Alternatives to corporate power: medicines
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Nick Dearden, director of Global Justice Now and author of Pharmanomics, tells Critical Takes why the dominance of medicine by Big Pharma is a worldwide problem. He outlines an alternative system for making and distributing medicines which prioritises benefits to society over private profits.
Including:
· Big Pharma’s primary goal is rent-seeking, not better public health (to 05:20)
· How Big Pharma and Trump bullied the UK into paying more for drugs (to 12:50)
· Cuba, South Africa and lessons from Covid (to 17:51)
· How to build public-led alternatives to Big Pharma (to 28:15)
· Policymakers are realising that the status quo is broken.
Here is a transcript, lightly edited for length and clarity:
Diarmid:
Hello. This is Critical Takes on Corporate Power and I'm Diarmid O'Sullivan.
As we learned during the COVID Pandemic, the production and supply of medicines and other vital drugs around the world is dominated by giant pharmaceutical companies, which are focused above all on their own profit.
To talk about why that's a problem and what we can do about it, I'm delighted to be joined by Nick Dearden who is director of the campaigning organization Global Justice Now, and also the author of a book called Pharmanomics, which is a highly informed and readable critique of the industry.
Nick, thanks very much for making time to talk.
Nick Dearden:
It's a pleasure.
Diarmid:
So let's start at the beginning. Why is the dominance of Big Pharma such a problem for the world?
Nick Dearden:
Well, it's a problem if you think that the purpose of this industry is to make the medicines that we all need to prevent illness, or to get us better when we are ill, and deliver those medicines to us in a way that's affordable, because that is not what this industry does at all.
In fact in my book I argue that in very many ways, rather than being seen as a medicine manufacturer, primarily you should see pharmaceutical corporations as hedge funds that do very little of the research and development that they keep telling us costs so much money.
Very often that’s done by the state, or it’s done by small biotech companies with money from the state. Rather, what the pharmaceutical industry does is work out which bits of that research are going to be winners … not in terms necessarily of making medical breakthroughs, but in terms of allowing the biggest amount of profit to be extracted. And they then set about milking that research for all that it's worth.
So they buy it up. They enclose the research that most of our new medicines are based on behind walls of intellectual property. And they keep that intellectual property as tight and as rigid and as long term as they possibly can so that they can keep deriving profits from it.
[It’s] really a form of rent-seeking because they are not in that process doing anything by and large to improve those medicines, either to make them easier to take or make them better in terms of the way that they work.
And that is just so far away from how not only we think about pharmaceutical companies, but I would argue our governments think about pharmaceutical companies that it's actually quite terrifying.
Our governments over the years have put all of their eggs in the basket of: “we must appease these pharmaceutical giants because without them, modern medicine collapses”. But in the same period that we've become more and more dependent on these companies, they have become less and less willing and able to do the research and to provide that research in a way that we can afford … that the future of medicine simply cannot be left in the hands of these monopolists, these behemoths.
Diarmid:
We'll go on to talk in a minute about the particular case of the UK. It's interesting when you talk about the centrality of proprietary intellectual property, because another aspect of that which I've seen in my work as a tax justice campaigner is that IP is relatively easy to move into tax havens or low-tax jurisdictions.
So not only do they extract rents from this, but they then don't necessarily pay very much tax. I mean, particularly American pharma companies, but also British and European, are very aggressive in trying to reduce their tax bills.
How does this problem that you've described fit into the wider problem of privatized healthcare around the world? In the book, for instance, you write about private hospitals and the problems of private hospitals.
Nick Dearden:
One way to look at it is that in Britain, people are devoted to the National Health Service because it's a part of our society that, for the most part, exists outside of market mechanisms. When I've got something wrong with me, I go to a doctor and if it's bad enough, I go to a hospital and money is never mentioned to me, right? I get the treatment that I need. Most of the time there, I'm not saying there's not problems with funding and so on, but the basic idea is this is not a market mechanism for dealing with our healthcare.
