The War on Drugs
May 30, 2025
The Law & The Judges
May 30, 2025
Drug Dealers
Part1
Zemiology is the study of social harms and the broader consequences of actions that may not necessarily be defined as crimes but still cause significant damage or suffering in society.
Most of the time phrases such as the ‘drugs trade’, ‘drug addiction’ and ‘drug dealers’ have a certain connotation relating to the harms (and crimes) associated with ‘drugs. For the most part, the images, representations and associations conjured up by these will not involve companies such as Pfizer, Roche or Bristol-Myers Squibb, nor products such as Oxycontin or Thalidomide.
In this chapter you will consider how drugs available on prescription or over the counter, that is, the legal products of the pharmaceutical industry, are not necessarily less and can be more – harmful than those drugs prohibited by law over which ‘wars’ are waged by states (as you read in Chapter 1).
If this is the case, then it is at least plausible to think of those who develop, make and sell these legal drugs – the pharmaceutical industry – as drug dealers, in the literal and the pejorative sense of this term. This chapter focuses on the nature, structure, and particularly the harms produced by the global pharmaceutical industry – an industry of such scale and reach that it is often colloquially referred to as ‘BioPharma’.
While reading the chapter, you will be thinking about a specific class of drugs: ‘substances that we identify as pharmaceuticals[which] are simply those substances that we use as human (or animal)medicines’ (Taylor, 2015, p. 5).So far, you have explored how some drug harms come to be constructed as crimes and how other harms come to be deconstructed, neutralised and rendered invisible or even desirable by powerful interests.
Part2
This chapter shifts the focus even further away from harms that are criminalised and examines harms that are entirely legal. harms that sit within a grey area between legality and illegality. harms that are regulated as potentially criminal but where such regulation is un- or under-enforced.
The picture that emerges is that harm and crime is routine, widespread and normalised across the pharmaceutical industry Introducing Big Pharma Medicines have, of course, been in existence as long as humankind, but there have been two major game-changers in the prevention and treatment of diseases: the discovery of antiseptics and vaccines from the 19th century onwards; then, the emergence of multinational pharmaceutical companies during the 20th century.
There is no doubt that millions of lives have been saved through the development of the modern pharmaceutical industry; for example, by 1980, smallpox is said to have been eradicated from the globe through systematic and sustained programmes of vaccination.
Health researcher Cynthia Gorney writes of seeing the vaccination card of a young girl, Sanjida, born in Bangladesh in 2005, who within weeks of her birth was an early beneficiary of Bangladesh’s new, free national immunisation plan, receiving vaccinations against whooping cough, measles, diphtheria, tuberculosis, tetanus, hepatitis B, and polio.
She notes how ‘an extraordinary global health history had been abbreviated ‘on Sanjida’s vaccination card: No one can tally accurately the total number of lives saved by widespread vaccination, but it remains one of the greatest achievements of modern medicine.
Part3
Measles, for example, was killing more than two million children a year worldwide in the1980s; by 2015, according to the World Health Organization, vaccination had dropped the death toll to 134,200. Mass vaccination has ended polio in all but three countries; Bangladesh and its giant neighbour India were pronounced polio free in March 2014As the industry data specialist Statista puts it, ‘The pharmaceutical industry is responsible for the development, production and marketing of medications.
Thus, its immense importance as a global sector is inarguable.’ (Statista, n.d. a). But at the same time, despite the obvious benefits associated with the pharmaceutical industry, its global reach does not ensure equitable outcomes in terms of the major causes of premature deaths across the Global North and the South.
Most deaths in high-income countries – such as the United States or Thuc – are the result of so-called ‘life-style diseases’ related to heart disease, cancers and dementia; meanwhile, in 2019, in Kenya, the leading cause of death was diarrhoeal diseases (Ritchie endorse, 2019).
Thus, writing in 2019, development economists Hannah Ritchie admix Roser noted that: Deaths from causes such as infectious disease, malnutrition, South Africa and Botswana, the leading cause of death is HIV/AIDS. (Ritchie and Roser, 2019)
So, while the pharmaceutical industry is predominantly considered as providing products which respond to harms, it can also exacerbate global inequalities by focusing on the areas with the wealthiest populations, governments and therefore markets, as opposed to those with the greatest health needs Big Pharma, big profits
The overwhelming majority of new medicines, including vaccines, are developed and marketed by private companies – whose very rationales to make a profit. And while there may be money to be made from selling these to large healthcare programs (whether provided through private health insurance schemes or public health services) across the Global North, there is little prospective value in sales in poor countries of the Global South such as those of sub-Saharan Africa.
