The pharmaceutical industry has grown at an unprecedented rate in the last forty years. The British drug industry expanded 10 per cent each year during the ten years before 1972, more than three times the growth rate for manufacturing industry, while the world industry has grown even faster (Widgery. 1979).
Although Jenner's smallpox vaccine was widely used by the beginning of the nineteenth century, and the first hypnotic was discovered in 1866, it was the discovery of aspirin in 1899 which marked the beginning of the age of new drugs which proliferated for the next fifty years. There are now about 7,500 preparations on the market, and the number is growing, despite the fact that in 1965 an assessment of 2241 products in Britain, of the 3.000 or so then available, judged 35 per cent of them to be ineffective, obsolete or irrational combinations and in 1971 the American Food and Drug Administration found that 60 per cent of the 2,000 products investigated by them lacked evidence for their therapeutic claims (Widgery). It has been estimated, that 95 per cent of health problems could be treated by 100-200 drugs (Shulman, 1982).
Obviously, neither the lack of usefulness nor, in some cases, the positive harmfulness, of the majority of modern drugs have hindered their growth. Although some medicines have considerably eased pain and misery (the discovery of insulin has saved the lives of millions of diabetics), the use and development of drugs has been abused and perverted under capitalism because of the enormous profits which can be made. Doyal (1979) has pointed out that in the USA in the years 1960-73 the average return on capital in the drug industry was around 18 per cent compared with 11 per cent for manufacturing industry as a whole, and a study in Britain showed profits of 26 per cent for 1967-69 compared with 12.6 per cent for manufacturing industries.
The enormous amount of capital needed for the research and development of new drugs creates a tendency towards monopoly as small firms simply do not have the necessary resources to compete against the giant multinationals.
The seventeen year patent protection given to new drugs also helps drug firms to monopolise the market and with an increase in cardiovascular diseases, road and industrial accidents, diabetes, cancers, respiratory diseases, suicide, drug abuse, alcoholism and mental disorders a ready supply of customers can be relied on. Thus capitalism, having caused an increase in stress-related illnesses, makes a fortune supplying remedies to alleviate them.
Robson (1973) has pointed out that far from stimulating research, patents tend to promote "molecular rouletting" whereby rival firms try to break into the market by providing drugs with minor modifications to those protected by patents. In this way considerable amounts of resources are used up to develop drugs similar to those already on the market with very little chemical advantage, if any, over their rivals but with the added risk of new side-effects. Clearly such drugs are not provided to cater for people’s needs but for profits.
The profits afforded by patent protection are considerable. The products of countries with Patent Laws are priced from 18 per cent to 225 per cent higher than drugs in countries without Patent Laws (Robson). Probably the best known, and most notorious. example of monopoly trading was the supply of chlordiazepoxide under the trade name Librium to the National Health Service at £370 a kilo when the actual cost was £9, and diazepam under the trade name Valium at £922 a kilo when the actual cost was £20.
Mitchell (1984) estimates that if drugs were prescribed by their generic names instead of by their trade names the National Health Service's drugs bill would be more than £50 million cheaper. In 1979 doctors wrote 370 million prescriptions at a cost of £750 million, yielding profits of £121 million. Medicines sold over the counter make further profits (Illiffe. 1983).
Considerable sums of money are spent on advertising medicines. Robson (1977) states: "Drug effectiveness is often open to question and is in inverse proportion to the amount spent on advertising the product." Thus 1.9 per cent of the cost of anti-diabetic drugs is spent on advertising but 13.9 per cent of the cost is spent on promoting products of dubious value such as antacids and cough and cold remedies. The role of the general practitioner in prescribing drugs is recognised by the drug industry, who spend more money per doctor on the promotion of drugs than is spent on medical training.
Drug firms, in fact, spend more on advertising than on research although they claim that expensive research justifies the high prices charged for their products. The haste to produce new. but often similar, drugs leads to many unsafe medicines being sold. Bodenheimer (1984) claims that an estimated 130,000 people in the United States die each year from adverse drug reactions and that as many as 60 per cent of the medications are entirely unnecessary. Hurwitz (1969) found that 2.9 per cent of patients in Britain had adverse drug reactions requiring hospital treatment.
