Capitalism as a basis for natural selection?

December 1, 2001 12:44 AM

Capitalism as a basis for natural selection? Third world countries are getting pasted because major pharmacutical companies won't cut their profit lines on HIV/AIDS fighting drugs. With infection rates verging on genocidal levels in Africa (with 62% of the world's infections), at what point does bottom line economics cross bottom line humanity? And does anyone else find it strange that a plague has teamed with profit margins to create a new paradigm for unnatural selection?
posted by Perigee (31 comments total)

the issue is not entirely profit: supply is not unlimited for HIV cocktails, and of course, those drugs are not cures for the disease; they merely slow the progress of HIV (in some, if not all? -- i'm not sure -- cases, freezing the progress altogether). distribution would be a logistical nightmare if the social policies of drug companies were to change and drugs were to be donated to countries of africa; who among everyone should receive access to a limited resource? i'm crossing my fingers for a vaccine: we need it.
posted by moz at 1:04 AM on December 1, 2001

Not a single thing you linked to can be read as implying that the horrible tragedy is a result of anyone's desire to "weed out undesirables" or any such nonsense. The problem is far more complex than just finding some evil scapegoat. Let the first among you who have dedicated years of work and tons of money to finding a cure be the first to throw the stones.
posted by marknau at 1:06 AM on December 1, 2001

Andrew Sullivan elaborates
posted by marknau at 1:14 AM on December 1, 2001

Pharmaceutical firms withdraw Aids drugs lawsuit. Johannesburg, April 19, 2001: "Amid mounting charges that it was putting profits over human life, a coalition of the world's biggest drug companies today dropped a lawsuit to block South Africa from importing cheaper AIDS drugs from third countries. The legal representatives of the drug companies said they would also pay the costs of the South African government, the respondent in the case...The action by the companies clears the way for imports of cheaper copies of anti-AIDS drugs, even if international companies hold the rights to manufacture and market the medicines in South Africa."
posted by Carol Anne at 4:43 AM on December 1, 2001

Third world countries are getting pasted because major pharmacutical companies won't cut their profit lines on HIV/AIDS fighting drugs.

Ever think that Africa's problem is not the pharmacutical companies, and MAYBE it MIGHT be the irresponsible people having sex in that country?

I don't want to see people die either, but if we're going to make comments such as yours, we should probably place the blame in the correct direction.
posted by presto at 5:25 AM on December 1, 2001

i agree with presto...genocidal? give me a break.
posted by clavdivs at 5:52 AM on December 1, 2001

this is, as marknau states, a complex issue. condescending attitudes to peoples of other cultures will not help the situation, IMHO.
drugs companies only this year withdrew that lawsuit under immense international pressure. The aids epidemic has been rife in africa for 10-15 years, how do they justify this apathetic approach. profits before people?
posted by asok at 5:57 AM on December 1, 2001

It's not a question of "Weeding out undesireables", marknau. Theoretically, AIDS could be considered a natural pandemic dieback of the species, as has happened many times in the past.

In that past, when the playing field was even, it was a question of genetics and perhaps a tad bit of luck in determining who would survive the plague, and continue the species. Today, there's a new wrinkle: genetics no longer plays the solitary factor in determining survival. Albeit unintentionally, it's possible that we're disrupting the process of evolution by adding our own, non-natural factor to nature's course of natural selection.

The question I posed is two-fold, and non-judgemental:

1) Is there a point at which there is an over-riding moral imperative demands treatment of a pandemic at all costs? People in Third World countries die all the time - in small numbers - of diseases we knock off here with a dose of antibiotics. This is not new. It's a question of if there is some scale of disaster at which we are obliged as members of the same race to interceede.

2) What are the implications, in the long-term, of man being capable of tinkering selectively with natural dieback situations like this? Even if we factor in the cultural aspects (safe sex and testing, etc. have leveled off the spread of contagion here, for example - ignorance is playing a factor in the spread of AIDS in Third World countries), this is a signpost of things to come; it is very possible the next pandemic could become survival of the most scientifically advanced and richest.
posted by Perigee at 5:59 AM on December 1, 2001

