Number 489 September 28, 2011

This Week: Drugs and War

"Quote" of the Week: "Dramatically Lower the Overall Costs"
A Correction, and Some Lessons Learned
Drug Shortages: What to Do?
When PR Isn't Enough: How Democracies Go To War


I sometimes don't proofread as carefully as I should, and usually the result is just a funny typo or two. But sometimes the problem is a little more significant. A reader pointed out a strange item in the last issue, in the article about drug shortages, that confused him. When I looked at it I realized that the error he noticed was a pretty darned interesting error. This week I apologize for the error, and then take the opportunity to point out some lessons that we can learn from it.

Speaking of the article about prescription drug shortages, I was remiss last week when I failed to offer any ideas on what to do about it. I attempt to remedy that this week.

In the process of talking about these drug shortages, I began to wonder why it is that so much of our public discourse in this country is limited to tinkering around the edges when we really need to get to the heart of the matter. I'm still working on it, but I think it has to do with our Propaganda ABCs. I'll offer some thoughts on this next week in a piece I'm calling "Ideology and Imagination." Stay tuned.

Imaginatively yours,



"Quote" of the Week: "Dramatically Lower the Overall Costs"

On May 26th, 2011, Vermont Senator Bernie Sanders introduced a bill into the U.S. Congress called the "Medical Innovation Prize Fund Act," or S. 1137. It would radically reform the system for developing new drugs in the United States. I talk about it elsewhere in this issue of the Notes, but the "Quote" of the Week comes from the section of the bill called the "Findings," which talks about the rationale for reforming the drug development system. Here is Finding #3 (the "products" referred to are pharmaceutical products):

"By de-linking research and development incentives from product prices, and by eliminating legal monopolies to sell products, it is possible to induce investments that are medically more important, procure products at low prices from competitive suppliers, radically lower pricing barriers for access to new medicines, reduce wasteful marketing and research and development activities, and dramatically lower the overall costs of acquiring innovation, while expanding access to that innovation."


A Correction, and Some Lessons Learned

Alert reader John wrote in last week to point out that the two quotations at the end of the prescription drug article in the last issue were "the exact same quote." This error is sufficiently interesting that I want to explain what happened, as I think it offers a little illustration of how journalistic sloppiness can lead to confusion. In this case I don't think it changes anything I said, but it could have. And therein lies a tale.

First of all, my "Quote" of the Week was directly taken from the Medscape article I cited, and I said that a comment from oncologist Michael Link "spawned the following explanation by the Medscape reporter: 'Low profit margins put manufacturers in a difficult conundrum. They can either lose money producing a lifesaving chemotherapeutic agent, or switch their limited production capacity to a more lucrative drug.'"

Then, at the end of my article on drug shortages, I juxtaposed that quotation with one from oncologist Ezekiel J. Emanuel, who said in a NY Times editorial, that "The low profit margins mean that manufacturers face a hard choice: lose money producing a lifesaving drug or switch limited production capacity to a more lucrative drug."

Then I quoted Michael Link, or so I said, when I was actually quoting the Medscape reporter, whom I had quoted in my "Quote" of the Week. My mistake was attributing those words to Michael Link, when it should have been the Medscape reporter. Sorry about that. But if you read closely, you'll see that it is not "the exact same quote," but that the Medscape reporter was really taking her words from Emanuel, and inserting the word "conundrum" for the original "hard choice."

A "conundrum" is different from a "hard choice," and I homed in on the idea that an oncologist and a reporter would say basically the same thing, but the reporter would consider it a riddle, or a puzzle—implying that manufacturers are having a difficult time figuring out what is at stake—while the oncologist's statement about a "hard choice" implies that they know what is at stake, but can't easily choose between profit and saving lives.