Part4
Moreover, such is the price at which these drugs are sold that many government authorities simply cannot afford to buy them on behalf of their populations. Hence there are many struggles across the globe over the pricing of drugs – struggles which occasionally hit the headlines in the North (that is, occasional outcries when the UK’s National Health Service refuses to allow access to certain treatments for relatively rare illnesses due to their cost)
Here, then, is one of the paradoxes of the industry: essentially it exists to make profits but at the same time makes products which are potentially of most benefit to the poorest people on the planet, consumers who cannot boost profits and who do not constitute ‘attractive market’ (Bosley, 2018).
For global pharmaceutical companies, it is financially more lucrative to invest in ‘me-too’ drugs – that is, higher-priced versions of existing products, which constitute ‘the main business of the pharmaceutical industry’ (Angell, 2005, pp. 74–93).
But it is also more profitable to market weight-reduction or erectile dysfunction pills than to make products available which would significantly improve survival rates across the globe in fact, the search for drugs that cure or mitigate cancer, mostly via research, which is significantly subsidised by governments and charitable foundations, is the most significant focus of many of these companies.
This is not simply for the likely future financial reward but for present profits: oncologic (treatments for tumours, including study of their development, diagnosis, treatment, and prevention), are threading class of therapeutic drugs based on revenues (Corporate Watch, 2006).
This holy grail of cancer treatments for the rich North is far more lucrative – actually and potentially – than the development or production of treatments for mass killers such as diarrhoea.
Part5
The global pharmaceutical industry is a highly profitable sector. It has the potential to save lives and make many lives better, but it is dominated by private corporations operating in an international capitalist economy.
So, rather than meeting the needs of consumers, it works to secure profits for the shareholders, directors and senior managers who own, control and operate the corporations.
For the corporation, acting in the best interests of its shareholders is its primary legal obligation (Tombs and Whyte, 2015) Dimensions of Big Pharma The characteristics set out below indicate the size, reach and the enormous sums of money at stake in the pharmaceutical sector –near or at the top of the list for profitability in any sector for many decades (Statista, n.d. b).
In 2014, global pharmaceutical revenues for the first time increased to over one trillion US$ (Statista, n.d. b), which was more than the gross domestic product of all but 15 countries (Statistics Times, 2015).
The global drugs market is controlled by a small number of global corporations, even if these are the tip of a much bigger iceberg (Taylor, 2015, p. 8). These corporations exist in an oligopoly, where a few sellers dominate an entire market, and this enables them to dictate drug prices (Statista, n.d. c)
The leading pharmaceutical companies come from the United States and Europe. Based on prescription sales, New York-based Pfizer is the world’s largest pharmaceutical company. In2017, it generated some US$52.5 billion in pure pharmaceutical sales. Other leading companies from the United States include Johnson & Johnson, Merck & Co. and AbbVie.
Part6
While Novartis and Roche (Switzerland), GlaxoSmithKline and AstraZeneca (UK), and Sanofi (France) are the European big five (Statista, n.d. c). Branded, patented medicines make up the largest share of pharmaceutical revenues by far (Statista, n.d. d).
The other paradox in this tangle of relationships is that governments (whose primary relationship with these companies is ostensibly to upon the drugs developed by such companies for the health of their populations. Harm and crime in the pharmaceutical industry In this section, you will look at some of the ways in which pharmaceutical companies prioritise their economic interests over consumers, states and the general interests of the public.
You will then consider the routine production of crimes and harms. Everyday harms of Big Pharma Often commented on in the literature on Big Pharma, the sector is characterised by a series of ubiquitous practices which operate in the four unfolding contemporary trends in harmful practices which characterise the industry.
First, he notes that from the early part of the 21st century, pharmaceutical companies began to turn their attention from developing ‘blockbusters’ towards ‘niche-buster’ drugs (Lex chin, 2018).
The former are treatments aimed at a mass market, such medicines control asthma; the latter are treatments for rare diseases, or ‘more and more expensive medications for narrower and narrower markets’, such as drugs designed to control very specific types of cancers (Lex chin, 2018).
