Knowledge brings progress, builds respect and authority, but also creates power, which should be exercised in a socially responsible manner. Scientists and researchers face ethical issues because knowledge and technologies bring enormous benefits through the increase in productivity, and improving quality of life, but sometimes - specially in the case of arms - increases their “effectiveness” in killing people. Undoubtedly, ethical issues are very prominent in applying knowledge and innovation in health and medicine.
In modern times we distinguish between medication based on scientific research, and those evolved through traditional herbal treatment – i.e., synthetic pharmaceutical drugs developed from chemicals, and traditional or natural medicines, evolved through history and proving effective for many diseases. Western medicine has traditionally been non-receptive, or even aggressive towards “Eastern Medicine”.
Many experts are advocating an integrated approach, to be most successful. When comparing the two, Eastern Medicine is claimed to be stronger in diagnostics (looking at human body as a system of interconnected organisms), and far fewer (if any) side-effects. Western Medicine is, however, advanced in operating procedures and instrumentation. Unfortunately, the integration of the two schools of medicine is advancing very slowly.
Among the reasons for this problem is the vested interest of the Western pharma industry, not wanting to lose any customers. For that purpose, they have taken a strong grip on the government agencies granting approval of drugs. Lots have been written critically specially about the US Food and Drug Administration, FDA - which has declared all-natural medicine as “alternatives” - giving synthetic drugs a huge advantage on the market.
Very few people know that FDA was created by Congress in 1909 under the pressure from oil tycoon John D. Rockefeller, who also took control over the American Medical Association, and pushed for the medical curricula and textbooks to be adjusted (treating all traditional medicines and procedures as “alternatives”). He gave lots of scholarships to universities that followed the new doctrine. Doctors who dared to protest against this brain-washing were expelled from the AMA, and banned to practice medicine. This could be the biggest marketing ploy in history, giving chemical, often petroleum-based drugs, a golden standard status, and marginalizing natural medicinal products. When research data emerged that petroleum-based drugs are addictive and bring numerous side-effects, and sometimes even cause deaths, Rockefeller cynically established the American Cancer Society, which purchased the results of these studies, and closed them from the public.
Is it strange that big pharma spends in America more money on hiring professional lobbyists than any other sector – including the ICT?
The Big Pharma
Big Pharma is a term for the world’s largest publicly traded pharmaceutical companies. It is one of the most powerful industries in the world, with global revenue of over $1 trillion already in 2014. An interesting comparison shows that the gross profit margin between 1980 and 2020 have been in the industry about 6%, while in pharma it was constantly growing and reached in 2020 already 29%. During 2010 and 2018 the comparison between the 357 S&P 500 companies and 35 Big Pharma is the following: revenue 130 versus 11.5 trillion $, and gross profits 42 versus 8.6 trillion $. Further comments are really not necessary!
But nowhere else in the world do the drug and medical device industries have as much power and make as much money as in the US. Thanks to their overwhelming power they also pay less tax than other sectors: the largest 20 companies have paid 2020 only 17% effective tax rates, while others were paying around 20%.
In 2017 six of the top ten pharmaceutical companies have their headquarters in the US. They include Johnson & Johnson, Pfizer, Merck, Gilead, Amgen, and AbbVie. But only 28% of Americans have a good opinion of Big Pharma. In fact, they are the second most hated industry in America.
While it has brought ground-breaking advances, the US pharma industry exerts undue influence to protect its interests. On the other hand, medical errors account for 240,000 deaths in the US annually, making it the third leading cause of death. Prescription drug mistakes account for 140,000 deaths annually (American Medical Association), which by any account is a staggering number. Side effects from pharmaceutical drugs can sometimes cause symptoms worse than the primary concern initially addressed. One might wonder how this happens in a field that is based on evidence and science-based medicine. On top of the advantages of profit-driven innovation, the pharma industry monopolizes and suppresses the alternative medicine industry, whether intentionally or by default by being such a giant. To further drive a wedge into a potential partnership between Eastern and Western medicine, the pharmaceutical industry legally steals herbal medicines, causing them to be banned altogether while breaching the path to integration.
