to my wallet than to my waistline. Today, thanks to two new books, I have a new fear: the prospect of everlasting damnation.

Eric Schlosser's Fast-Food Nation is a frightening and disturbing update of Upton Sinclair's The Jungle. Spend a few hours with Schlosser and you'll become more intimately acquainted with your ground beef than you ever wanted to be. Consider the people who get the meat into your waiting fingers. The injury rate among meatpackers is the highest of any US occupation. Every year about one-third of all slaughterhouse workers--roughly 43,000 men and women--suffer an injury or an illness that requires first aid on the job. Given the inevitable exchange of blood and other bodily fluids in which these injuries result, their oppression is your health hazard. The same goes for the burger-flippers behind the grill. Fast-food employees are the largest group of low-paid workers in the United States today, earning on average $5.74 an hour. One-quarter of the workers in the restaurant industry are estimated to earn the minimum wage--a higher proportion than in any other US industry. (No wonder the National Restaurant Association is perhaps this nation's most vociferous opponent of living-wage laws.) Again, worker oppression results in consumer health peril. Reading Schlosser, we hear stories of teenage workers serving meat after dropping it on the floor, picking their noses into the food, smoking on the job and watching cockroaches and rats feed and defecate on unprepared foods.

A single hamburger often contains beef from dozens up to hundreds of cattle from as many as six countries. If just one morsel becomes infected with the E. coli microbe, the burger can kill you. For the luckier ones, it can result in kidney failure, anemia, internal bleeding, seizure, stroke and coma. As company lawyers pay victims in exchange for their silence, in the past eight years some half-million Americans, mostly kids, have become seriously ill from E. coli infections. Every week, a few of them die.

I've not even said a word about the economic and environmental destruction the industry routinely wreaks on the farmland it controls, the neighborhood mom and pop operations it destroys, and the evil mind-games it plays with our children. (The McDonald's corporation, the world's largest owner of retail property, is also its leading spender on advertising and marketing, much of it directed at small children.) And forget mad cow.

Still hungry? Peter Singer's new collection, Writings on an Ethical Life, asks you to think again. Singer, whose musings on "speciesism" single-handedly jump-started the animal rights movement a quarter-century ago, wants to know what right you have to be eating what was once a conscious being in the first place. "All consumers of animal products are responsible for the existence of cruel practices involved in producing them. Our moral responsibility should compel us to avoid hamburgers because every time we eat one we are contributing to a cycle of suffering not only of animals, but also of humans, for the grain used to feed the animals we consume is more than enough to end hunger in many less industrialized and affluent countries." (If you want stomach-turning evidence of rampant anti-animal sadism in the beef industry, check out Schlosser's account of a visit to a slaughterhouse "somewhere in the high plains.")

All right, let's say you do decide to transform your life, swearing off not only animals and fish but also dairy. You are now a vegan, and you decide to celebrate by taking your family out to a fancy new neighborhood health-food restaurant serving only the most high-minded meals of vegetables, fruit, nuts and berries. Not so fast, says Singer. The $200 or so you are about to spend on a meal you don't really need would help transform a sickly 2-year-old into a healthy 6-year-old somewhere in the Third World--offering safe passage through childhood's most dangerous years. If instead of going out to dinner, you dial either (800) 367-5437 for UNICEF or (800) 693-2687 for Oxfam and give them your credit card number and 200 bucks, that child will live instead of die. If you go out to dinner instead--well, sorry, but the kid is dead.

OK, now let's say you donated the money--I hope you did--and decide to go out to dinner anyway. Is that enough? Not really, I'm afraid. There are millions more starving kids out there, and I'm guessing you've got more than $200 you don't really need. I know your friends and relatives don't seem to be giving away their extra money, but most people didn't resist the Nazis or Stalinists when they had the chance, either. Does that make it right?

Here's the problem. I can't answer any of these arguments, but I can ignore them. At least I intend to (except for the $200 one--I did stop in the middle of writing this article to fork over $200 to Oxfam). The trouble seems to be that I'm a massive hypocrite. I make sacrifices for my principles but not, apparently, ones involving hamburgers and steaks. I like them too much, torture or no torture, starving kids or no starving kids, E. coli risk or no E. coli risk.

