But even should single-payer somewhat ameliorate the economic stranglehold of Big Pharma, it doesnt do much to alter two other pressing issues: First is the philosophy of drug design, which, in fact, reflects essential problems in how humanity interacts with Nature. Second, is the relative absence of an independently functioning physician class, behaving like the clinical scientists for which---supposedly---their medical education prepares them.
Like finding a particular snowflake, goes a radio commercial by one of the major pharmaceutical companies, touting the creativity of its researchers in discovering one new antibiotic after another. For just after theyve discovered one, they remind us, those clever bacteria set right about genetically mutating to develop resistance. What they dont tell you---dont dare make you more-cognizant of, particularly if youre a religious fundamentalist who detests micro-evolutionary theory---is that the antibiotic immediately begins to select for resistant bacteria almost as a side-effect of its very discovery.
But the war never ends, as the commercial tells it.
Paradoxically, the problem is that very solution---seeing it as a war, wherein the bacterias metabolism must be clubbed to death like a baby seals. The whole concept of discovering chemical after chemical to which bacteria develop resistance should tell us that Nature is much more clever at adapting chemistry than the biochemists who toil for their daily bread in the laboratories of Big Pharma; that, in fact, its the war ethos that comprises the problem. A much more propitious avenue, for example, might be to place more emphasis on developing drugs that might bolster the efficacy of ones anti-bacterial immune system responses. But of course, we all know the problem there---much, much less repeat business. Lower profits.
How many of us really believe that rather than simply absorbing the raps and the wrappings of the endless parade of drug reps, that our family practitioners are burning the midnight oil studying the clinical literature, searching for glitches in the data that might, for example, identify Vioxx as having a high probability of serious side-effects---even assuming that the drug companies would actually publish the correct clinical data. Sorry, John Q. Patient, thats, for the most part, just not happening. Although they make a better living than most of the rest of us, life for your family practitioner is just too short and just too crowded. The systems not set up to work that way.
Parenthetically, an even better example than Vioxx is the Ortho Evra patch, where, apparently, the actual clinical data was available: a 60% higher steady-state estrogen level than for the pill. In light of estrogens known side-effects, this fact, alone should have triggered a high-percentage of MDs to get mighty suspicious about possible side-effects like heart attack and stroke. In a system where those sorts of suspicions had to mostly await the death of otherwise healthy women in their twenties, something about the basic mode of primary-practitioner functioning is very very wrong.