Friday, October 05, 2007

Industrial Pathologies

Is any given bombing in Italy the work of leftist extremists, or extreme-right provocation, or a centrist mise-en-scene to discredit all extreme terrorists and to shore up its own failing power, or again, is it a police-inspired scenario and a form of blackmail to public security? All of this is simultaneously true.


Thus every Part was full of Vice,
Yet the whole Mass a Paradise...
The worst of all the Multitude
Did something for the Common Good.
... ...Luxury
Employ’d a Million of the Poor,
And odious Pride a Million more...
... ...the very Poor
Liv’d better than the Rich before...

--Bernard de Mandeville, The Fable of the Bees

Today, Pfizer announced its new superlative as the top spender in global research. The pharmaceutical giant trumped vying corporations Ford , Johnson & Johnson, Microsoft and DaimlerChrysler for the title.

Surprising? Not really. In the fields of biotechnology and pharmaceuticals, investment is the name of the game. In 2005, Pfizer reported spending $8.18 billion in research (Wired). Does this mean Pfizer will return more than that in its profits? Probably, considering its status in the medicine business world. However, not all pharmaceuticals that invest top dollar reap what they sow.

Drug development takes many years, many trials and, as a result, lots of money. It’s a high roller’s game of poker, with much to lose but even more to gain. A report by Tufts University in 2001 based on information from 10 drug companies estimated a cost of $802 million per drug for research and development.

Average costs come from the “clinical phase” of development, which passes through three separate phases. Each phase increases in number of participants, and cost. Like some bizarre game show, as a company reaches a new stage, it has higher costs but intoxicatingly higher potential returns. A drug that clears Phase III of clinical trials, gets FDA approval and makes it to production is guaranteed to be a cash cow. In fact, the $802 million estimated cost of one distributed drug includes the cost of previous experimental drugs that didn’t make it to the finish line.

If a company, such as Pfizer, produces and markets a successful drug, they re-invest that money to make more successful drugs. It’s a matter of making that first home run drug that will propel the company forward to make more drugs and, of course, more money.

Pharmaceutical research and development demands high investment. So it’s not surprising Pfizer is the world’s leader in research. And it’s not surprising that two of the four top research investors (the other being Johnson & Johnson) are pharmaceutical companies.

However, pharmaceuticals also need wise investments. What does this mean? It means if you’re a company interested in making profit, you’re going to develop products for a financially secure audience. This is why AIDS therapy in so-called third world countries is a widespread pandemic. Populations most susceptible and ailed by HIV, such as parts of Africa and the African-American population in the United States, do not, by themselves, signify financial incentive for pharmaceutical companies. The population in the affected parts of Africa, and even parts of America, simply do not have the means to pay for such drugs.

One solution has been to create a financial incentive for research in low-profit drug treatments. The Gates Foundation has spent $450 million, or 60% of their total annual spending, to fund their global health initiatives concentrated on what are referred to as the Big Three diseases: HIV/AIDS, malaria and tuberculosis (Gates Foundation, Fortune Magazine). This NGO philanthropy (epitomized by the Gates Foundation and mirrored by the Clinton Foundation) well outlines the body of low-return research and investment.

Then where is the rest of the money going? What’s the recipient audience of Pfizer’s investment? With my own, homegrown research, I’d like to propose my own classification of Pfizer targeting termed industrial pathologies. The bulk of Pfizer’s research goes into treating ailments acquired through the rigor of the industrial political economy.

For example, just about half (somewhere around 48%) of Pfizer’s patented drugs treat stress. Now, this is a crude and simple categorization. I realize that, but I hope to defend this gross generalization by a bit of clarification.

Stress is a key component of work. To do work, we must feel inclined to do so. Commonly this is called the internal drive of someone to do work. Internal drive can truly be internal, i.e. one can derive pleasure from their work, or it can be imposed. Imposed internal drive describes a method of working where one is forced to work due to outside stressors, such as a boss. A boss functions as inspiration to do work, as she or he has the ability to fire the working individual. As a result, the boss may impose internal drive on the individual by symbolizing the stress of losing one’s job or receiving reprimand for not finishing an assigned task.

