The Guardian

How big pharma’s money – and its politicians – feed the US opioid crisis

Tom Marino might have withdrawn from consideration as Trump’s drug czar, but drug money is coursing through the veins of Congress – contributing directly to an epidemic that kills thousands of Americans each year.

The pharmaceutical industry attempted to place blame for the crisis on the millions who have became addicted instead of the mass prescribing of powerful opioids. Photograph: Dominick Reuter/AFP/Getty Images

 

Chris McGreal, in Washington         October 19, 2017 

Donald Trump was not wrong. Hours before his nominee for “drug czar” withdrew from consideration over his part in a law limiting the Drug Enforcement Administration’s ability to crack down on pharmaceutical distributors feeding the US’s opioid epidemic, the president took a shot at the influence of drug companies over Congress.

“They contribute massive amounts of money to political people,” he said, standing next to Mitch McConnell, the Senate majority leader.

“I don’t know, Mitch, maybe even to you,” he added.

Trump was right on both counts. Pharmaceutical companies spend far more than any other industry to influence politicians. Drug makers have poured close to $2.5bn into lobbying and funding members of Congress over the past decade.

Hundreds of thousands of dollars have gone to McConnell – although he is hardly alone. Nine out of 10 members of the House of Representatives and all but three of the US’s 100 senators have taken campaign contributions from pharmaceutical companies seeking to affect legislation on everything from the cost of drugs to how new medicines are approved.

Trump’s nominee for drug czar, the US congressman Tom Marino, was forced to withdraw after a report by the Washington Post and CBS’s 60 Minutes highlighted his role in forging legislation that hinders the DEA’s ability to move against drug distributors or pharmacies recklessly dispensing the opioid painkillers at the heart of the epidemic, which claims more than 100 lives a day.

Marino’s acceptance of substantial donations from those same companies compromised his nomination to head the federal agency charged with tackling the opioid crisis.

But for Congress, the process was nothing unusual. Hundreds of millions of dollars flow to lobbyists and politicians on Capitol Hill each year to shape laws and policies that keep drug company profits growing. The pharmaceutical industry, which has about two lobbyists for every member of Congress, spent $152m on influencing legislation in 2016, according to the Center for Responsive Politics. Drug companies also contributed more than $20m directly to political campaigns last year. About 60% went to Republicans. Paul Ryan, the speaker of the House of Representatives, was the single largest beneficiary, with donations from the industry totaling $228,670.

The impact of so much drug company money coursing through the veins of Congress is often incremental or largely unseen by the American public, such as the industry’s efforts to block competitors in India from making generic versions of HIV/Aids medicines that are more affordable to developing countries.

But on occasion it has a hugely visible impact.

In his comments alongside McConnell, Trump was vocal in his criticism of what he said were pharmaceutical manufacturers “getting away with murder” by charging much higher prices in the US than other countries. That is the result of a 2003 law, in effect written by the industry, preventing the federal government from seeking bids for the manufacture of drugs and medical devices – a process used in other areas, such as defense spending.

Instead, the pharmaceutical companies can charge whatever price they want for drugs bought for the publicly run Medicare and Medicaid programs – and the federal government has no choice but to pay up.

Tom Marino, second left, at a Trump rally in Hershey, Pennsylvania, in 2016. Marino faced scrutiny over donations from pharmaceutical companies. Photograph: Matt Rourke/AP

Meanwhile, the drug companies say that to allow foreign imports would endanger the quality and safety of medicines in the US. But that justification has been widely scorned in the face of escalating and sometimes opportunistic pricing, such as the surge in the price of EpiPen antidotes to allergic reactions last year, to $600.

Britain’s National Health Service negotiated a price of about $70 for the same product. Scores of attempts by some members of Congress to introduce legislation to bring down the price of prescription medicines or to let people buy them from Canada, where they are often cheaper, have failed to make it out of committee.

While lobbying shapes medical policy across the board, it has had a profound impact on the opioid epidemic as deaths quadrupled between 1999 and 2015. The pharmaceutical industry poured resources into attempting to place blame for the crisis on the millions who have became addicted instead of on the mass prescribing of powerful opioids.

The relatively small number of members of Congress who led the charge against the epidemic years before it became a significant political issue have struggled to push through legislation.

Representatives Hal Rogers and Mary Bono saw repeated efforts to pass laws curbing the mass prescribing of opioid painkillers fail amid concerted campaigns by the drug makers. Rogers and Bono founded the Congressional Caucus on Prescription Drug Abuse in 2010 and proposed several pieces of legislation over a number of years.

Bono, who was alerted to the opioid crisis after Chesare, her son with the late singer Sonny Bono, became addicted, said there was a false but effective campaign by companies profiting from the epidemic to portray any attempt to rein in the mass prescribing of painkillers as depriving millions of people of legitimate treatment for chronic pain.

“We were getting tremendous pushback from the industry. It was a massive, well-organized effort,” she said. “Of course we felt it, maybe indirectly at times. We didn’t have an awful lot of people lining up to help us.”

