Drug companies influence research; they also affect what gets published.
Organic farming critic Dennis Avery is supported by generous contributions from several chemical companies, all of whom profit from the sale of products prohibited in organic production.
The war on terror is threatening to overshadow a far more deadly threat—the AIDS epidemic.
Attorney General John Ashcroft throws out Oregon's assisted suicide law, against the wishes of a majority of Oregonians and in defiance of a 1997 Supreme Court ruling.
Talk about good times for Washington's mercenary culture. Even as officials scrambled to explain why they had not acted more quickly to protect postal workers from anthrax contamination--or to deal with the public's fears regarding the disease--they were showing solicitous concern for Bayer, the maker of the anthrax-fighting antibiotic Cipro.
Faced with the choice of protecting public health or protecting a corporation's intellectual property, Health and Human Services Secretary Tommy Thompson instinctively chose to stand by Bayer, whose Cipro patent doesn't expire until late 2003. Never mind that it could take Bayer twenty months, working nonstop, to meet the government's target of a sixty-day supply for 12 million people, while generic drug companies say they could jointly reach that goal in three months. Initially, Thompson said he had no authority to override Bayer's patent, and it was only after public and Congressional criticism that he used his leverage to force Bayer to reduce its price for Cipro. Of course, if Thompson were to invoke federal law allowing the compulsory licensing of Bayer's Cipro patent to meet the current emergency (paying the company a fair royalty), he would be hard-pressed to keep arguing against similar measures to address the AIDS epidemic in the developing world.
The highly profitable pharmaceutical industry has invested heavily--doubling its campaign contributions between 1996 and 2000 to more than $26 million--to insure that it gets a Congress and Administration friendly to its interests. And it has paid off. In July the House soundly defeated an amendment sponsored by Bernie Sanders that would have allowed US wholesalers and pharmacies to import FDA-approved US-made drugs sold overseas. Given the price differential, such a change could have saved Americans $30 billion or more a year. According to Public Campaign, members who voted to protect Big Pharma from competition received, on average, $9,000 in campaign contributions from that lobby in 1999-2000, compared with $2,800 to members who voted the other way.
Nor are the drug companies alone in enjoying a special level of concern in Washington. Emboldened by Congress's hasty and over-generous bailout of the airlines, leaders of the insurance industry threatened to take the economy down with them if they too weren't promised a multibillion-dollar rescue package. Hollywood wants a tax break to keep it from moving studios abroad. Restaurants and hotels want taxpayers to subsidize 100 percent of the cost of their customers' three-martini lunches and golf junkets. Travel agents, car rental agencies and amusement parks want to give everybody a $500 tax credit to bolster their businesses. And every money-making corporation that ever got caught trying to avoid paying its fair share of taxes now hopes that this is the moment to kill off the alternative minimum tax. Meanwhile, the hundreds of thousands of workers who are out of a job since September 11, or barely hanging on, can't get Congress to extend their unemployment benefits or to help them keep their healthcare.
The lesson for an anxious public wondering whether the government can protect them--from sickness, from joblessness, from being treated as second-class citizens--is that it's time to throw the money-changers out of the temple. While battling terrorism abroad, we must also fight corporate greed here at home.
John Elias, my patient, has a dilemma. He can't afford to buy his medicines and also pay his rent. I'm sure he won't give up his apartment just to keep his veins filled with my chemical suggestions. But he is willing to take whatever free drug samples I provide. Luckily, drug company representatives visit my office regularly and drop off oversize, brightly colored boxes of pills, one or two pills per box. Sometimes I can fill a plastic bag with enough medicine to supply a patient's needs. Still, my sample closet is not as well stocked as the local pharmacy.
The explosion of samples occurs most often when two drug companies are competing over a similar product. When I have one set of pills, it's Elias's diabetes that's treated; when I have another set, it's the hypertension. He does not die, but his blood pressure goes up and down, and his blood sweetens with rising sugar, which lowers whenever I happen to have the right pills. Elias leaves my office smiling, more comfortable with his predicament than I am.