It's rather strange then that the pharmaceutical products that our doctors and our hospitals purchase or subsidize us to purchase are effectively bought off some of the most financialized profit hungry corporations that exist i.e. the pharmaceutical corporations.
And this creates a real problem because you have a socialized healthcare model trying to interact with a rent-seeking, profit-hungry bunch of monopolies.
And at times our governments have come up with ways to try to control that behaviour and the amounts that those pharmaceutical companies can charge. We've always had forms of price control, but particularly the creation of NICE and so on was really important.
[NICE is a public body in the UK that decides which medicines should be available to patients via the National Health Service].
So in effect, it's a kind of price control on what the NHS will pay for new medicines. The pharmaceutical industry absolutely hates this, of course, and says, you know, this is an impediment to our God-given right to charge whatever we want for these medicines.
The UK government, to greater or lesser extent, has defended those price control up until last December when [UK Prime Minister] Keir Starmer signed a deal with Donald Trump
Because Donald Trump got into the game [and] decided that he was going to back the pharmaceutical corporations because we were all ripping off these poor bodies with our price control mechanisms. And so he wanted to get rid of the price control systems.
And Keir Starmer has basically gone along with that. I mean NICE of course still exists, but he's basically said: we will now pay more for new medicines, even though we're not going to be getting anything additional. We just simply going to pay more for the types of medicines that we were already getting.
Essentially what that means: unless more money goes into the NHS, the NHS is going to have to take that money from somewhere else. And that somewhere else could be frontline services, could be ambulances, could be staff. It could be any manner of things, many of which are more likely to improve longevity of life and health outcomes than the new medicines that the pharmaceutical companies are selling to us, that in any case, we would likely have got at a reduced price.
So it poses a battle, a war, between our socialised healthcare system [in the UK] and monopoly corporations, and it's really up to governments to defend our healthcare system and not to blink first. And unfortunately, the current government has not done that.
And so I think we're really going see in the years to come the problems that exist with that tension between a highly privatized, highly financialized model of healthcare and a socialised model of healthcare.
And unfortunately at the moment it's a socialised model of healthcare that's losing out. And eventually, of course, it gets eroded to the point where it simply won't work anymore. And I think pharmaceutical corporations have a huge interest in that because, as I’ve said, they absolutely hate the idea that a government anywhere on the planet can constrain their ability to charge whatever they can get away with.
That’s a really important point in all of this: the amount of money that pharmaceutical companies charge for their products is not based on the cost of production of those products plus profit. Not at all. And they don't even pretend it is, because most medicines are produced very, very cheaply indeed.
They claim it is based upon the cost that it's taken to research medicines – which is high, I would certainly accept that - but it isn't really based upon that either. As I said, a lot of that work is done outside of the private sector anyway, or certainly outside of the big monopolies. It's simply based upon whatever they think they can get away with. Whatever they think they can charge in a market with no constraints.
Diarmid:
And you can actually see that if you look at the accounts of pharma companies, big ones, which almost no journalists seem to do, and you see that the profit margins by and large are very large.
In fact in the UK you had one prominent American company saying: “oh, we can't make enough money in the UK.” And I wrote about this for Critical Takes because it really annoyed me. If you look at the accounts, you could see the reason they're not making any money in the UK is they don't book the profit here.
The profit is booked in Ireland and they make medicines in Ireland – fair enough, there's some legitimacy to that - but the reason it's in Ireland is because Ireland's a tax haven. And another chunk of the profit is being booked, I don’t know, Delaware [a tax haven within the US] or somewhere where they keep the formula for the drug.
It was interesting actually to see how the political lobbying works. Because clearly these companies had picked out that if governments are a herd of zebras, then the UK is a relatively weak zebra that's drifted away from the herd. It's not within the European Union any more. The government has staked its credibility on bringing in more foreign investment to make the economy bigger. And clearly the pharmaceutical companies [saw that].
