The Public Good

Americans need to reclaim the concept of the public good, and nowhere is that more important than in health policy.

Law Professor Fran Quigley has a new book coming out that examines the interface–or more accurately, the lack of an interface–between Big Pharma, Congress and the common good. Quartz recently published a review of the book, and began by referring to the infamous “Pharma Bro,” Martin Shkreli, who purchased a life-saving drug that had been on the market for some time, and jacked up the price astronomically–because he could.

Shkreli is not an outlier, according to Indiana University law professor Fran Quigley’s new book Prescription for the People. The pharmaceutical industry jacks up prices on life-saving drugs to extort windfall profits from desperate patients as a matter of course. That’s an immoral way to treat medicine, Quigley argues. The solution? Stop treating medicine as private property—and start treating it as a public good, like education or infrastructure.

It’s one thing to allow private companies and markets to set prices for items like big-screen TVs or cars, Quigley explains via email. In those cases, “purchasers can compare prices and walk away from the transaction if they wish.” But a patient with cancer or a child diagnosed with Type II diabetes can’t just walk away. “That kind of choice is not present when the good in question is life-or-death and there are no options for comparison shopping,” he writes.

 One of the great virtues of Quigley’s book is its explanation of the major role government plays in drug research. Big Pharma has long justified high prices by citing the costs of R & D; as Quigley points out, much of that research is funded with our tax dollars–but drug companies, not taxpayers, enjoy the return on that investment.

Furthermore, drug companies don’t actually funnel the bulk of their profits into research and development. Case in point: Reuters has reported that Pfizer made $45.7 billion in revenue in 2014, of which it spent $14.1 billion on sales and marketing and $8.4 billion on research.

The book details the various ways in which drug companies’ concern for the bottom line takes precedence over concern for the public’s health, and it goes into considerable detail about the perverse public policies that have facilitated those companies’ profitability.

The genesis of those favorable policies? Follow the money.

How did we get to this point? “In the last 40 years, the pharmaceutical industry has deployed billions of dollars of lobbying and political campaign contributions” to change laws to their benefit, Quigley says. One of their most remarkable successes was the 1980 Bayh-Dole Act, which allowed corporations to patent publicly-funded research. This means that pharmaceutical corporations essentially receive monopolies to sell government-created products, “truly one of the most bullet-proof business models in modern history,” Quigley says.

Quigley also takes aim at current patent practices.

The US should even consider ending medicine patents altogether, Quigley argues. “The patent system fails miserably in making medicines available to those who need them,” he says. Studies show that 70% of newly marketed drugs make no therapeutic advances on existing medicines; they are “me-too” drugs that try to carve out a portion of already existing markets for things like cholesterol medication, without bringing any improvements to the table. Furthermore, patents prevent competitors from building on previous research. Expanding grants for patent-free, open-source research would focus medical research on innovation, and make research findings available to everyone immediately, Quigley argues.

Quigley is not the only observer who faults the current patent system; economist Dean Baker goes considerably farther:

Are corporate patent and copyright monopolies a form of government-licensed private taxation? Dean Baker of CEPR thinks so: “Government-granted patent and copyright monopolies are actually much more important in determining future flows of income than debt. In the case of prescription drugs alone, patent and related protections raise the price of drugs by close to $370 billion a year over the free market price, a bit less than 2.0 percent of GDP. This is considerably larger than the current interest burden of the debt, which is approximately 1.6 percent of GDP, net of money refunded from the Federal Reserve Board to the Treasury. These monopolies are effectively like privately collected taxes.”

The book is Prescription for the People.

I know Fran Quigley, I know both his passion and his meticulous attention to fact and evidence. He’s a clear writer and a clear thinker. You should buy the book.


  1. Big pharma has been a major opponent of Cannabis relegalization. In many cases Cannabis is a better medicine than can be produced in a lab, with far fewer negative side effects. They will lose billions of dollars upon relegalization, as well they should.

