Last year I wrote about the rebellious teenagers ‘diagnosed’ with the newly invented Oppositional Defiant Disorder (ODD) and the highly profitable industry that has grown up to ‘treat’ – that is, abuse – them (MW, January 2012). The American Psychiatric Association has included ODD in the latest edition of its authoritative handbook, the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), together with Disruptive Mood Dysregulation Disorder, for people who get angry too often, and Hoarding Disorder, for people who don’t like to throw things away.
The Biomedical Model
In early May the Division of Clinical Psychology of the British Psychological Society called for a halt in the process of defining all sorts of deviant or inconvenient behaviors as physical illnesses that can be treated using drugs. In the view of many psychologists and other critics of psychiatry, one important reason for the prevalence of this ‘biomedical model’ of mental distress is that psychiatrists and their associations are financially dependent on – in other words, bribed and corrupted by – the big pharmaceutical companies (see Jamie Doward in The Guardian Weekly, May 24, 2013). Plus, of course, it is much easier for psychiatrists to scribble a prescription than try to get to the bottom of the troubles of some obnoxious stranger – and they still get paid very handsomely for their time.
The British physician Ben Goldacre levels a similar accusation against the medical profession as a whole in his book Bad Pharma: How Drug Companies Mislead Doctors and Harm Patients (Faber and Faber, 2012). He clearly documents the control that the drug companies exercise – sometimes openly, often secretly – over the testing of their drugs and over the flow of drug-related information. Various devices, some quite ingenious, are used to rig clinical trials. If, as sometimes happens, the rigging fails and results are still different from those desired, then they are simply suppressed. Companies have extensive rights over data that are, after all, recognised as their property.
Even the most conscientious doctors are therefore in no position to form balanced judgments about the relative advantages and disadvantages of the various drugs on offer for a given medical condition. They are easy prey for the orchestrated and persistent sales efforts of Big Pharma and its hordes of hired drug pushers, more widely known as ‘drug reps’ – perhaps as many as one drug rep for every three doctors. ‘Drug rep’, by the way, is one of those wasteful occupations that will not be needed in socialism.
Suppressed data often includes information sent in by doctors about dangerous or even fatal side effects suffered by patients taking a drug. True, such information eventually leaks out and becomes public knowledge. At that point the company adopts the pose of a ‘responsible corporate citizen’ and dramatically withdraws the drug from the market, pretending that it has only just become aware of the danger and is taking prompt action.
In Tom Nesi’s Poison Pills: The Untold Story of the Vioxx Drug Scandal (St. Martin’s Press, 2008), a writer with long experience in the pharmaceuticals industry tells the inside story of Vioxx, a painkiller used at the height of its success by tens of millions of people in a score of countries. Vioxx was launched by Merck with great fanfare in May 1999. Over time evidence accumulated to the effect that while Vioxx might do less harm to the stomach than competing painkillers – a major selling point – it did entail increased risks of heart and kidney disease and stroke. After years of doing everything possible to conceal these dangers, including vicious smear campaigns against whistlebowers, Merck finally acknowledged the evidence and took Vioxx off the market in September 2004.
A Business Expense
A company that continues promoting and selling a drug after it is known to be dangerous may well end up being sued and paying out hundreds of millions of dollars in damages. However, this has no discernible deterrent effect because a really successful drug – a ‘blockbuster’ like Vioxx or Pfizer’s anticonvulsant Neurontin – makes profits reckoned not in the hundreds of millions but in the billionsof dollars annually. Payment of damages can be calmly contemplated as one business expense among others.
So can the fines that companies routinely pay for breaking the law. The Danish professor Peter Gotzsche recently published an article in The British Medical Journal (December 14, 2012) entitled ‘Big Pharma often commits corporate crime, and this must be stopped’. Gotzsche easily collected information on numerous crimes by googling the names of each of the ten largest drug companies in combination with the word ‘fraud’. The most common crimes, he tells us, are ‘illegal marketing by recommending drugs for non-approved (off-label) uses, misrepresentation of research results, hiding data on harms, and Medicaid and Medicare fraud’. Crimes are ‘widespread and repetitive [and] probably committed deliberately – because crime pays’. Fines are large, but profits are larger.
Dr. Goldacre calls for ‘evidence-based medicine’ – a system in which medical decisions are systematically based on all the knowledge currently in existence. Such a system would require free, rapid and universal access to widely pooled information. The development of computerised systems makes this goal increasingly feasible in technical terms. What blocks its achievement is capitalist property relations, which inevitably encompass information as well as material commodities.
Thus, only a socialist society can create the basic conditions under which evidence-based medicine can flourish. Scientists and physicians will be able to cooperate freely to develop drugs and treatments that are safe, comfortable and effective.