Abstract
In this paper, I will argue that the current discussions about regulating certain activities concerning the pharmaceutical industry do miss a crucial point. The Pharmaceutical Industry is a story of success, providing a wealth of new discoveries and applied technologies, which have greatly enhanced our lives. The current call for strict regulation of the Pharmaceutical Industry makes the unwarranted assumption that such regulation will not disturb the mechanisms of the Industry’s success. I will claim that a centralised regulation profoundly transforms the direction of travel. I will also claim that the role of the executive in bypassing regulations creates a parallel industry of subsidiary regulations to counter such bypassing. The predictable consequence is the increasing role of central regulatory control and the progressive slowing down of the success of the Pharmaceutical Industry leading towards an undesirable mediocrity. The conclusion I wish to advance is that our choices are not limited to ‘a wild open market’ and ‘a regulated open market’ scenarios, and the strategy to avoid a robustly regulated but mediocre Pharmaceutical Industry may involve ‘non-open market scenarios’ which have so far been absent from the alternatives discussed.
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Notes
The comment that it only takes one black swan to prove that not all swans are white (regardless of how many white swans one may have counted) is a popular expression of David Hume’s observations on the problems of inductive logic. Here it stands for those facts that stand out from the view that regulation is not an impediment to success.
While Doyal states this in ‘corporative advantage’ speech—that the 1911 Act “offered more freedom (for physicians) to practice medicine as they chose, and there was general agreement that it probably doubled the pay of the average doctor” (Doyal 1985, p. 169)—for a Profession which prides itself in advocating for the benefit of the patient, this increased freedom was indeed a widened scope to protect and provide for the patient.
Doyal, for instance, refers to the 1911 National Health Insurance Act as being designed to ‘improve national efficiency’ (Doyal 1985, p. 166). This is further made clear from the Report of the Actuaries from 21st March 1910, which Doyal quotes: “married women living with their husbands need not be included, since where the unit is the family, it is the husband’s and not the wife’s health which is important to insure”. (Doyal 1985, p. 167).
For example, Kelman’s Marxian approach is illustrative: a population is "optimally functional for health if the last increment of resources directed towards health contributes as much to overall productivity and accumulation as it would if diverted toward direct capital investment" (Kelman 1975).
Sheila Rowbotham describes the growing intervention of the state as a protection of future productive capacity, even if introduced as ‘leftist’ policies. Quoted in: (Doyal 1985, p. 170).
The concern that different Commissioning Consortia would be obliged to operate under competition law, and therefore restricted in their ability to cooperate between them or with NHS Trusts, was publicly stated at the Nottingham LMC meeting 28/09/10 and acknowledged there by Dr Peter Holden, a member of the General Practice Committee of the BMA currently considering the implications of the White paper.
With “one in seven board members of first-wave consortia has a link to a private company” and “one in 10 consortium board members were directors of private providers”, it is no surprise that “19 of the 52 first-wave pathfinder consortia had board members with interests in commercial providers” and in three cases these members were at least 50% of the board (Iacobucci and Slater 2011).
The presentations by the GP’s involved in running Serco Health, Health at Work, Nations Healthcare at the Bart Debate “Views from the Dark Side” organised by the Nottingham Medico-Chirurgical Society on the 13th of May 2010 were illuminating in this respect.
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Calinas-Correia, J. Big pharma: a story of success in a market economy. Med Health Care and Philos 16, 305–309 (2013). https://doi.org/10.1007/s11019-012-9384-x
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DOI: https://doi.org/10.1007/s11019-012-9384-x