We translated the introduction to an interesting book on the pharmaceutical industry, written by a worker associated with Lotta Communista in Italy in 2001. Over the last two decades the dynamics concerning the pharmaceutical industry that are described in the introduction have only become more acute. Our main criticism has to attack the most obvious obscenity of profit interest and patent laws, which cause unnecessary deaths and suffering of millions, in particular amongst the working class and the global poor. Here we can state some recent examples and statistics.
We see a general tendency towards the ‘evergreening’ of drugs, meaning, companies make only slight modifications to existing drugs in order to justify an extension of patent rights. The investment of the big pharma companies in research and development is shrinking, the expenditure on marketing and legal protection of their patents increasing. The development of necessary new mass medication, in particular new antibiotics, is neglected, while corporate strategies focus on expensive drugs with limited social impact. For example, none of the Big Pharma companies looked seriously into coronaviruses before the pandemic, despite various smaller epidemics prior to Covid-19. A prime example of the decadence of the industry is Purdue Pharma, a company that fueled the opioid addiction crisis in the USA, which killed up to three hundred thousand working class people over the last two decades and which made the owners billionaires.
On a global level the bloc confrontation between the US and China also expresses itself in pharmaceutical production and trade. When it comes to HIV medication or Covid vaccines, the US state tries to protect the profits of its pharma companies and hinders global cooperation to develop efficient medication. Large parts of the working class in the global south either cannot afford necessary medicine or have to put up with substandard drugs, e.g. estimates published by the UN Office on Drugs and Crime in 2023 put the human cost of falsified and substandard medicines at up to 500,000 deaths a year in sub-Saharan Africa.
During the Covid-19 pandemic companies like Moderna were 100 percent supported with public funding to develop a vaccine, but the company cashed in all profits – several members of its board became multibillionaires, including its CEO – and refused to share their research insights. This caused a global split – virtually everybody in Asia, Africa, and Latin America that had received a vaccine at all had got one from Chinese manufacturers.
The concentration process in the pharma industry creates its own bottlenecks. For example, there are two companies, Eli Lilly and Novo Nordisk, that control some 75 percent of the global insulin market. The current shortages in insulin are not easily counterbalanced by additional manufacturing capacities. Global supply-chains in times of global wars, underfunded transport and manufacturing infrastructure, artificial supply restrictions by the manufacturers in order to get better prices from the public health systems and a general labour shortage are reasons for severe medication shortages, also in the US and Europe.
All this is just scraping the brutal surface of class medicine. At this point we haven’t even talked about the actual research and production process of pharmaceuticals and its internal contradictions. This has to take place from a workers’ perspective. In the coming weeks we will interview pharmacy workers in the UK and research workers in India in order to get a better grasp of the issue. Comments and insights are always welcome!
——————————–
Edizioni Lotta Comunista, 2001
Introduction
Caffeine, camphor, morphine and adrenaline – apart from a stethoscope these were the utensils that Bulgakov’s ‘Young Doctor’ was carrying in his satchel during the times of the civil war in Russia in the 1920s. Of course, medicine at the time, in particular popular medicine, comprised many other, more or less fantastical remedies – but the ‘Big Bang’ of the chemical-pharmaceutical industry had only just taken place. The really effective weapons, for example against bacteria, were still little more than a dream in the minds of the scientists and still in process of concretisation. One still had to wait another quarter of a century for the arrival of penicillin.
Today the satchel of doctors in the rich western world can even be empty, given that in the nearby pharmacy there are thousands of remedies readily available, which, even if they don’t always attack the cause of the illness, at least alleviate its symptoms.
Within half a century medication has changed natural history, meaning, the ‘normal’ course of many illnesses. It is still contested to which extent the increase in life expectancy is due to medicine and to which extent the consequence of better living conditions, nutrition etc.. But there is no doubt that the pharmaceutical industry, like few other industrial productions, has profoundly changed not only the individuals’ material conditions, but also their very way to ‘conceptualise illness’. At least in the industrialised nations, in the majority of cases the very word ‘illness’ has lost the devastating meaning that it historically possessed. Similar to the word ‘hunger’, which for us, more often than not, evokes only a sensation of pleasant languor, rather than the atavistic torment of humanity.
The sense of disillusionment and incredulity is thus so much stronger when it is confronted with the reality of many illnesses, old or new, that are still incurable. In fact, within the paradigm of productive activity there has never been a branch of manufacturing that is at the same time object of such great expectations and fierce criticism like the pharmaceutical industry.
