The United States is rife with crises: from the economy to the environment to student debt—and the problems facing workers don’t stop there. The country is now suffering a major shortage of drugs for cancer treatment due to a single manufacturer, Intas, closing its doors. The shortage is so bad that doctors are being forced to ration these drugs. This means many cancer patients are receiving lower-than-ideal doses, delays in receiving their treatments, or substitute medication that can be less effective or have harmful side effects.
For the nearly two million Americans diagnosed with cancer every year, this is a serious obstacle to survival. Already, cancer is the second-leading cause of death in the country. Approximately 40% of all Americans contract the disease sometime in their lifetimes, and only about half survive. To put this into perspective, every American has a one in five chance of dying from cancer; any disruption to treatment can only push those numbers up even higher. There are other, longer-term consequences, as well, since the shortage is a major barrier to desperately needed clinical trials, hampering research to save lives in the future.
Why the shortage?
The common link between all the drugs in shortage is that they are generics. When a company’s patent on a medication runs out, any other company can manufacture the drug. In theory, with more suppliers, more competition should make the drug more available, and lower prices.
However, capitalist reality doesn’t work this way. The situation turns into its opposite: as capitalists undercut each other with lower and lower prices, generics become less profitable. As time goes on, fewer and fewer capitalists want to invest in their manufacture. This leads to monopolization, where one company has the lion’s share of the market. Then, as the monopolizing business struggles to make profits on these cheaper drugs, they cut corners, lower quality controls, and eventually shutter operations due to shrinking profits or because they are forcibly shut down by a regulating agency. The loss of this manufacturer suddenly leads to a shortage.
This is exactly what happened with Intas, an Indian conglomerate with manufacturing plants in India, Mexico, and the UK. In short, the anarchy of the capitalist market has created dire scarcity for life-saving drugs.
Some may wonder: if generics are the problem, why don’t we allow companies to keep their patents forever?
We can see how this “solution” would work by looking at what happens to drugs that are still under patent. For example, the patent for the life-saving EpiPen (epinephrine) is owned by Mylan and expires in 2025. Since Mylan owned exclusive rights to manufacturing, prices rose sixfold from 2007 to 2016. Two doses went from $100 to a whopping $608. At the time of this article’s writing, the retail price for two EpiPens is $713, or approximately $600 with a discount.
To put things more simply, permanent patents on drugs lead to monopolies that can price-gouge to their heart’s content. This is what generic manufacture is supposed to prevent in the first place. But under capitalism, there is simply no way to prevent monopolization, or as Marx termed it, the concentration of capital. The patent and company owners are under no obligation to produce anything if the profit motive doesn’t move them to do so.
To complicate matters somewhat, it is true that in the case of Mylan’s Epipen, there is a generic version available. Mylan itself created a generic version of epinephrine in 2016, as a concession to public outrage over its price gouging. However, the FDA requires generic manufacturers to prove equivalency to the EpiPen, which requires expensive research. As a result, generic epinephrine still costs hundreds of dollars. If its price ever lowers, then epinephrine will run into the same issues as any other generic.
Under capitalism, the choice is either scarcity through lack of production despite knowhow and capacity, or scarcity through profit-driven high prices.
Other capitalist solutions
To come back to the shortage of generic drugs, the nonprofit Civica Rx claims to fight shortage crises by stockpiling large quantities of generic drugs and then selling them to hospitals.
However, this is not really a solution at all: the hospitals still need to buy from Civica, which means that Civica’s prices need to be competitive with other companies’. Civica can appeal to the morals of the hospital buyers all it wants, but hospitals are first and foremost businesses. This means that in times of economic crisis, they will be forced to choose from the cheapest seller to stay open, just like any other company. Although Civica is a “nonprofit” in name, it still requires money (profits) to run, so it will be forced to lower its prices and eventually shutter as well. The word “nonprofit” is not a “get-out-of-jail-free” card from a global economic system—it’s just a tax category.
Another possible solution is for the government to stockpile generic drugs to use in times of need. Assuming the government can be persuaded to do this, this would require huge amounts of tax money. The American government is already in a massive debt crisis from trying to put out other fires through spending. The result has been some very nasty inflation, and even more Keynesianism would only make it worse.
None of these solutions work because the problem is at the core of capitalism itself: markets, which are driven by profit. Commodities are produced until they become unprofitable, whether people need it to survive or not.
Fight for a socialist planned economy
Luckily, capitalism is not the only economic system possible! If the majority expropriates the capitalists and sets up a workers’ government, we could sweep away the irrational market economy and replace it with a planned economy.
This would mean we could democratically choose how much of each medication is produced, based on human need, instead of leaving it to the “invisible hand” of the profit-thirsty market. We could choose to fund cancer and other disease research so that even better drugs are produced. The wealth to do this already exists—we just don’t control it collectively, as a class.
This would require nothing short of a communist revolution, which is a serious task. However, no other solution can end artificial drug shortages or any of the other crises caused by capitalism’s domination of our lives. The task of expropriating the capitalists and planning the economy has been accomplished before, and is possible to do again. The working class is already far and away the largest and most powerful class; what is missing is a communist leadership to unite it behind a revolutionary socialist program. It is urgent that we build that leadership today—join the IMT and help end capitalism for good!