You had American, British, European pharmaceutical companies all pushing the same message in the media and the journalists would just report it without really questioning it: “oh, it's terrible. Oh, we can't make any money.” And it worked. Clearly they were working to some extent in concert with each other to get endless articles into the press, putting their point of view, and it paid off.
Nick Dearden:
It's shocking, isn't it? And really, journalists really don't understand this. Partly I'm sure nowadays journalists spend too much time regurgitating press releases because they haven't got time to do the proper investigation.
But it was so hard to get this story out and when the [US-UK] trade deal text was actually published - it was sneaked out just before Easter, so not very long ago - it was reported almost universally as: “Wow, the [UK] government's avoided [US} tariffs. Good old government and it's going to bring investment back into the country by doing this deal with Trump that means we pay more foreign medicines.”.
What absolute nonsense. I read the deal and I was actually just making myself more and more angry as I went through the deal because I’ve never seen a trade deal like this before, signed by a Western country, where the obligations are entirely one-sided.
All Trump’s done is said “we won’t impose tariffs”. The UK has said to Trump, and by extension to the pharmaceutical companies, we will allow you to dictate how much our NHS allocates to new medicines produced by big pharmaceutical companies. That’s absolutely extraordinary and yet it was reported in the press as: “oh, we've evaded these tariffs”.
The second point, that the investment's going to come back [to the UK], is also rubbish. The pharmaceutical companies at the beginning of last year instituted a coordinated [effort] - in my opinion, it was coordinated very clearly because they signed joint letters and so on, and their announcements came out one day after the other – where they basically said: “Investment has ceased in the UK. We’re not building this plant any more.” Classic capital strike, in order to bully the [UK] government to back down.
The [UK]government said: “We’ve got to get that investment back.” But what they've done here is not getting that investment back at all. [The companies] have no interest in bringing investment back here. The investment's going to the United States, because that's what's Trump has dictated.
And so we're in a really, very, very difficult position here where we're going to be paying much more for our medicines. We are increasingly reliant and dependent on a sector which has no real interest in the diseases that we suffer, unless they can make a lot of profit out of treating those diseases, right?
Many people will have heard of the antibiotic apocalypse that's coming: antibiotics are becoming less effective because we've overused them. The second part of that problem is pharmaceutical companies haven't done really any work in terms of research and development into replacement antibiotics, either new forms of antibiotics that haven't been discovered or alternatives to antibiotics.
Why? Because there's no profit in it, not because it is not one of the most urgent medical problems we face as humanity. It is. But because they know that if they invented this, it's going to be a second- or third-line medicine that would be used very sparingly and would certainly not come online in any big way until their patent has expired. They're not going to make enormous profits out of it, and so nothing's gone into it.
This isn't just a kind of, you know, lefty campaigner saying this. Jim O'Neill, formerly of Goldman Sachs, [who] coined the terms BRICs. You know, incredibly intelligent guy. He was put to work by David Cameron [British Prime Minister from 2010 to 2016] who was genuinely worried about this antibiotic situation and said: well, what incentives can we put in place to make you do the research that you need to do?
And after five years [O’Neill] just came back and he's like: I don't believe a single word you people [the pharmaceutical companies] say because you've made all these promises but you've not done it. And frankly, if it was up to me, I would just nationalize large parts of this industry. This is a guy who had the Conservative whip in the House of Lords.
Diarmid:
He was someone you'd expect to be very rightwing and pro-Capital in his views. And in fact turned out to be, as you say, basically calling for nationalization. Which I think offers a really good sort of segue into the question of what we do about this.
Because obviously the UK is a rich and relatively influential country with a lot of resources, a lot of state capacity. So if Big Pharma can do this to us, imagine what it's like being a lower-income country and trying to get access to vital medicines. As we saw in in the COVID pandemic, you are right at the bottom of the list when it comes to securing medicines you need at a price that you can afford.
