The Moral Injury of Healthcare Capitalism

Moral Injury - Is the damage done to one's conscience or moral compass when that person perpetrates, witnesses, or fails to prevent acts that transgress one's own moral beliefs, values, or ethical codes of conduct.

Introduction - We have an undiagnosed problem in our country. Ok we have many but for this purpose of this post, I’m going to concentrate on healthcare. What is the problem you ask, its simple, we believe and assume healthcare-based capitalism’s conscience or moral compass has been damaged due to all the violations of ethical codes of conduct of late. In other words, we believe healthcare capitalism has experienced a moral injury and can prevent future transgressions. We forget, or won’t accept, that even in healthcare that trade and industry are controlled by private owners for profit which is vastly different from a chronic patient with a deadly disease who needs innovation and discovery by sundown.

Healthcare-Based Capitalism - Yesterday, the New York Time’s published an article entitled “How a Drugmaker Profited by Slow Walking a Promising H.I.V. Therapy” (The New York Time's Article). The essence of the article was that Gilead, according to their own internal documents, delayed a new version of a H.I.V. drug that was supposed to be a game changer in order to extend the patent life of their current H.I.V. drugs that have been wildly successful.

Publicly Gilead claimed that the new drug was not “sufficiently different from an existing treatment to warrant further development”. To put it another way, why develop a new HD TV when the current market of HD TVs are the best possible products available without some kind of further innovation. Privately, Gilead had devised a plan to delay the new drug’s release in order to maximize profits even though executives had reason to believe it might turn out to be safer for H.I.V. patients (their current H.I.V. drug was causing kidney disease and osteoporosis in many patients, the hope was their new drug would not have this side effect). This is according to internal documents made public in litigation against the company.

The “patent extension strategy”, as the newly released internal Gilead documents repeatedly called it, would allow the company to keep prices high for its current H.I.V. drugs. Patients would be switched to its new drug just before cheap generics hit the market. This strategy was potentially worth billions of dollars.

To put it another way, Gilead (one of the world’s largest drugmakers) has embraced a well-known capitalistic tactic of gaming the U.S. patient system in order to protect their billions on current best-selling drugs in their portfolio. We know and have accepted that all pharmaceutical companies make this business decision at some point in their timeline. Its business, not personal as the kids say.

Gilead’s lawyers, in court filings, claim that the allegations against the drug manufacturer are meritless. They are denying that the company halted the drug’s development to increase profits. To prove this, they cite a 2004 internal memo that estimated Gilead could increase its revenue by $1 billion over six years if it released the new version of their H.I.V. drug in 2008. As per usual, the lawyers have borrowed from Gilead’s marketing department to claim that “research and development decisions have always been, and continue to be, guided by our focus on delivering safe and effective medicines for the people who prescribe and use them.” In other words, Gilead is basically puppies trying to make the world smile while the patients suing them are just after the evil dollar.

Before I go any farther, let me make something perfectly clear. As a chronic human I have no trouble with David Swisher and others who are currently suing Gilead for employing their “patent extension strategy”. In a just world, these patients who were harmed by Gilead’s business decisions should receive a billion trillion million dollars (yes I do have an accounting degree why do you ask ) from Gilead along with the executive teams million-dollar homes and cars. The executives of Gilead should be in the unemployment line by the time I finish this post. Hopefully this is perfectly clear to everyone.

Let’s Cause Trouble - Here's where I might get into trouble with my patient advocacy friends. If we replace H.I.V. drug with a sock, ski, or computer, the executives at Gilead would probably be cultural, or at least business world hero’s for having the foresight to wait 10 years before releasing their new sock, ski, or computer and earning billions in new profits. At the very least, Gilead shareholders would be happy with the billions in new profits. After all, Gilead is in the business of making profit; yes, it is that simple.

Here comes more trouble. Since profits are the goal of business in our capitalistic system and the tool to obtain those profits is the manufacturing of X (X being anything from meds to skis to socks), do we have the moral or ethical right to be upset by what Gilead did? In reality, their decision was based on the right of business to make profits. Devil’s advocate time, what did Gilead do that was so wrong? They implemented a commonly used business tactic in order to make higher profits. Apple (I love you master Apple, please don’t take away my newish laptop) does this yearly and now has a stronger balance sheet and net worth that half the countries in the world, yet they are mostly celebrated for their success.

Let’s End Strong and Make the Brain Work - The ugly truth is we seem to enjoy the outrage moral injury brings in cases like this but don’t really want to do the work necessary in order to prevent companies from making business decisions like what Gilead did. For example, how many of you that are outraged by what Gilead did have voted for political candidates that support a single payer system? How many of you have advocated for a single payer system? I can’t guarantee a single payer system would have prevented Gilead from making this business decision, but I’m convinced it probably would have prevented it.

How many of you that are outraged by what Gilead did have taken a moment or two and examined your own thoughts on capitalism in healthcare? News organizations and social media influencers love when company X develops an MRI that can take a 3-D imagine of my heart in order to examine the damage my atrial fibrillation has done however they don’t like to mention how many of me will not be able to afford this new capability. We all love to advocate for patient or human centered care healthcare systems but what does that mean. More importantly, should pharmaceutical companies, like Gilead, be included in a patient centered healthcare system?

At present, I do not have answers to these questions. In fact, I’m still wondering if there are more questions that need to be included in this discussion before we start working on answers. All I know is this, companies like Gilead do not care if I have chronic pain or H.I.V. but that’s not necessarily their fault nor am I positive they that they should care. Their definitional purpose is the make profits, the larger the better. They are currently not designed to take care of me. Our current culture is designed for them to make profits, the larger the better. If by accident they improve my quality of life by helping with my chronic pain, curing H.I.V., or by manufacturing a killer sock that does not quit, well that just helps us (the royal us) accept that my quality of life is dependent on the all mighty dollar. However, if we accept our lives are dependent on profits, then we need to also accept that if I get hurt in Gilead’s quest for larger profits, our current system has determined that to be an acceptable outcome so maybe we should calm down on the moral injury outrage until we are truly willing to accept and implement wholesale changes (move to a single payer system for example) to our capitalistic based healthcare system.