Big Pharma
Profits vs People
The Heinz dilemma is a famous thought experiment that tests our moral reasoning. In it, a woman
lies dying, and her husband cannot afford to purchase the drug doctors tell him may save her. The
husband tries, unsuccessfully, to borrow the money so he asks the pharmacist/doctor if he might
buy the drug cheaper or pay the difference later. The pharmacist/doctor refuses and claims that he
is entitled to profits associated with selling the drug. The husband faces the dilemma: should he let
his wife die because he cannot afford the drug, or should he steal the drug and save his wife’s life?
The reasoning people use to resolve the dilemma is believed to indicate their level of moral
reasoning. But what if the whole dilemma is based on a false assumption? What if, instead of
questioning which course of action the husband should take, we were meant to question the
premise that the doctor/chemist (and by extension, pharmaceutical companies) have a right to make
profit, even where it costs people their lives?
Pharmaceutical companies operate globally, producing and selling products needed to save lives.
The factors contributing to the growth of globalisation within the industry rests in drivers such as the
need for manufacturers to reduce costs associated with manufacturing and testing clinical drugs and
to expand their markets into emerging economics where demand for advances in medicine are on
the rise.
At the time that this book goes to publication, the world is in the grip of a global pandemic: Covid 19,
a strain of the coronavirus. By the end of June 2020, over 10million cases of the virus had been
confirmed, 5million pronounced recovered, and more than 500,000 had died. Not surprisingly,
pharmaceutical companies are investing in research to find a cure. In an effort to secure a vaccine
most countries have invested government money into vaccine research and trials, but after such a
vaccine is created, the pharmaceutical companies will hold the patents and set the prices, effectively
controlling the degree to which a vaccine will be affordable to all. This profit driven motivation has
been elevated above the importance of saving lives.
In February, 2020 US President, Donald Trump stated a vaccine for coronavirus may not be
affordable for all Americans because pharmaceutical companies have a right to make profit. Trump
also recently sought to purchase exclusive rights to a promising vaccine being developed in
Germany, which would have given America controlling interests over vaccine production and
costing, and raised humanitarian concerns over whether fairness and equity should be sacrificed for
self-interest and massive profits.
In 2018 the global pharmaceutical industry revenue was reported as being more than 1.2 trillion
American dollars. While pharmaceuticals have clearly achieved good in the world, their power as an
industry also raises ethical issues that need consideration. Before the current pandemic,
pharmaceutical companies had already been criticised for putting profits before people. For
example, in 2015, Martin Shkreli, CEO and founder of Turing Pharmaceuticals, was described as ‘the
most hated man in America’ when he hiked up the price of anti-parasitic drug, Daraprim, from
US$13.50 to US$750 per pill after he obtained the manufacturing licence of its production.
Another clear global example of this problem is big pharmaceutical companies and AIDS medications
sold in developing nations such as South Africa. AIDS remains a significant issue in South Africa, with
many people in that nation being unable to afford or access the antiretroviral treatments that allow
people to manage their condition and still live meaningful lives after contracting the virus. A review
of health care conditions post 2005 identified high cost of pharmaceuticals as being an issue of
inequality across the nation, as only those with private health insurance (approximately 20% of
people) could afford to access the drugs needed to treat AIDS. To address the crisis the South African
government passed legislation allowing a generic formulation of AIDS medicine to be imported and
sold cheaply in order to save lives and reduce the economic disparities that meant so many were
dying of AIDS because they could not afford the medicine. In response, many global pharmaceutical
companies banded together to oppose the legislation, citing it as an infringement of patent rights
that would eat into global profits for AIDS medications. Their focus was not on the preventable
deaths, and the good they could achieve by simply reducing the costs of medications to mean more
people could afford their product, but rather that cheaper alternatives would undercut their profits.
This profit maximisation focus clearly becomes more of an ethical issue given the power over life and
death pharmaceutical companies can wield through the pricing of life saving products. And while it is
easy to say companies have the right to profit from their products, this remains an easier position to
take for those fortunate enough to be in a position to afford the costs of such medications, or of not
needing to find ways to cover these ongoing medicine costs. Even in developed nations, the power
of pharmaceutical companies to charge exorbitant amounts for medications raises questions on the
right of companies to charge such high prices for life saving medications. Depending on brand and
specific medication prescribed, the cost of asthma medication in America can be as much as $500 for
Americans who are unable to afford health insurance. This effectively means that thousands of
Americans may not be able to afford medication and thus face the increased risk of unnecessary
death from a preventable condition. In this instance, changes to patent laws in America meant that
more affordable generic brands cannot be manufactured and sold, meaning only the expensive
options remain available, despite the fact so many cannot afford them. This has life and death
implications that thousands of people must live with daily, and yet the profit margins for
pharmaceutical companies continue to rise.
Links to websites for articles to start your research:
https://www.bing.com/search?q=covid+19+numbers&go=Search&qs=ds&form=QBRE
https://www.forbes.com/sites/isabeltogoh/2020/02/27/health-secretary-alex-azar-refuses-
to-guarantee-coronavirus-vaccine-would-be-affordable-for-all/#b165e45490c3
https://www.politico.eu/article/germany-confirms-that-donald-trump-tried-to-buy-firm-
working-on-coronavirus-vaccine/
https://www.smh.com.au/business/companies/wework-co-founder-is-the-new-most-hated-
man-in-america-20191028-p534v8.html
https://cyber.harvard.edu/people/tfisher/South%20Africa.pdf
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1119675/
https://www.goodrx.com/blog/heres-why-asthma-inhalers-are-so-expensive/
https://www.atsjournals.org/doi/10.1513/AnnalsATS.201703-259OC