  2. Big Pharmaceutical companies are having their “cake” of government funded research while feasting on obscenely huge profits, and finally people are connecting the dots to our lobby-bought congress, et al. This new book will further the call for Universal Health Care.
    A heartfelt thank you, Fran Quigley.

  3. If people think the situation is bad now, just wait for the destruction of HHS. Just because Price is gone does not mean that “downsizing” and “cutting the fat” are not still the order of the day for the Trump Administration. Heaven help all of us!

    And while I am ranting, let me say this about the Vietnam War documentary shown on PBS. If it took from the mid-fifties to the mid seventies to end that mountain of government immorality and corruption, what makes us think that voting in 2018 and taking back the Senate is going to end the current wave of immorality and corruption?

  4. Most of us on this blog know about Big Pharma’s ownership of members of Congress and the billions of dollars they spend on lobbying. They fought hard against the original plan for the ACA and managed to get the protection in the final draft that they wanted.

    The problem is – even though the public knows this goes on, it seems that we aren’t able to do anything to stop it because we don’t have the money that it takes to buy members of Congress. Knowledge doesn’t give us any clout at all.

  5. As compelling as arguments for putting medicine in the public sphere, single payer, and the concept of “right to health care” are (I basically agree with all of them), adoption of them all won’t completely resolve the issue. There remains, for example, the issue of who/what process determines priorities in which diseases are to be addressed, and how much should money should be allocated (and when) to drugs to treat them? A government panel? (I am by no means anti-government). Does the child having an extremely rare but fatal malady deserve the same funding priority as tens of thousands who have more common ailments? And how do we deal with the question of self-responsibility for one’s wellbeing? While I detest hateful claims that, for example, those contracting HIV must bear the fatal consequences of “violating God’s law”, it’s hard to ignore completely the concept that human beings do make bad choices in diet (and not always because they are poor) that others who make better choices are expected to fund. (And yes, I still am my brother’s/sister’s keeper).

  6. On a related note – if you subscribe to Netflix there is a recently released movie about whistleblowers at the NSA. It is a real eye opener.

    If you get the chance, please watch “A Good American” on Netflix.

    The reason I knew about it is that my friend from Vienna edited the film. He told me about it two years ago, but it was prevented from being released in this country.

    The billions and billions of dollars that continue to be siphoned from taxpayers and sent straight into the pockets of corporate CEOs and high ranking government officials is obscene. Even more shocking is the fact that our government has had the ability to protect our individual identities and private information, but the powers at NSA chose not to because their pockets wouldn’t have been lined with millions and millions.

  7. As an example of Big Pharma markup and profit; watch the uplifting TV ad for the drug Harvoni for Hepatitis C with no warning of the cost. My daughter is disabled with several life-threatening illnesses; one of them WAS Hepatitis C. Due to her general health condition, she wasn’t deemed worthy using expensive medications or finding help to pay her portion for a new life-saving drug, Harvoni. The 4th or 5th time she was near death due to the Hep C, Eskenazi doctors found someone to cover her $700 PER PILL portion of the $1,152.58 PER PILL for the Harvoni. It cured the Hep C completely which increased her liver function and in turn, aided her other serious illnesses. Her health is much improved, she is still disabled but generally in better health. Research uncovered the fact that it costs $17 PER PILL to manufacture Harvoni.

    Theresa poses a vital question due to the current administration regarding our hopes of “taking back the Senate” in 2018. Getting rid of both McConnell and Ryan, increasing our Democratic odds in the Senate and the House would move us back to conditions in President Obama’s administration prior to January 1, 2010. The Democratic party could not maintain their leverage because they didn’t make use of what leverage they had. Even IF we can gain a Democratic hold in 2018; nothing will change with Trump and Pence in the White House. Our best hope is not to lose any ground till 2020 but Big Pharma and corporate “people” will still maintain their stranglehold on everyone below the 1% no matter who is elected to the presidency.

    Our problems are not only regarding health care; I read recently that it wasn’t the wealthy against $15 minimum wage but those who believe workers in low level positions are not worth that amount because they are unable to function in other jobs. Let them try to get through their days without those “low level position” workers to serve them, including some in health care facilities and their local pharmacies.