The economics of this shift are attractive: in the United States, by law, the Food and Drug Administration support research into such treatments by providing direct grants, tax credits on clinical trial expenses, and seven years of marketing exclusivity after any such new drug is approved (Dolgin, 2010, p. 837).
Part7
Meanwhile, about 14 million people die each year from infectious diseases, many of which are preventable or treatable, such as acute respiratory infections, diarrhoeal diseases, malaria and tuberculosis. …
This health crisis is caused by several inter-linked health – and very often a matter of life and death – is the supply of effective and affordable medicines and people’s access to such medicines and treatments. (Corporate Watch, 2006) Second, Lex chin claims that Big Pharma creates harm by corrupting the regulatory process.
The industry exerts pressure directly on Thean supranational organisations such as the European Union, through a variety of techniques from lobbying to financial donations. In a series of texts, science policy expert John Abraham (1995) has examined the ways in which drugs companies are able to generate science which supports favourable regulatory decision-making. Lex chin’s third claim is that the industry exercises extensive controls –power – over knowledge about the benefits and harms of pharmaceutical products.
‘Corporations control all aspects of the trials from their initial design to the way that they are conducted and analysed, how they are reported to drug regulatory agencies … whether and how they are published, and how they are largely presented to doctors’ (Lex chin, 2018).
Somewhat differently, but related, the investigative journalist Martin Walker (1994) has documented the organised (and at times veering into the illegal) opposition of the industry against alternative treatments; in so doing, itis common to deploy the discourse of expertise – that is, calling upon the claims of experts and the language of science to undermine the legitimacy of alternative medicines.
Part8
Finally, Lex chin notes the strengthening of Big Pharma’s intellectual property rights – and therefore the strengthening of Big Pharma – by extending patents over products. A patent legally protects the inventor of a product from others making or selling the same product for a specified number of years.
In principle, the patent system is a way of encouraging or rewarding research and development investment and entrepreneurship. However, in practice it guarantees a time-limited, legalised monopoly, benefiting the already rich and powerful – while at odds with the capitalist mantra of competition.
The use of patents was bolstered by the Trade Related Intellectual Property Rights agreement (TRIPS), negotiated by the World Trade Organization between 1986 and 1994, proving to be ‘a means of maintaining and consolidating the power of Big Pharma’(Lex chin, 2018).The borders of harm, legality and illegality echini’s observations have introduced you to how Big Pharma commonly operates in harmful ways, which are mostly wholly legal and ‘mere’ effects of power.
But there are also other, much more legally ambiguous practices which sit at the borders of harm and crime. Corporate Watch (2006) – a UK-based campaigning and research body– highlights a series of the practices that straddle the borders between harms, legal and illegal practices, or crimes including: overpricing of drugs. immoral marketing. influencing of doctors. ‘Kicking the poor ‘
The borders between harmful practices being legal or illegal can often be very difficult to define – originally fined over £84m by the Competition and Markets Authority in 2016 for over-pricing epilepsy drugs sold to the NHS, Pfizer successfully appealed against the fine in 2018.
The cost of the drugs might be considered immoral – and clearly harmful. But although the over-pricing was initially determined to be illegal, it was later deemed to be legal. Profit-making companies need to make profits, and this is frequently done at the expense of others – for example, consumers or health providers who obviously do not have unlimited budgets to buy drugs and treatments.
Part9
But these harms can be produced in ways that are legal – simply pushing prices to the limit that any market can bear – or in ways that maybe illegal if detected and then allowed by courts or regulators.
(This can be achieved by companies manipulating production costs or other expenses to justify the high charges for their products.) Marketing can be said to be particularly immoral when direct-to-consumer (DTC) marketing is used, in the hope that consumers will ask their doctor for a specific drug.
This marketing may take place in various ways – through magazines and on television as is permitted in New Zealand and the USA for example or, where such forms of advertising are illegal as in much of western Europe, via the internet or social media.
Here, companies might abide by the law in any jurisdiction regarding marketing but may create new demand for, or dependencies on prescription drugs, thereby generating harm – harms that are therefore legal. Or some forms of what appears to be legal advertising might trip over into illegality if false or exaggerated claims are made for some medicines and products, relating, for example, to sexual performance, hair restoration or weight loss. Doctors can also be influenced.