"profits before people?" what does this mean. i would not mind talking about this, but with rhetoric(mine withstanding;) like this, how can you answer...yes in this case profits before people asok, how about that. No? what does 10 billion in capital do in america...keeps people working, living. so, that 10 billion goes to aids or to people working (yes i know people with aids work) but this is the choice you leave...one or the other. Do you know what it costs to keep a person in the best care when they have aids? The fact that the go'vt would pay somewheres near 8000$ a month to keep someone alive for a few months is a testament to our country. human life is valuable until the end. The real thing that does bother me is when the Clinton admin considered aids in africa a national security threat or clear and present danger...some stupid term to describe what he wouldn't do."survival of the most scientifically advanced and richest" if it comes to that, then you will see acts that make the holocaust seem...
posted by clavdivs at 6:23 AM on December 1, 2001

i would welcome a drugs industry that worked in a magnamimous way, providing the best in research to help human beings contend with the 'thousand natural shocks that flesh is heir to'.
claiming that selling aids drugs at full price to africans keeps americans in work is disingenious, to say the least. if that is what you are infering. would you work in a company that made money off the back of the worlds poor, ill and destitute?
otherwise, are you proposing that the government of america should subsidise drugs companies to make drugs for the poorer countries?
'The fact that the go'vt would pay somewheres near 8000$ a month to keep someone alive for a few months' is something any tax-payer would expect!
i would say that if the drugs companies put 10% of their advertising budgets aside to educate people as to healthier ways of living then less people would get ill. However, that is not a strategy that would be acceptable, as the market for drugs would diminish, demand drops and so does share price.
that is what profits before people (i admit, a prevocative phrase) results in.
posted by asok at 6:45 AM on December 1, 2001

I think that's a quite slanted summary of the issue here; countries like Brazil and South Africa have already found methods of getting cheaper AIDS drugs, both using the (legal) possibility of compulsory licensing as a stick to get the drug companies to offer them better deals. I've yet to see a ruling on whether importing of Indian or Brazilian generic drugs (rather than local generics) falls into the category of what the WTO rules allow you to do in response to public health emergencies, but as South Africa has demonstrated, it can be done. I wish it was easier, I wish that the pharmaceutical companies weren't so truculent, and I wish that the U.S. weren't quite so inclined to make vague threatening noises every time a developing nation made ready to exercise its rights as a WTO signatory, but to assert that pharmaceutical company intransigence is the result of some sort of horrible eugenics ploy -- or even the major cause of the AIDS epidemics that are causing such havok throught the Third World -- is just wrong.

Worth noting: Brazil and South Africa have some of the best public health infrastructure among developing nations; without the ability to ensure the proper distribution and use of the medicine, even countries with an unlimited supply of drug cocktails would be hard-pressed to make effective use of them.

Previous MeFi discussion on AIDS and on pharmaceutical patents, most of it quite good from all corners: 1 | 2 | 3
posted by snarkout at 7:11 AM on December 1, 2001

To follow up on Marknau's comment, Sullivan's description of generic drug companies (at best copiers of American products and at worst thieves. They're the Napsters of the drug world--only worse, because they charge for what they steal rather than give it away for free.) is viciously dunderheaded. Generic drug manufacture is, as I've said time and time again on MeFi, legal by international treaty even while a patent is in effect under certain circumstances; Brazil, for example, merrily churned out generic copies of drugs created before they were a WTO signatory, and only created a fuss when they discussed the possibility of compulsory licensing for drugs patented later. The intellectual property sections of WTO agreements explicitly allow for compulsory licensing in case of an epidemic; although I believe the idea was to allow vaccine creation, say in the event of a smallpox breakout (or compulsory licensing of Bayer's Cipro in the evident of an anthrax crisis, not that we in the West would ever, ever consider that), it would certainly allow for AIDS drugs. Does Sullivan not know this, or does he not care?

Further, Sullivan's dismissal of Brazil's immense success with public health initiatives to distribute AIDS medication suggests that he's got a conclusion that's looking for an argument.
posted by snarkout at 7:26 AM on December 1, 2001

Ever think that Africa's problem is not the pharmacutical [sic] companies, and MAYBE it MIGHT be the irresponsible people having sex in that country?

First of all, there's a logical fallacy here: that there has to be one "problem" responsible for the situation. The pharmaceutical companies' behavior and the "irresponsible people having sex" are independent factors. The drug companies should still behave responsibly given the situation they have.

Many of these people were infected before they knew anything about AIDS. And even when the disease was known, they may not have been aware of all the risk factors. I remember seeing a clip some years ago of an African political leader claiming that there was no AIDS problem in his country because there were no homosexuals.