Being an American, you are probably no better. We are the wealthiest people in all human history, and yet our government does not even come close to meeting the extremely modest United Nations-recommended target of a set-aside of 0.7 percent of GDP to overseas aid agencies. Our piddling 0.1 percent is less than one-third of Japan's contribution and a tenth of Denmark's. Don't tell me that these organizations are inefficient at feeding people. Everybody is inefficient at everything. They are good enough. Singer, a vegan who gives away 20 percent of his salary as a tenured faculty member at Princeton, insists that there is "something incoherent about living a life where the conclusions you came to in ethics did not make any difference to your life." He's right. We're living a morally incoherent life, you and I. And as Schlosser demonstrates ad nauseam, it's even pretty stupid from the standpoint of our own self-interest. So how do we justify it?

I wish I knew.

Single-payer healthcare is favored by the public, yet the insurance industry has too much to lose if it is enacted.

The Bush Administration's health policies for Africa basically amount to the moral equivalent of the death penalty for 25 million people.

There wasn't much good news to report from the year 2000, but topping the list in health terms was the long-overdue final shutdown of the Chernobyl nuclear power station on December 15. Unit Four at the Ukrainian complex blew up in 1986, spewing radioactive death and destruction around the planet. Evidence points to a skyrocketing death rate among the 800,000 "liquidators" who were forced by the Soviet government to help clean up the stricken reactor, while new studies also show escalating cancers among civilians in the downwind areas.

Earlier in the year, on the fourteenth anniversary of the Chernobyl debacle, the Radiation and Public Health Project and Standing for Truth About Radiation (STAR), a national safe-energy organization, released a pathbreaking study showing that radioactive emissions from commercial reactors are having catastrophic health effects on people living near them comparable to those experienced by nuclear weapons workers, for which the Energy Department has finally admitted responsibility. The study, by Joseph Mangano, a nationally known epidemiologist, compared infant death rates in areas surrounding five nuclear power plants while they were operating and in the years after their shutdowns. Mangano found that from 1985 to 1996, average nationwide death rates for infants under the age of 1 dropped 6.4 percent every two years. But in the areas surrounding five reactors closed down between 1987 and 1995, infant death rates dropped an average of 18 percent in the first two years. "It's hard to imagine a clearer correlation," says Mangano. "The fetus in utero and small babies are the most vulnerable to even tiny doses of the kinds of radiation emitted from nuclear power plants. Stop the emissions, and you save the children."

Published in the journal Environmental Epidemiology and Toxicology, Mangano's study covered these reactors: Wisconsin's LaCrosse, which closed in 1987; Rancho Seco, near Sacramento, and Colorado's Ft. St. Vrain, both closed in 1989; Trojan, near Portland, Oregon, which shut in 1992; Connecticut's Millstone plant, which closed in 1995. Later research on two additional reactors, Maine Yankee and Big Rock Point in Michigan, both of which went cold in 1997, showed that infant death rates fell a stunning 33.4 percent and 54.1 percent, respectively.

"Forty-two million Americans live downwind within fifty miles of commercial reactors," says Mangano. "The Nuclear Regulatory Commission allows nuclear plants to emit a certain level of radiation, saying that amount is too low to result in adverse health effects. But it does not do follow-up studies to see if there are excessive infant deaths, birth defects or cancers." Additional research by Mangano also indicates a drop in overall cancer deaths among elderly people living near nuclear plants once they are deactivated.

On June 5 the Supreme Court ruled that some 1,900 central Pennsylvanians living downwind from the Three Mile Island nuclear plant could sue for health damages. Local residents and researchers claim that a plague of death and disease followed the March 28, 1979, radiation leak at TMI Unit 2.

Even longer-overdue justice is coming to workers in the Energy Department's nuclear weapons production facilities. From the 1943 beginnings of the Manhattan Project to the ongoing enrichment of uranium at gigantic plants in Ohio, Kentucky and Tennessee, the government has denied virtually all claims from thousands of workers suffering from a range of radiation-related diseases. But the DOE finally issued a series of sweeping admissions after DOE-sponsored research found excess worker deaths from cancer and other causes at fourteen DOE facilities. A DOE report issued in May confirmed that hundreds of workers at Ohio's Portsmouth Gaseous Diffusion Plant, whose supervisors did not require them to wear protective masks, routinely inhaled uranium dust, arsenic and other lethal pollutants. President Bill Clinton signed into law a federal compensation program for DOE workers exposed to radiation, beryllium and silica. The program will cover some 600,000 people involved in making nuclear weapons.