So let's talk about: what do we do? You talked a lot in Pharmanomics about what an alternative public-led system for inventing, making and distributing medicines would look like. So talk us through what that alternative might look like.
Nick Dearden:
Sure, and I think at core it is about wresting control and the chokeholds and bottlenecks away from these Big Pharma monopolies. We need a sector for making our medicines which is far more diverse than the one we've got now. And that needs to have a heavy element of state investment and some state control.
And let's be honest, as I've already said, we already have a lot of state investment going into this. It's just that we don't get the return that we should be seeking on that investment.
So what does that look like? I think COVID is a really good example actually. As you said, COVID was when much of the world woke up to this. Because all of a sudden, unless you were a seriously rich country who was going to pay whatever was demanded of you, you were not going to get these vaccines in time.
But what was really interesting there was one country in the world which is not wealthy, in fact has been under an economic blockade for many years. i.e. Cuba, managed to invent two or three very effective vaccines. And it did that because it recognized that it couldn't rely on the big pharmaceutical companies because of the economic embargo that it was suffering from. And healthcare has always been a key element since the [Cuban] revolution,
Diarmid:
Cuban doctors and nurses and their provision of healthcare to low-income countries are famous, of course.
Nick Dearden:
Yeah, that's right. And they recognized there was this interaction between their health system and the medicines that are used in that health system, and so that they had to create institutes and so on.
And this is an idea that so many of us have in the modern world: you imagine creating a public institution that's going to be this really bureaucratic, sclerotic kind of body. I mean, that's not what these institutions are at all and in some ways they have a healthy dose of competition in terms of the way that they work through the science and what they're going to be able to develop and so on.
Nonetheless, quite extraordinary. And Cuba wasn't on its own. And in the middle of the pandemic, it was South Africa that really got very upset about the situation. I think the importance there is that there are unfortunately some countries in the world that are very poor and kind of just accept that they're going to be at the back of the queue and there's not much they can do about it. South Africa was not in that category and South Africa was deeply upset about the levels of unfairness that applied to COVID vaccines.
And so it said, right, we're just going to set up an institute. It’s not going to be run by the state but the state is going to have a good deal of control over it. And we're going to research mRNA because we don’t know how to make it at the moment.
And the big companies that we've approached, Pfizer and Moderna, that wasn't a big company but has now become a big company because of this; they just said [to South Africa]: “no, we're not giving you this. We're not helping you with this at all. You either buy the finished product on the terms we demand or you don't.”
And they [South Africa] said: “well, we're just going to do it”. And very, very quickly they got their heads around mRNA technology.
Diarmid:
I know nothing about medicine except which end it usually goes in. But mRNA, that was the basis of the COVID vaccines we’ve all had?
Nick Dearden:
The new-wave ones, yes. There's lots to be said there about why those two big companies used mRNA technology. It was a risk using that technology and Cuba thought it was, for example, too much of a risk so they used older-fashioned [technology], which also worked fine.
But mRNA was a revolutionary way of making vaccines, essentially, and that was the other thing South Africa realized. None of us knew how long the pandemic was going to go on, but they realized there was a chance they would make a breakthrough and it would be too late for the pandemic. But nonetheless mRNA, they figured, could be really important in terms of providing vaccines for TB vaccines, vaccines for HIV. And so they thought that it was important that they got their head around this technology and they did, and they cracked it.
And then what they did was something I think that was truly revolutionary. They said: “This does not belong to us. We are going to share this without patents to governments and companies around the world that we think can make this stuff safely and to a high standard.”
And they have a whole training programme where scientists come from around the world and learn about this stuff. So lots of countries are now able to use this technology, and I think there's something in there that's really important, not just for very rich countries, but for countries across the spectrum.
I mean, no country can do this entirely on its own. But we can do it by working together, cooperating and sharing outside of the economic mechanisms that we've developed, which we call free market, but aren't really anything to do with the free market. In the case of medicines it’s a pure monopoly system: one company has the right to do this essentially, or decide who else has the right to do it and how much they need to pay for that.