Pharma companies focus on providing drugs that drive income and profit, regardless of whether they are the best product available. This is consistent with the fact that a return on investment and a promise for profit is the priority written in all the mission statements for stockholders, with a secondary promise to advance health care.
If the industry were not-for-profit, health care around the world would be available to everyone and would cost a fraction of what it does now. Doctors and pharmaceutical companies would work side by side with acupuncturists and Chinese herbalists. Additionally, research would hold a level of integrity that it does not currently. There would be no reason to hide research since healthcare would be the priority, rather than profit. Instead, the pharma industry is vastly influential through its enormous budget for lobbying, public marketing, and direct payments to doctors. Drug companies have paid out hundreds of millions of dollars, and in some cases, billions of dollars, to settle whistleblowing lawsuits for paying kickbacks to physicians for prescribing certain drugs to patients. It is estimated that in 2012 and 2013, there were $60 million of direct payouts to doctors in the U.K. per year (The Association of the British Pharmaceutical Industry).
While doctors might deny that taking money from drug companies influences their judgment about a medicine, it is hard to imagine how one can stay neutral, especially when research findings are only partially published and usually only published when they favor the sponsoring pharmaceutical company. Acupuncture is usually the last recommendation a Western medical doctor will make - after prescribing drugs or surgery – especially when prescribing drugs can be lucrative for the doctors. Surgeries use the most drugs in the shortest amount of time as one will need antibiotics prior to the surgery, anesthesia during the surgery, and pain medication afterwards.
On the other hand, traditional Chinese medicine is truly focused on individual and community health care, finding the source of the person's disease and healing it; when one party has ulterior motives or lacks integrity, the other party might disengage from wanting to partner with them, which will make progress impossible. There is not enough space to cover the entire corruption of the pharmaceutical industry. The problems in the industry are well known, and many books have been written about them. Unfortunately, with very limited impact, except in raising awareness.
Chinese herbal medicine is firmly established and has not changed much in the last 5,000 years. The same dosage, safety information and indications for diseases, as well as contraindications with other herbs that were taught then, are still being taught today. However, synthetic drugs are so new and potentially dangerous, that research is constantly being done, yet every three years pharmaceutical books expire and new ones need to be purchased. This adds further fuel to the fire separating Eastern and Western medicines.
Spending on lobbying
The largest pharma companies and their two trade groups, Pharmaceutical Research and Manufacturers of America (PhRMA) and Biotechnology Innovation Organization, lobbied on at least 1,600 pieces of legislation between 1998 and 2004. According to the non-partisan Center for Responsive Politics, pharma companies spent $900 million on lobbying between 1998 and 2005, more than any other industry. During the same period, they donated $89.9 million to federal candidates and political parties, giving approximately three times more to Republicans than to Democrats. According to the Center for Public Integrity, from January 2005 through June 2006 alone, the pharma industry spent approximately $182 million on federal lobbying in the US. In 2005, the industry had 1,274 registered lobbyists in Washington, D.C. A 2020 study found that, from 1999 to 2018, the pharmaceutical industry and health product industry together spent $4.7 billion on lobbying the US Federal government, an average of $233 million per year.
The pharma industry is holding on to its title as the top lobbying force in Washington amid pressure from lawmakers at all ends of the ideological spectrum. Drugmakers in the US have spent more than $129 million through September 2019, slightly down from nearly $133 million at this time last year, but still far more than any other industry. The larger pharma/health products industry, which includes medical devices and dietary supplement companies along with drug makers, spent $228 million through the third quarter of 2019, a record-breaking pace that is up to $10 million from this time last year. House Democrats recently advanced legislation that allows the federal government to negotiate the price of drugs that lack generic equivalents. The bill passed the House Ways and Means Committee recently without a number of amendments proposed by progressive Democrats who argued the bill isn’t strong enough.
