Superbugs: The Intersection of Technology, Healthcare and Ecology
The technological revolution is more than smartphones, driverless vehicles, factory robots, and automated harvesters, just as the ecological crisis is more than climate change, pollution, and mass extinctions. The evolution and proliferation of superbugs, which are harmful bacteria that are resistant to antibiotics, illustrate the complex intersection of technology, healthcare, and the environment in the era of capitalism and private property.
As the revolutionary Frederick Engels said way back in 1876, “Let us not flatter ourselves overmuch on account of our human victories over nature. For each such victory, nature takes its revenge on us … It brings about the results we expected, …but it has unseen effects which only too often cancel the first.”
Drug-resistant infections are now the third leading cause of death in the United States, at 162,000 a year. A study by a British expert panel shows that if the trend continues, in 2050, they will kill 10 million people a year globally. The World Health Organization says we face a problem so severe, that it threatens the achievement of modern medicine.
How Did This Problem Develop?
Bacteria are the oldest and most numerous organisms on earth. In addition to about 30 trillion human cells, your body contains 39 trillion bacteria, most of which provide metabolic services that keep you alive. A few, about 100 species, can cause serious illnesses if they get into your blood.
Alexander Fleming accidentally discovered the naturally occurring antibiotic penicillin in 1928. Still, it was only during wartime in the early 1940s that its practical medicinal value was used to save injured soldiers. In the postwar period, the possibilities to fight infection in the civilian sector were realized. Soon following, in the 1950s, the first antibiotic resistance became a problem worldwide. This set off a biochemical arms race: bacteria develop immunity to existing drugs, scientists develop new drugs, bacteria evolve again. This cycle continued for several decades, but after the 1980s, development slowed, and since 2000 very little has been done because the development of new antibiotics is not lucrative enough for Big Pharma.
Alexander Fleming did not patent penicillin; he rejected the idea of claiming ownership of a natural substance. So, the strategy for pharmaceutical profits was not to claim a monopoly but to promote high volume sales. Originally prescriptions were not required, and penicillin was not only dispensed to patients but put in ointments, toothpaste, throat lozenges, gum, and even lipstick.
Other antibiotics occurring in nature were developed, but these were patented to ensure profits. From 1948 through the next decade, over one hundred natural bacteria killers were found, most in tiny amounts in soil. Research and development was motivated not by health concerns but by how profitable they could become. New products with minimal changes were introduced to extend patent life and keep prices high.
Fully 64 percent of U.S. antibiotic sales by weight are sold for use in animals, as are the great majority worldwide. Much of this is excreted into the environment and piles up in “lagoons.” This negatively affects not only workers on farms and in slaughterhouses, but surrounding communities and in the end, all of us. The consequence is that resistant bacteria develop extremely quickly and become pervasive throughout the environment. This extensive use of antibiotics is not even shown to actually help meat production and safety.
Big Pharma Globally
Worldwide, Big Pharma is the world’s most profitable economic sector. The top 10 companies project $373.4 billion in revenue in 2019 and have profit margins of 15-20%. Despite their protestations of the expense of developing new drugs, they spend up to twice as much on marketing as they do on research and development. All of this is without regard to ethical standards. A study by Global Citizen found that between 1991 and 2015, U.S. pharmaceutical companies paid 35.7 billion dollars to settle state and federal charges, mainly relating to drug pricing fraud and unlawful promotion of drugs. Many were for repeat offenses, as fines for unethical practices became a “cost of doing business.”
We can see Purdue Pharma’s role in the opioid crisis as a current example when it heavily promoted Oxycontin and assured doctors it was not addictive. National Public Radio reported that Purdue was sued by over 2,000 local governments, and after striking a settlement for 3 billion dollars, it then declared bankruptcy. A New York Times’ report revealed in December, 2019, that as scrutiny of Purdue Pharma’s role in the opioid epidemic intensified over the past dozen years, its owners, members of the Sackler family, withdrew more than $10 billion from the company and distributed it among their trusts and overseas holding companies!
