Defenders of capitalism might argue that without a system of renumeration tied to productivity, advancements, scientific or otherwise, will come more slowly. They might point out that, for all its flaws, the hyper-capitalist United States has lead the world in space exploration, in biomedical research, in nuclear development, etc. That even if money is more and more unequally distributed, most people benefit from the vaccines cooked up, the antibiotics discovered, the blood pressure medications developed. When one views science as the primary implement of improving the world and also sees science as a competition, capitalism seems like a perfect dance partner. Scientists can be pushed to develop life-saving and life-sustaining products by the joint allure of profit and personal recognition. Is it possible that this system has become perverted? Sure. It is possible that science has been co-opted by the capitalist machinery to make the inhumane economic system more tolerable? Absolutely. Many scientific advances are only necessary to counter problems that have been ‘pioneered’ by a capitalist system that has runaway. Even if capitalism has pushed scientific advances forward, it has also undoubtedly created the conditions that make such speedy science necessary. By pointing out examples of our capitalist society creating a ‘demand’ and scientists responding to that ‘demand,’ I want to shed light on how alternative economic models would not bring scientific advance to a grinding halt but rather can synergize to benefit humans at unprecedented levels.
One of the most abhorrent concepts prevalent in a capitalist, profit-driven society is artificial demand. Consider the marketing practices that have made diamond engagement rings the symbol of a loving relationship. In 1938, De Beers launched the immensely successful “Diamonds are Forever” campaign that has successfully equated diamonds with love. Yet, we don’t need diamonds. This is not an example of capitalism providing for the needs of the people but creating a need. The ‘need’ had been met by use of slave labour with a healthy dose of artificial scarcity to maintain high prices.[i, ii] Perhaps even more insidious are the ‘artificial’ demands brought about as by-products of accelerating-profit models of capitalism. These by-products are not addressed directly by the companies at fault but instead by other industries that have emerged to make society tolerable in an industrial world. Tobacco companies knowingly sell toxic, cancer-causing, and addictive products while pfizer makes millions a dollars a year by selling chemotherapy for lung cancer. Food manufacturers sell addictive and sugar-loaded products, hiding information that link such food stuffs to a whole slew of health disorders, and a whole industry has arisen around treating type II diabetes. Not a single scientific talk that I have attended on the topic of lung cancer or type II diabetes has addressed that the necessity of their work does not arise from the natural tendency of the human body but almost entirely from the greed of corporations that care more about selling products than the health of consumers. Scientists take on a air of nobility, as stoic individuals tackling the problems of the day. From this perspective, big pharma is seen as a necessary evil, providing the capital and (profit) motivation necessary to develop therapeutics. Thus, many scientists have come to accept the capitalist machinery as necessary for their work. This is despite most scientists working under socialist conditions, being publicly funded by tax-payers.
Let’s first talk about lung cancer and smoking. It 1950, the first large-scale study linked smoking cigarettes with lung cancer.[iii] Shortly after, in 1953, the major tobacco companies in the United States approved of a large-scale disinformation campaign to muddy the waters.[iv] PR companies planted stories suggesting other causes for the increased incidence of lung cancer and teenagers were aggressively targeted with ads to maintain their consumer base all while tobacco companies denied that cigarettes were addictive or unhealthy. Eventually, it became undeniable that smoking causes cancer and rates of smoking have been plummeting in much of the Western world. Yet, a new industry has arisen; treating lung cancer. If one googles “lung cancer market,” you might feel uneasy about the number of market research firms offering portfolios that have latched onto the growing market for lung cancer globally (due to a long latency period between smoking and lung carcinogenesis, lung cancer stills kills 1 in 14 Canadians). This billion dollar-a-year market is presented as a wonderful investment opportunity. Of course the pharmaceutical industry is about making profit and no CEO is going to look the gift horse in the mouth. Yet, scientists at non-profit Universities are on board, spending tax-payer dollars to research potential therapies that, if promising, will be patented and sold to for-profit conglomerates. Thus, the efforts of scientists are co-opted to ease the suffering of the victims of the tragic scam pulled by tobacco companies. In addition to the scientists trying to minimize the by-products of capitalism, social forces are also at work to shift the blame from corporations to the individual. Stigma about being a smoker is on the rise and a tension emerges in science.[v] Despite being a leading killer in the united states, lung cancer is underfunded by the federal government, in part due to biases surrounding the perceived “personal” choice to smoke.[vi] If scientists can’t save your life, don’t expect to much sympathy for your abuse at the hands of greedy corporations.