Critics of the pharma lobby argue that the drug industry's influence allows it to promote legislation friendly to drug manufacturers at the expense of patients. The lobby's influence in securing the passage of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 was considered a major and controversial victory for the industry, as it prevents the government from directly negotiating prices with drug companies who provide those prescription drugs covered by Medicare. Price negotiations are instead conducted between manufacturers and the pharmacy benefit managers providing Medicare Part D benefits under contract with Medicare. In 2010 the Congressional Budget Office estimated the average discount negotiated by pharmacy benefit managers at 14%.
According to Marcia Angell, former editor-in-chief of the New England Journal of Medicine, "The United States is the only advanced country that permits the pharmaceutical industry to charge exactly what the market will bear."
As long as the pharma industry is driven by profit rather than stimulating the health of the world by providing the best products and thorough research, it will be linked to corruption, disable alternative medical communities, and harm the health of the public. While Chinese medicine focuses on the root issue that caused the illness, leading to either acupuncture or herbal formula for the short term, the pharmaceutical industry is collectively an enormous business - whose business it is to sell medications to as many consumers as possible and for as long a period of time as possible. The goal is selling medications and profit maximization, not health care. As Dr. Arnold Relman, former President of the New England Journal of Medicine wrote, "We should not allow the medical-industrial complex to distort our health care system to its own entrepreneurial ends."
The quality of knowledge economy/society is reflected in the position of those who generate, apply, use and benefit from knowledge and innovation created and marketed. Most countries haven’t achieved a desirable balance yet, between the key actors in the process, since they tolerate the abuse by big corporations who are taking advantage of their knowledge-based power – including mighty monopolies, particularly in the domain of the pharmaceutical sector.
Consequently, in most cases, members of societies are punished economically, but when it comes to the pharma sector, on top of that, a heavier price is paid, i.e. big numbers of unnecessary deaths and suffering of patients due to ineffective medical treatment. For the 21 century this is definitely unacceptable!
It is absolutely necessary to protect the public interest, and the key instrument governments can use are their certification agencies. Most probably not as much in other countries, but it has been argued that the FDA in the USA is way too much influenced by the big pharma corporations – which follow strictly their profit motives. This means that the public is left the victim of insatiable greed of big pharma!
As these companies are financially so powerful, they can easily donate hundreds of millions to the FDA (its current budget being 5.5 bn USD) – which undoubtedly affects their independence and opens avenues for undue influence. One of the ways to achieve corporate interests is to propose experts for the FDA evaluation committees – who are supportive of their new drugs. As it is well known worldwide, pharma companies bribe doctors – rewarding them for prescribing their drugs. It is regrettable that doctors accept being bribed! As a result, millions of patients continue consuming certain drugs over many years – often with no, or even dubious results. What a cynical vitious circle!
Big Pharma also has the means to unduly manipulate legislators, through the most efficient and expensive lobbyists (who earn in the US up to 300,000 $ annually, which is three times more than their European colleagues).
What could be a solution to the grave abuse of knowledge & power in this strategically important sector? As long as profit will be the main driving force in the pharma sector, it will be impossible to eradicate these abuses – so the only solution is to impose a non-profit status for pharma companies. At the same time, governments could introduce policies to encourage integrative medicine – which will help both sides to be more effective in protecting public health.
And who could represent and defend the legitimate interests of patients effectively? It is primarily the health-related NGOs, and hopefully some political parties, having the power to challenge the governments and parliaments. But, most important is that the broader public will become aware of the dramatic dimensions of the problem, realizing that solutions are at hand, but it will take a fight with Big Pharma, giving priority to their profit motive over serving public health. The media also will have an important role, but they must first be authentically informed about the nature and dimensions of the problem. And here some think tanks and independent experts have a great job to be done. But, first the authentic information and detailed data demonstrating the real situation have to be presented, and in this task the media also have to be properly involved.