Pharmaceutical industries and universal human rights

COMMENTARY – The term ‘Big Pharma’ refers to the pharmaceutical industry as a whole, and has evolved over the years into a pejorative term representing an entity comprised of politicians, corporations, NGOs and scientists who operate against consumers’ good to maximize profit. [1] This belief is commonly known as the ‘Big Pharma conspiracy theory’, and while the demonization of the pharmaceutical industry is perceived by many as extreme and intellectually lazy, [2] the overwhelming rates of penalty fees and public settlements for wrongdoings committed by big drug companies – amounting to $35, 7   billion between 1991 and 2015 [3] – suggests that these accusations may hinge on some truth. This article will therefore delve into recent scandals involving pharmaceutical companies, before considering arguments on their so-called ‘eugenics practices on the poor’ and violation of women’s right to health. These considerations will be placed in the larger context of universal human rights, and the impact of diverse actors from the pharmaceutical industry on these rights will be examined.     

 

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The Birth of Big Pharma - source: Flickr

Scandals concerning pharmaceutical industries

During the past decade, many scandals involving powerful pharmaceutical companies have emerged, prompting an important critical examination from both the media and researchers of the mechanisms within the medical field. For instance, in January 2017, Jeffrey Glazer, the CEO of Heritage Pharmaceuticals (a multi-million drug manufacturer based in the USA), pleaded guilty to violating US Antitrust Laws by conspiring with manufacturers to increase the prices of generic drugs. [4] Similarly, in April 2017, Aspen Pharmacare (the largest African drug company) was accused of attempting to sell medicine in Europe for 40 times their previous price, and of threatening to cease providing the drugs to the Italian and Spanish governments if they refused to comply with the new demands. [5] In fact, a legal loophole allows drug companies to change prices if the medicine is branded with a different name, which is designed to make drugs cheaper after patents expire, but can lead to price hikes in the event of a company having no competition. [6]

These proceedings have led many to argue that the pharmaceutical conglomerate provides unequal access to health care based on financial capacity, because of ambitions to maximize profit. Journalists have dubbed this a “eugenics practice on the poor” and have identified a dilemma of “profit versus people” [7], in which profit has seemingly maintained the upper hand.

 Another aspect of Big Pharma methods that the civil society has publically taken issue with is the lobbying, and at times bribery system. Indeed, in February 2016, Novartis offices in South Korea were raided by local authorities after suspicion grew regarding their providing of illicit bonuses to doctors. [8] Two other drug manufacturers (GlaxoSmithKline and Sciclone) were forced to pay settlements earlier in the year, after accusations of corruption (of physicians in the former’s case, and other pharmaceutical companies in the latter’s) were made. [9] These examples cast light on a crucial structural problem within the industry, which is constituted of a market in which the demand (diagnosis and prescription) is set by the supplier (the doctor issuing the drug), leaving the patient/consumer with no agency and limited alternatives. [10]

Furthermore, research conducted by Lisa Cosgrove, Sheldon Krimsky, Manisha Vijayaraghavan, and Lis Schneider, authors of Financial Ties between DSM-IV Panel Members and the Pharmaceutical Industry, found that 56% of DSM (the Diagnostic and Statistical Manual of Mental Disorders) panel members had one or more financial ties with pharmaceutical companies, ranging from research funding (42%) to consultancies (22%). [11] They assert that “connections are especially strong in those diagnostic areas where drugs are the first line of treatment for mental disorders”, suggesting that connections within the medical industry are indeed present, and lobbying has an undeniable impact on the course of treatment prescribed by physicians or those designing diagnoses.  

Finally, the concept of ‘disease mongering’ has emerged to describe another concern raised by the civil society. The term refers to the practice of medicalizing ordinary life (which includes turning personal problems into medical ones, risks into diseases, mild symptoms into serious ones, and ordinary ailments into medical problems) in order to expand the market of prescription drugs. [12] As Ray Moynihan, author of the book Selling Sickness: How drug companies are turning us all into patients, contends “A lot of money can be made from healthy people who believe they are sick”, thus prompting pharmaceutical companies to use ‘disease awareness’ campaigns as marketing strategies. [13] The danger in this includes economic waste, flawed diagnoses and treatment, as well as a diversion of resources and priorities from more significant (and perhaps less profitable) diseases. [14] Notable examples of disease mongering include baldness or social phobia, two relatively common and ordinary occurrences that are today medically treated. [15]

