The opi­ate of the bosses

Financial Mirror (Cyprus) - - FRONT PAGE -

The cyn­i­cism with which phar­ma­ceu­ti­cal firms have en­cour­aged opi­oid drug use is ap­palling. Pro­vid­ing far too lit­tle anal­y­sis and over­sight, they dis­trib­ute opi­ates widely, along­side mis­in­for­ma­tion about how ad­dic­tive the drugs truly are. Then they en­tice doc­tors with in­duce­ments and give­aways – in­clud­ing trips, toys, fish­ing hats and, in one case, a mu­sic CD called “Get in the Swing with OxyCon­tin” (one of the most pop­u­lar opi­oids) – to pre­scribe them.

In 2007, sev­eral ex­ec­u­tives of the par­ent com­pany of Purdue Pharma, which mar­kets OxyCon­tin, pleaded guilty to mis­lead­ing doc­tors, reg­u­la­tors and pa­tients about the risk of ad­dic­tion as­so­ci­ated with the drug. The com­pany was hit with some $600 mln in fines and penal­ties.

Yet Big Pharma was un­de­terred. In the decade since, the dis­tri­bu­tion of opi­oid drugs has ex­panded sub­stan­tially, driv­ing a rapid in­crease in ad­dic­tion and death rates. Mul­ti­ple state at­tor­neys gen­eral are now tak­ing drug man­u­fac­tur­ers – in­clud­ing Purdue Pharma, John­son & John­son, Endo Health So­lu­tions, Inc., and their sub­sidiaries – to court for mar­ket­ing and dis­tribut­ing their prod­ucts by “ne­far­i­ous and de­cep­tive” means.

Of course, Big Pharma is tread­ing a well­worn path. En­ergy com­pa­nies have long been known to make false state­ments about cli­mate change in­ten­tion­ally, just as min­ing com­pa­nies and man­u­fac­tur­ing firms, whether in cloth­ing or tech, have per­sis­tently turned a blind eye to ter­ri­ble, even abu­sive, con­di­tions faced by their work­ers.

In 1994, the so-called Cig­a­rette Pa­pers, some 4,000 pages of in­ter­nal doc­u­ments leaked from the tobacco com­pany Brown & Wil­liamson, showed that the in­dus­try en­gaged for years in a pub­lic cam­paign to deny the ad­dic­tive qual­i­ties of nico­tine and the health haz­ards of smok­ing, de­spite in­dus­try-funded re­search show­ing other­wise.

This year, new in­ves­ti­ga­tions, in­clud­ing by the World Health Or­gan­i­sa­tion, showed that ma­jor tobacco com­pa­nies like Philip Mor­ris have con­tin­ued to use covert and il­licit tac­tics to ad­vance their busi­ness in­ter­ests, at the ex­pense of pub­lic health.

All of this high­lights the fun­da­men­tal flaw in the ar­gu­ment that large-scale dereg­u­la­tion, such as that ad­vo­cated by US Pres­i­dent Don­ald Trump, ben­e­fits so­ci­eties. Yes, elim­i­nat­ing reg­u­la­tion can help com­pa­nies to in­crease their profits. But at what cost?

The opi­oid

epi­demic,

for

ex­am­ple,

has be­come a heavy bur­den for the US gov­ern­ment (and thus tax­pay­ers), as it has strained law en­force­ment and the health sys­tem. And that does not even in­clude the costs borne by the epi­demic’s vic­tims and their fam­i­lies and com­mu­ni­ties. Even fu­neral di­rec­tors are fac­ing new risks and chal­lenges, from deal­ing with over­dose vic­tims’ rel­a­tives to safe han­dling of vic­tims’ bod­ies.

Mean­while, the com­pa­nies that have so glee­fully en­riched their ex­ec­u­tives and share­hold­ers typ­i­cally face lit­tle, if any, blow­back from their il­licit or un­eth­i­cal ac­tiv­i­ties. Even when they do, other com­pa­nies and in­dus­tries don’t seem to learn from it – or, worse, they learn the wrong lessons.

The les­son phar­ma­ceu­ti­cal com­pa­nies seem to have taken from the chal­lenges to Big Tobacco is to hide their ac­tiv­i­ties bet­ter, rather than to be bet­ter. Per­haps they as­sumed they would have more lee­way, be­cause they also pro­duce life-sav­ing med­i­ca­tions.

The good news is that pres­sure on com­pa­nies is mount­ing, not least be­cause some in­vestors are be­com­ing jit­tery. Last month, a coali­tion of unions, pub­lic pen­sion funds, state trea­sur­ers, and oth­ers es­tab­lished the In­vestors for Opi­oid Ac­count­abil­ity. Bring­ing their col­lec­tive $1.3 trln in as­sets to bear, the coali­tion’s mem­bers plan to scru­ti­nize the ac­tions of boards of di­rec­tors more closely, in or­der to strengthen ac­count­abil­ity and en­cour­age in­de­pen­dent board lead­er­ship.

The No­bel lau­re­ate econ­o­mist Mil­ton Fried­man fa­mously ar­gues that the only so­cial re­spon­si­bil­ity of busi­ness is to max­imise profits. But, when firms’ ef­forts to cre­ate share­holder value lead to such far­reach­ing con­se­quences – or “ex­ter­nal­i­ties,” in economists’ par­lance – for the rest of so­ci­ety, the ar­gu­ment that self-in­ter­est ad­vances so­cial wel­fare falls apart.

Physi­cians are bound by the Hip­po­cratic

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