At the Freakonomics blog there is a fascinating “quorum” (four people answer the same question) about the drug industry. “What can you tell us — good or bad — that we don’t know about drug companies?” was the question. Three of the answers were bad things, one was a good thing — pretty predictable given who was asked. What interested me was how bad were the bad things (very bad) and how good was the good thing (barely good). The answers make the drug industry look very bad, in other words.
You are reading this because of my fear and dislike of pharmaceutical drugs. Long ago, I had trouble sleeping through the night. If I went to a doctor, I knew I would be given a prescription for a drug that would be ineffective (long-term) and dangerous (due to biases in the way drugs are tested). So I struck out on my own and via self-experimentation eventually found several solutions that did not involve drugs. (The first was to stop eating breakfast.) This is how I realized the power of self-experimentation to find unusual solutions to everyday problems.
Why does an industry entrusted with something so precious — our health — come across so badly? In Systems of Survival, Jane Jacobs pointed out two moral “syndromes” (sets of values): the commercial syndrome and the guardian syndrome. The commercial syndrome (e.g., be honest) was appropriate for businesses; the guardian syndrome (e.g., be loyal) was appropriate for governments. Why just two? Because there were two fundamental ways of making a living, Jacobs said: trading (business) or taking (government). She pointed out the trouble that arises when governments act like businesses or businesses act like governments. It is bad news, for example, when policemen are given ticket quotas. Quotas are a business tool.
I recently experienced the problem Jacobs pointed out when my scooter was towed by Avenue Tow Service (Berkeley, CA) — using power given them by the city government. They broke the windshield. No surprise they lied about it. Why should they bother telling the truth? Unlimited power is a government tool.
The drug industry is a much larger example of the same thing. What is trading? You trade voluntarily. The two parties are roughly equal in strength. What is taking? The powerful take from the weak. Although drug companies are businesses, they deal with people who are weak (sick) and have no other choice. So in essence, they take rather than trade. One of the Freakonomics examples of bad behavior was price gouging.
The federal government has given drug companies this power, just as the Berkeley city government gave Avenue Tow Service the power to tow my scooter. The federal government has done so because it has failed to effectively support research into non-drug solutions. (Norman Temple and I wrote about how almost all research money goes in the wrong direction.) This leaves the drug industry, like the company that towed my scooter, with a monopoly. Unlike a conventional monopoly (a single company) it is industry-wide. But the effects are the same — a business starts to take rather than trade. And they do things that, when exposed, make them look very bad.
Seth, it would be hard for me to disagree more with you. You say that drug companies deal with a weaker party (the sick), who “have no other choice”. But if decent profits – and drug companies in general are hurting these days – are not available, the drugs they develop wouldn’t be there in the first place. Then the sick would have no choice whatsoever. “Price gouging” is a euphemism for “I think you charge too much, and I want it at a lower price… my price”.
I do agree with regard to your ideas on sleep, but if you think that the average person is going to laboriously try different methods for getting decent sleep, rather than quickly and easily take a pill, you’re dreaming. If people operated like that, there wouldn’t be any obesity problem, to take one example.
The pharmaceutical industry has done more good for more people than any equivalent government source, and without stealing money in the form of taxes like the government does.
Two questions, Dennis: 1. What other choice do most people have than take the pill their doctor prescribes? 2. The Freakonomics example isn’t price-gouging? (If you don’t like the term price-gouging, call it something else.) You don’t think that sort of pricing is widely seen as offensive?
What about doctors? for some reason, no one wants to criticize them. It’s taboo. It’s easier to criticize drug companies.
But Doctors are directly responsible for our health care mess. The AMA has lost its soul.
Doctors? Have you seen a doctor in the last fifteen years? They have miserable lives. I would say the insurers have made whores out of them, but whores make good money and don’t need to see forty clients a day to make ends meet.
See “Sicko” and get back to us.
(I wish Moore would do a film on Big Pharma — imagine the sequence he could create on the procession of Homecoming Queens the drug co’s keep pumping through every medical office building in the country.)
Seth: You ask about the choices of the sick, but thanks to “Big Pharma” they’ve got more choices than ever. And at any rate, poor health does not give anyone a claim on others’ resources, at least not in my moral universe. “Price gouging” is indeed seen as offensive, but Americans have never shied away from having the government force others to give them free goodies. Personal responsibility is so last century.
The issue is a company’s conspiring for years to hide evidence that their drug was useless — if not dangerous — while billions rolled in from people who believed their promises of better health and longer life.
Is there a right not to be defrauded? The law says so.
Tom, I deal with some doctors who have lunch catered four times a week, week after week, by the pharmaceuticals reps and who are making more than $600k a year.
Most prostitutes net a great deal less, and get far fewer free lunches.
lol
Point taken.
The disparity between neuroscientific knowledge and drug efficacy is striking. The causes of Alzheimer’s are well known, but no drug can treat it. The neurological causes of depression are not well known, but lots of drugs and even ECT can treat it well, much of the time, though probably not as well as the drug companies would have us believe.
It’s worth being reminded that a lot of the drugs Big Pharma creates do help people a lot.
Well…if a drug is under patent, we’ll hear about its benefits — a lot.
I was startled by the study a few days ago that appears to show that pregnant women who drink a lot of caffeine have a 25% chance of mis-carrying (up from 12.5% of women who don’t drink much caffeine) – a doubling of risk. After all the ferocious battles in this country over abortion, I really don’t understand the silence on caffeine, which is clearly aborting far larger numbers of children every day. (The story got some play, but it’s already faded and will be forgotten in a month.)
But can you imagine if Merck owned the patent for Vivasurin a drug that could reduce miscarriages by 50%? They could charge $10/day minimum, and every pregnant woman in the country would be on it. Merck would make a couple of grand off every baby born, and the ads would be everywhere.
“The neurological causes of depression are not well known”
Has anyone here read work by Griffin and Tyrrell on the causes of depression (incidentally, some of it stemming from Griffin’s self-experimentation)? If so, what do you think about it?
s there a right not to be defrauded? The law says so.
The entire research thing and the buried studies is a real crime.
There are real problems with drugs that work but that can’t be patented, such as the Chinese herbal remedy for malaria that turns out to actually work, is cheap and not worth the trials. The UN has been working out a protocol for approving financing for it (but not opening the floodgates to tapping funds for worthless folk remedies at the same time).
Tom, you and Tim make excellent points.
“Merck would make a couple of grand off every baby born, and the ads would be everywhere.”
Yeah, and we’d see the Merck executives holding guns to people’s heads to force them to fork over the money, just like they’re doing now.
What a bunch of whining socialists everyone in this country has become.
“Tom, I deal with some doctors who have lunch catered four times a week, week after week, by the pharmaceuticals reps and who are making more than $600k a year.”
I worked at a doctor’s office in a rural town hundreds of miles from a large city. Every lunch was catered at the most expensive restaurants in town. The doctor did not have an objection.
The drug companies’ sales representatives were likable people. The doctor, making much more money than everyone else in the office, was an outsider socially. As a result, the doctor loved to talk with the drug company rep.
I can’t honestly blame the doctor. The lunches were a great opportunity to get the bitter office employees together to share a meal. And like I said, the sales reps. were extremely likable.
The bottom line: The American Medical Association needs to look into this. But I don’t have a lot of faith they will.