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Last autumn, type 1 and their allies held vigils across the US to remember all those who had lost their lives due to the high cost of insulin in 2019. Though the particular uptick in death-by-insulin-rationing is perhaps uniquely American, it exemplifies a much larger structural crisis of nearly boundless profit extraction by the pharmaceutical industry (and industries all across the economy) that is impeding access to medicines worldwide and distorting our democracies.
In the richest country in the history of the world, the effects of this extraction are particularly striking. Life expectancy is declining, a full third of Americans report not taking medications as prescribed due to prohibitive costs, the profit-fuelled opioid epidemic has cut a swathe through innumerable communities, and the vast majority of the costly‘innovation’ coming from the pharmaceutical industry is clinically worthless.
In addition to these disastrous consequences for public health, business as usual in the industry is exorbitantly expensive – and increasingly so. As momentum builds in the push for a universal health insurance programme for all Americans, we ought to be asking ourselves if such a plan might not fast turn into a massive and unsustainable corporate welfare programme if we don’t also address the stranglehold that Big Pharma has on our medicines system.
The noxious trends we see from this sector – high prices, recurring shortages, increasing post-market safety issues, increasing financialisation (which contributes to inequality, itself an indicator of health outcomes) – are all natural outcomes of an industry oriented towards the singular goal of maximising profit. To get different outcomes, we need a different design. Despite the dismal backdrop– or perhaps because of it – we may be arriving at a moment of opportunity to radically transform the US pharmaceutical industry, reclaiming it in the public interest. Outrage at the excesses of the drug companies is at an all-time high. Between extortionate pricing, illegal and dangerous misbranding and mismarketing of medications, and epic tax evasion, a growing portion of the public and policymakers alike are calling for change. The 2,000-plus lawsuits being levied against Purdue Pharma for its role in the opioid epidemic are emblematic of a growing consensus that exclusively for-profit pharmaceuticals might be bad for our health. Furthermore, these lawsuits represent a one-time opportunity for public actors to leverage settlement funds to radically transform the industry itself.
A public option
Fortunately, countries around the world have already effectively modelled one structural alternative in the pharmaceutical sector: public ownership. Public sector pharmaceutical research and development, production and distribution of everything from saline solution to first-in-class biologics occurs around the globe from China and India to Sweden, the Netherlands, France, Cuba, Brazil, South Korea and beyond. From mass production of chemical drugs to bespoke preparations of the newest cancer therapies, public pharmaceutical enterprises play a key role in assuring consistent and adequate supplies, driving down costs and directing innovation towards the most pressing public health needs. In a number of cases, these public industries were created or expanded due to the shortcomings of the private pharmaceutical industry in meeting the basic needs of national health systems – a situation often exacerbated by trade conditions imposed by economic ‘partners’ like the US.
Calls are mounting for a ‘public option’ in US pharmaceuticals. In late 2018, Senator Elizabeth Warren and Representative Jan Schakowsky introduced a bill to create a public Office of Drug Manufacturing. Influential think tanks and physicians’ organisations are advocating public pharmaceutical R&D and production, and polls show that public production of pharmaceuticals is now popular with voters across the political spectrum. The resurgence of public ownership in other key sectors, such as banking and energy, is building a base of support for greater public sector involvement in healthcare.
With the British Labour Party’s 2019 ‘Medicines for the May’ policy, the transatlantic echo chamber was repeating the same message: medicines must be reclaimed as a public good. Establishment of a full supply chain public option in pharmaceuticals for the US would be a huge step towards achieving that goal.
Dana Brown is director of the Next System Project at the Democracy Collaborative and author of the Democracy Collaborative report Medicine for All: The Case for a Public Option in the Pharmaceutical Industry.