In particular after the Second World War an unlimited confidence and impatient expectation spread through society. The hope was that medical science would ‘in a good moment’ discover a solution for all ailments, from incurable diseases to the ‘pathological state’ that is perceived as the worst and without remedy: ageing. On one side it is expected that the factories materialise the scientific knowledge in the form of medication ready for use and available from the pharmacy downstairs; on the other side a burning hatred has been growing towards an industry which not only didn’t manage to hold a ‘promise’, but which is also too oriented towards the cynical compass of profits and permits itself occasional deadly ‘oversights’.
The great illusion in a rapid and definitive victory over illness have fostered currents of mistrust in industrial products and the appeal of ‘alternative medicine’. According to the WHO, one quarter of the world population consumes three quarters of the global pharmaceutical products. This quarter of the population – comprising primarily the middle and upper classes – can afford to consume those ‘alternative’ means, with an esoteric and ecological touch. In the rest of the world these ‘alternative’ remedies are an expression and imposition of poverty. In the developing countries traditional medicine, with all their myth of ‘ancient wisdom’ and charlatanry, are often still the only ones available.
The sharpest critiques, though, are expressed on a ‘moral’ level. Certain ‘nonchalant’ commercial practices or cynical choices which the common mentality more or less accepts as inevitable in other sectors are considered as intolerable for a productive activity that proclaims to work towards an ‘ethical’ goal.
As the historian J. Liebenau has written [1], the pharmaceutical companies don’t behave any different from other companies, and don’t have any qualms when it comes to using the typical means of commercial warfare, from dumping to infringement on the ‘intellectual property’ laws, i.e. the patents. The difference, if there is any, lies in the effort of these companies to present themselves as being moved by better ethical motives, having high science as their field of work and human health as their goal.
Science presents itself as ‘being for progress’, but – according to Marx – under the capitalist conditions of production, this ‘being for progress’ becomes ‘being for the surplus value’. The health industries are no exception to the law of profit, and the ethical motivations themselves become marketing instruments.
A typical example is the battle over the protection of property rights when it comes to inventions and discoveries. Patents have always constituted one of the weapons of the trusts to transform competition into a monopoly, as Lenin wrote in 1916, and, vice versa, their violation is used as a means to undermine oligopolistic status. Instead, the petit bourgeois ideology of ‘peaceful’ and ‘honest’ competition rushes to the rescue of the contenders in the economic warfare.
From its onset, the pharmaceutical industry has been bestowed by many with a kind of principle of exceptionality, given its particular social use. On the basis of this principle, it is argued that medical drugs should be exempt from patent protection and that the inventions and discoveries in this field are the common wealth of the entire humanity. But this is true for all fruits of social labour, and to affirm this would consequently mean to oppose all private appropriation of the products of social labour. In reality, none of the criticisms of patent law goes that far. Therefore, the effort is to reestablish ‘free’ competition, meaning, the freedom to exploit the new inventions and discoveries in order to obtain, in turn, a profit.
Of this nature were also the criticisms that were raised against the monopoly status that the German chemical corporations had conquered and around which they erected a protective wall of patents and agreements etc.. At the end of the 1960s, Italian companies justified their own systematic violations of patent protections around imported molecules in the same way. The motivations of Indian companies today, which copy western drugs without paying royalties, are also in this vein.
We can see the irony of history when those accusations that the Americans raised against the Germans in the first decades of the 20th century are now used against the multinationals based in the United States. These accusations are revived with new vigour in the various ideological currents of European imperialism. In a ‘double’ irony, during the days of rage of the ‘modern barbary of the imperialist epoch’ after the attacks on 9/11, Washington ‘requested’ from the German group Bayer to ‘renounce’ the patent of Ciproxin (ciprofloxacin), the most used antibiotic against the anthrax bacillus. The attacks of bioterrorism with carbuncle spores have spurred a demand for large and expensive quantities of Ciproxin and pushed the American health minister to request an exceptional mobilisation of funds to cope with the situation. The renouncement of patent rights by the German corporation would have reduced the medication to the level of a generic drug, allowing the government to import it at heavily reduced prices from those countries which had already copied it illegally. The Indian company Ranbaxy Laboratories quickly declared itself ready to supply a large quantity for a definitely ‘interesting’ price.