So that's the bit that we've got to break, and I think that's going to need the state possibly putting more money into research and development, but certainly ensuring that [the state gets] a better return in social terms on that investment.
And that means not simply selling this stuff to a big pharmaceutical corporation who will then enclose it with IP. Joe Stiglitz has a very interesting view on this. He says that we're supposed to be in a knowledge economy and yet we have the highest intellectual property walls in human history around things like medicines, that are something all human beings are probably going to need at some point in their lives, and that doesn't make any sense at all. I mean, you are privatising the knowledge economy, and of course that's exactly what they're doing. And so we need to de-financialise and deprivatise that.
None of this is to say that I think the state needs to be producing every single medicine on the market. Not at all. I think they need to produce some of it because I do think we need that backstop. And that may be loss-making, but at the end of the day, we can never allow ourselves to get into a situation like COVID again where politicians really were against the wall because they simply didn't have the capacity because they put all of the eggs in the Big Pharma basket. They need to be able to call their bluff.
We also need the state to create regulatory models where we ensure there is a balanced economy in these areas. And one example of that is it should be a good and profitable business to do biotech research technology without having to become a big pharmaceutical monopoly.
Diarmid:
Well, that's it, isn't it? Because the classic model is if you're a scientist at Cambridge [University] and you form your own company, and then if you strike lucky, you sell out to one of the giant companies, AstraZeneca or something, and they buy you out and you become rich and they get the IP. So how do you get away from that constant concentration of ownership around IP?
Nick Dearden:
I've spoken to people who run small companies and they're like: “look, this is the only business model. All I can do is hope Pfizer notices me and buys me, and that's not what I want, but this is the only way that I'm actually going to make money from what I’m doing.”
I've already mentioned Moderna, so it is theoretically possible to break through, but it's very unusual. Very, very unusual. And Moderna was an almost entirely public company in many ways. I mean, it wasn't public in the way that it operated, but it was at one point a hundred percent funded by the US state to develop mRNA technology.
I think one of the reasons that [former US President] Biden became so infuriated with Big Pharma during COVID was precisely that he knew how much had been pumped into Moderna and yet they still wouldn't behave in a reasonable way. And so he realized the hard way that actually this industry is not interested in any way in the public interest at all.
And if you want to guarantee the public interest, you need a far greater degree of public control than we have at the moment.
Diarmid:
So just to round off, let's think about how we might get from here to there. Perhaps use the UK as an example. What would have to happen, step by step, to move away from this concentrated, monopolistic, rent-seeking model towards something which is more socialized, which is more open, which is driven by a social return rather than purely a financial return. How will we get there from here?
Nick Dearden:
Long term? We need to start investing in research and development, but ensure that research and development is not simply allowed to be privatized. At the moment the [UK] government's plan for doing more R&D at universities is we need to make it easier to spin off companies. That's not we what we need to do at all, because it's quite easy to spin off companies. The problem is those companies then get gobbled up.
So what we need to do is ensure that when we're putting this money into research and development, whether it's done directly by the state or whether it's done by somebody else, there are strict rules which dictate how you are able to use the intellectual property on that, how much you're able to charge for any medicines produced with it, and who has access to those medicines.
It's not beyond regulators to be able to put that kind of a framework into place. They would face significant pushback from the pharmaceutical companies, but let’s make a virtue of the difficult situation we find ourselves in. They're not investing in the [UK] anyway, so we're going to have to do something different.
And given that we spend money on this, let's make sure that that research and development can be used in a fundamentally different way than simply whatever makes as much profit as possible for the big pharmaceutical companies.
There was a policy document that was written actually when Jeremy Corbyn was in charge of the Labour Party [from 2015 to 2020], and we worked with them on it, called Medicines for the Many. It’s a great policy document that describes how you would begin getting from there to here.