Some of the pressure came through industry-funded groups such as the Pain Care Forum, which spent $740m over a decade lobbying in Washington and state legislatures against limits on opioid prescribing and similar issues, according to the Center for Public Integrity.

Among those who received political contributions from the group were Senator Orrin Hatch, who took $360,00. The senator introduced legislation intended to head off one of the bills put forward by Rogers and Bono by proposing a federal study of pain treatment. Hatch, who is running for Senate again in 2018 even though he previously said he would not, is the recipient of the most political donations from the pharmaceutical industry so far this year, at $208,000.

Bono said the American Medical Association was instrumental in blocking another law, the Ryan Creedon act, to require doctors to get training on the risks of opioids. The AMA objected to it as a burden on physicians.

Drug companies gave more than $200,000 in campaign contributions to Jason Chaffetz (who recently left Congress), acting as the single largest donor to his re-election fights. Chaffetz, as chair of the committee on oversight and government reform, led an effort against the Centers for Disease Control and Prevention to reduce opioid prescribing by recommending that doctors first seek alternative treatments for chronic pain.

Lobbying by the wider healthcare industry also had an important impact on the shape of Barack Obama’s Affordable Care Act (ACA), widely known as Obamacare.

The chair of the committee drafting the ACA legislation, Senator Max Baucus, was at the time the single largest recipient of health industry political donations, with $1.5m given to his political fund over the previous year. Baucus led votes in the committee against the inclusion in the legislation of public insurance strongly opposed by private insurers who saw a threat to its profits.

Baucus was known within the health industry for annual fly-fishing and golfing weekends in his home state of Montana that lobbyists paid handsomely to attend. Other members of the committee received hundreds of thousands of dollars, including Senator Pat Roberts, who at one point tried to hold up the bill by claiming lobbyists needed three days to read it. The drafting of large parts of the ACA was done by a former vice-president of a major health insurer, Wellpoint.

In his attack on drug company money in American politics, Trump failed to mention that the companies were among the leading donors to his inauguration alongside tobacco and oil companies.

Pfizer, the maker of Viagra, was the largest pharmaceutical donor, giving $1m.

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Resilience

There Could Be a Real Solution to Our Broken Economy. It’s Called Universal Basic Assets.

By Marina Gorbis, originally pub. by Medium.com – October 16, 2017

Institute for the future

“The marketplace in which most commerce takes place today is not a pre-existing condition of the universe,” says author and Institute for the Future fellow Douglas Rushkoff. “It’s not nature. It’s a game, with very particular rules, set in motion by real people with real purposes.”

Over the past 100 years such rules have fostered unprecedented economic growth. However, today they are also producing deeply damaging social and ecological outcomes.

The numbers are striking. In 2010, 288 of the richest people in the world collectively owned as much wealth as the bottom 3.5 billion people. Last year, according to a recent study by Oxfam International, just eight people owned as much wealth as half of the world’s population.

In this moment of massive wealth inequality​,​ we urgently need to develop a new model for society to deliver both social and economic equity.

The answer may be in the concept of Universal Basic Assets (UBA),​ which​ in my definition​ is​ a core, basic set of resources that every person is entitled to, from housing and healthcare to education and financial security.

It Can Get Worse

The social instability caused by vast economic disparities is likely to only grow deeper under the pressure of two forces.

The first is the unrelenting progression of global warming that is already driving massive migrations of climate refugees due to wars, water and food shortages.

The second force — rapid advances in automation, artificial intelligence, and machine learning — is undermining traditional sources of income for vast swaths of populations in developed and developing countries alike.

A whole set of new technological tools, from networking to machine learning to robotics, are making it possible to produce goods and services in abundance without employing large numbers of workers. Growing numbers of people are making livelihoods in various types of flexible yet precarious employment arrangements rather than in stable, well-paying jobs that come with essential social benefits and risk protections.

As a result, the system that worked relatively well under conditions of scarcity is poorly suited to fulfill the needs of many when products and knowledge can be produced in abundance by relatively few.

In a healthy society, every person has the right to resources to safely live, learn, heal, and grow into the best version of themselves. These are Universal Basic Assets.

A Framework for Equity

We urgently need to design a new framework that delivers greater social and economic equity. Some economists and activists are proposing Universal Basic Income, a guaranteed minimum payment for everyone, as a way to ensure a guaranteed minimum for people to live on. We believe that a universal basic income is only the first step in making our economic system more equitable.

French economist Thomas Pikkety, author of the best-selling book, Capital in the Twenty-First Century, documented that in this point in history, it’s impossible for a person simply earning a salary to see the same economic returns as investors and capital owners secure through their assets.

Such disparities are likely to grow ever larger as the result of automation. An enterprise with fewer workers can reward owners with larger profits. As a result, solutions to economic inequality need to address more equal access to primary assets that generate better economic and social outcomes.

