Every year, it seems, a handful of pharmaceutical CEOs are brought before Congress and asked to explain why drug prices in the United States are so high. But year after year, no legislation to dramatically reduce drug prices is signed into law.
As early as 1959, Congress was holding hearings on this issue. As Alexander Zaitchik recounts in Owning the Sun: A People’s History of Monopoly Medicine from Aspirin to COVID-19 Vaccines, the pharmaceutical industry as we currently know it first began, albeit in a smaller form, in the post-war years.
There is a significant amount of government intervention in the pharmaceutical industry, but that government intervention is done to protect pharmaceutical companies and the patents that they hold.
Patents, as a general concept, are not exactly new. The practice first started in sixteenth-century England, where the Crown had the absolute authority to grant exclusive patents. Perhaps unsurprisingly, the system was ripe for abuse. Indeed, a number of the United States’ Founding Fathers, influenced by Enlightenment ideals of reason, liberty, and the pursuit of social and scientific progress, were actually quite skeptical of patents.
In Owning the Sun, Zaitchik notes that Thomas Jefferson, like many other Founding Fathers, saw most patents as anathema to the newly created nation of the United States. “After inventing a tool that reduced the labor required to process hemp stalks, Jefferson did not seek a patent on the device, but published the specifications of his invention anonymously, ‘in order to forestall the prevention of its use by some interloping patentee.’ ”
The Enlightenment philosophers, and the political leaders that were later influenced by them, had a strong devotion to science and freedom of thought. Patents, particularly on any invention that was of a medical or scientific nature, were seen as fundamentally incompatible with scientific progress and intellectual freedom.
The accepted principle among scientists, for most of U.S. history, was that if inventions were not shared in the public domain and were unavailable to be replicated by anyone with the means to do so, then scientific progress would rapidly decline.
The history of the rise of patented and monopolized medicine is extremely complex, but Zaitchik manages to effectively weave that history together to show just how much institutional science and medicine has changed since the beginning of the twentieth century. The mainstream view held by scientists and physicians that saw patented drugs as unethical eventually started to wither away. As Zaitchik explains it, “Together, the worlds of academic science, organized medicine, and drug companies initiated the process of revising and shaking off the honor codes that had long buffered them from the crass commercialism of other industries and their own worst natures.”
Advancements in pharmaceuticals in the 1950s were truly groundbreaking. Methylphenidate (Ritalin) was found to be an effective non-amphetamine stimulant; diabetes drugs other than insulin were synthesized; and meprobamate, the first drug designed to exclusively relieve anxiety, was invented.
After World War II, drug companies that had produced medicines essential to the war effort were becoming increasingly wealthy and used lobbyists to influence Congress. The end result was—and still is—the American public having their tax dollars used to fund medical and pharmaceutical research, oftentimes at public universities, which pharmaceutical executives then use to finish developing new drugs, receive an exclusive patent on them, and charge exorbitant prices to U.S. patients.
One of the most fascinating aspects of the history that Zaitchik lays out in Owning the Sun is how the influence of neoliberal ideology and economic policy has made the problem of pharmaceutical patents and unaffordable drug prices much worse.
While classical free-market economists of the Enlightenment Era were opposed to patents—they saw them as slowing down innovation and fundamentally incompatible with free-markets—many influential neoliberal intellectuals, backed with funding from economically conservative think tanks such as Health Policy Research and corporations such as Pfizer, were more than happy to view patents as property rights that corporations should have exclusive rights to for as long as possible.
Zaitchik highlights a critically important aspect of monopoly medicine and pharmaceuticals that is rarely discussed in the United States: There is a significant amount of government intervention in the pharmaceutical industry, but that government intervention is done to protect pharmaceutical companies and the patents that they hold.
As the coronavirus pandemic has shown, however, the monopolization of pharmaceuticals is now a global issue. A number of countries, including the United Kingdom and Switzerland, have refused to temporarily waive the patent-exclusivity on the Pfizer/BioNTech COVID-19 vaccine, ultimately preventing low-income countries from producing the vaccine locally.
Despite the fact that monopolized pharmaceuticals have expanded globally, the most significant legal and economic reforms to the pharmaceutical industry are going to have to begin here in the United States, where we started the problem in the first place.
Attempts at reform will be enormously difficult, but it is essential that they occur. After all, our lives are now depending on it.