Now the next stage is that the research and development is not enough. You need to be able to turn that into medicines that you can give to people in the form of pills or vaccines or whatever it is. I would suggest the best way to do that is to support a range of companies that are able to manufacture medicines in this country and around the world and, again, do it in different ways to Big Pharma.
We already have some of these companies. We have generic medicine companies. The problem is they can't get their hands on the research of the new medicines for 20 years plus, till the patents are expired. But there's no reason if we were producing research and development that wasn't constrained by that intellectual property, that those companies, if we had them, could get hold of it and could begin churning out the medicines that we need.
And as I say, I don't think all of those need to be owned by the state at all. I think we need to just regulate how they operate. In fact, I think it's fine for them to be able to make profits, but reasonable profits, you know, not this kind of addiction to very, very high profits that you see in the pharmaceutical industry at the moment.
And maybe, as I've already said, you would probably want a couple of public manufacturers too, to backstop and to ensure the competition exists within the marketplace, which at the moment it doesn't at all. So that's roughly how I would go about doing it. I think there are then questions about how you share that intellectual property globally …
Diarmid:
… Yes, I was going to say: what about those countries which simply don't have the resources to put together their own public-backed R&D model? How do they get access to new discoveries?
Nick Dearden:
In my ideal world, you begin forming regional hubs of both research and development and manufacturing. So in Africa you could have a few hubs.
And as a matter of fact, China … I don't want to pretend China has a perfect record in this regard at all: as it’s getting more successful in the global economy, the draw of intellectual property is growing for it. But [China] does tend to do things in a different way. Indeed in COVID it worked with countries like Egypt - it charged something for its research and development and it had diplomatic agreements in place – but nonetheless, it was quite happy to show the Egyptian government how to make COVID vaccines and other governments too. And from there they could churn them out.
So I think regional hubs is really important. If we [in the UK] want to be helpful in that regard, we should be using international development money to support the setup of some of that stuff. Much more useful than selling medicines to someone forever is to actually allow them to create those medicines themselves.
But there is a demand issue as to whether those factories or research and development hubs can sustain themselves in the long term. I think probably for many countries in the world, that would only be possible if you did it in a pooled way through a regional hub.
Diarmid:
The model you describe … is not an entirely publicly-run system for inventing and making and distributing medicines [but] the state invests in it in crucial ways. It's underpinned by public money and by public manufacturing capacity, and then you would have to have international agreements of some nature to ensure that countries which aren't part of those regional blocs, or which don't have the capacity to do it as we do in the UK, would be able to get access to those medicines.
Nick Dearden:
Yeah. And then you can take emergency measures as well. Which we have the ability to do, we just never really do it. If a company is making a drug that we believe, well, that just represents sheer profiteering and we really need this drug for human health, we can issue a compulsory license. We can just say: “well, we're taking it off you and we're going to make it ourselves.”
That’s as always been possible. In fact, in the 1960s Harold Wilson's government [in the UK} did it fairly regularly. There was an absolute crisis because so many people were on things like Valium and so on in the Sixties and Seventies, and it was actually a drain on the National Health Service, and there was all sorts of drugs, antibiotics and so on that we bought from Italy, which didn't at the time have patents on drugs.
That's something else to remember about all of this. The idea of patenting medicines is new. It was all part of the creation of the [World Trade Organisation] that made this global. At the time the WTO TRIPS Agreement came in, in the mi-1990s, almost no countries in the global South had patents on medicines and it had only been twenty years since most countries in Europe had put patents on medicines.
So in the 1970s, Italy didn't have a patent regime on medicines. It could produce antibiotics generically and we [in the UK] bought them from them overriding the patents of big pharmaceutical companies because Harold Wilson said: “You’re profiteering.”
Diarmid:
It is a useful reminder, as with so many of these issues that we cover on Critical Takes, that the reality we're facing now is one that's really only one or two generations old. This incredible dominance of these giant rent- seeking organizations and the enormous political influence they have is relatively new. I mean, multinationals weren't invented in the 1980s, but the enormous sway that they hold is something which is relatively new. It means that it also won't last forever.
