The pharmaceutical industry, like oil companies and arms manufacturers, isn’t viewed highly in the public imagination. And for good reason. There is growing awareness of an inherent conflict of interest in the testing of drugs by the companies that manufacture them — like Pfizer, Merck and Eli Lilly — and a steady stream of tales from journalists, researchers and doctors of deliberately dodgy trials, buried unfavorable results, and purchased academic journals.
Yet the greatest crime of the world’s major private pharmaceutical companies is not what they do, but what they don’t do.
Antibiotics revolutionized healthcare. In the ongoing war against bugs and infection, these companies have abandoned their posts at the most critical time: when the enemy is mounting its most ferocious attack in generations. As these firms continue to shirk their duties — effectively abandoning antibiotic research for some 30 years now — senior public health officials are warning that the world could soon return to the pre-antibiotic era, a miserable, fearful time that few people alive now remember. We have forgotten how common and deadly infectious disease once was. We’ve taken antibiotics for granted, but we can hardly blame ourselves for such complacency.
The director of the US Centers for Disease Control and Prevention, Thomas Frieden, warned authorities of their “limited window of opportunity” to deal with the “nightmare” presented by the rise of a family of bacteria highly resistant to what are often our last line of antibiotic defense: the suite of drugs known as carbapenems. A few months earlier, the UK’s chief medical officer, Sally Davies, used similar language to describe a future “apocalyptic scenario” in 20 years’ time, when people will be dying from infections that are currently understood to be trivial, “because we have run out of antibiotics.” Davies described how the phenomenon “poses a catastrophic threat” to humanity akin to that of climate change and imagined a scenario in the coming decades in which “we will find ourselves in a health system not dissimilar to the early 19th Century,” where any one of us could go to the hospital for minor surgery and die from an ordinary infection that can no longer be treated. Major interventions like organ transplants, chemotherapy, hip replacements and care for premature babies will become impossible.
What did the pre-antibiotic era look like? There was 30% mortality from pneumonia. Mortality from appendicitis or a ruptured bowel was at 100%. Before Alexander Fleming’s serendipitous discovery of the first antibiotic penicillin, hospitals were filled with people who had contracted blood poisoning through cuts and scratches. These scratches often developed into life-threatening infections. Using amputation or surgery as common medical responses for scraping out infected areas is not pleasant or preferred, but these were the only options for the doctors.
Reports in medical journals, charity organization analyses, government studies, and the pharmaceutical sector’s own assessments attribute the dangerous threat to insufficient market incentive - lack of profit. Unlike drugs that millions of people have to take for the rest of their lives to target chronic illnesses such as heart disease — drugs that suppress symptoms but do not cure — antibiotics are usually taken for a few weeks or months at most. This makes antibiotics unfavorable for capitalism.
The Infectious Diseases Society of America in 2008 put it: “[Antibiotics] are less desirable to drug companies and venture capitalists because they are more successful than other drugs.” It is long-term therapy — not cures — that drives interest in drug development, the paper concluded.
Only four of the global Big Pharma 12 are engaged in antibiotic research. Capitalism encourages these firms to cherry-pick the products that make the most money for their shareholders, such as Viagra. A common criticism from the Left of these companies has been that their profit-seeking hurts the poor of the developed and developing world, who can’t afford their drugs. This is true as far as it goes, but doesn’t tackle the scale of this problem. It is the capitalist command to accumulate profit that pharmaceutical companies must obey that is the major threat to public health and needs to be done away with entirely.
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