Why Is There Medicine?

When I was out of the country about 40 years ago, I received the sad news that an uncle had died back home. He was a lifelong forklift driver at Whirlpool in his late 40s.

There was no email, no Internet, and overseas telephone was insanely expensive back then, so I didn’t get many details. He had enjoyed his life, denied himself very little, and had a lot of abdominal fat to show for it.

From Cheeseburgers to Paradise

A couple of years later, when I asked his son about the cause of death, he replied “cheeseburgers.” In other words, he clogged his cardiac arteries with cholesterol and died of a heart attack.

Despite a lot fewer cheeseburgers, my grandmother had died suddenly of the same problem a few years earlier. She was in her own yard, in the middle of some do-it-yourself projects, about this time of year. And then she was gone.

She wasn’t the only one in my lineage who died of blocked arteries. And so when I got my own diagnosis 20 years ago and they wheeled me across a Las Vegas parking lot to Sunrise Hospital, you might have expected me to ride that gurney with a sense of doom.

But the medical science had advanced so far that my main concern was whether my car would be towed from the clinic lot before I went home the next morning. I knew I was going home after my angioplasty, the operation that would have saved my uncle and my grandma.

And it wasn’t just a slick new operation under the hood that bought me these past 20 years. It was statin drugs, paired with periodic liver function testing. And a symphony of pharmaceuticals that have tamed my high blood pressure and diabetes, without insulin injections.

I lift weights and swim laps at the YMCA now. I walk miles across town because I feel like it. In the summer, I jump off diving boards with grandkids, or swim off West Coast beaches. I hike in the woods if the insects aren’t too fierce.

And so I am unable to pile on when others denounce Big Pharma or the medical industry. I am deeply grateful to them, not just for saving my bacon, but for the sacrifices they had to make before they ever made a nickel off us.

The Making of a Greedy Lifesaver

Nobody was born a surgeon or pharmacist. They were born with two arms and two legs, and they only got 24 hours in each day, just like us. But when high school friends were patrolling the mall, the future medical professionals were home cramming for Saturday morning AP tests. When we came back to the dorm from Kirkwood Avenue, they were still bent over organic chemistry homework.

I am grateful, also, to the impersonal corporations that developed my medications. There is great legal and financial risk in pharmaceutical research and development. Most new medicines are money losers. Research and regulatory compliance are incredibly expensive, without any guarantee of a payoff in the end.

Nothing Noble About Envy

When the pharmaceutical company finally does produce a winner, it is begrudged high profits that it needs to cover all the losers, all the medicines that crashed and burned, and to finance the next promising idea. Critics suddenly materialize to denounce the company’s greed. It costs nothing to claim other people’s stuff, of course, or to claim other people’s innovation and diligence as your own “human right.”

But it also discourages further innovation and diligence. Investment and risk-taking can and will cease if we swoop in to dispossess innovators just as their efforts are about to pay off. And therefore such class warfare victimizes all of us, not just the pharmaceutical companies.

In some ways, the pharmaceutical industry is a victim of its own public successes. We don’t hear about a miraculous drug until it’s marketed on television or recommended by a physician. We rarely hear anything about the ideas that didn’t work out, unless we’re investors.

But you can be sure that investors are alert to the failures, and to the attempts to confiscate the profits that flow from the successes. Your retirement fund’s money manager would be negligent if he failed to pay attention to the companies’ profits.

Honoring the Leach Above the Ox

If that American investment dries up, who will develop medicines and medical technology in the future? Canada? We can buy medicine much cheaper there than in our own country. Why not just outsource the pharmaceutical industry, including all investment, innovation, regulatory compliance and risk-taking to Canada? That ought to make the AARP happy.

The truth, of course, is that Canada is a parasite on American investment and innovation. Most, if not all the cheap medicine that you can buy in Canada or Mexico is produced in the U.S. and would never exist if not for American investment, which in turn would not exist without American profits.

It’s annoying that foreign countries can piggyback on our pharmaceutical industry, not only on American producers but on American consumers who pay the prices that sustain the research and development, including regulatory compliance, by the American industry. But make no mistake: parasites can’t replace the U.S. pharmaceutical industry. And why would they want to?

Investment is Voluntary

If you think it’s far-fetched that U.S. pharmaceutical companies would walk away from the market, consider what’s happening in antibiotics. There’s been very little antibiotic research by the major drug companies in recent years, not because they’re discouraged by the science, but because it’s almost impossible to make money on antibiotics once you develop them.

There are 42 antibiotics in human trials now, according to Businessweek magazine, but “only four come from the largest 50 drug companies.” Yet the smaller firms are financially ill equipped to survive the regulatory approval process, which can stretch nearly 20 years into the future. We are presiding over the death of U.S. antibiotic research and development precisely when we need it most urgently.

Chickens are coming home to roost after decades of casual, promiscuous misuse of common antibiotics. Pathogens have developed resistance to entire classes of antibiotics.

The consequences are grim, according to the Centers for Disease Control. It undermines “our ability to fight infectious diseases and manage the infectious complications common in vulnerable patients undergoing chemotherapy for cancer, dialysis for renal failure, and surgery.”

We Must Harness Greed

Pharmaceutical corporations are not funded by Santa Claus. They eventually make money from consumers, if all goes well. But initial investment comes from shareholders who can pick up the phone at any time to move their money into General Motors or Budweiser. Shares for antibiotic manufacturer Melinta Therapeutics have fallen 94 percent since early 2018. Achaogen filed for bankruptcy last month.

Achaogen, you may recall, is the company that developed an antibiotic that kills deadly carbapenem-resistant enterobacteriaceae (CRE) in the test tube. The company got part-way through the regulatory gauntlet. Despite its feats of scientific research, the corporation couldn’t hang on until profitability. Its assets will be auctioned off next month. Corporations are not indestructible.

I have no human right to antibiotics, or to any other pharmaceuticals, or to anybody’s involuntary medical services. But my right to freely contract for antibiotics and medical expertise has been lifesaving, as recently as last year. I am hoping for more greed, not less, in the pharmaceutical industry.

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