Cisplatin is as close to a “wonder drug” as we’re likely to see in our lifetimes. Before it was used to treat testicular cancer, the survival rate was lower than 10%. After its introduction, 95% of patients were treated successfully. Cisplatin treatment more than doubles the response rate for ovarian cancer. It has important applications in head, neck and lung cancer treatments. Incredibly, this extremely powerful drug is also relatively cheap to produce; doses cost the manufacturer roughly $10 per vial.
Why, then, with a drug so powerful, effective, and cheap to produce, are 90% of cancer treatment centers in the U.S. are facing critical shortages of cisplatin and other common cancer drugs? In some centers oncologists are being forced to triage their patients to save supplies; only those most likely to be fully cured are given these life saving drugs. Those who don’t make it onto the triage list are left with alternative treatments that are either less safe, less effective, or considerably more expensive.
But none of this is new. This is the latest instance of an ongoing drug shortage crisis that has been happening for decades.
A report from 2011 detailed the rising number of drug shortages going back to the 1980s and intensifying in the mid-2000s. “The number of drug shortages has been rapidly escalating in recent years; ASHP/UUHC reported 70 in 2006, 129 in 2007, 149 in 2008, and 166 in 2009.”
In 2018, things had not gotten better. The Drug Shortages Task Force Public Meeting produced a report that year detailing still rampant, life threatening drug shortages: Drug Shortages: Root Causes and Potential Solutions.
In April of this very year shortages included those powerful cancer drugs — and there were other shortages reported for over 300 drugs.
Capital’s explanation of drug shortages: supply chains, lack of incentives and regulatory challenges
In the 2019 report, the FDA’s task force identifies “three root causes for drug shortages:
- Lack of incentives for manufacturers to produce less profitable drugs;
- The market does not recognize and reward manufacturers for “mature quality systems” that focus on continuous improvement and early detection of supply chain issues; and
- Logistical and regulatory challenges make it difficult for the market to recover from a disruption.”
Richard Pazdur, director of the FDA Oncology Center of Excellence and the Office of Oncologic Diseases, gave an interview outlining the causes and the FDA’s potential solutions for this latest shortage in cancer drugs. “Today’s critical shortage of cisplatin and carboplatin occurred because manufacturers failed to invest in enhancing production capacity,” said Pazdur.
He goes on to outline how one of the factories was shut down after a failed FDA inspection. And then, “As a result of the cisplatin shortage, a ripple effect was observed leading to an increased demand for carboplatin and the manufacturing challenges in meeting an increased carboplatin demand… A failure to invest in newer equipment, processes, or management practices that can prevent quality-related manufacturing breakdowns is often a root cause and appears to be tied to the economics of producing low-cost, older sterile injectables where profit margins are increasingly squeezed.”
While this analysis is largely correct, it is incomplete. Yes, the market is the cause, but what about the market? The anarchy of production.
What is this anarchy? Because capitalist production is not keyed to the needs of the people, but only responsive to changes in market conditions — changes in price — the amount of any given commodity needed by society is never precisely known. Instead of calibrating production to meet needs, capitalists (investors, owners of capital) watch the prices in the market. Now, prices trail behind any given social need, but they are the best markers the capitalist has of where to invest his money. When the capitalist sees prices drop, he takes his money out of that kind of production. When he sees prices rise, he puts his money back.
Clearly there is a demand for these drugs. If there is a demand in the market, that means there is profit to be made and a capitalist should step in to capitalize on that demand by increasing supply.
But, these shortages have been going on for decades! Where is the increase in supply that we should be seeing?
Because the cost of production of, say, cisplatin, is only $10/dose and is sold at roughly $20/dose, the profit from its production is 100% — that is, $10 in profit for every $10 spent. In contrast, the active ingredient of Xanax costs roughly 3 cents per dose, but a single Xanax pill costs roughly $3. That’s a profit of 1,000%. Of course, drug companies guard the active ingredient costs with iron walls to prevent the public from seeing how much we’re being fleeced for necessary medicine. Congress alone is permitted to see the current data.
There simply isn’t enough of a profit motive for companies to prioritize the production of low-cost drugs. Furthermore, drugs are developed at the end of a very tenuous and dysregulated supply chain. They are finished products made from the finished products made from other finished products. A disruption at any point in this chain (such as a shortage of a raw material or a plant being closed for a failed inspection) causes the whole thing to come crashing down. For high-profit commodities, corporations will often spend money to conduct studies, secure supply chains, and make sure they are producing enough to reach market demand. But if the value of a cisplatin pill is a mere 100% while a Xanax pill is 1,000%, they will never spend the money to investigate the cisplatin shortfall.
Worse, when there is a shortfall in production, it suddenly becomes more lucrative to produce the medication. The price increases. A recent shortage of ADHD medications resulted in a price rise to consumers of nearly 1,000%. Where a drug’s profit ratio is relatively small, it makes more sense (from the point of view of the criminally profiteering Pharma CEO, not from the point of view of the person who needs medication, of course) to simply let the shortages happen.
Capital’s proposed solution: market based incentives and half-measure reforms
Since there is no way the capitalists can acknowledge that crises arise necessarily in the for-profit mode of production, they can’t offer a solution that will do anything but try to find a way to put more money in the capitalist’s pocket.
Here is what the FDA’s Drug Shortage Task Force recommends as ”enduring solutions:
- Creating a shared understanding of the impact of drug shortages on patients and the contracting practices that may contribute to shortages;
- Developing a rating system to incentivize drug manufacturers to invest in quality management maturity for their facilities; and
- Promoting sustainable private sector contracts (e.g., with payers, purchasers, and group purchasing organizations) to make sure there is a reliable supply of medically important drugs.”
“Creating a shared understanding of drug impact shortages” is a nonstarter. Companies know what the impact is. They do not care. No amount of “understanding” can impact the need to place profits above all else. It is a company’s fiduciary responsibility to maximize profits.
“Developing a rating system to incentivize… manufacturers” is nonsensical. The report suggests that more stringent scrutiny will somehow right the ship. Any measure to increase oversight and safety, which of course should be a priority, will only tighten the already narrow profit margins these companies are working with.
What we have left is the real solution for the capitalist class: “Promoting sustainable private sector contracts.” What does this mean? Essentially, raising prices. Their solution to shortages of affordable life saving drugs is to raise the price.
The real solution: fully socialized healthcare
The only true solution to the problem of drug shortages, one that does not rely on market Band-aids, is to move healthcare from a for-profit system to a for-need system, and the only way to do that is to fully socialize healthcare.
When will enough be enough? People are dying from lack of access to life saving drugs. Over 60% of bankruptcy filings in the U.S. Empire involve medical debt. Yet still, the idea of free healthcare for all is still treated as a radical political position in this country. The capitalists who rule us reject socialized healthcare. Why? Because they are, in turn, ruled by the profit motive.
We need a system that is ruled not by the needs of the wealthy to produce profits, but the basic needs of all. It is only through a fundamental change to the mode of production that we can ever realize the equality and human dignity that we all deserve.
