Fear of Death and Greed Within the Pharmaceutical Industry

           Our cultural fear of death can be observed throughout several facets of the U.S. health care system.  Although the last blog focused on how it impacts end-of-life spending, this blog will focus on how our cultural fear of death, when combined with greed, plays out within the pharmaceutical industry.  Furthermore, there is an alternative to what we have created.

Cultural Taboos:  Suffering, Aging, and Death

Robin Hanson, a professor in the Department of Economics at George Mason University who has a major interest in health policy, explained how deeply embedded the fear of death is within American culture and what we will do in efforts to control it.  He described:

The fear of death is a powerful influence on our thinking, even if we are not often conscious of it.  Our society, like all others before it, has a strong need to feel in control of death, even if we must embrace fairy tales and quack cures to gain that sense of control.  The idea that we mostly do not understand and cannot control death is just not a message that people want to hear.  The message that medical miracles can control death, in contrast, is a message that people do want to hear.

U.S. health care (notably, the pharmaceutical industry) plays upon our cultural fear of death and strives to control it.  Daniel Callahan wrote that a cultural change is needed if we are to regulate health care costs.  Yes, there are economic and management problems within the health care system.  However, the system also contains a deeper cultural issue—we typically see suffering, aging, and death as ‘enemies.’  Callahan asked, “should death be seen as the greatest evil that medicine should seek to combat, or would a good quality of life within a finite life span be a better goal?”  The U.S. health care system has taken the first route—combating death.  Perhaps it would be beneficial to explore where this thought structure has taken us.

The Deadly Combination: Fear of Death and Greed

It is important to see how our deep cultural taboos and fears, such as death, diffuses into our health care system.  Does our cultural fear of death alone drive health care or is there something else to the puzzle?  In our efforts to modulate death, something else has entered the health care equation.  The late Professor Emeritus of Economics at Duke University, Thomas Naylor, boldly stated that American health care “rests perilously on two principles: fear of death and greed.”  When our fear of death is combined with greed, things get really messy.

            The pharmaceutical industry serves as a perfect example of what happens when greed exploits our fear of death.  First and foremost, the pharmaceutical industry is a booming business.  According to Dr. Len Saputo, the 2002 revenue of the ten pharmaceutical companies in the Fortune 500 reached $35.9 billion.  These profits surpassed the combined profits of the remaining 490 companies, which was $33.7 billion.  In this short video, ex-drug-pusher Kathleen Slattery-Moschkau explained that the pharmaceutical industry must first please Wall Street.  The industry is not based upon science, but marketing.  Advertising plays a key role.  In order to increase the potential for profit, the industry plays off of our deepest insecurities and fears.  Expanding upon this idea, American journalist John-Manuel Andriote declared, “by manipulating our fear of suffering and death, big pharmaceutical companies are able to keep us coming back for expensive medications.” 

Since profits are most valued within the pharmaceutical industry, the needs of the patients are overlooked (at best) to purposefully ignored (at worst).  Saputo summarized:

Over the past two decades, the pharmaceutical industry has moved very far from its original high purpose of discovering and producing useful new drugs. Now primarily a marketing machine to sell drugs of dubious benefit, this industry uses its wealth and power to co-opt every institution that might stand in the way, including the U.S. Congress, the FDA, academic medical centers, and the medical profession itself.

Patients’ needs have been severely compromised as Big Pharma became a ‘marketing machine.’  A major ethical issue that arises is that the pharmaceutical companies literally profit off of the suffering and sickness of Americans.  The sicker the country is, the more money Big Pharma makes.  Things that would benefit sick individuals—drugs that actually help people or health-promoting self-care activities such as proper nutrition, movement, and healthy stress management—are not Big Pharma’s focus.  Sadly, sickness is great for business.

Although it may seem that this situation cannot get any worse, it already has.  Big Pharma has intentionally created new ‘diseases’ and ‘conditions’ that play on peoples’ fears and emotions.  Lynn Payer called this ‘disease mongering.’  She wrote that disease mongers try “to convince essentially well people that they are sick, or slightly sick people that they are very ill.”  This is when our cultural fears of sickness, suffering, and death come into the mix.  A great example of this took place in the 1920s.  Melody Petersen described Listerine’s marketing tactic of “creating public anxiety” about halitus.  This word simply means bad breath, however, it was meant to sound like it may cause serious issues, such as sickness or death, if left ‘untreated.’  Of course it will not cause a person to die, however, a person who was considered ‘healthy’ now had a reason to feel that she may not be as healthy as she once thought.  Her bad breath must be treated before something ‘bigger’ goes wrong. 

This marketing strategy is still utilized today within Big Pharma.  Petersen described how the market was expanded with the drug, Detrol.  The drug company ‘created’ more potential customers by creating a new ‘health problem.’  They expanded the target market to include individuals who simply urinate frequently (nine times a day or more).  Often times, drug companies will appeal directly to the consumer.  This Detrol commercial is a good example of such a marketing technique.  Len Saputo explained that the ‘core intention’ of direct-to-consumer commercials is to “entirely bypass the medical profession and appeal directly to consumers, hoping to induce them to ask their doctors for a remedy for some real malady or for a supposed illness newly identified.”  Such advertisements play upon the fears and emotions of individuals, convincing them that something is inherently wrong with them.

An Alternative Perspective

It is very powerful to go back to Daniel Callahan’s question about whether medicine should fight against death or if a “good quality of life within a finite life span’ would be a more appropriate goal in health care.  The pharmaceutical industry has played out the former option—death has become a medicalized ‘problem’ that we fight against.  When we combine this with our cultural fear of suffering and death and Big Pharma’s greed, soon we have a system of medicine that massively profits off of the sick.  Patients are being manipulated.  Marketing and advertising based upon Americans’ insecurities and fears became the very foundation of the pharmaceutical industry. We have gone so far down this route of ‘fighting death’ and it has taken us nowhere.  In fact, the health care system and the well-being of patients are in crisis.  It makes you wonder… should we be combating death?  Look where it has taken us.

Despite this grim picture, Callahan provided an alternative perspective.  What would it be like if we really admitted our mortality to ourselves?  Would health and good quality of life become the goal of the life we do have?  Perhaps the health care system would stop focusing on controlling death, and Big Pharma would no longer need to manipulate and scare ‘consumers.’  Starting a cultural conversation about death and natural life cycles would be a great place to start.  There is the potential for real improvement if we explore our cultural fears.  This can lead us to a more patient-centered health care system that values self-care practices and health instead of sickness.  Health-promoting treatments and practices, such as Chinese medicine, nutrition, movement, stress management, and energy medicine, could become the foreground of life.  The exploration of our cultural (and personal) fear of death may be exactly what we need to do in order to learn more about life and health.  Because of this, it is finally time for the U.S. health care system to explore it as well.