"See you in a month, Doc. And don't worry. I got enough pills here to last me a good ten days."
I do worry--about the remaining twenty days, about his risk of a heart attack or a stroke--but samples arrive at the drug company's rate, not in response to my urgent requests.
Elias is disabled, the result of a spine operation that didn't go his way. He has Medicare, but like millions of other disabled and elderly Americans, he's unable to afford the secondary insurance that would include a drug plan. He earns too much in his part-time clerical job to qualify for Medicaid, which also covers prescriptions, or to be accepted into a drug company's "Share the Care" program. He does qualify for New York State's EPIC plan, which allows some Medicare patients to fill all their prescriptions for under $100 per month, but he says he can't afford even that. He says he won't consider leaving his job to get Medicaid as others have done; he's proud of the fact that he can still work.
Elias lives in his wheelchair; the levers and locks are extensions of his arms, the wheels his legs. He navigates the street outside my office, leaning back on two wheels to jump the curb. His arching wheelies are another man's sidestep. But he has not managed to navigate his other diseases the way he has his paralysis. When I tell him the dangers of not controlling his diabetes and his high blood pressure, his smile fades. "When you're out, then I'm out," he says simply.
Meanwhile, the same company that makes his diabetes pill offers to fly me, all expenses paid and with a $1,000 stipend, to a frolicking weekend in Naples, Florida, where I would hear lectures for three hours a day on a drug I already prescribe, before adjourning to the surf and a sightseeing sunset booze cruise. The competitor invites me to the corporate box at the ballgame, with a lobster buffet and a live calypso band to entertain us between innings.
The drug salesman infiltrates the somber atmosphere of my medical office, trailed by a huge sample case on tiny wheels. It's uncanny: He knows how much of his drug I prescribe, and he wrongly assumes that I will respond to his enticements. He provides catered lunches to my office staff where the only apparent cost is listening to him harp on about a product that he freely admits I know more about than he does.
Despite the money spent on massive advertising, the manufacturers insist that exorbitant drug prices are the result of research and development. Several of the industry's best researchers are former professors who have been wooed away from the universities for higher salaries and better laboratories, and for every participant in the drug pipeline, from discovery to production, the excitement is almost palpable. New medicines for arthritis, hypertension, high cholesterol and diabetes improve the quality of life with fewer side effects. However, the new drugs are sold in Canada and Europe for a much lower price--a $15 pill in Detroit may cost $5 across the river in Windsor, Ontario--and there are foreign chemists producing these drugs in the laboratory and companies selling them for a fraction of their cost in the United States.
The more expensive the drug, the more difficult it is to determine how it is going to be paid for. Recently, a new wonder drug for arthritis became available in two formulations, one oral, the other intravenous. The choice of which form to use illustrates a basic problem in reimbursement. Since Medicare pays only for the more expensive intravenous, patients are being hospitalized unnecessarily to receive it.
As a doctor, I'm frustrated by the current system's inability to consistently provide for a patient's medicinal needs. Clearly, there is a need for government to intervene, but it's crucial that this intervention include an understanding of inflated costs and a plan for combating this inflation. As Medicare expands to cover pills, will the federal government drive a hard bargain and negotiate a lower price per pill the way HMOs, hospitals and other countries already do? I don't see how taxpayers can avoid being penalized if the government agrees to pay top dollar.
This year, after many insufficient attempts to maintain his health with samples, Elias wheels into my office with, if wheels were legs, an almost detectable swagger. All his years in service as a clerk have finally paid off. He is now the recipient of secondary insurance with a drug plan. He is one of the lucky ones. Now all his medications will be covered, at least for the moment.
"I'm ready to be healthy," he says with a grin that reveals his neglected teeth. "Lay those prescriptions on me."
Read Richard Kim's report on the Stop Global AIDS March here.
Read the UN Declaration of Commitment on HIV/AIDS here.
New York City; Saturday, June 23, 2001--The Stop Global AIDS March today brought together thousands of AIDS, debt relief, anti-racist and anti-globalization activists from around the world
The concept captures fundamental characteristics of today's world order.