The list of crimes of which the pharmaceutical industry is
accused is legion. According to a professor at Copenhagen University,
prescription drugs are now, behind heart disease and cancer,
the third most common cause of
death in the West and estimated to be responsible
for half a million deaths a year in the over 65s. The editor of the UK’s Lancet
magazine, Richard Horton, contends that maybe
half
of all scientific research is simply untrue, “afflicted by small sample
sizes, tiny effects, invalid exploratory analyses and flagrant conflicts of
interest”. In 2012, two French researchers claimed that half of all drugs
prescribed in that country were either
useless
or dangerous and responsible for 20,000 deaths annually.
There is an obvious connection between these outcomes and
the character of the pharmaceutical industry – capitalist corporations duty
bound to maximise short-term profit for their shareholders. Even western
governments, in unguarded moments, agree.
A
2003 report for the UK’s Treasury (finance department) conceded that the
pitfalls of a market in healthcare were overtreatment and the abuse of monopoly
power. But then pressed ahead anyway.
But that connection, clear to any reasonably honest person,
is not what stands out here. What is most interesting is how this profit
maximising model has so thoroughly infected the apparatus of regulation. Horton
blames individual scientists who too often “sculpt data to fit their preferred
theory of the world”, medical journals aiding and abetting the “worst
behaviours” and universities engaged in a “perpetual struggle for money” and
“high-impact publication”.
What’s clear is how far these institutions are from
providing, in the writer Ben Goldacre’s words, “a competent regime of
regulation”. There is a deep ethical rot at work, seeping outwards into
society’s foundations. What’s more the ethical rot is essential for capitalism
to function effectively.
Financial dis-regulation
Consider finance. Seven years after a monumental financial
crash, triggered by ordinary people defaulting on mortgage payments,
sub-prime
mortgages have made a comeback in the UK, an event unencumbered by
government regulation. Regulations drafted after 2012’s Libor rigging scandal
have been
watered
down. The bank levy, intended as recompense for the financial crisis and
bail-out, has been
reduced
(as an incentive, many think, to keep HSBC headquartered in Britain), a
‘penalty’, in any case, more than compensated by the huge 38% drop in corporate
income tax, from 28% to 18% since 2010.
The EU, in the TTIP negotiations, is pushing for
the
US to adopt weaker financial
regulations (on derivatives) than it has at present. And as part of the
separate ‘Trade in Services Agreement’ between the US, Europe, Japan and
Australia, it is proposed to make it mandatory that countries accept “any new
financial service”.
Government regulation is giving way on many fronts to
voluntary
agreements, in the UK and EU, which have been proven to fail.
But I believe the deliberate feebleness of regulation has a
deeper cause than ‘regulatory capture’ or ideological blindness. It stems from
a recognition that economic growth now depends on facilitating avowedly
anti-social practices. Aside from the pharmaceutical and finance industries,
consider the way the food processing industry works. Huge amounts of sugar are routinely
and covertly added to
a
range of products, not just the openly sugary fizzy drinks, and have caused
an epidemic of Type 2 Diabetes. The publicly funded NHS is obliged to treat
this scourge which consumes a tenth of its budget. Yet, the UK government sets
its face against regulation, preferring a toothless ‘responsibility deal’.
The extractive industries, oil, gas and coal, rely on taking
fossil fuels out of the ground, in
increasingly
dangerous places, a practice which will inevitably take the world into the
realms of civilisation-devouring global warming.
Mrs state-mop
The role of the state now is merely to mop up, whether in
the form of bank bail-outs, NHS spending or flood defences, the detritus caused
by these anti-social practices. Because, at root, the economic and political
elite cannot imagine another form of economic growth.
The
Angry Person’s Guide to Finance, a pamphlet published by the UK’s
Red
Pepper magazine in 2014, contends that a “serious regime of strict financial
regulation” could outlaw securitised debt, derivatives, the shadow banking
system and the whole shebang of
‘financial
weapons of mass destruction’. But at the cost of plunging the world economy
into a deep depression, as companies fold like dominoes. Similarly, stringent
regulations for the production and marketing of prescription drugs would proscribe
many of the products relied on by pharmaceutical companies for their profit
stream. At a time when these companies already provoke
grumbling
from their shareholders for not being profitable enough investments, this
would be absolutely lethal.
The urgent question, therefore, is whether there is another
form of growth that can safeguard the public interest and not degenerate into
flagrantly anti-social forms of profiteering. An answer is taking shape in the
proposed policies of Labour party leader Jeremy Corbyn. A mix of
part-nationalisation,
regulation, and public investment, can invigorate economic growth and
substitute for anti-social private sector growth. Because private investment is
so weak, public investment, through the state (or as Corbyn proposes a
National
Investment Bank) can direct economic growth to more benign ends, such as
investing in renewable energy or retro-fitting houses, than the ‘instant
gratification’ approach that the corporate sector relies on when left to its
own devices.
However, what this policy alternative leaves in doubt is
whether it can replace or merely augment socially harmful private sector
growth. The economist Harry Shutt says the western world has been afflicted by
a ‘glut of capital’ for four decades. With a decline in the demand for fixed,
or productive investment, mainly because of technological progress, the economy
has to find increasingly speculative or harmful outlets for profitable
investment. This ‘wall of money’, added to by the growth of private, stock
market invested pension schemes, is inevitably funneled into speculative or
useless (copycat prescription drugs) investment, because sufficient productive
outlets do not exist.
In 2013 the
UK Parliamentary Commission on Banking Standards concluded that
institutional shareholders, such as pension funds and hedge funds, were
incentivised to encourage the banks they invested in to pursue ‘high risk
strategies’ and, in the run-up to the financial crisis, some were actually criticising
banks for ‘excessive conservatism’. In other words, the problem of growth
harmful to the public interest is systemic and not the handiwork of greedy or reckless
bankers.
Liable for your sins
What this means is that any economic strategy based on
public investment has to contend with this ‘actual existing capitalism’ and, as
I have argued before, probably cannot pull the plug on it without
precipitating
an economic meltdown. It is also why Harry Shutt and
others
argue that more drastic action is required to get to the root of a capitalism
hostile to the public interest.
Shutt
proposes restrictions on limited liability; the right, first introduced in
Britain in the 1850s, that shareholders in corporations are only legally
responsible to the extent of their monetary investment, and that if misdeeds
happen, only the company, never its shareholder owners, can be sued. Limited
liability should only be granted, in Shutt’s opinion, if a company agrees to a
public veto on board decisions concerning major investments, employee pay and
pricing.
To return to the Lancet’s Richard Horton. I believe the
ethical corrosion he talks about - the scientists sculpting the data to fit the
theory, the medical journals giving the green light to dubious drug trials, and
the universities engaged in a perpetual struggle for money - has an ultimate
cause; the shareholder-based corporate model of capitalism currently ensconced
in power and which we regard as untouchable. And any attempt to reverse this
moral decay has to contend with the ultimate cause.