Kalman Applbaum
Abstract
Medicines and health care represent an ultimate arena for the application of marketing because our needs in that province of experience are deep and subject to the sort of manipulation at which marketing excels. In the United States, marketing has created an ‘Overdo$ed’, ‘Overtreated’ ‘Rx Generation’ (the titles of just three recent bestsellers). Meanwhile, in most of the rest of the world people suffer from diseases whose incidence would be dramatically reduced if they had ready access to the medicines already in use in the west fifty years ago. The overconsumption of pharmaceuticals in affluent countries, and the degradation of health services for poor people in most other countries, are related. Critics such as Paul Farmer point out that the principal culprit in causing growing health inequality is the relinquishment of formerly public administrative responsibilities to market forces; market forces are a form of ‘structural violence’ that brings together opportunistic profit-taking and inept or uncaring state planners to produce a dangerous combination of international exploitation and indifference. We can greatly advance our understanding of market forces by studying the powerful, organised design of ‘big pharma’, the world’s wealthiest industry, as it confronts the world’s healthcare infrastructure in an attempt to standardise and control its sources of profit.