MSZ (October 1984)
The Benefits of the Pharma-Industry
The pharmaceutical industry does not get away without a bad press: whether it’s prices that “bankrupt our healthcare system” or drugs that are withdrawn because of too many deaths, “disturbing” sales figures for psychotropic drugs prescribed to children, or rheumatism medicines that are allegedly used in fake indication or that at least damage the intestines and the liver, one thing should be to blame for the “scandals”: the business that is done with disease.
This is about
A business like any other ...
First of all, there is a need for remedies, no shortage of illnesses, and help provided – but it is by no means a matter of course that the patient receives them, because medicines and medical services are only available for money. Demand is only satisfied when it is solvent, that is the principle of this market economy for all the things one needs to live, and providing people with the means of mere existence forms the safest business basis for the suppliers. The vast majority have only one way to get hold of a livelihood: the employment of their labor power, which must be ceded to others who profit from it, under conditions determined by the other party. Pharmaceutical manufacturers are also aware that this usually means ruined health when they advertise their products by using images from the world of work: a single illustration of the consequences of exploitation, ranging from the so-called degenerative joint diseases of the assembly line worker to the vagintis of the typist are enough. This also quite simply explains the almost inexhaustible demand for means to restore performance capacity and why the pharmaceutical industry flourishes.
So the truth of the buzzword “making a business with health” is different than those critics who denounce excessive prices, too high profit margins, and sneaky advertising tricks would have us believe, blaming nothing but violations of the sacred principles of the market economy that are bad for your health. Because the consumption of health is the means of business, it breaks down, and repairing it for re-use becomes a profitable business of its own. Where lack of property compels people to carry their hide to the market and to expend their health in the service of wealth, is it supposed to be a scandal that even illness, which is necessarily the result, is capitalized on?
... with a state-guaranteed ability to pay
However, in order to restore the worker’s health to the extent that he will be able to work again, social state assistance is needed: if the money for which a wage-worker burns himself out and depletes his health would be enough to restore him in the predictable and certain cases of illness, then he would truly not have first needed to wear himself out. Then he probably would have been able to “take it easy” and achieve the “healthy life” that his family doctor recommends to him with his own cynicism. But because the wage is measured in such a way that it also permanently and appropriately precedes the wage labor – namely so that with each completed work week the economic compulsion for the required effort renews itself – it is therefore not enough to help the worker through periods of sickness-related wage losses, let alone pay the costs of restoring a work-capable body. Therefore, the public power, out of social concern for the provisioning of a sufficient amount of work-capable people, organizes a comprehensive compulsory savings from the entire wage-earning class and cuts the wage in advance through health insurance contributions. Free from the direct relation between performance and individual consideration, the big sum of compulsory savings is available for distribution to the various fractions of producers and prescribers from the compensation fund for ruined health, without encountering an obstacle in the limited ability to pay of its clients. This is the basis for a crisis-proof and profitable business – the companies are assured of success when health insurance honors their products as "advance treatments" in trade-off with other healing methods and includes them in their payment obligations. The market already insures that the benefit intended by the state, for which it obligates one side to payment and the other to profit, works out:
Healing at any price
Every “widespread disease” is an offer for sales and profits. Planning for the profit to be made brings the research departments of pharmaceutical capital into high gear, where something can be “realized”: depending on the size of the market, “hundreds” of anti-rheumatic or cardiovascular drugs are no wonder, let alone “useless.” Because their effect corresponds perfectly to the need they express: they make the damage suffered sustainable and are therefore used particularly successfully where the damage has progressed so far that it makes itself painfully noticeable. The fact that arthritis or so-called degenerative diseases cannot be eliminated, just as little as coronary sclerosis, does not detract from the medical success, since the effect is precisely to make it bearable so that one can again be exposed to further damage. This is the benefit of the “blockbuster seller” which, of course, nobody wants to criticize. At best, it should be perfected:
“What is offered as a remedy for rheumatism relieves or suppresses at best some signs of disease – it does not heal. This is not surprising: No one knows what rheumatism is all about. The causes of the widespread disease are still unknown. So far, there has not been much effort in basic research.” (Spiegel: Doubtful Therapies).