How about type II diabetes? Or other complications that can be brought about by obesity? These are becoming even more prevalent, with nearly half a billion people living with type II diabetes around the world.[vii] What is driving this epidemic? At a scientific talk, little will be discussed about the social determinants of health. But poorly walkable and impoverished urban centres, where sugar-laden food stuffs are among the only options contribute to the problem.[viii] As does the marketing of sugary breakfast cereals specifically to impressionable children.[ix] The Sugar Research Fund (SRF), which has ties with The Sugar Association (a trade association in the United States for the sucrose industry), secretly funded a review in the influential New England Journal of Medicine that disputed any connection between a high-sucrose diet and heart disease.[x] And, just like the tobacco industry, the SRF buried scientific studies that linked a high-sucrose diet to heart disease.[x] This is capitalism. This is putting profit before all else. Yet, rather than severely impinging on life span, scientists, ever heroic, arrive on the scene to develop therapies. Concurrently, the discussion is shifted from holding corporations culpable to blaming the individual. Further towards the stigmatization of obese individuals society does step.[xi] Doctors can be cruel and non-compassionate to their obese patients while pharmaceutical companies thrive in the market that has emerged for medications that keep people alive. Scientists keep people alive and societal forces (social media, movies, healthcare) mobilize to blame the individual not the corporation.
It is tempting to simply argue that these are isolated cases. That, despite pockets of suffering, the capitalist machine is also self-correcting and ultimately helps keep people, and our planet, healthy. Bollocks. Consider antibiotic resistance. Since the golden era of antibiotics (half of all commonly antibiotics currently in use were discovered in the 1950s), antibiotic resistant bacteria have become more and more common.[xii] Infectious diseases that used to be easily treated are now able to kill once again. 700, 000 people die a year from antibiotic resistance bacteria.[xiii] We are in crisis mode. But wait, doesn’t the emergence of antibiotic resistance simply renew demand for new antibiotics, making the development of such life-saving drugs profitable? That is what I used to think. Instead, company after company have abandoned their antibacterial research programs. In fact, only four pharmaceutical companies remain in the field of antibacterial research.[xiii] In October of 2018, I was treated to a cynical talk given by Dr. Jenn Leeds, who was the head of antibacterial research at Novartis, a major pharmaceutical company. They are no longer head of antibacterial research because antibacterial research is no longer conducted at Novartis. Why? It is simply not profitable enough. Dr. Leeds discussed how newly developed antibiotics will not replace old antibiotics for first-line treatment but would be held in reserve for treating cases of antibiotic resistance. This alone would decrease the ‘consumer’ base and with the FDA requiring plenty of safety data, the price of development is high. Simply put, despite widespread recognition that antibiotic resistance is threat (present and growing) to human society, if corporations aren’t getting paid, do not expect them to develop drugs from a place of goodwill.
Why are antibiotic resistant bacteria becoming more common? The vast majority of antibiotics are not used to treat human infections but are instead added as a supplement to the feed used in industrial agriculture.[xiv] The use of antibiotics keeps animals alive in unhygienic, crowded factory farms and also stimulates growth. At the same time, the large-scale use of antibiotics allows for efficient selection of bacteria with innate resistance, allowing for the emergence of antibiotic resistant bacteria that can infect humans through contact with animal products during slaughter, butchering, packaging, and consumption. Again, a serious and growing health concern that stands to directly affect all humans on this planet was brought about by corporate greed. And the capitalist system has washed its hand of responsibility because dealing with the problem, within the agricultural or pharmaceutical industry, is simply not profitable. While scientists struggle to reign in the problem, much blame has been cast on the average person. Rather than blame industrial farming corporations, ill patients asking (or demanding) antibiotics for viral infections are tossed under the bus. The WHO first discusses how the individual can help mitigate the antibacterial resistance crisis before talking about how the agricultural industry can be reformed; everything else written by the WHO suggests that the individual and the corporation are equally culpable.
Not only do for-profit corporations fall to the spectre of the mighty dollar, the capitalist urge has infected the university mode of research. At a recent talk by a graduate student at the University of Toronto, a research program screening drugs for a severe skin disorder was discussed. Having screened half a million or so drugs, approx. a dozen candidates were discovered. Due to the ongoing patent process, only one drug could be identified to the audience. This is quite typical. But more egregious, the PhD student off-hand mentioned that they were only following up on the drugs that could be patented, in keeping with university’s mandate. The moderator, of the socialist persuasion, interrupted to clarify that, indeed, the tax-payer funded research at the university was being guided by considerations of profit, not societal benefit. The drug that was candidly discussed was actually a natural product that cannot be patented. If this drug was developed as a therapeutic, it would be affordable for all people. But this is become less and less the priority, even at tax-payer funded institutions, which are beginning to resemble corporations.