However, wide-scale complacency on the issue of disease mongering has been observed. For instance, the US Food and Drug Administration’s recent proposal to relax restrictions on off-label marketing can be understood as an encouragement for the medicalization of ordinary symptoms. [16] The reason for this disregard seems to be the involvement of an overwhelming number of powerful actors within the process, which involves physicians as well as patient groups, as it seems to be driven by the medical profession and fueled by industries. [17]  

In this sense, the pharmaceutical industries appear to manipulate both the need for medicine, through the practices of lobbying and disease mongering, as well as its monetary value, by virtue of monopolies and bribery. Experts have theorized that these developments are driven by Big Pharma’s capitalist ambitions, which would represent an important violation of the universal human right to health regardless of socio-economic status, as increasingly expensive drugs become inaccessible to lower classes, and lack of transparency flaws the quality of treatment individuals receive.  

Gender and health care

It is a well-known fact that women have been particularly discriminated against in western medicine throughout the years. In a previous article, the International Center for Peace and Human Rights (CIPADH) traced back the pathologizing of femininity to ancient Greece, before examining the prevalence of hysteria and asylums from the Victorian era to modern day history. [18]  

Today, evidence points to the fact that pharmaceutical companies too, are involved in women’s inadequate access to health care. Moynihan goes as far as claiming that “the social construction of illness is being replaced by the corporate construction of disease” [19], implying that the constructed nature of typically ‘female’ ailments are today sustained by Big Pharma’s alleged practice of disease mongering, specifically directed towards women and feminine issues.

The HPV (Human papillomavirus) vaccine, designed to prevent cervical cancer, is a relevant illustration of this argument. Indeed, governments from all over the world (USA, Canada, France, the UK etc.) were involved in sponsoring and promoting this vaccine (Gardasil) to incite women and young girls to purchase it. However, research surfaced soon after the release of the drug, questioning not only its efficiency, but also the motives of the companies selling and producing it. To start with, little information on the effect of the vaccine was made public before it was administered, as very few clinical trials were conducted, and the number of research candidates supposedly failed to represent the entirety of the concerned subjects. [20] Today, we know that the efficiency of the vaccine is dubious, will take about 15 years to evaluate correctly, and that there are many side effects pharmaceutical companies had not anticipated, including risks of infertility, sudden deaths, heart attacks, paralysis, loss of hair etc. [21] Furthermore, it has been reported that there existed no epidemic of cervical cancer before the vaccine, as incidence and mortality rates were especially low. Additionally, other efficient ways existed to cure the cancer, suggesting the actual need for the vaccine can be challenged. [22] This fact, coupled with the high price of Gardasil - which costs $404 for the three required doses, making it one of the most expensive vaccines in the world -, have subsequently led experts in the medical field to question the motives of pharmaceutical companies in marketing the drug, thus relating to the argument of disease mongering to inflate financial gain.

Another notable example of women’s health being put at risk by pharmaceutical industries is contraception. Indeed, studies show that women of the younger generation are today increasingly distancing themselves from the pill, which was the chosen contraceptive for 57% of French women in 2000, and only 43% in 2016. [23] This rapid decline has been explained with claims on women’s hormonal troubles linked to the contraceptive, causing mood swings, loss of libido, and headaches, for instance, as well as worry-some medical side effects such as the development of dangerous embolism and thrombosis (blood clotting). [24] In her book J’arrête la pilule, Sabrina Debusquat goes over the many dangers of the pill, which has been proven to be carcinogenic and to provoke infertility. She asserts that the pill arose from eugenics efforts to limit the reproductive abilities of ethnic minorities, and not solely in an attempt to provide more rights to women, contrary to common belief. [25] This argument supports the previously mentioned idea that pharmaceutical industries are on certain points unconcerned with women’s overall health, and the release and marketing of drugs aimed at them in fact serve corporate or political agendas.   

Conclusion

Although these assertions remain theoretical, and are ignored or critiqued by many, their simple existence bears witness to a growing distrust in the pharmaceutical industry, which should be payed attention to. Indeed, the demonization of the industry as a whole can be relegated to the realm of conspiracy theories, but one should nonetheless be attentive to this movement, that has been gaining influence in recent years, and has on its side convincing evidence drawn from extensive academic research and countless examples of monetary settlements and scandals.   

By Manon Fabre – Research Assistant at CIPADH

Bibliography

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[25] Sabrina Debusquat. J’arrête la Pilule. Éditions Les Liens qui libèrent.

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