November 16, 2024
RFK Jr.’s main claim to fame, apart from his ancestry, is from saying crazy things about vaccines. As has been well-documented, vaccines have not led to autism or killed thousands of people. They have saved tens of millions of lives and protected billions of people from debilitating illnesses. By discouraging vaccinations, RFK Jr.’s crazed rants contributed to dozens of deaths and thousands of preventable cases of measles in American Samoa in 2019.
But even though his vaccine rants may be nonsense, RFK Jr. does have a very real point when he complains about the corruption of the pharmaceutical industry. The industry routinely exaggerates the benefits of its drugs and downplays their potential harms. The most visible manifestation of this corruption was the lies they spread about the new generation of opioids not being addictive, which helped fuel the opioid crisis. But these problems occur all the time, even if the consequences are not typically as extreme.
The reason for the corruption is simple. Government-granted patent monopolies, and other forms of protection, allow the industry to sell their drugs at prices that are often twenty or thirty times the cost of producing and distributing the drug. It’s rare that a drug would sell for more than $20 or $30 per prescription without these monopolies. With patent protection, drugs can sell for hundreds or even thousands of dollars per prescription.
With such enormous profits to be made, the industry has an enormous incentive to sell as many prescriptions as possible, even if it means misleading doctors and the public about the safety and effectiveness of their drugs. This problem is hardly a secret.
Medical journals have struggled for decades to try to ensure that the data studies are based on is real. They even struggle to ensure that the authors are real. There is a longstanding problem of ghost-authored articles where industry hacks would draft a paper promoting a drug, and then pay a researcher to send it in under their name. Journals have cracked down on this practice so it at least rarer, but it surely has not ended altogether.
Then there is the issue of paying doctors to promote drugs. It is illegal for a drug company to pay a doctor directly to promote a drug, but they can pay speaker fees or find other ways to get money to a doctor willing to say positive things about their drugs.
And this corruption even extends into the Food and Drug Administration (FDA). Three years ago, Biogen got the FDA to approve its Alzheimer drug Aduhelm, even though there was little proof of its effectiveness and clear evidence of negative side-effects. The agency approval went against the views of many of its own experts.
Apparently, the company had extensive contact with FDA officials in which it was able to push the case for Aduhelm. Biogen had planned to sell the drug for $56,000 for a year’s treatment, which could explain its extraordinary efforts to get the drug approved. (The approval was later reversed.)
The patent monopoly system is clearly at the center of the corruption problems with the FDA and the industry more generally. When there is so much money on the table, people will cheat, just as they are willing to break the law to sell fentanyl and other illegal drugs.
We have chosen patent monopolies as the primary mechanism for financing the development of new drugs and vaccines. We encourage companies to spend hundreds of millions of dollars on research, which they can then hope to recoup if they have a successful drug by selling it at prices far above its production cost.
We could eliminate this problem by choosing a different funding mechanism. We could pay for the research upfront, as we already do to a substantial extent with research funded though the National Institutes of Health and other government agencies.
We could double or triple this funding and look to replace the funding supported by patent monopolies. If we had all drugs selling at free market prices we would likely save more than $500 billion (line 121) a year ($3,300 per family) on prescription drugs and other pharmaceutical products. This would also mean that no one would have to beg their insurer or do a GoFundMe to pay for a drug that is essential for their health or their life.
And we could almost entirely eliminate the problem of corruption in the pharmaceutical industry. If the government is paying for the research, we could require that it be fully open. This means that all results would be posted on the web as soon as practical. No one would have incentive or opportunity to lie about the safety or effectiveness of a drug since all the relevant data would be on-line for any researcher or doctor to evaluate. Furthermore, there would be no money in pushing lies.
If RFK Jr. really has an interest in ending corruption in the pharmaceutical industry, he could take the lead in pushing to end patent-financed biomedical research. Unfortunately, as with much of MAGA, the populist rhetoric is just for show. He may cost many lives by making vaccines less widely available and discouraging people from taking them, but this will do nothing to weed out corruption in the industry.
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