Implicit in the "irresponsible people having sex" phrase is the idea that these people are getting what they deserve for behaving badly. I think people need to keep in mind that having sex is necessary for procreation, and because of that, it's a primal, instinctual desire and doesn't always respond well to reason. Having sex is what people have done for eons to keep the species going. To convince people that a necessary behavior is suddenly fatal takes some doing, and I don't think we get anywhere by vilifying people who can't control primal urges based on risk assessments that they may not have had the knowledge to make.
posted by anapestic at 8:37 AM on December 1, 2001

Perigee,

First, nice post. Here are some thoughts.


I don't see how an economic market is necessarily "unnatural" selection. If fact, AIDs is a "natural" disease and there's no reason we can't see what is happening in Africa as a natural selection in action. Over time, nature will select in favor of those people who are monogomous or don't have unprotected sex.

I'm not sure if you have a problem with drug company profits, but if you do, how about some thoughts on why drug companies should drop their profit margins for AIDs drugs. And don't make an appeal to humanity, morality, and so on. Profit is an economic notion, not a moral notion. It's just a residual number. Suppose that the profits on HIV drugs were 0, but the cost was exorbitant. Would drug companies still be evil? According to people who rail against the drug companies, the answer would be no. (they are not profiting) However, the general welfare of society would not be improved at all. So, in my book, people who have a problem with drug profits really aren't arguing for the welfare of society. In reality, of course, the drug companies do attempt to maximize their profit. However, economic theory tells us that when profit is risk adjusted, i.e. it is "reduced" by some measure of risk, then all economic activities return comparable amounts of profit. This acts as a check upon the drug makers greed. On the other hand, if we penalize drug makers, and reduce the risk-adjusted return they receive from their research efforts, they will stop this research and enter new lines of business. Guess what. No more new drugs. For anyone. We all lose.

Finally, if one does wish to bring morality into the picture, one could say the it would be immoral for drugmakers to not attempt to maximize profit. To understand this perspective, one must understand that the total capital available to a society is a precious, limited resource which, when properly used, can improve the welfare of everyone alive today, and those yet to be born. In many ways it is no different than clean air or clean water. Now, the drug companies have been able to claim a bit of society's total available capital and with it, they have undertaken the risky enterprise of developing a new drug. The drug works. It is only moral that they pay back society by increasing, as much as they can, the total amount of capital available to society. Society, through the markets, can then reallocate the capital to new projects which will presumably again increase the welfare of society in general. That's the genius of capitalism.

Ah, you might say, Wouldn't it be just as moral to give the drug away to those who need it? Wouldn't that help society just as much? Well, the price of the drug is a measure of that. The price of a manufactured product is an indicator of the amount of capital committed to create and deliver the product. To sell it for less than the highest market clearing price hurts everyone. It is immoral to do so.

Okay, I'm taking off my cold-blooded economists hat. And before everyone points out all the real-world limitations which break the simple model described above, let me admit that they exist. However, overall, the model described above is valid. I offer exhibit A. that the capitalistic model we benefits everyone who participates in it.
posted by prodigal at 8:45 AM on December 1, 2001

Here's what oughta happen: a consortium of world governments should band together to buy out the patents on important drugs.

You could have the U.S., U.K., France, Germany, Japan, etc. all get together and tell Pfizer or Bayer or Dupont something like this:

"Thanks, folks, you've done a fantastic job! This new medicine is great! Now, at the moment, we have a major crisis on our hands, so we're going to have to nationalize this one medication and put the formula in the public domain. But--we're not going to do so without just compensation. Here's our offer: X Billion dollars/euros/yen for your research, plus the receipts you were expecting to get over the next Z years. That should be enough to give you a nice reward for your efforts, plus enough to invest in coming up with the next round of drugs for the next crisis. Whaddya say?"

posted by gimonca at 9:16 AM on December 1, 2001

how about some thoughts on why drug companies should drop their profit margins for AIDs drugs. And don't make an appeal to humanity, morality, and so on. Profit is an economic notion, not a moral notion.

Why not make an appeal to morality? None of this takes place in a vacuum. Firms and their researchers deserve to see a return on time and money invested, certainly, but given the size of the epidemic it's appropriate to question the way these corporations are structured: how much consideration is given to actually curing or stemming disease versus increasing shareholder value? How much incentive is profit, and how much is research retarded by companies keeping their research secret?

