Words: Kseniia Mikushina (she/her)
‘Big Pharma’ generally refers to all the beneficiaries of prescription drugs, most notably: pharmaceutical companies. The resulting oligopoly of the industry means a mere handful of pharma firms have the power to produce the vast majority of drugs on the market. Holding such power is bound to lead to corruption within the industry. The resulting conspiracy theories that rival this capitalist approach to healthcare can seem absurd such as the theory that human immunodeficiency virus (HIV) was cultivated by the US government, or that speculation that the treatment for cancer was being withheld from the public. However, there is an abundance of very real cases that illuminate how morally compromised the industry is, which are just as hard to wrap your mind around.
Perhaps, one of the most prominent and ultimately shocking cases that raises the question of the social responsibility of big pharma is the case of ‘America’s most evil family’ – the Sackler family renowned for almost single-handedly fuelling the opioid crisis in the US with their drug OxyContin (Oxycodone). The first wave was triggered by the rise of opioid prescription in the 1990s, with a subsequent rise in cases of fatal overdose with prescription drugs. OxyContin is a semi-synthetic opioid that was advertised as an effective painkiller (masking its highly addictive nature). Purdue Pharma employed an aggressive marketing strategy, claiming that OxyContin was less addictive than the alternative drugs on the market due to its slow-release form. As it was suggested by the evidence, Purdue Pharma knew of this reality ofOxyContin. So, what exactly did the FDA do? Curtis Wright who oversaw OxyContin approval a year later went on to work for Purdue Pharma with a $400K contract. In the end, the state and Sackler reached a $6 billion settlement, leaving them billions richer and with no jail time.
Not only will Big Pharma not acknowledge bringing about a healthcare catastrophe, but they also express reluctance to help people inadvertently. Age-related macular degeneration (AMD) is a surprisingly common disease impairing central vision. In 2005 it was discovered that Avastin, originally manufactured to treat colon cancer, can revolutionise treatment of AMD. As a result the same drug company made another drug Lucentis, marketed exclusively as a drug for AMD. The two treatments were proven to be identical for treatment of AMD but differed in price, $50 for the dose of Avastin against $2000 Lucentis. Both drugs were licensed for use in France at significantly lower cost than in the US, however France could not convince Big Pharma to produce syringes to treat AMD with Avastin. Despite this, doctors prescribed Avastin Off-label to treat AMD, leading the makers of Lucentis to sue.
It’s clear to see given this long standing history that while Big Pharma presents some questionable ethical dilemmas, it is also being vastly influenced by government policies in place. Where drug regulatory bodies vary between countries, we see differences in drug licences and prescription costs. In the battle between Avastin and Lucentis the reason why France could offer lower prescription costs relates directly to the authorities that regulate them, whereas in the US, the FDA has no power to edict the prices Big Pharma are charging Moreover, the FDA collects user fees from Big Pharma when they submit drug applications for approval following inauguration of the Prescription Drug User Fee Act (1992), making it an absurd conflict of interest, with the FDA delivering good customer service instead of being vigilant police.
In conclusion, while Big Pharma balances the pursuit of innovation with profitability it progressively loses the trust of the people. The boy who cried wolf should take it upon themselves to give back to the community, however, I do believe that the government should put in more effort in controlling prices, handing out certificates, and overall taking care of its citizens.