Nick Dearden:
The tax point you makes is really important too in that regard. As part of writing my book, I went back and read No Logo, Naomi Klein's book, a really seminal book in the Nineties that all of us anti-globalization activists had a copy of.
It's absolutely fascinating how at the very beginning she really explained what financialization was and what was happening in the global economy. They [multinationals] were moving value away from their factories, their productive assets, their workers, into things like intellectual property in these so-called intangible assets, which are now absolutely dominant on the spreadsheets of big multinational corporations.
Of course, it allows them to move their money around much more easily. But I would say it's bigger than that. I would say it represents an enormous shift of value and power from labour to capital, which is the story, of course, of the last 30-40 years, isn't it. And so much of the reason that we’re in the deep, deep political crisis we're in.
Diarmid:
Although, interestingly, mentioning the tax issue, what pharma companies now have to do is to put their factories in tax havens because basically the tax justice movement over the last fifteen years, combined with governments being short of money, has created such a stink that the rules are slowly changing to require pharma companies to have more of what they call “substance”, which means that they put factories in Ireland or Costa Rica or Switzerland or somewhere with a low tax rate.
In fact, as I was saying earlier, the reason that American pharma companies don't make much profit in the UK is that they're booking it somewhere else. And I'm also an Irish citizen, so I have mixed feelings about that. But yes, it's absolutely, it's got a long way to go to reverse that neoliberalization of everything.
So just to conclude, this has been fantastic overview of what the problem is and also a really clear and actually quite pragmatic take on how we get out of this and what the alternative might look like.
The question I always ask everyone at the end of these interviews is: do you feel optimistic that this kind of transformational shift can happen?
Nick Dearden:
I always say it's my job to feel optimistic because I'm a campaigner, so I kind of have to, otherwise I wouldn't bother getting out of bed anymore …
Diarmid:
Well, that's what everybody says actually. That’s the usual answer.
Nick Dearden:
But you know, in a real sense I am optimistic because I think there's a recognition that goes back even before COVID among many, many policy makers. We’ve already mentioned Jim O’Neill and to some extent David Cameron, the former Prime Minister, but there's lots of politicians on the Right, as well as on the Left throughout Europe and in the United States saying this has to change.
In fact, before Trump - Trump has represented an enormous reversal - Joe Biden really did actually start taking Pharma on in a big way. For the first time, he allowed the [US] Federal government to negotiate prices, and that was bringing the price of some medicines down.
That was a huge step. I was astonished to wake up one morning and a tweet from Joe Biden saying: “I'm taking on Big Pharma and this time we're gonna win”. Extraordinary thing for an American president to say.
And I think that represents something underlying the economy, that some of the more enlightened policy makers, even if they're on the right of the spectrum, have woken up to: you just cannot run an economy like this, you can’t run capitalism like this. It’s quite literally eating itself.
And it's fascinating looking at the pharma companies, just how much less innovative they've become under the period of financialization. Because all of their innovation goes towards how we extend our intellectual property You need lawyers and lobbyists more than you need scientists and doctors if that's your game. And tax advisors.
And you are eating yourself. It was fascinating just looking at the difference between the turnover of companies every year and how much they were returning to shareholders. There was a significant number of years where they were returning more to their shareholders than they were making in profits. They exist as cash machines for the super-rich.
And so anybody with a notion that, well, we actually want an economy that's going to work in the long term is going to be forced to the conclusion that we therefore have to do things differently. That might not mean doing things exactly as I've spelled out today, but I think the idea that it has to be different - almost anybody who's looked at this seriously comes to that conclusion.
Diarmid:
I think I'll book that as a sort of kind of tempered optimism about the future. If something can't go on forever, then it probably won't go on forever. So on that note I'll say thanks very much for a really fascinating, in-depth take on what we do about Big Pharma.
Nick Dearden:
It’s a pleasure, thank you.
This is the end of the transcript.