Friday, September 2, 2011

Capitalism Is Killing The Advance Of Healthcare

The scientific advances of the last century - and even of that last ten years - have been dizzying. The ability to turn ordinary skin cells into stem cells that can become any type of cell in the body; organ, limb and face transplants; gene therapy - all these things have pushed us to a place that our great grandparents couldn't have dreamed possible. It has been this sense of accelerating change that has generated the enthusiasm amongst futurists like Ray Kurzweil, author of The Singularity Is Near for the idea that we will soon cure aging. And yet, while there are advances, there are also terrific obstacles that come from a healthcare system based upon profit. In the last blog post on cancer I discussed a treatment option - adoptive cell transfer - that is being ignored because it lacks a clear path to profitability for pharmaceutical companies. But the distortions that arise from a for-profit model of research in healthcare go deeper than simple neglect.

We have been led to believe that research is objective, driven by the "scientific method", which inherently resists bias and distortion. Most of us know or suspect that this isn't the case, at least not always, where research is carried out by private companies that have an interest in a certain outcome. But  the truth is more sinister than even that. Even where the research takes place in the public sector using public money, the drug must be submitted by a drug manufacturer to the regulatory bodies - FDA, Health Canada, etc.

Since all pharmaceutical manufacture takes place in the private sector, the only sponsorship for new treatments is going to come from the private, for-profit sector and they won't sponsor anything that doesn't have a clear path to profitability. This distortion of true research and development is exacerbated by the dynamic of neo-liberal ideology and cutbacks, which has seen more and more public sector research come to depend upon private-public partnerships; basically, money from pharmaceutical corporations. And this leads not only to distortions in the priorities of research, it often leads to outright corruption as researchers who release papers supporting this or that drug are also on the payroll as consultants and speakers for the pharmaceutical company that makes the drug. And researchers who dare to challenge the positive findings that big pharma expects of their sponsored studies are in for a rough ride. In the late 1990s Dr. Nancy Olivieri, a researcher at Sick Kids Hospital and a University of Toronto professor, dared to reveal potential side-effects from an experimental heart drug. She was fired, defamed and then sued by drug manufacturer Apotex. While she later won a lawsuit, the company reneged and refused to pay the settlement even after she won a second suit in 2008. However, Olivieri's courage and principle is all too rare, as the above linked article notes:

No one knows the total amount provided by drug companies to physicians, but I estimate from the annual reports of the top nine US drug companies that it comes to tens of billions of dollars a year. By such means, the pharmaceutical industry has gained enormous control over how doctors evaluate and use its own products. Its extensive ties to physicians, particularly senior faculty at prestigious medical schools, affect the results of research, the way medicine is practiced, and even the definition of what constitutes a disease.

It is at our own peril if we forget that big pharma isn't in the business of saving lives or innovating healthcare - it's in the business of making profits. Yet, this dynamic never appears in the writings of tech boosters and singularitarians like Ray Kurzweil who are enamored of the power of the market to deliver the best tech at the quickest pace. One often reads complaints, for instance, that the FDA doesn't recognize aging as a disease and, therefore, there is no incentive for pharmaceutical corporations to put money into researching a cure. But this misses two key points. First off, the refusal to designate aging as a disease is actually meant to protect people from snake oil salesmen who would promise drugs that cure aging and which do nothing. There are, after all, already over the counter nutraceuticals, supplements and other expensive "treatments" that promise to stop aging - and which do nothing.  Secondly, this prohibition on aging cures doesn't prevent the development of treatments for the diseases of aging - arteriosclerosis, cancer, Alzheimer's, etc.

And, finally and perhaps most importantly, where big pharma wants a disease designation it has the money and connections to effectively lobby for it. Obesity is an excellent example of exactly this dynamic. The rise in obesity from the mid-1970s or so until today is clearly a social phenomenon, rather than a "biological" or "medical" one. Changes in the North American diet, the end of post-war affluence and the slow decline in living standards, have all contributed to this. The rise in diabetes is a related phenomenon, resulting from a high carb, low nutrient diet - basically the rise in importance of cheap, processed foods in the North American diet. These health problems are not diseases, by and large, but the symptoms of broader social and economic changes, which require a social and economic, and not a medical, response; things like higher incomes and better services to reduce the financial burden on families as well as reduced working hours and access to quality childcare to free up more time. Even better urban planning to make walking and cycling viable forms of commuting would help. Yet suburbs continue to be built (and, these days, go bankrupt) and wages and public spending continue to decline as research into anti-obesity drugs and new medical treatments for diabetes, as well as various types of implantable medical devices & surgical interventions - insulin pumps, bariatric surgery, in vivo fat melting machines - is a massive industry.
According to research and markets, the global anti-obesity market was valued at $1.1 billion in 2009. It is forecast to grow at a Compound Annual Growth Rate of seven percent for the next seven years to reach $2 billion by 2017.

The result is that the medical and pharmaceutical industry is chasing dollars to fix problems that are social, not medical. Meanwhile, the money spent on anti-obesity drugs, statins for cholesterol, drugs for the treatment of diabetes, could be used more effectively elsewhere. The sad truth is that the American government alone spends around a trillion dollars on the military - money that could be spent on providing quality, high nutrition meals to the American population and still have money left over to feed the rest of the world. It is a cascade effect of distorted priorities that lead to further distortions down the line. We keep attempting to treat the symptom when the cure is right in front of us. In the meantime, those conditions that truly are medical and truly can only be treated with various forms of medical intervention face neglect.

NEXT: Aging is a Social Disease


Emily said...


L W said...

I feel the need to mention one thing when it comes to the treatment and research around diabetes.  There is no doubt that it has increased in recent years because of the increase in obesity.  However, it is only research into type two diabetes that has increased.  In fact, I would go so far as to argue that research into type one diabetes has been diverted. 

For those of you that don't know the difference.  Type I is diabetes that is acquired in early childhood.  It is the result of the pancreas never working to regulate blood sugar.  Type II is acquired later in life and it tied to poor diet and aging.  As someone who has a diabetic mother and uncle (my uncle died from Type I diabetes) I'm discouraged by the shift of interest from type I to II.  A few years ago they seemed to be close to a cure for nonoperational it's hardly discussed in comparison to new drug treatments for type II diabetics.

Nevermind the fact that they'd developed a synthetic/robotic pancreas but the government will only pay for it to be implanted in people under the age of 18.  I guess youth are the only ones worth a cure.

Withercanada said...

and keep in mind too some obesity is genetic.

Shawn Whitney said...

Thanks for sharing that example of exactly the point I was making above. The distortion in priorities is hurting and killing many people.

Shawn Whitney said...

The percentage of obesity that is genetic is vanishingly small. What is genetically inherited is a greater or lesser capacity to metabolize carbs in a way that doesn't lead to obesity.

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