Terrorism and the Health-care Crisis

Which is a greater threat?

by Charles K. Fink

Z magazine, September 2002

There are, of course, greater threats to humanity than terrorism. It is telling, however, to compare how the United States allocates resources in response to these threats. Approximately 3,000 people died in New York and Washington as a result of terrorism in 2001. But that same year three million people died worldwide from AIDS, according to the World Health Organization. This figure includes 1.3 million men, 1.1 million women, and 580,000 children under 15. According to a story carried in Newsday, April 27, 2001: "United Nations Secretary-General Kofi Annan yesterday called for creation of a multibillion-dollar global trust fund for treatment and prevention of the world's AIDS pandemic. Annan's plea, issued as the annual meeting of the Organization for African Unity convened in Abuja, Nigeria, resonated in Congress as Secretary of State Colin Powell testified before the House Appropriations Committee.

"On the subject of HIV/AIDS," Powell told the committee, "it is a pandemic of the worst kind. It is not just a health crisis; it's an economic crisis. "It's a crisis of survival for not only families, but in some cases for whole nations, who see up to a third of their population already affected by this terrible disease." Powell said the AIDS pandemic is one of President George W. Bush's "first priorities. We have been meeting on this regularly over the last two weeks. "

However, neither Powell nor other members of the Bush administration would talk of dollar amounts. The Administration's proposed budget calls for a reduction in domestic AIDS care expenditures.

Annan called for creation of a "war chest," as he called it, funded by the world's richest nations to the tune of $7 billion to $10 billion a year. Current combined AIDS donations from all sources to Africa and other beleaguered nations comes to roughly $1 billion. Advocates for global health recently called for several billion dollars a year from the United States.

On March 15, 2002, the New York Times reported: "Mr. Bush was seeking $38 billion in additional financing for the Pentagon on top of the $328 billion Congress authorized for the current fiscal year, an increase of 11.6 percent. " The result: a military budget for 2002 of $366 billion. This is larger than the combined military budgets of Europe, Japan, South Korea, Australia, Russia, China, and all potential enemies or "rogue" nations, such as Iran, Iraq, and North Korea. Why would the United States spend hundreds of billions of dollars on the military, but devote a comparative pittance to AIDS relief?

The AIDS epidemic is one aspect of the health crisis ravaging the Third World. According to the World Health Organization, tuberculosis killed 1.7 million people in the year 2000, and malaria killed more than a million, mostly in Africa. These are treatable diseases. According to Food First, every year 12 million children die from hunger or treatable diseases and at least 700 million people are chronically malnourished. According to the World Health Organization, 2.4 billion people in the Third World do not have adequate sanitation facilities and over a billion do not have access to clean drinking water. As a result, 2.2 million people, mostly children under 5, die from dehydration caused by diarrhea. Perhaps 5,000 children under 5 (or 18,000, according to Ramsey Clark) die each month in Iraq because of the combined effects of war and economic sanctions. Most of these deaths are due to contaminated water.

In 2001, the Pentagon approved production of the F-22 Raptor Stealth Fighter Jet. Each plane will cost taxpayers $20 million and the entire fleet will cost $70 billion, according to "NPR News" (May 28, 2002). Despite complaints that the F-22 Raptor serves no legitimate military purpose-the United States already has by far the most advanced Air Force in the world-funding for the project is unlikely to be cut. Lockheed Martin, the corporation awarded the contract, has virtually guaranteed congressional support by hiring 1,200 subcontractors in 46 states. This is a familiar strategy. Rockwell won congressional support for the production of the B-1 bomber by employing 5,200 subcontractors in nearly every congressional district in the country.

According to World Vision, just 50 cents could feed a hungry child for two days. A rehydration tablet costing a penny could save a child dying from dehydration. For $4.6 billion, the amount of money devoured by the U.S. military in three days, all people in the world could have access to clean drinking water. According to the UN, no more than $40 billion a year would be needed to meet all the basic needs of the poor. According to Derrick Jensen, for what the military spent in 2.5 hours in 1990, "smallpox was eliminated back in the 1970s. For the price of a single B-1 bomber, about $285 million, the government could provide basic immunization treatments, such as shots for chicken pox, diphtheria, and measles, to the roughly 575,000,000 children in the world who lack them, thus saving 2.5 million lives annually" (The Culture of Make Believe).

There is a health crisis in the United States, one that puts over 40 million Americans at risk. On February 9, 2002, the New York Times reported: "At least two million people lost their health insurance in the last 13 months as unemployment rose and growing numbers of consumers decided they could not afford steeply rising costs. Health care economists said that at least 40.4 million Americans, based on conservative estimates, were uninsured by January 31."

California has the largest number of uninsured, 6.3 million, according to two-year-old Census Bureau statistics, which were adjusted late last year and recently published. Texas was next, with 4.4 million. New York had 2.8 million, Florida 2.6 million, Illinois 1.6 million, Ohio 1.3 million, and New Jersey I million.

The reason for this crisis is that health care in the United States is not distributed according to the medical needs of Americans. It is distributed according to socio-economic status.

At a conference on biomedical ethics sponsored by the University of Miami, Dr. Steve Miles from the University of Minnesota, related the story of a woman who approached him with the following dilemma. She was suffering from heart disease and breast cancer, and was taking prescription medication for both. She told Dr. Miles, "I cannot afford all the medication that I am taking. So my question is: Which is worse, to die from heart disease or to die from breast cancer? Because I have to choose."