New Assets, New Rules

In designing Universal Basic Assets we take into account access to traditional physical and financial assets like land and money, as well as the growing pools of digital assets (data, digital currencies, reputations, etc.). We also recognize and assign value to exchanges we engage in as a part of maintaining the social fabric of our society but that do not currently carry with them monetary value (caring, creative output, knowledge generation, etc.).

In essence, we need to look at the concept of assets in its broadest sense, considering three classes of assets: private, public, and open.

Private Assets

Private assets are resources that we own individually. Housing, land, personal money, and retirement accounts fall into this category.

Since the 18th century, thinkers across the political spectrum have been advocating for equitable access to private assets, with some focusing on redistribution of incomes in the form of various types of taxes in order to achieve greater economic equity (Universal Basic Income comes under this umbrella). Others frame the issue around equal access to opportunity — that is, giving people a more equal starting point for achieving economic and social mobility. In this latter category, legal scholars Bruce Ackerman and Anne Alstott, for example, propose creation of The Stakeholder Society by granting a one time lump sum payment of $80,000 to everyone upon reaching the age of maturity. The UK’s Child Trust and efforts to create Individual Development Accounts (IDA’s) in the U.S. similarly aim to give children a head start while helping them understand personal finance and the importance of saving for and investing in the future.

Public Assets 

Public assets include resources collectively owned by the public and are managed by different types of government bodies on their behalf. They can include everything from national parks to mineral and cultural resources to critical parts of physical or digital infrastructure.

The four countries that have consistently been at the top in global rankings of social mobility are Denmark, Norway, Finland, and Canada. What they have in common is a high level of access to public resources like education, healthcare, and transportation.

If you are born to a poor family in Denmark, your chances of attaining economic success are not that different than those of your peers born into wealthier household.

Access to a whole variety of public assets makes it possible for children in countries like Denmark and Finland to move up the social and economic ladder independent of where they start.

In the United States, by contrast, your socio-economic status at birth is a big determinant of how well you will do as an adult.

Within the U.S., access to public resources accounts for regional differences in socio-economic mobility. Children born to families at the bottom fifth of the income distribution, have a 10 percent chance of reaching the top fifth of income levels during their lifetime if they live in San Francisco, New York, or Boston. The chance for the same children living in Charlotte, Columbus, or Atlanta is 5 percent, and for those from Memphis, only 2.8 percent. This is largely due to lower access to public schools, transportation, healthcare, and, of course, well-paying jobs. Being born poor dooms you to staying poor.

Open Assets

Open assets are resources that are owned and managed neither privately or by a government. They are open to anyone and governed by a defined group.

Open assets are created in what MIT Media Lab researcher and IFTF affiliate John Clippinger calls the “open sector.” According to Clippinger, in the open sector, a group of “founders” create a set of initial conditions from which rules emerge through the interactions of participants.

Clippinger cites the example of the British Common Law, a basis for America’s legal system, which evolved from customs and norms, and was eventually codified into constantly evolving laws. “It wasn’t top-down. It was constantly reinventing itself around the circumstances, and there was no single point of control,” he says. This is how the open software community operates today. Wikipedia is another familiar example of a community bound by common practices and principles that has established an architecture and a set of practices for entering and editing information, which in turn, has made it possible to create an open resource used by billions of people worldwide.

In the analog domain, we find examples of open systems for value creation in physical communities such as Burning Man or Freespace, where no money is allowed. People choose to come together freely and exchange or gift each other anything from physical goods to knowledge and services. This model is probably the form of existence most familiar to us as a human species as this is how many of our human ancestors lived before we invented money and market capitalism.

However, we don’t have to participate in the open-source software movement or go to Burning Man to experience non-monetary, non-profit-based economies — we participate in them on a daily basis in many ways. We don’t pay for love, for dinners at our parents’ homes, for our child’s affection, for art and music and other creative outputs that have become invisibly woven into the infrastructure of our daily lives (if we are lucky). As we transition to new forms of value creation we have opportunities to enlarge our pool of open assets and reconsider how and what we assign value to.

In the face of rising economic inequality in a society where those with capital get richer far faster than those who labor, we need to focus attention on more equitable distribution and access to a variety of assets. This would ensure not only greater socio-economic mobility for individuals but also help sustain the social fabric of our society.

Let us not forget that high levels of economic inequality come at a price not only for the poor but also for the extremely wealthy themselves. Some are building protective bunkers on secluded islands as they prepare for the inevitable social upheavals. Historical research shows that any concentration of wealth and power requires investments in vast networks of expensive security institutions leading to what Dr. Rachel Kleinfeld calls privilege violence. Such violence stems from a “power structure that allows or enables violence against some citizens as the price for maintaining extreme privilege.”

Creating a new kind of economy based on Universal Basic Assets can enrich all of our lives. Without it, the future may be a much poorer place for everyone.

For more on this topic, please read the IFTF working paper “Universal Basic Assets: Manifesto and Action Plan” (PDF)