In a recent research report on the financial prospects of genome editing treatments for biotech companies, financial giant Goldman Sachs inadvertently sparked outrage by asking whether curing patients constitutes “a sustainable business model.” The report notes that while curing diseases is, in fact, the point of medicine, it is difficult to maintain “sustained cash flow” to developers and researchers when people do not require prolonged treatment. The reaction from the media and the general public was, predictably, one of immediate anger.
However, the real reason for the profound discomfort this question causes goes deeper than this incident, and even deeper than the matter of genetic engineering or the influence of Goldman Sachs. The disturbing truth that underlies these discussions is that in a system where the responsibility of developing life-saving medication falls to profit-seeking corporations, the question posed in the report is unavoidable.
It is more the crassness of seeing it stated so plainly that inspires disgust than it is the actual calculation behind it. The state of healthcare for much of the population of this country would be regarded as a human rights violation if society had not decided that the tradeoff of certain people being denied refuge from illness was worth the supposed benefits of a private, profit-driven medical-industrial complex. For the most part, the calculus of this decision is obscured by a byzantine healthcare system so exhausting and expensive to navigate that engaging with it rarely leaves time to examine the fundamental root of the misery it creates: the irreconcilable conflict between the philosophical aims of medicine and the profit motive.
Any student who takes enough biology courses will inevitably happen upon the name of Rudolf Virchow, a late 19th century Prussian biomedical scientist. Outside of the laboratory, however, Virchow is notable for an arguably greater contribution to the betterment of the human condition: he was one of the earliest and most ardent activists for a social and political understanding of health justice. In Virchow’s view, the role of the doctor in society was not simply that of a dispassionate scientist, nor was it enough to simply hope that the machinations of political and economic power would optimally distribute health care on their own. Rather, Virchow wrote, “The physician is the natural attorney of the poor,” and “Medicine is a social science, and politics nothing but medicine at a larger scale.”
Juxtaposed against these lofty ideals, Pfizer’s decision to discontinue research in Alzheimer’s and Parkinson’s treatment — a decision justified in a press release as bringing “the most value for shareholders and patients” — is even more striking. So is the announcement that the family that owns Purdue Pharma, infamous for its aggressive and allegedly misleading marketing of OxyContin for decades, made the 2015 list of Forbes’ richest U.S. families just as the full horror of the opioid epidemic began to enter the public consciousness. These phenomena are not isolated incidents resulting from a failing system, but rather the urge to maximize profit working as intended. If the entire justification for a profit-driven health industry relies on the notion that it will create optimal healthcare outcomes for the rest of society, it is necessary to examine whether it is actually doing so. If not, it must be asked whether there really is no better allocation of resources than one that creates massive profits for pharmaceutical and insurance executives while deepening income inequality and driving patients into unbearable debt.
There is no easy solution for remaking the leviathan of the American healthcare system. Even the most idealistic supporters of single-payer healthcare will admit they face an uphill battle, particularly given the massive influence that multibillion dollar industries like insurance and pharmaceuticals wield. Change, however, begins first with the acknowledgement that the current conditions are unacceptable, and second, perhaps more importantly, with the affirmation that better things are possible and that tomorrow is not constrained by the failures of yesterday. If Virchow was right and politics truly is medicine on a large scale, it is long past time this nation acknowledges the sickness infecting its body politic — not only as a series of isolated incidents, but as a systemic crisis in need of transformation.