Victims of the American health-care crisis, though they may far outnumber the victims of terrorism, are comparatively invisible.

The propaganda machine has been, as usual, quite effective in distorting public perception. According to a survey conducted by "NPR News" (June 5, 2002), "when asked about the two most important problems facing the nation, 10 percent mentioned health care, ranking further behind problems such as the economy (37 percent), terrorism (29 percent), war (21 percent), and crime (16 percent)." NPR's corporate loyalties were obvious. Its coverage began: "Adding prescription drug coverage to Medicare is a hot topic again on Capitol Hill. Such a benefit would cost hundreds of billions of dollars, but no one knows where that money would come from." No one knows? Or is NPR unwilling to say? NPR raised the possibility of making cuts in foreign aid, but pointed out, correctly, that such cuts would be woefully insufficient. (Less than 1 percent of the federal budget is devoted to foreign aid.) Predictably, NPR did not raise the possibility of making cuts in military spending, which, if brought down to levels comparable to other nations, would be more than enough to add prescription drug coverage to Medicare. In fact, it would be enough to provide prescription drug coverage for all Americans. Last year Americans spent $156 billion on prescription drugs, according to "ABC News." In the year 2000, shortly before the "war on terrorism," America spent $343 billion on the military, compared with $60 billion spent by Russia, $45 billion by Japan, $42 billion by China, $34 billion by the United Kingdom, $27 billion by France, and $23 billion by Germany. Nor did NPR make the obvious indictment of the capitalist system: that money that could be used to provide health care for needy people is instead diverted to wealthy people.

Drug manufacturers blame the high cost of prescription medication on research and development. But the pharmaceutical industry actually spends more money on administrative costs and advertising than on research. Even more disturbing: on average, 18.6 percent of the cost of drugs is pure profit for corporate shareholders, by far the highest profit margin of any industry in the nation, according to Congressperson Bernie Sanders. Add to this another disturbing fact: the vast majority of new drugs developed in this country over the past six years, about 80 percent according to the FDA, are minor modifications of existing drugs (so-called "standard" as opposed to "priority" drugs), developed, not for the purpose of improving human health, but for the purpose of increasing market share. Add one more fact: taxpayers subsidize research and development for the pharmaceutical industry through the National Institutes of Health-whose budget this year is $23 billion-and yet, unlike shareholders, have no right to a return on their investment. According to Dr. Barnadine Healy, former head of the NIH, "There's no other industry in which you have so much public investment in the fundamental knowledge that enables...the development of the commercial industry itself" ("ABC News," May 30, 2002).

Consider one example reported by the New York Times on June 5, 2002: "Attorneys general from 29 states accused Bristol-Myers Squibb yesterday of illegally profiting through several fraudulent schemes to keep lower-priced generic versions of Taxol, a life-extending cancer drug, off the market...." The states' lawsuit says Bristol-Myers and American BioScience filed a "sham court action" that helped delay the availability of a cheaper version of Taxol, a drug that can cost up to $10,000 for a course of treatment lasting several months.

New York's attorney general, Eliot L. Spitzer, said the companies' actions had cost state governments, patients and their insurers "many, many millions of dollars." The lawsuit seeks to recoup the extra money that the plaintiffs contend that state governments and cancer patients were forced to pay for Taxol from December 1997 to April 2001, when several companies began selling generic versions of the drug and the price fell.

Taxol, which is known generically as paclitaxel, was discovered by government scientists at the National Cancer Institute. The government spent more than $32 million to develop it, according to the states' lawsuit. Later, the government granted Bristol-Myers the exclusive right to sell Taxol in the United States for five years, starting when the Food and Drug Administration approved the drug in December 1992.

The states' lawsuit contends that Bristol-Myers illegally extended the five-year period by fraudulently obtaining two patents from the United States Patent and Trademark Office. Taxol cannot be patented, but delivery methods can. The lawsuit contends that

Bristol-Myers misused the patents to keep generic companies from selling a lower-priced version of the drug.

This, incidentally, is not the first time that Bristol-Myers Squibb has been sued for such machinations. On May 30, 2002, "ABC News" reported: "BuSpar is an anti-anxiety drug manufactured by Bristol-Myers Squibb. After the company had had a monopoly on the drug for years, the patent on BuSpar was set to expire on November 21, 2000, which meant a cheaper generic version was supposed to be approved by the FDA and available to consumers the next day."

Just hours before its patent on BuSpar expired, Bristol-Myers Squibb got a new patent on what the drug becomes after you swallow it. The law is written in such a way that Bristol-Myers was able to then keep the generic drug off the market, claiming that it would violate its new patent. There was no innovation involved-only an innovative legal strategy.

Drug companies such as Bristol-Myers Squibb do not exist for the purpose of enhancing human health; they exist for the purpose of making money. Health-care spending is largely a matter of subsidizing such industries and ensuring the profitability of investment for stockholders. There may or may not be Americans destined to die from future terrorism. In a system that allocates health care on the basis of socio-economic status, rather than on the basis of medical need, there will inevitably be Americans who die because they are poor or uninsured.

Charles K. Fink teaches philosophy at Miami-Dade Community College.

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