  8. When does the greater public good infringe upon the private well being? If I choose to make healthy choices resulting in better health, at what point does my private wellbeing become at risk by having to share more in the cost of medical treatment of others who refused to exercise and depend upon convenience foods to satisfy hunger. Am I being a bit … petulant?

  9. Don; while I support Bernie Sanders’ battle for “single payer” health care for all, I am aware this cannot be an instantaneous solution for a number of reasons. This country’s total health care and tax situations are not geared to healing the sick or providing decent wages so that people can pay for health care, buy food and medication. Everything connected to health care is now big business and aimed only at higher and higher profits. Both health care and taxes are aimed at keeping the wealthy, wealthy and making them wealthier.

    President Obama was completely open when the ACA was enacted regarding the fact that it needs work; not even including large sections written but not passed under the George W. administration could get the Republicans to work with Democrats to resolve the known problems. And here we are today with more problems and NO leadership at any level of government. Single payer health care is a goal to aim for and WORK to accomplish; imagine the mess if suddenly a single payer bill was enacted before all other connected problems were eased or resolved.

    By the way; anyone know how Gen. Kelly’s health is holding up babysitting Trump, his family and the dwindling appointees in the White House?

  10. I believe that the amount of marketing is undercounted. Phase 4 clinical trials are primarily marketing trials, but still looked upon as research.

    In a perfect world the NIH’s orphan drug program would be much bigger than it is and we wouldn’t spend so much money on drugs for diseases we can already control with medications or diet and exercise. I agree with Professor Quigley that we shouldn’t have patents for medical drugs or devices. Too often, money is spent on trying to find ways to extend the life of the most profitable patents to the detriment of real breakthroughs in medical science.

  11. JoAnn, your example about your daughter shows just how greedy and hard-hearted our government reps are and how they have no problem at all getting into bed with the pharmaceutical industry or other powerful industries who are willing to line their pockets and make sure they keep their jobs in DC. I am glad that your daughter finally received the financial assistance that she needed. However, if the profit margin on $17 cost to make those pills was reasonable, she most likely could have afforded to buy them on her own and would have been healthier much sooner.

    We sometimes wonder how those people sleep at night. I believe they manage to insulate themselves from the harsh realities that they participate in causing and that keeps them from having to face their true selves in the mirror.

    If John McCain had not been diagnosed with a life-threatening cancer just before a vote to destroy the ACA took place in July, I believe that he would have followed party lines and voted to end it. However, it seems that his own fatal diagnosis woke him up to the realities that millions face every day, but would not have access to the care they need if it wasn’t for the ACA. I do believe this was divine intervention at work.

  12. As mentioned above, the R&D justification for high Rx prices doesn’t survive scrutiny. Recent research has discovered that Pharma companies spend much more on stock buy-backs and dividends to shareholders than they spend on research and development. Also, just the difference in prices here vs Europe pays for over 160% of worldwide private R&D spending.

  13. As an aside, but one that will certainly affect many of those on expensive medication, CHIP was not extended. It expired yesterday. Nine million children and poor pregnant women will go without necessary life-saving and preventive care because greedy, self-interested Congressmen could not find a way to get to it for a vote.
    We have to rank among the most inhumane country in the world. We have the resources but refuse to offer them to those most in need.

  14. Why should anyone be surprised at the price gouging of Big Pharma? Their corporate officers have been openly saying for years that they are in business to make money, not cure people. With the egregious addition of Medicare Part D, the Bush administration took all constraints off price controls through market pressures. This law disallowed Medicare from negotiating best prices.

    Furthermore, since the rest of the world caps drug prices, Big Pharma makes up the difference in promised revenues and revenue increases to their stockholders, by running up the U.S. prices. Considering the number of lobbyists Big Pharma employs, it is clear what they’re doing with another piece of that revenue. Shockingly, bribing the Congress isn’t all that expensive.

