Nikolaus Kopernikus beim Beobachten der Gestirne (Detail von Jan Matejkos Gemälde)
Most of us are aware of the deep problems in the current US pharmaceutical industry. Yet few may realize that today’s issues stem from changes that occurred centuries ago.
As I explain in The Apothecary’s Wife: The Hidden History of Medicine and How it Became a Commodity, the current medication system was established between 1650 and 1740, when professionals used the scientific revolution to push women out of the medical space. At that time, domestic medicine was dominant. Women were the primary sources of medicine in their communities, making medication from organic ingredients at home. Despite using the exact same ingredients for their own medicines, apothecaries and physicians persuaded the public of the superiority of their treatments and began charging for them. Medicinal substances transformed from free, household goods for everyone into commodities available only to those with means. This transformation normalized the practice of withholding life-saving medications from people who could not afford it — and valuing the economic success of corporations over the lives of some citizens.
The forces that transformed medication into a commodity are still with us. For example, domestic medicine encouraged sharing recipes to maximize healing, but today’s commercial medicine attempts to keep recipes secret to maximize profit. The US patent system and the battles between corporations making generic and brand-name drugs is a logical result, even when those mechanisms imperil patients’ health and lives. (See also Victor Roy’s Capitalizing a Cure: How Finance Controls the Price and Value of Medicines.)
Regulation is another legacy of medication’s economic transformation. In an attempt to exclude quacks from the medical marketplace and to protect consumers, 17th- and 18th-century professionals began testing competitors’ medicines to prove their inferiority and then publicizing the results. Joshua Ward (ca. 1685-1761), for instance, widely sold “medications” made of metals such as lead and antimony despite knowing that ingesting them could be fatal (Chapter 7 in The Apothecary’s Wife has a lot to say about him). Regulatory entities such as the Food and Drug Administration and European Medicines Agency should do this work now. History provides ample proof that when guided by science, regulation works. It has also shown us that lax oversight, such as in the famous case of thalidomide, the furor over aduhelm, and today’s generic drug industry, endangers patients.
We also continue to experience the fallout from the campaign to elevate “the New Science.” Its 17- and 18-century advocates made it seem more impressive by casting this new way of thinking and discovering as too difficult for ordinary people. That strategy generated an ongoing suspicion of science and a profound misunderstanding of how science functions. Although particularly virulent in the United States, this skepticism and ignorance of science abounds worldwide.
For the United States, this legacy will be even more obvious and determinative after the new government is sworn in on January 20, 2025. The Affordable Care Act of 2010 (ACA) is America’s only attempt so far at a public health system. For decades, the Republican party on the whole has been opposed to the ACA and national health care more broadly, drawing on the value system that displaced domestic medicine’s ethos with one that prioritizes corporate health over human health. 17- and 18-century professionals recognized this issue in converting medication into a commodity, but decided against adding a mechanism for treating the impoverished. Repealing the ACA would be returning to the three-hundred-year-old roots of today’s system. Similarly, the current nominee to lead the Center for Medicare and Medicaid Services (CMS), Mehmet Oz, has pursued profit opportunities in medicine with disregard for science and the health of ordinary people. He has even promoted colloidal silver (more upscale than Joshua Ward, but an equally ancient claim). It is likely that the provisions in the Inflation Reduction Act of 2022 requiring the CMS to negotiate the prices that it pays for pharmaceuticals will be ignored or removed.
Skepticism and suspicion of science undoubtedly will bear down on federal divisions, departments, and institutes responsible for health care and science. Regulation is a probable early casualty. The nominee for Secretary of Health and Human Services (HHS), Robert F. Kennedy, Jr., harbors these views, exemplified by his opposition to vaccines, fluoridated water, and pasteurized milk. Kennedy’s misunderstanding of how science works, not to mention the role of regulation, leads to a hostility toward scientists that has much in common with witchcraft fears. History suggests that under such leadership, HHS and the CMS will authorize the use of unscientifically tested treatments, reject the scientific foundations of the regulation process, and nurture a national hostility to science and scientists.
The consequences of this approach will appear quickly. Federal opposition to vaccines, for instance, will swiftly raise the mortality rate, especially the infant and child mortality rates, to spectacular highs. As Olivia Craighead drily wrote after Mehmet Oz’s nomination, “Fingers crossed colloidal silver works for measles.” Outbreaks of easily prevented, highly communicable, frequently fatal or permanently debilitating diseases such as measles and pertussis (whooping cough) will likely negatively impact the economy. Tourism will drop as visitors choose to avoid such a perilous environment. The national failure to provide a reliably healthy, sound workforce will curtail domestic productivity and obstruct foreign investment.
Prognostication in this case is fairly easy. Addressing these values and beliefs about the role of medication is not. They are rooted in medication’s transformation into a commodity. Knowing where these ideas came from, however, offers insight into the current system, and as history shows, insight is a step toward action.
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