The cause of rheumatism is already well-known and recognized as unavoidable by physicians, as shown by its definition of rheumatism as a “collective term for wear and tear on the muscular or skeletal system.” But precisely for this reason, great “basic research efforts” and meticulous typologies of the forms of the disease are not necessary, because with such types of disease nothing remains to be done but to deal with the damage. And pharmaceuticals comply with this purpose of modern medicine. Its mechanism of action is blockade: beta-blockers inhibit the excitability of the heart so that effort can continue without immediate effects on heart and blood pressure; H2 blockers accomplish the same thing on the stomach, so that anger and tension occur without the constant “pressure pain in the epigastrium” or the re-flaring of an ulcer, and psychotropic drugs make it possible to keep up in nerve-wracking “situations” by “psycho-vegetative decoupling” = attenuation of the excitation centers in the central nervous system.
Because medications help the patient get well enough to go back to work, where he is exposed to damage again, he sooner or later not only returns to his doctor, who then diagnoses the progress of physical destruction as a “chronic disease,” but he ultimately can no longer make ends meet at all without long-term medication. This cycle produces the compulsion to take lifelong medications, and the permanent chemical intervention in the organism brings about its sure-fire effect. Hence the complaint about a “widespread drug addiction among the population” (see the bestseller: “Diisease by Prescription”) is ludicrous, for which even the commercials – “manipulation” – of the pharma industry should be responsible. And the constant talk about the “side effects” which bring the pharmaceutical industry the accusation that it is “ineffective” at “healing” are trivializing. An accusation that lives off the ideal of undoing the effects of wage labor without wanting to scratch it – and this pill has yet to be invented!
Until then, the alleged “makeshift solutions of conventional therapy” will be realistically supplemented with alternative methods of bearing up: from sandbags for rheumatism to “a fundamentally new attitude toward illness (not always bad), health (always take care of it) and danger of medication (to be enjoyed with care)” involving “new communicative healing methods” (facilitating a lot of babble) will be used to achieve the same effect without the chemical “side” effect! (all quotes from: “Disease by Prescription”)
The progress of the business
Of course, the success of encouraging bearing up exercises is necessarily modest, and the beneficial efforts of the pharmaceutical industry to make progress in medical repair procedures remain indispensable. The search for substances with few side effects, the refinement of known therapies, has long been a welcome means of competition in the pharmaceutical market, as has research into new active agents. Whether this opens up “promising fields of research,” however, depends not least on what are defined by health insurance and authorities as treatment-worthy diseases from the point of view of public health and what is ranked in recently discovered “minor ailments” or “natural consequences of the aging process.” So that the yardstick of profit does not limit basic research too much, the state rewards them with additional profit security and provides new developments with a correspondingly long patent protection for the sole profitable use. And even if “innovation” is not the purpose of the effort, a lot of research activity takes place – whereby sometimes a molecular variant modifying already known (successful) substances is sufficient to circumvent the patent protection and on the other hand, an already discovered substance is not yet developed for “market readiness” – until the market is ready for it.
And if a new substance is found, the competitive interest requires the quickest possible readiness in order not to let others catch up and get in on the money making as quickly as possible, which does not remain without consequences for the quality of the products: the mass application has an experimental character, and harmful effects are only “discovered” when the number of deaths is too high. In any case, the accepted level is exceeded if, as in the thalidomide scandal, the hoped for offspring are transformed into pharmaceutical gimps; on the other hand, this proceeds somewhat more generously when a few hundred old people are already scrapped anyway:
“We have identified a number of fatal incidents. However, treatment for the worst of these rheumatic diseases and in advanced age is always associated with high risk.” (A spokesman for Ciba-Geigy)
This man refers very self-confidently to a calculation of damage and benefit which is laid down in the new medicines law:
“Safety means that the possible risk is in reasonable proportion to the indication and the expected therapeutic benefit.”
The risk is acceptable if it corresponds to the “state of medical feasibility,” the “failures” are within the scope of the preceding health ruination, and the treatment on balance has a positive effect on public health – which certainly takes the above-mentioned “incidents” into account.
The state is therefore firstly aware of the effects of providing for the supply of means of compensation on the principle of profit and secondly not indifferent to them. It wants to limit these effects and make the resulting damage manageable without seriously limiting the principle of profit, which is so beneficial to it. With laws and regulations, it successfully takes a stand for the principle of capitalist pharmaceutical production against its negative effects:
Knowing of the harmfulness of these products, it has imposed on the manufacturer a duty of disclosure about the harmful effects of its drug and shackles physicians with a duty to inform about this, in order to limit the impact to a tolerable level. And because the “suspicion of misleading or even fraudulent promises” in terms of effects, indication, etc. is part of the business, the manufacturer is required to provide evidence of “quality and effectiveness” so that the benefits are not just on paper.