    If we listen carefully, we can hear Karl Marx laughing is head off. He predicted that unfettered capitalism would destroy itself from within. By adopting the philosophy of: “How much will you pay to live a little longer or not hurt?”, Big Pharma is working very hard to fulfill that prediction.

    The rest of the civilized governments see no major issue with investing in their people, while we continue to do everything in our power to make sure that the rich people get richer even if it’s off the backs of the sick, the elderly or, for that matter, anyone who needs medication for anything.

    Did your author voice her disgust at the money changers in the temple of well-being?

  15. On a brighter note, former wingnut thug congressman and even former head of HHS, Tom Price is a shoe-in to land a multi-million dollar gig as a congressional lobbyist for big pharma. Only question is how soon he can make the move. Ethics and written law won’t stand in his way. Neither will wingnuts in congress.

  16. JoAnn Green, here’s hoping for better times for you and your daughter. Big Pharma can go to HELL!

  17. From the above: “One of their most remarkable successes was the 1980 Bayh-Dole Act, which allowed corporations to patent publicly-funded research.”

    A good example of Bipartisan – Republicratism. Translation the people get screwed by both parties.

    The Bayh, in the Bayh-Dole Act, was Birch Bayh. Birch was the father of Evan Bayh, who married Susan Bayh.

    Now from a news article dated Oct 29, 2009:
    Evan Bayh, the junior senator from Indiana, is in the middle of a heated debate in the Senate on whether a public option should be included as part of President Obama’s health care reforms. He’s worried aloud that any public option would be a nod to socialism and counter to his principles as a fiscal conservative. When pressed on the issue, he’s said he’s simply a vessel reflecting the views of his Indiana constituents.

    His wife, Susan Bayh, sits on the board of WellPoint ( WLP) in her hometown of Indianapolis. Over the last six years, Susan Bayh has received at least $2 million in compensation from WellPoint alone for serving on its board.

    She joined Anthem Insurance (the precursor organization to WellPoint) in 1998, when she was 38 years old and a midlevel attorney working for Eli Lilly ( LLY). Her work experience prior to her stint at Lilly was five years as a junior law professor at Butler University in Indianapolis. Her work background at the time she was appointed to the Anthem board would have been surprising, given that she had no insurance experience and was relatively young and inexperienced to serve as a director on a multibillion-dollar board.

    However, Susan Bayh had one competitive advantage that made her stand out as attractive to Anthem: She was married to Evan Bayh — former governor of Indiana who, in 1998, was elected to the U.S. Senate.

  18. Thanks, Nancy; another government “health care” ripoff is Medicaid for those who were suddenly seriously ill or injured to the point of disability. My son was a brick mason in Florida, made a nice living; he was also one who helped those in need, often buying food for homeless he saw along the road. He would hire those who wanted work. He was rear-ended on the highway resulting in 7 fractured vertebrae and was fully disabled. He sold belongings to live but had no health care; used food pantries to eat till finally, with the help of his vehicle insurance attorney, qualified for food stamps. It took 14-15 months for the attorney to qualify him for Medicaid; their doctors diagnosed Mark with terminal cancer. The pain treatments alone for his fractured spine were $800 each. It took another year for him to be approved for Social Security Disability; he repaid me (which I did NOT want) with part of his retroactive Disability check. Received his first monthly check for $1,495 on a Monday, that Friday he received his cancelled Medicaid notification due to his income being too high. I wrote to Michelle Obama who forwarded my letter to the district Medicaid/Medicare office who contacted me, included a form for him to apply for special “medically needy” Medicaid assistance. He qualified but…that required he spend $1,210 each month from his $1,495 Disability check for his medical needs which would qualify him for a small percentage of assistance with his medical payments. He couldn’t live on $285 monthly so refused their “assistance”, got what little medical care he could on his own. He was found dead on his living room floor less than 18 months after receiving his first Disability check. He was 55 years old.

  19. JoAnn, your family has been hit with more health and financial disasters than any family should ever have to endure. I am so sorry.