The point I was making still stands, the point being that any medical system in which a choice between profit and life is seen as either a conundrum or a hard choice is a very sick system. But let's go a little further to reveal two journalist lessons that can be drawn here. The lesson that can be drawn from my mistake in not noticing that the quotations I cited were basically the same (with a crucial difference) is to be careful not to become so enamored with an obvious point that I fail to notice another obvious point. A secondary lesson for me is to spend a little more time proofreading, a lesson I learn again and again.

For the rest of you, the lesson here is that a reporter can take someone else's words, play with them a little bit, and give the impression that the thought originated with the reporter and not with the someone else. Reporters claim to be, and are often thought to be, "objective," while their sources make no such claim, so this is not a trivial bit of confusion. The question of who is thinking what is an important one, and anything that confuses that issue is not good journalism. Now, whether the Medscape journalist was being sloppy or unethical I don't know. It's a conundrum!

Finally, the error that John pointed out may be interesting, but it's still an error, and I apologize for it, and offer my thanks to John for calling it to my attention. I always encourage readers to read closely, and John obviously does!


Drug Shortages: What to Do?

After the last Nygaard Notes came out I heard from a number of people who were completely outraged about the drug shortages I described. I thought it would be a good idea this week to follow up with a few ideas of what people might do about it. I only have a couple of ideas to offer, since I haven't been able to find much evidence of organized work on this issue.

For example, I wish I could point to an organized effort to remove drug research and development from the private market altogether. That is, to place the responsibility for research, development, and production of life-saving drugs in the hands of public entities rather than the gigantic, enormous, colossal, gargantuan, immense, mammoth corporations that currently are failing us so badly. To speak of such a thing—nationalization, that is—in the current political climate may make me seem like I'm completely out of touch with reality. Maybe I am, but that doesn't mean it's not a good idea.

Back in 2004 Ohio Representative Dennis Kucinich put forward a bill called the "Free Market Drug Act" that would have created publicly-funded research corporations to conduct drug research and development, and would have placed all drug patents in the public domain. Despite having nine co-sponsors, the bill went nowhere, in fact it went so nowhere that it has not been introduced again, and there's no other bill like it to the best of my knowledge. To read about the Free Market Drug Act you can go to the Kucinich website and click on "Issues," then "Health".

Now, in 2011, maybe the best we can do is to offer our support for a bill before Congress called the "Medical Innovation Prize Fund Act." It's a little bit like the Kucinich bill. As explained by economist Dean Baker in the June 1st 2011 Huffington Post, the bill would "create a prize fund that would buy up patents, so that drugs could then be sold at their free market price. The bill would appropriate 0.55 percent of GDP (about $80 billion a year, with the economy's current size) for buying up patents, which would then be placed in the public domain so that any manufacturer could use them at no cost."

(When Baker says "their free market price," he means the prices that pharmaceuticals would demand if they were not patent-protected. That would be a LOT less than the current prices charged by Big Pharma.)

The $80 billion investment in the Prize Fund Act would save the country more than $250 billion per year. The bill, introduced by Vermont Senator Bernie Sanders, currently has no co-sponsors. So maybe you'd like to contact your senator and tell them to become a co-sponsor. A good summary of the bill can be found on the website of the not-for-profit Knowledge Ecology International (KEI). The article links to other good articles, and also to KEI's own 10-page overview of the bill.

If you want to know more about the larger issue of how we finance drug research and how we could finance drug research, a very useful paper called "Financing Drug Research: What Are the Issues?" was put out by the Center for Economic and Policy Research back in 2004 (Dean Baker again, chief author) that compares the current patent system with four alternatives that have been proposed by various people. It's 27 pages long, a little dated but still an eye-opener. You can find it online HERE.

I wish I could offer more resources for action aimed at putting all life-saving medical knowledge into the public domain, but I don't know of any groups that focus on this issue specifically. One group that does not focus on this issue specifically, but that does sort-of advocate for it, is Physicians for a National Health Program (PNHP) They deserve our support.