The abuse of antibiotics has been more rampant, and the consequences more catastrophic in lesser developed countries. As historically documented by both UCSF and Oxfam, the material presented to physicians in lesser developed countries grossly exaggerated product effectiveness and minimized or omitted potential hazards. As a direct result of this intensive promotion by both multinationals and local manufacturers, over-prescribing and misuse of antibiotics are rife throughout the global South.
A 2018 OECD report stated that anti-microbial resistance (AMR) is projected to grow more rapidly in low and middle-income countries. In Indonesia, Brazil, and the Russian Federation, between 40 – 60 percent of infections are already resistant, compared to 17 percent in OECD countries. Poor sanitary and work-safety conditions, malnutrition, climate change, war, migration, among others, contribute to the worse conditions in the poorest countries, such as Afghanistan and Gaza (Palestine). But there are no national borders in what is called the “resistome,” no barriers that prevent or even slow the global spread of resistance genes.
The active pharmaceutical ingredients of the antibiotics prescribed in Europe and North America are usually manufactured in China and then made into pills or capsules in India, as well as Pakistan, Bangladesh, and Southeast Asia. Pharmaceutical companies have gone where wages are low, and regulation is weak. The supply chains are complicated and fuzzy for the public and regulators. Most production is by locally owned companies that compete to produce drugs for multinationals. One way for them to save money is to offload the cost of waste disposal into the environment. As Ian Angus wrote in his 2019 article “Superbugs in the Anthropocene” the effluent from a plant may flow into streams and rivers, providing, “a giant Petri dish for anti-microbial resistance.”
What Could Have Been, What Could Be
One “free market” model proposed for solving the superbugs problem is to give incentives (bribes) to those very same pharmaceutical companies to get back into the business of developing more antibiotics that might be effective for a while. How can we possibly trust the very companies that have already made billions by overpromoting antibiotics and other drugs? It’s another self-serving solution such as bailouts for banks and General Motors, or hiding behind bankruptcy like Purdue Pharma and Pacific Gas and Electric are doing in the wake of the consequences of their gross irresponsibility.
This is just one of many “unnatural disasters” engendered by the failure of capitalism and private property to deal with climate change and other environmental conditions. Hurricanes and superstorms such as Katrina, Sandy, Harvey, and Maria; wildfires, polar vortexes, oil leaks from the Keystone pipeline, natural gas explosions, lead poisoning in Flint and Newark, contaminated water in the Appalachians – these and many more that frequently have the most severe effects on poor communities. But it doesn’t have to be this way.
“Those who hailed the first antibiotics as miracle drugs were not wrong,” writes Angus. “What those chemicals could have been was a way to work with nature, to use natural processes to overcome diseases that had plagued us for thousands of years. Used with appropriate humility and careful stewardship, in conjunction with a global drive to eradicate the conditions that cause infectious diseases, penicillin, and its successors could have been boons to humanity for centuries. But that would have required a radically different economy and society.”
The nationalization of the pharmaceutical industry for the benefit of the people is an idea that has been brought up in various forms and is an immediate solution to these problems. Bernie Sanders and Elizabeth Warren have each proposed partial nationalization as have Physicians for a National Health Plan in the United States, and other forces in the U.K. The proposed Expanded and Improved Medicare for All system would stop gouging by Big Pharma by forcing negotiation for prices as well as eliminate the role of health insurance corporations.
A united push by the movements around healthcare and ecology would be a powerful force for pushing nationalization. Only by having real public control over essential services and production in health care, housing, education, to name a few, can we ensure the well-being of humanity. RC
Further Reading: Ian Angus, “Superbugs in the Anthropocene: A Profit-Driven Plague,” Monthly Review, Vol. 71(2). www.monthlyreview.org/2019/06/01/superbugs-in-the-anthropocene/ (Unless otherwise noted, the statistics in this article come from this article).
March/April 2020 Vol30. Ed2
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