So medicine. Obviously, the pharmaceutical industry is evil. I don’t think anyone would dispute that. But how is it evil and why and what are the alternatives? Those are important questions. A lot of people see the pharmaceutical industry as essentially one giant conspiracy, with tentacles controlling scientists, doctors and the government. Like, literal tentacles, I assume. Therefore, anything put out by the pharmaceutical industry is automatically suspect and you should always go for alternative medicine, which is not evil.
Obviously, I disagree, I mean, I don’t think the pharmaceutical industry consists of literal octopus people with literal tentacles literally controlling doctors with their telepathic bursts of energy. That would be silly.
But it’s interesting for me to think about why people think this way about the pharmaceutical industry. So why do people think this way? Well, it’s because big pharmas makes medicine that sometimes doesn’t work, sometimes drastically so. They charge more for medicine than they should, especially life-saving medicine. And a bunch of other stuff, but mostly those two. Obviously, this is evil stuff, but it’s important to remember where that evilness comes from. Now you could make the argument that it’s evil just for the sake of it, but that’s not really a very convincing argument, is it? I mean, people are never just evil for the sake of being evil. I’m not even going to source that. It’s easier to just assume that it’s because of profits. So let’s go with, big pharma is evil because they love profits.
But look. I’m being a bit harsh. Everyone loves profits. Loving profits doesn’t make you evil. I love profits. I’m pretty sure I’m not evil. The problem is the structure of how we create and sell medicines, which messes the incentives way up. TThe source of the problem is that the people producing the medicines – remember, evil corporations – are also the people selling the medicines and they are also, a lot of the time, the people who are funding the scientists in charge of testing the medicines.
This is what leads to all that shady stuff has happening. Ben Goldacre has written a lot about this. This structure gives the drug making companies an incentive to fudge the details, to sell stuff that’s not ready for consumption and to just cut corners as much as possible. One of the easiest way to do this is to simply not report any findings that don’t go the way companies want them to go. Another is to exaggerate the finding that do go their way. All in all, yes, it’s not the greatest system. As we’ve established, shit gets messed up.
Here’s the thing though. This is something that’s really important, but it can easily be forgotten. The problems, dramatic as they may be are still happening kind of on the margins. Highly publicized reports of wrongdoing are highly publicized because they are unusual. Most of the time, medicine works. Reasonable people can disagree on how big the problems are, how systemic they are (I would probably lean towards pretty big and pretty systemic) but the thing is, the basic framework of medicines work. Or kind of works anyway. Near enough. Cancer treatment is a thing. Antibiototics are a thing. They do what the labels say they do, most of the time, at least. And the thing is, people are getting healthier. For example, child mortality is at historic lows and decreasing , and life expectancy is at historic highs and increasing. Obviously these are just two pieces of information, but fewer children are dying and people are living longer. Seems like we are doing something right. But sure, you could argue that any rate of mismanagement is unacceptable, and this would be a pretty persuasive argument.
But what does this mean, in practical terms? Well, for one, it means that if the system is broken, it’s broken because there aren’t enough checks on it, aren’t enough balances to make sure it doesn’t kill people. If the problem is that the people making medicines are also the people in charge of testing whether they work then the solution is to change the system. A lot of people suggest alternative medicine, but I don’t see how that doesn’t also have the same problems. It is also made by people who stand to make money and those people also are in charge of making sure it doesn’t kill you. Only, instead of having to go through a rigorous, if biased, testing procedure, they have to go through nothing.
Opting for something outside of the modern medicinal framework not only does not fix the main problem, the incentives – making money – are the same for alternative medicine companies. Actually, it’s worse, because it actively removes the system we have put in place to stop companies from gaming the system. What makes companies evil – any profit making company – is that though they are driven by people who can be nice or mean or whatever, but the logic of their structure requires them to put profit over any other consideration, unless constrained by some exterior force. Companies selling alternative medicine are just as evil, and if they are any less evil, it is only because they are smaller than big pharma, about a tenth of the size, in the US, but growing fast.
Obviously, there’s the massive conspiracy hypothesis that I mentioned earlier. That is, that the whole system, companies, scientists, governments, are all bought and paid for by big pharma, and everything we read in “reputable” journals is just humbug. In this telling, all medicine is a lie, to further the capitalist machine. Now, don’t get me wrong. I’m a socialist at heart, and I bleed as red as anyone, but this is quite an extraordinary claim. For me, and hopefully you, to change your mind, would require pretty extraordinary evidence. I haven’t seen this evidence. My claim is much simpler. It is simply that drug companies are evil, and they do everything they can to make money, but they are constrained by a system that forces them to occasionally make good life-saving drugs and they make these in a very grudging sort of way and try to game this system as much as they can. This doesn’t mean the state of medicine is great, or even fine, but it certainly means it’s better than any other alternative available to us right now.