It's entirely possible that the political climate will evolve to the point where a serious proposal to nationalize the entire drug industry will become thinkable in the United States. If and when that happens, I hope you'll be able to read about it in Nygaard Notes. I also encourage readers to either start your own group and make some noise about this, or to work within existing groups—unions, political parties, advocacy groups, non-profits—to take up this issue and demand some serious reform of our drug research and production systems.

Finally, this issue of the Notes is specifically about drug shortages. But if the larger issues of patents and copyrights—and the even larger issues involving the ownership of ideas—are important to you, you should check out the afore-mentioned Knowledge Ecology International, whose mission states that they are "learning about the opportunities to manage knowledge resources in ways that are more efficient, more fair, and responsive to human needs."


When PR Isn't Enough: How Democracies Go To War

Writing last July in al Jazeera, U.S. cartoonist and commentator Ted Rall remarked on the relative lack of protest against U.S. wars in Iraq and Afghanistan. Said Rall, "Numerous explanations have been offered for the vanishing of protesters from the streets of American cities. First and foremost, fewer people know someone who has been killed."

This is no accident. U.S. leaders know that one of the most powerful deterrents to war conducted by a democracy is to have the general population be witness to the realities of war. They know that when the war "comes home" most of the people at home want nothing to do with it. The images on the TV from Vietnam that I grew up with—body bags containing friends and family, children coated with blazing napalm—helped to fuel a powerful anti-war movement within the general population in the U.S.

Knowing the powerful impetus for peace that such images create, U.S. political leaders since Vietnam have been determined to do everything possible to prevent gruesome war images from reaching the voting population.

A couple of general strategies have been pursued to keep the public from witnessing the endless wars that are needed to maintain the empire. One is in the realm of public relations. Keeping media as far away as possible from the havoc wrought by the U.S. war machine is one way to do this. A couple of weeks into the Anglo-American attack on Afghanistan in 2001, USA Today ran an opinion piece by a member of their board of contributors that began, "A friend who works as a high-ranking public-information (that is, publicity) officer for the U.S. Army told me that he does not expect to be sent any place near Afghanistan, because 'we plan to release as little information as possible, or less.'" (I don't know what is less than "as little as possible," but we know what he means.) Added the writer, the policy began in earnest during the pathetic U.S. invasion of tiny Grenada in 1983, when "The media were ... forced to rely almost completely on accounts provided by the Pentagon."

That's not journalism, that's Public Relations, and it works to an extent. But sometimes journalists insist on doing journalism, even in wartime. The strategy that's been developed to deal with that is to require that journalists be "embedded" with U.S. troops, in the hope that this will assure more or less sympathetic coverage of the violence that is witnessed. This type of overt PR strategy on the part of the Pentagon is then reinforced by an amazing level of self-censorship on the part of the corporate media. In a 2008 article headlined "4,000 U.S. Deaths, and a Handful of Images," the New York Times remarked that "If the conflict in Vietnam was notable for open access given to journalists . . . the Iraq war may mark an opposite extreme: after five years and more than 4,000 American combat deaths, searches and interviews turned up fewer than a half-dozen graphic photographs of dead American soldiers." In other words, 99.9 percent of U.S. deaths have remained invisible to the voters whose government is executing the war. (Iraqi deaths are not only invisible, they aren't even recorded. "We don't do body counts," as a U.S. general said.)

Despite the limited reporting on the ravages of war, some realities of war do not need the help of the media to have an impact. When people know someone who has been killed in a war, they are bound to demand some accountability for such sacrifice, and to demand a very high level of justification for it.

The experience of Vietnam—which not only appeared on television, but also featured a military draft that made the war personal for a broad cross-section of the public—got U.S. warmakers to thinking: How can we conduct our wars when dead bodies of people who are related to voters keep turning up? We appear to have come up with an answer: Remote-control war. The Pentagon, with the blessing of the Obama administration, is hard at work developing this capacity even as we speak. I'll talk about this in the next Nygaard Notes.