According to a report by The Conference Board in March 2005, half of Americans working are satisfied with their jobs. Of that half, only 14% are “very satisfied” (Seattle Times). From this report, I feel I can safely surmise that other half of the American work sector are not satisfied with their jobs and will not be working not from pleasure. Rather, these workers will be functioning off an imposed internal drive.

For the sake of argument, let’s say stress is an imposed internal drive. Stress can be viewed as being dictated from our society. For example, what did President Bush say we could get the nation back on its feet after Sept. 11th? “I encourage you all to go shopping more.” (White House transcript)

A novel approach, indeed. But the same message has actually been sent many different ways. Most recently, Kraft Foods, Inc. needed to increase the sales of their American cheese. The solution? An ad campaign called “The Happy Sandwich.” The thrust of the advertisements is making a grilled cheese with Kraft American cheese will make you happy. Forever?

“We’re not promising happiness; no brand can,” Ms. Delaney [vice president for marketing at the cheese and dairy business unit at Kraft] said. “What we’re promising is that for the three or four minutes you’re having a Kraft grilled cheese sandwich, you’re happy.” (NYTimes)

To ensure people associate ”happy” with ”Kraft Singles sliced cheese,” Kraft will spend, annually, $400 million (of a total $1.4 billion) on the product’s marketing.

From this logic, we can surmise up to half of the working population is working under stress and out of dissatisfaction to quench an instructed feeling of necessity. In short, stress is a way of life for a majority of our country. Perhaps this is the fuel for the American dream, which we now swagger around internationally as our enormous GDP. Because as a whole we’re not cunning business people (obviously, by our $9 trillion deficit, but damned if we don’t like to work!

The one problem is the rising stress levels, accompanied by rising dissatisfaction, is having an impact on our public health. Obesity and smoking, the two major American public health epidemics, can be causally linked to, and potentially explained by, stress. Got a health problem and need to solve it? Why don’t we just pop some pills? But who on earth could provide such a good?

Got a problem with hypertension from work? Why not try ACCUPRIL®! Stress with the boss leading to high blood pressure? Why hello, NAVASC®! Cardiovascular problems? Come on CADUET!® INSPRA!® and TIKOSYN!®

Stress can also lead to an increase in appetite and, combined with inactivity, leads to obesity. Obesity can lead to diabetes, an issue doctors had to confront when trying to distinguish between developed (through obesity) and non-developed diabetes. Hence the name Type II diabetes. The rise in infant and adolescent obesity, coupled with the increase of Type II diabetes, may lead to, for the first time ever, a reversal of life expectancy by the mid-century. To clarify: For the first time in human history, children will NOT be living longer than their parents due to obesity. Have no fear! Pfizer offers EXUBERA® and many other medicines to fight the symptoms of obesity, including high cholesterol, cardiovascular problems and Type II diabetes.

What else happens when you’re stressed? Shoot, I know I’m forgetting something. Oh! Right! The drug that started it all…VIAGRA!®

In fact, Pfizer even benefits from the smoking epidemic with CHANTIX®, a drug used to curb one’s desires for cigarettes. But, if you’re so smoking to relieve yourself from stress that you need a prescription to quit, you may very likely get addicted to CHANTIX®.

Stress is a structural pathology of the current political economy. Rich pharmaceuticals, such as Pfizer, are benefiting from the negative health impacts of stress and other structural pathologies. Mental illness and lymphomatic cancers can be seen as the negative consequences of our political economy. But surely no one actually benefits from these problems, right?




Pops said...

One major issue with HIV drugs in developing countries is the resisiance of US pharmaceutical companies to allow generic drugs to be produced at lower cost supposedly because it impacts their profits for research development. Probably false...

Coogan said...

Thought you might find this interesting, Dad. My friend Six sent it to me after reading the post:

Generic producer cleared to make AIDS drugs for Rwanda

from Canada Press