  20. Lots of great comments this morning and I especially like Theresa Bowers remarks regarding how like Vietnam the problem before us is much more than the 2018 election. I can only add a quote I heard from Comedian Lewis Black, “…we’re the only country on the planet to turn illness into a goldmine.” It will be difficult to convince the powers that be it should be otherwise.

  21. It was that capable people interested in improving the country became at least temporary public servants for mostly non-financial reward.

    Now every politician it seems is a corporation selling influence to other corporations in return for votes delivered through advertising, largely fake news, funded or provided by their corporate customers.

    Like all corporations, individual political corporations follow the one rule of make more money regardless of the impact on others.

    It has rendered democracy dysfunctional.

    Now what?

  22. Thanks, Sheila. I appreciate the shout-out for the cause! (And being called a “clear writer” by the most skilled communicator I know is the icing on the cake . . .) If anyone here knows groups or individuals who may be interested in getting involved in advocacy on access to medicines, please let us know at People of Faith for Access to Medicines, We are pushing hard to change this toxic system!

  23. Big Pharma is no different from other corporations, though their unpaid use of government-sponsored research which they subsquently patent (and thus monopolize) is added to the usual taxpayer dole of tax cuts, tax loopholes and other corporate welfare trickledown benefits lavished on the rich and corporate class, but which, because their products involve life, death and suffering rather than assembling widgets, makes their efforts seem particularly reprehensible. Such corporate welfare added to Big Pharma’s greed and misconduct in pricing makes nationalizing their industry increasingly attractive.

  24. Another good work is “An American Sickness: How Health Care Became Big Bussiness and how
    you can take it back”. Dr. Elizabeth Rosenthal, who is also editor of The Kiser Health News Foundation. She also reported similar policy roadblocks for American patients.

  25. I had an idea that congressmen should be required to wear sponsors (donors) logos on their clothing when they are in session and campaigning – like pro golfers. Make it clear whose interests they really represent.

  26. daleb – Good idea! And let’s extend such labeling to the executive and judicial branches as well, including appointed secretaries of the various agencies they were appointed to destroy, such as, for instance, Betsy DeVos, the Darth Vader of public education.

  27. Nancy; I am back again with another family member story, a greatly extended family member but family, nonetheless. Zane Davidson’s story and a few others are on the front page of the Star this morning; Zane is my sister-in-law’s nephew. I ranted about this situation before, some will remember. He was one of what the state of Indiana public health officials refused to classify as part of a “cancer cluster” in Johnson County about 2 years ago. It is doubtful that they even investigated the known polluted areas or the polluters, Indianapolis cannot even end the direct dumping of hazardous waste into our waterways here in the capital city. With Pence as protection from forcing the issue; it is doubtful investigations will be done or research into the area due to Trump’s attempts to decimate the EPA.

    The public health officials in Johnson County stated originally that it was NOT a “cancer cluster” due to the different types of cancer diagnosed. Obviously they have swept under the rug Karen Silkwood’s reported different types of plutonium cancers connected to Kerr-McGee’s carelessness in Oklahoma. Karen was obviously murdered before she could supply full information but Kerr-McGee is long gone…the plutonium cannot be safely stored or destroyed as easily as Karen Silkwood was. They have also forgotten Love Canal; which at last report was still a deserted ghost-town situation due to dumping hazardous waste and many cancers. Also lost is Erin Brockovich and her discoveries of many types of cancer due to Pacific Gas and Electric dumping hazardous waste into California ground, contaminating many waterways. Jon Schlictman in Boston lost everything trying to get the government to at least investigate Beatrice Foods (Bird’s Eye frozen foods, Peter Pan peanut butter, et al.) dumping hazardous waste causing different types of cancers.

    Johnson County now has nearly 40 – FORTY – confirmed cases of childhood cancer diagnosed in the county since 2010. Many county residents believe (and reported) contamination of the Webb Wellfield from area manufacturers and industry is “a likely contributor” and has been known by State agencies for decades. If nearly FORTY childhood cancers in one Indiana county is not a “cancer cluster” – what is?

Comments are closed.