There, I said it.
I know that there have been many people recently who have come out to criticize Martin Shkreli on raising the price of a medicine relied upon by AIDS patients and others with compromised immune systems by roughly 5000%.
What many people are only now starting to realize, is that he may actually have done us a huge favor.
He did not do anything that other drug companies weren't already doing. He was just so brazen and shameless about it that it blew up in the drug industry's face.
In his greedy awful way, Shkreli perfectly illustrated the problems with our current for-profit drug research system.
Shkreli was born in Brooklyn in 1983, according to The New York Times, but he may just as well be an imagined manifestation of national guilt over a broken health-care system, broken largely because of the costs of medications. The little red guy with a pitchfork on our collective arthritic shoulder, Shkreli is a product, not a cause. Defeating him is treating a symptom, not creating a cure. In mocking his hubris we mock a person for operating within a system that we created and continue to subsidize. It took a firestorm of public outrage stoked by every national news outlet and multiple presidential candidates to get Shkreli to remit. But there are many more Shkrelis, and there will continue to be more Shkrelis.
The reliance on for-profit drug research has to come to an end.
Whether or not you consider them a problem, let's look at some of the aspects of the for-profit drug industry that we deal with on a daily basis (at least in the US).
How many TV commercials might one see on a given day, marketing some drug or another, ostensibly to treat some disease or condition? Sure, we may be treated to some pleasant images of puppies and beach houses, as the narrator runs through the litany of possible side effects that could range from excessive diarrhea to suicidal thoughts, but does it really make medical sense to be advising people who likely have little professional medical training, whose judgement may be severely compromised by their afflictions, to judge what medical treatment is best for them?
My favorite one is about how calling dry eyes a "disease" makes it "a big deal." And that has nothing to do with trying to sell me this medicine you want me to take for the rest of my life for a condition I might not even consider a problem?
Perhaps the marketing of drugs directly to consumers may not rise to the level of a social ill. But at the same time, it is clearly not the best way to play matchmaker between a patient and the medicine they need. People need objective analysis of what their medical needs are, which medicines will be most effective, and what potential side effects are considered reasonable for their conditions. When we instead have a system that tries to get the patient to use their medicine, regardless of if it best suits their needs or not, and primarily driven by profit, there is a clear conflict of interest. True, doctors are supposed to help patients in this regard; but even they can't be expected to be experts on what drugs are out there, and how to best screen patients for what treatments would be most effective for their individual circumstances. Pharmaceutical representatives and salespeople may actually still be an important facet of our medical industry even without for-profit medicine; but when they're prioritizing profit, and selling their own products over their competitors, the needs of the patient will inevitably fall by the wayside.
And that's just for the drugs that haven't yet been brought into multi-million dollar lawsuits. Let's not forget what havoc for-profit drug research does in the whole drug approval process in general. A drug approval process, a FDA agency, completely compromised by a revolving door policy between the drug companies, and the regulators that are supposed to police them. Drugs allowed onto the market, allegedly undergoing a stringent safety and efficacy process, but later on found to be deleterious after all.
And the idea of drug patents has unleashed upon us the conundrum of generic brand medicine. When the patents run out, the market is flooded with supposedly-equivalent, yet cheaper versions of the original medicines. Which brings about a whole new set of problems, such as if generics really are the same.
And speaking of drug patents, let's not forget the role it has played in the ongoing TPP dispute.
There are many serious issues raised by the Trans-Pacific Partnership (TPP), but the one that may have the greatest long-term impact is its provisions on drug patents. The explicit purpose is to make patent protection stronger and longer. While these provisions are likely to lead to higher drug prices in the United States, they will have their greatest impact in the developing world.
Perhaps without the problem of drug patents, the Obama administration would've had an easier time getting TPP past the opponents. Perhaps the TPP opponents would have had less to be opponenting about in the first place.
Then there is the growing prescription drug abuse epidemic plaguing our society. A problem largely driven by the over-reliance on prescribing powerful drugs that should really be administered more responsibly. Though it's not even just painkillers that are being over-prescribed.
We could also think about how drug costs play a role in the continuing Obamacare battle. Really, the idea of affordable health care, in general.
Prescription drug costs are rising dramatically in the United States. Based on a recent survey by Consumer Reports, 33% of Americans were paying an average of $39 more out of pocket for their regular prescription medications, and 10% were paying as much as an extra $100. Among the drugs that saw the highest increases were medications for asthma, high blood pressure and diabetes, which went up by more than 10% last year.
And finally, probably the most pernicious part to me, yet defensible to others, is that the drugs that do the most good, that treat the deadliest and scariest diseases, or are the most useful, also happen to be the ones that cost the most. I imagine that if the cure for the common cold were to be developed today, it would cost thousands of dollars; a cure for cancer, I probably couldn't even imagine. If, instead, the costs of researching these drugs were subsidized, how could we as a society justify not making such cures available to anyone and everyone who ends up needing them?
Now, don't get me wrong. I do believe there are truly well-meaning people in the drug research business, even as it is now. While Big Pharmaceutical is one of the few private industries despised by so many on both sides of the aisle, at the same time, few other industries make their money literally saving peoples' lives.
But there has to be less wasteful, less predatory ways to balance the importance of researchers developing important new medicines, and being able to be rewarded in a way that reflects the immense service they provide to our society. At the very least, there needs to be some acknowledgement that people like Martin Shkreli, whose contribution to the actual development of these drugs is probably less to do with the actual treatment and more about making that treatment profitable, are not really necessary. At best, our current drug research system allows these opportunists to come along for the ride, like parasites.
In squaring the outrage we feel over the Shkreli incident with our current reliance on drug research companies, we have to consider if the current system is really worth supporting.
Developing new and innovate medicines and treatments is not a simple task. I would concede that such valuable treatments are incredibly difficult to develop, requiring millions of dollars, years and years of trials, and the majority ending up having to be abandoned.
But the idea that the private sector is the only viable way to combat these problems to make sure useful, safe and effective drugs are produced regularly, well, considering how far we have come, I can't help but find that type of thinking archaic. There have already been alternative systems proposed; Shkreli may have just provided one of the best examples ever for taking these proposals more seriously.
At the end of the day, despite what some Ayn Rand fetishists may advocate, not everything should be privatized. Some basic, important services should be offered to everyone, as one of the benefits of living in a modern civilized society, and efforts to game the system in a way that some people are able to unscrupulously profit from these things should, frankly, be scrutinized with great suspicion. The moral and ethical ramifications of doing otherwise are immense.
People should be able to work with professionals to ensure they get the best treatment that works for them. For this to happen, the treatment needs to be affordable, and there needs to be researchers who have the resources and incentives to develop those treatments in the first place. For-profit medicine as it currently works in this country is neither the best way or the only way to ensure these goals are met.
We can take Martin Shkreli to task for what he has done and what he represents in our society. But thanks to him, maybe more and more people now will start to appreciate the problems with our current for-profit drug research system, and call on our leaders to seriously address these problems.