I will end with one last anecdote from a graduate student presentation at the University of Toronto. This student was asked to give a special talk for authoring the best paper published in the past year. The talk outlined a research program into the mechanisms of pexophagy, a cellular process of recycling the peroxisome, an organelle involved in the break-down of fatty acids. The science was exciting for identifying a key protein involved pexophagy and how the process of pexophagy can be upregulated during cellular stress caused by amino acid starvation. However, every talk is framed. And this talk was framed by a discussion of kwashiorkor, a condition caused by a diet severely deficient in protein but that otherwise provides enough calories. The most notable symptom is the distended abdomen. One observation made by the scientists was that peroxisome numbers were decreased in liver tissue taken from individuals with kwashiorkor, which is similarly observed in animals starved of amino acids. By identifying key molecular players in this process, they were excited at the prospect of developing a drug to treat kwashiorkor. My head snapped. I looked around the room. Nobody seemed aghast. Was I going crazy? There already a cure for kwashiorkor. It is called protein. One shortcoming of the scientific method is that scientists begin seeing the world as a collection of scientific problems. Not everything problem requires a new pill. I contend that many ills can be prevented by an equitable distribution of materials.
We labour under the myth that capitalism is the ideal system for providing the impetus for advancement and progress in the fields of health and technology. Ignoring the question as to what truly matters in life, I argue that capitalism is responsible for many of the most pressing scientific challenges. In the quest for profit, corporations create as a side-effect entirely new markets. New companies, under a capitalist model, arise to make profit off of the sickness brought about. Or not. Because capitalist corporations are under no obligation to develop life-saving or earth-saving technologies and medications if they are not profitable. While a socialist model can satisfy these societal needs, the classic model of socialist research (i.e. the university) has been co-opted by the capitalist scheme. With a redistribution of material and alleviation of the profit motive, not only can the ails of society be minimized, materials can be mobilized to defend the planet and the health of its citizenry.
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[ii] Turrell, R. (1982). Rhodes, de beers, and monopoly. The Journal of Imperial and Commonwealth History, 10(3), 311-343.
[iii] Doll, R., & Hill, A. B. (1950). Smoking and carcinoma of the lung. British medical journal, 2(4682), 739.
[iv] Proctor, R. N. (1996). Smokescreen: The Truth Behind the Tobacco Industry Cover-up. JAMA, 276(12), 998-998.
[v] Stuber, J., Galea, S., & Link, B. G. (2008). Smoking and the emergence of a stigmatized social status. Social science & medicine, 67(3), 420-430.
[vi] Carter, A. J., & Nguyen, C. N. (2012). A comparison of cancer burden and research spending reveals discrepancies in the distribution of research funding. BMC public health, 12(1), 526.
[vii] Unnikrishnan, R., Pradeepa, R., Joshi, S. R., & Mohan, V. (2017). Type 2 diabetes: demystifying the global epidemic. Diabetes, 66(6), 1432-1442.
[viii] Auchincloss, A. H., Roux, A. V. D., Mujahid, M. S., Shen, M., Bertoni, A. G., & Carnethon, M. R. (2009). Neighborhood resources for physical activity and healthy foods and incidence of type 2 diabetes mellitus: the Multi-Ethnic study of Atherosclerosis. Archives of internal medicine, 169(18), 1698-1704.
[ix] Schwartz, M. B., Ross, C., Harris, J. L., Jernigan, D. H., Siegel, M., Ostroff, J., & Brownell, K. D. (2010). Breakfast cereal industry pledges to self-regulate advertising to youth: will they improve the marketing landscape?. Journal of public health policy, 31(1), 59-73.
[x] Kearns, C. E., Apollonio, D., & Glantz, S. A. (2017). Sugar industry sponsorship of germ-free rodent studies linking sucrose to hyperlipidemia and cancer: An historical analysis of internal documents. PLoS biology, 15(11), e2003460.
[xi] Clair, M., Daniel, C., & Lamont, M. (2016). Destigmatization and health: cultural constructions and the long-term reduction of stigma. Social science & medicine, 165, 223-232.
[xii] Davies, J. (2006). Where have all the antibiotics gone?. Canadian Journal of Infectious Diseases and Medical Microbiology, 17(5), 287-290.
[xiii] Wanted: a reward for antibiotic development. (2018). Nature Biotechnology, 36(7), 555.
[xiv] Silbergeld, E. K., Graham, J., & Price, L. B. (2008). Industrial food animal production, antimicrobial resistance, and human health. Annu. Rev. Public Health, 29, 151-169.