One could claim that the USA would also include the German renunciation of an important patent amongst the ‘tangible’ signs of solidarity, thereby throwing a medical product on the table of relations between the big powers. The American authorities have invoked the clause of a health emergency, but the big conglomerates have averted the risk of yet another breach in the international pharmaceutical patent system. In this case it would have been the USA to open that breach, while even in the recent health emergency provoked by the AIDS epidemic in Africa the US had fought for the patent rights of the multinationals. During the African emergency the request to suspend the patents for antivirals for human purposes came from South Africa and in the first line of protagonists there was another Indian corporation, Cipla. Finally, in order to avoid a dangerous precedent, a compromise was chosen and the Bayer group agreed to supply the American government with Ciproxin at half of its price.
The ‘ethical’ image that the pharmaceutical industry has tried to give itself now turns against itself. Orphan drugs are another example. [2] There are innumerable diseases that are ignored by research because they are not very common and the eventual remedies would have a restricted market and therefore a modest return on investment. Or diseases like malaria, which is still very common and hits millions of potential ‘consumers’, albeit poor ones. It is better to push the millionth medication for hypertension on the market, which will certainly meet demand in the high levels of purchasing power of the elderly population who are protected by the health systems of the rich western markets. Analogously, the debate about the research, use and patentability of genetically modified organisms and about biotechnology in general is drowned in a sea of ideology in which navigate real risks and irrational fears, ecologist fashions and protectionist clashes. The final choices in the matter will be dictated by the financial, commercial and industrial interests and to demand from the industries a behaviour to the contrary of market laws is like pretending that an ass could fly.
In fact, the production of goods, also those of ‘general interest’ like medical drugs or devices, is production of commodities. Their producers decide independently from the social effects that production could entail, given that they themselves are subjected to the laws of capitalist production.
“Every individual producer in the world economic system realises that he is introducing a certain change into the technique of production; every owner realises that he exchanges certain products for others; but these producers and these owners do not realise that in doing so they are thereby changing social being”, observed Lenin in Materialism and Empirio-Criticism.
The science that is applied in industrial production can therefore supply both the remedies for diseases and the means to cause them. During the Second World War within the ambit of the activity of the Committee on Medical Research, the same companies that participated in the ‘small Manhattan Project’ for the production of penicillin also collaborated to develop bacterial-biological weapons. The studies about the suspension of liquid particles in the air can serve both to develop aerosol for the cure of bronchitis and for the preparation of combat gas or aggressive chemicals. At the same time medical equipment, such as lasers for microsurgery and echographs are derived from military technology. This bidirectional use of science within the ‘capitalist conditions of production’ is not directed by good sentiments, but, in the end, by the economic forces that operate and clash with each other on the market in its cyclical process.
It’s the very clashes and changes in the relations of power between the groups which are the principal objects of the analysis which we have tried to illustrate, together with the specific dynamics of the health industry.
Since the end of the war the concentration process has decimated the companies of our country, reducing them by a third at least. Italy, which counted 1,300 companies in the 1950s, has 287 today. The 1970s also witnessed an attempt to create an international corporation out of several historical Italian pharmaceutical companies. This struggle involved big industrial and financial societies, both native and foreign – with the major groups of state capitalism lined up on opposing fronts. The ‘attempt of the 1970s’ was not successful and its epilogue was the acquisition of Farmitalia-Carlo Erba by the Swedish group Pharmacia in 1993. The pharmaceutical industry in Italy has left the international arena, relegated to niche activities or sales on licences.
In the last two decades two major waves of fusions and acquisitions have caused a strong acceleration of the process of concentration of a sector that is traditionally considered to be very fragmented in comparison to other industrial branches. In 1979 the ten largest companies shared less than 25% of the global market. In 1999 they control around 40%, but the geography of the relations of power has changed.
The last century began with German enterprises having a quasi-monopolistic position and ended with a clear predominance of US-American and British multinationals. Until the 1970s the big German corporations still ruled the global pharmaceutics, despite the disaster of two military conflicts, the fragmentation imposed by the victors and the seizure of patents as ‘loot’ of war. The ‘peaceful’ competition has managed to put them once more in grave difficulties. Many companies of the Old Continent have been superseded in terms of product innovation and market penetration by US companies and are forced to run for cover in a continuous struggle over the carving up of the world market.
(October 2001)
Footnotes
[1] Jonathan Liebenau, Medical Science and Medical Industry – The formation of the American Pharmaceutical Industry, The Johns Hopkins University Press, Baltimore 1987
[2] According to the US Food and Drug Administration (FDA), an orphan drug is defined as one “intended for the treatment, prevention or diagnosis of a rare disease or condition, which is one that affects less than 200,000 persons in the US” (which equates to approximately 6 cases per 10,000 population) “or meets cost recovery provisions of the act”.