It's advisable to examine the overall effect on society since the people granted these firms into existence in the first place.
posted by Ty Webb at 9:50 AM on December 1, 2001

To answer Moz, and add to snarkout's point about health infrastructures: no drug stops HIV-1. In all cases, the drugs slow the reproduction of the virus, but cannot eliminate it from the infected host. The damn thing mutates at a phenomenal rate, and eventually develops resistance to everything we've thrown at it so far - even combinatorial therapy.

The problem with making generic antiretrovirals available throughout Africa is the lack of a robust health infrastructure such as those of Brazil or South Africa. In addition to the usual compliance issues, HIV chemotherapy is not simple: among other things, it requires constant monitoring of patient health and viral load. This leads to the strong possibility of widespread sub-therapeutic dosing, a situation which promotes the development of viral drug resistance. The one immediate application of generic antivirals in Africa is in the prevention of transmission during birth: transmission rates can be reduced from 30-40% down to (IIRC) 5-8% by a brief period of chemo just prior to the birth. In fact, one drug (nevirapine) can be given as a single dose prior to birth and still achieve these sorts of results.
posted by sennoma at 10:02 AM on December 1, 2001

prodigal, wouldn't it be fair to say that the "genius of capitalism," as you put it, is being hindered by patent law in this situation? The market is not able to dictate the price of AIDS drugs; the price is set arbitrarily by certain companies.
posted by Doug at 10:09 AM on December 1, 2001

Now, the drug companies have been able to claim a bit of society's total available capital and with it, they have undertaken the risky enterprise of developing a new drug. The drug works. It is only moral that they pay back society by increasing, as much as they can, the total amount of capital available to society.

"Millions on research but not one red cent for public health"? Ignoring the fact that the general health and longevity of a population is presumably a public good (just as non-belching smokestacks and unpolluted rivers are public goods) and thus of economic value, drug companies already make a vast proportion of their income from Europe, Canada, and (particularly) Japan and the United States. If we're casting a gimlet eye on the issue and considering only the increase or decrease in total world capital, isn't the increased African and East Asian production due to a healthier populace going to largely compensate for the relatively small amount of money that would be lost to the pharmaceutical industry if they reduced their prices, even dramatically, in the developing world?

I'll defer to Sennoma on the efficacity of making the drugs available -- as I said, improving the public health infrastructure in Third World nations, as Brazil has done so successfully, is a huge requirement to get the maximum benefit from them -- but a purely macroeconomic argument seems more complex than it might on first glance.
posted by snarkout at 10:15 AM on December 1, 2001

No-one has a right to live at my expense. Doing so is parasitism and the body humanity, like any other organism, will die if it continues.

I, for one, am not about to sacrifice my hard-earned Pharmacia-Upjohn dividends because someone can't pay for what they produce. If they can't pay for the bread I bake they can go hungry as well.

Does anemia give someone a "right" to another's blood?

Then how can anyone claim the drug companies (we the shareholders) should bleed themselves for greater Africa?
posted by ophelia_hardin at 10:28 AM on December 1, 2001

Ophelia, what a clever and biting piece of satire your post is! Please, keep the good work up, "comrade." ;)
posted by Doug at 10:47 AM on December 1, 2001

Doug, YHBT. But good.
posted by sennoma at 10:50 AM on December 1, 2001

that is what profits before people (i admit, a prevocative phrase) results in.

So here's a taste of bitter reality for all you idealists. Your own personal spending habits reveal the value that you place on things. You spend money on the things that will give you the most "bang for the buck" in preference to other spending.

So, when you buy that bag of chips, or cool electronic gizmo, or high-speed internet access, or in fact spend any money above what is absolutely necessary for survival, you reveal the fact that your comforts are more important than buying drugs for Subsaharan Africans.

So spare us the piety. Proposing simplistic and hopelessly idealistic solutions that you don't even believe in yourself is counterproductive. Start with yourself, and when you've got that all figured out, you can tell the rest of us how to live.
posted by marknau at 12:28 PM on December 1, 2001

Now back to Perigee's questions. Thanks for the calm correction of my initial misunderstanding, Perigee.

1) Is there a point at which there is an over-riding moral imperative demands treatment of a pandemic at all costs?

My (highly controversial) answer to this is NO. Why? Because responsibility for and authority over a thing should be equal. I have no authority over the lives of these people. I have no say in how they live. I therefore have no responsibility. Same goes for the U.S. Government. We have no authority. We are not allowed to structure their cultures, traditions, and governments. So we have no responsibility.