The DOE's admissions give new weight to public demands that the commercial reactor industry come to terms with public health risks now that numerous aging and leaky reactors are waiting in line for extended licenses from the NRC. "How much more of this bodies-in-the-morgue approach to public health research do we need?" asks Robert Alvarez, executive director of STAR. "Shutting reactors may save lives. What more needs to be said?"

Chris Kraus reviews Cool for You, by Eileen Myles.

Foundations formed when nonprofit hospitals became for-profit are often not living up to their obligations.

The Journal of Nutrition wrote about
Some researchers who tested chocolate out.
It may help stave off heart attacks, they claim.
Red wine, we've known for years, can do the same.
Without the need of any doctor's urging,
I feel a healthy diet plan emerging.

If politics got real...the debate over costly prescription drugs would turn to more fundamental solutions like breaking up the pharmaceutical industry's patent monopolies, which generate soaring drug prices, and rewarding consumers for the billions of tax dollars spent to develop new medicines. As a business proposition, that sounds radical, but it would actually eliminate outrageous profit-skimming at taxpayers' expense and liberate lifesaving medicines from inflated prices so millions of people worldwide could afford the health benefits.

At present, the government picks up the bill for nearly all basic research and development, mainly through the National Institutes of Health. Then private industry spends about $25 billion a year on more R&D--essentially taking NIH discoveries the rest of the way to market. The companies mostly do the clinical testing of new compounds for safety and effectiveness, then win regulatory approval for the new applications. This is one instance where a bigger role for government, by taking charge of the scandalous pricing system, could produce vast savings for the public--as much as $50 billion to $75 billion a year.

The National Institutes of Health and independent scientists working with NIH grants generally do the hard part and take the biggest risks, yet there is no system for sharing the drug companies' subsequent profits with the public treasury or for setting moderate prices that don't gouge consumers. Instead, the drug industry reaps revenues of $106 billion a year, claiming that it needs its extraordinary profit levels in order to invest heavily in research. The companies are granted exclusive patents on new products for seventeen years (or longer if drug-company lobbyists persuade Congress to extend them). Meanwhile, the manufacturers collect royalties (and less profit) on the very same drugs under licensing agreements with Europe, Canada and other advanced nations where the governments do impose price limits. Thus, Americans pay the inflated prices for new medicines their own tax dollars helped to discover--while foreign consumers get the break.

Years ago, although reform was mandated by law, NIH abandoned its efforts to work out a system for moderating US drug prices--mainly because the industry refused to cooperate and had the muscle in Congress to get away with it. Now that soaring prices have inflamed public opinion again, Dean Baker of the Center for Economic and Policy Research proposes a more radical solution. NIH should be given control over all drug-research policy, Baker suggests, and Congress should put up public money to cover the industry's spending (probably less than $25 billion because marketing costs get mixed into the research budgets as well as money spent to develop copycat drugs, which are medically unimportant). The exclusive patent system would be phased out, perhaps starting with cancer drugs and other desperately needed medicines whose prices are too high for poor nations to afford. For $25 billion or less in new public spending, brand-name drugs would largely disappear, but, Baker estimates, prescription costs for Americans would shrink by as much as 75 percent overall.

A less drastic solution, suggested by James Love of Ralph Nader's Consumer Project on Technology, would limit use of exclusive patent rights and, if needed, compel drug-makers to grant royalty licenses to other US companies to make and sell the same medicines, thus fostering price competition. Competing companies would be required to contribute a minimum percentage of revenues to R&D to maintain research spending levels. The government could also require companies to help fund government or university research.

The prescription-drug debate of Election 2000 is a long way from either of these visions for reform, but events may lead the public to take them seriously. Drug prices are inflating enormously. If Congress fails to make it legal, the bootlegging of cheaper medicines from Canada and other countries where the prices are controlled is bound to escalate, and the present system might break down from its own lopsided design. As a matter of public values, the discovery of new health-enhancing medicines ought to be shared as widely--and inexpensively--as possible, especially since public money helped pave the way to these discoveries. Jonas Salk never sought to patent his polio vaccine. He thought his reward was knowing how greatly his work had advanced all of humanity.

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