Unfavourable results from drug research are frequently covered up in the interests of profits. Shulman states that the anti-arthritic drug Opren was taken by 700,000 people in Britain and caused 3.500 adverse reactions and 61 deaths in two years. But "By April 19th 1982. when "Opren" was licensed in the USA. 25 "Opren" patients in the UK had died. The Sunday Times investigation shows that Lilly failed to inform the Food and Drug Administration of this until after the licence was granted for the USA. A further five cases in the USA of dangerous side effects were not reported to the British authorities".
Bodenheimer (1984) has described how MER/29 was marketed by William S. Merrell Company in 1960 for lowering cholesterol and withdrawn two years later after more than 5,000 cases of side effects had been reported. An investigation by the American Food and Drug Administration revealed that laboratory notebooks had been falsified to produce favourable research findings.
The human testing of drugs is frequently contracted out to private clinics who exploit the unemployed and the poor to be guinea-pigs in the testing of potentially dangerous substances for paltry payments. The absence of legislation regarding the human testing of drugs in Britain has led to foreign drug companies testing drugs in British clinics to evade stricter laws in their own countries. In particular, the loss of the captive prison population in the United States for drug testing has led to more frequent contracting out of human drug research to Britain.
Drugs which are restricted or banned in the United States or Britain are sold in underdeveloped countries, often with serious side-effects. Depo-Provera. an injectable contraceptive banned in the United States, is widely used in underdeveloped countries; chloramphenicol, reserved for the treatment of typhoid in Britain because of the risk of developing aplastic anaemia, a potentially fatal condition, is sold over the counter in South America. The sale of antibiotics for trivial infections has led to resistant strains of more serious infections developing in countries such as Mexico and Brazil.
The tragedies that have resulted from the use of Thalidomide and Debendox. both of which caused severe birth defects in thousands of children and led to law suits for compensation, have not lessened the pharmaceutical industry's enthusiasm for new drugs or made them any safer. This is because under capitalism goods are produced for profit and human needs are always secondary; the drug companies make such enormous profits that compensation, even in the few cases where it is paid, amounts to only a fraction of annual profits; the state, acting in its role as facilitator of capital, allows the drug industry to produce drugs which can maim and kill.
Although drugs arc often tested in underdeveloped countries to avoid litigation arising from serious side-effects, research into parasitical and tropical diseases is a fraction of the amount spent on cardiovascular diseases and cancers, which are common in developed countries, because of differing abilities to buy drugs. Because drug firms are multinational they are able to exploit low-paid labour in underdeveloped countries. Profits are also increased by avoiding taxes. As it is also extremely difficult to determine the extent of profits made abroad, profits declared in Britain or the USA may represent only party of the enormous gains made by the pharmaceutical industry.
At best drugs are a substitute: an attempt to cure or alleviate rather than prevent disease; at worst they cause suffering, pain and death through misuse. Psychotropic drugs used for depression and anxiety are all too often taken instead of trying to secure political and social change and reduce people's capacity to fight against their exploitation. The elimination of poverty and the diseases it causes will come about through the establishment of socialism and not the hastily researched. dubious remedies of multinational drug firms who prey on human misery to amass large fortunes.
Carl Pinel
References:
Bodenheimer. T.S. (1984): The transnational pharmaceutical industry" in Issues in the Political Economy of Health Care, edited by John B. McKinlay. Tavistock.
Doyal, L. with Pennell, I. (1979): The Political Economy of Health, Pluto Press. p193.
Hurwitz. N. (1969): "Admissions to hospital due to drugs '. British Medical Journal. 1. 1539.
Iliffe. S. (1983): The NHS: A Picture of Health? Lawrence and Wishart, pp159-160.
Mitchell. J. (1984): What Is To Be Done About Illness And Health? Penguin Books.
Robson J. (1973): "Take a Pill . . . Marxists in Medicine, p.9.
Robson. J. (1977): "Quality. Inequality and Health Care". Marxists in Medicine. pp29-30
Shulman. J. (1982): "Pills and profits — dealing with the drug companies'. Medicine in Society. 8(3) 18-22.
Shulman. J. (1983): "The Opren affair — tragedy or scandal". Medicine in Society. 9(1) 26-31.
Widgery. D. (1979): Health in Danger, Macmillan. pp84-88.