If the situation threatens something within our demesne, only then do we have a call to action.

2) What are the implications, in the long-term, of man being capable of tinkering selectively with natural dieback situations like this?

When I asked a similar question of a more authoritative cow-orker, I was led to believe that changes in the human gene pool take long periods of time. On the other hand, I know that Native Americans lacked resistance to smallpox, unlike the Europeans who suffered through the diebacks.

On the gripping hand, I realize I am not well-enough informed in this field to give anything but layman speculation on factual matters.
posted by marknau at 12:59 PM on December 1, 2001

If you pull back the curtain you realize that the NIH and NCI (with taxpayer money) performed the crucial pre-clinical research for the majority of HIV drugs and actually owns the patents on some.

The fact that drug companies would profit from taxpayer funded research and then pressure the government to retaliate against countries who legally produce generics is outrageous.

But this has all been said before. We should really get a script to do it instead for every HIV drugs thread.
posted by euphorb at 1:33 PM on December 1, 2001

i'm crossing my fingers for a vaccine: we need it.

i was looking around for stuff on aids vaccines and found IAVI. they put up this page today where you can keep track of trials going on around the world.

it's cool to see the intersection between business, government, charitable foundations, NGO's and kenyan prostitutes in the provisioning of a pseudo-public good. (like a vaccine strictly speaking is rival and excludable, but community health is non-rival and non-excludable by definition) how could it be met any other way?

Here's what oughta happen: a consortium of world governments should band together to buy out the patents on important drugs.

j. bradford delong, a berkeley economist, recently addressed the federal reserve (along with lawrence summers) and proposed just such an approach in their paper:

"like the French government's purchase and placing in the public domain of the first photographic patents in the early nineteenth century... The work of Harvard economist Michael Kremer (1998, 2000), both with respect to the possibility of public purchase of patents at auction and of shifting some public research and development funding from effort-oriented to result-oriented processes (that is, holding contests for private companies to develop vaccines instead of funding research directly), is especially intriguing in its attempts to develop institutions that have all the advantages of market competition, natural monopoly, and public provision."

[btw, the new post interface rux! :]
posted by kliuless at 3:53 PM on December 1, 2001

I apologise for not knowing where I read this article, but I did read a long, pretty credible sounding article, possibly in the New Yorker, about the AIDS numbers in Africa.

What it came down to was that a myriad of diseases were automatically being classified as "AIDS" by doctors and hospitals there, without any standard testing. Somebody's really sick and dies? AIDS.

Again, I don't remember where I read this and am not claiming it's true; if somebody knows the article I'm talking about I'd appreciate a pointer.
posted by cps at 7:13 PM on December 1, 2001

It may seem that while there is hope in USA and Western Europe, much of East Europe, Asia and Africa has a growing AIDS epidemic that they can't do much about. As traditional healers in Haiti and South Africa try their hand at curing the ill, Nigeria is importing cheap generic drugs to deal with the issue.
posted by tamim at 12:09 AM on December 2, 2001

My understanding is more children die in Africa per day from diarrhea contracted from unclean water than people die per day from AIDS. In fact -a child dies every eight seconds. This is so simple to prevent. Aren't we all the drug company?
posted by quercus at 6:26 AM on December 2, 2001

Having sex is what people have done for eons to keep the species going. To convince people that a necessary behavior is suddenly fatal takes some doing, and I don't think we get anywhere by vilifying people who can't control primal urges based on risk assessments that they may not have had the knowledge to make

However, to blame the pharmeceutical companies because people are dying is forgetting the reason that people are dying.

It may be hard to convince them that having sex might not be the best thing to do, but if telling them that they have a high chance of dying from AIDS if they have sex isn't enough to stop them, why should anyone else have to pay for their mistakes?

I do feel sorry for those that die from AIDS because of other causes beyond their control (tainted needle at a hospital, for example), but when the single point of failure is a person's willpower, I find it hard to feel sorrow for them. I can wish that it had not happened that way, but I would have to find other ways to satisfy my "primordial urge".

They made a choice to have sex. it was not forced on them.
posted by presto at 6:27 AM on December 3, 2001

AIDS and drug use. An interesting take on the Afgan situation thrown in.
posted by asok at 7:11 AM on December 3, 2001