A Role for Government

What with a an election in the USA at the end of the year, and the possibility of Bernie Sanders, described by some as a rabid socialist (although in parts of Europe he would probably be regarded as right of centre) we see a lot on the web from people who seem to say government is the problem, and basically they could spend their money much more efficiently than the government. No comment about what on. This raises the question, what should a government do? The classic minimalist response is to organize defence and to maintain and defend the value of the currency. Ever since Imperial Rome, the latter responsibility has withered, and debasing the currency has continued ever since. Now Central Banks seem to want to maintain a controlled inflation, so that long term government debts become easier to pay.

However, currency is for some other time. The question really is, do you want to reward uncontrolled greed, or do you think society should provide some sort of fairness? I personally think society should be organized to give all its young a fair chance at making the best of their lives and also to make up for the rough cast of the dice for some. I do not believe that private enterprise cares sufficiently for the common good. A couple of medical examples follow.

I suspect most of my readers have never heard of Sumatriptan. Do not feel bad about this; neither had I until I read Wednesday morning’s newspaper. Apparently there is a health problem called “cluster headaches” which for a very few people cause excruciating pain, and the only reliable way of relieving these is an injection of an appropriate dose of Sumitriptan. The relevance of this to the issue of governance is that Sumitriptan recently came out of patent protection and the pharmaceutical company that made it stopped making it and handed over (for unknown financial benefit) the formulae, etc, to a generic drugs manufacturer in India. The problem is, nobody thought to work out what would happen during the transition. You do not learn to make a drug overnight, and the pharmaceutical company probably decided it did not want unsold product on its books. The net result is there is a period of a few months during which world supplies have effectively dried up, and none will be available for a few weeks or months. So we have a period of unnecessary torture for those who drew the short straw of life and suffered this condition. Much better to maximize shareholder profit than make a little too much drug and let a few who depend on it have a normal life.

Have you ever heard of colistin? Again, probably not. This, according to “Chemistry World”, published by the Royal Society of Chemistry, is the most common antibiotic of last resort, and it has now discovered bacteria resistant to it. What this means is that unless we discover further antibiotics of significantly different chemical structure, we are going to have surgery revert to 19th century failure rates. You may protest that surgery has advanced well since then, and it has, but equally we have many more procedures that are much longer and much more difficult. What has gone wrong is that with the search for profit, antibiotics, which were an exceptional discovery that saved countless lives have also been grossly misused. There was probably not much that could have been done to prevent the silly from not completing courses, but nevertheless if usage was better controlled and with the large choice available, we probably could have got through, particularly if the special ones were reserved for special cases. The idea of having antibiotics in stock feed to accelerate growth was just silly, and greed and convenience got in the road of thinking, including thinking about what happens next. When antibiotics persisted into animal effluent, there was a spread of increasingly dilute antibiotics, at just the low concentration needed for local bacteria to have to develop immunity to it. On top of that, the use of various antibiotics in some parts of the world as prophylactics was just plain irresponsible.

But, you say, science will find more. Maybe, but who will find more? The major pharmaceutical companies probably will not, other than by accident, because it makes no financial sense to look for them. That may seem a strange comment, but think. Suppose it searches, and spends millions of dollars, and then maybe hundreds of millions of dollars getting the drug through the clinical trials and approval processes. What happens next is it does not sell very well. Why not? Because it then becomes the drug of last resort, to be used only under the most extreme circumstances. And this is where the issue of the commons is so important. Society as a whole needs a drug the bacteria have not seen often enough to develop resistance, but that means it has not been used very much. The pharmaceutical company needs massive sales to recover its costs and make a profit.

The public has to make a choice. Either it needs to take responsibility and pay to develop such drugs that are in the public interest, or it has to hope that a major company behaves out of the goodness of its heart. What do you choose?