A range of practices, which again extends from the legal to the illegal, may involve greater or lesser degrees of harm. Some seem entirely harmless; you might have noticed, for example, a note pad or calendar carrying a company’s logo on your GP’s or hospital doctor’s desk – it is worth thinking where this came from. Such ‘freebies’ are regularly supplied by companies to medical practitioners and seem innocuous, but they are part of a spectrum of practices.
This spectrum ranges from sponsoring doctors to attend conferences or conventions, funding aspects of their research, and influencing the content of medical publications and education – all of which inculcate in the doctors’ minds a reminder or favourable view of the goods and services of these companies and their products. Finally, and as you have seen earlier in this chapter, Big Pharma finds a series of ways of ‘kicking the poor’, a phrase that for Corporate Watch (2006) covers a range of harmful practices, each of which may be partially legal but also entails aspects of illegality.
Part10
These include the use of the patent system to prevent the manufacture and sale of cheap generic drugs; failing to develop ‘drugs to combat malaria, tuberculosis, sleeping illness and other tropical diseases because there is no profit in it’(Corporate Watch, 2006); and targeting the poor of the Global South for drugs testing – which is legal and regulated, but a site of harm and where practices can and do stray into illegality. Corporate crime in the pharmaceutical industry
You have seen that the pharmaceutical industry is a site of harmful, morally dubious but essentially lawful practices; and it also engages in practices which sit on the borders of, or within a grey area between, harm and crime. Now you will consider pure and simple law-breaking within the industry. There exists a significant body of academic research which attests to the routine and widespread fact of crimes committed across the global pharmaceutical industry.
More than 35 years after its publication, the classic industry/corporate crime case study arguably remains John Braithwaite’s (1984) study of corporate crime in the pharmaceutical industry, which provides a powerful documentation of the sheer range of crimes in which companies may be engaged or implicated.
Braithwaite reveals common practices of bribery, negligent and fraudulent safety testing of drugs, unsafe manufacturing practices, anti-trust violations, the illegal promotion of licit drugs, dumping and testing of drugs on the populations of the Global South, and various forms of financial illegalities (including fraud and transfer pricing) which he summarises simply as ‘fiddling’ (pp. 279–89).
Braithwaite begins by surveying a range of forms of bribery prevalent within the industry and concludes: ‘bribery is routine and widespread in the international pharmaceutical industry, and large amounts of money are involved’ (1984, pp. 30–2).
The motivation here is the need to gain approval for drugs which have been developed either to be licensed to market or, if licenced, to be in demand. This incomprehensible when you consider the many years, and the substantial sums of money involved in bringing any new pharmaceutical product to market.
So anyone who can be bribed is bribed to ease the licensing and demand for products, including ‘doctors, hospital administrators, cabinet ministers, health inspectors, customs officers, tax assessors drug registration officials, factory inspectors, pricing officials, and political parties’ (Braithwaite, 1984, p. 32)
Part11
In a later piece, Braithwaite noted that ‘the most serious corporate crimes in the pharmaceutical industry were, and still are, in the safety testing of drugs’ (Braithwaite, 1993, p. 13). He went on to note thurifer, anti-competitive practices and over-pricing, product safety offences, tax crimes and fraud remained widespread (Braithwaite, 1993).
More recently, writing with Professor of Health Policy Graham Dukes and Health Policy Consultant John Moloney, Braithwaite concluded that crime in the industry had become worse over the 30 years since his original 1984 publication (Dukes et al.,2014, p. 272).
Safety testing of drugs Criminologist Paddy Rawlinson and public health expert Vija Yaalvendan (2015) trace unethical drug trials back to Nazi Germany –horrific experiments that were justified by the fact they were conducted on Jews and Gypsies, understood in Aryan ideology as sub-humans.
After the Second World War, the Allies introduced the 1947Nuremberg Code, a set of ten guiding principles for the safety of human subjects in clinical trials, followed some 20 years later by the Declaration of Helsinki (the World Medical Association’s own ethical guidelines), which aimed ‘to ensure that medical practitioners put the well-being and safety of the participants as their primary concern’(Rawlinson and Yaalvendan, 2015, p. 9).
Yet 50 years later, unethical drug trials continue across the globe and, if not focused on ‘sub-humans’, target ‘society’s most vulnerable. In the current climate of commercialised medical research, an integral part of the global marketisation of health delivery, vulnerability is largely defined in economic terms, further qualified by marginalising factors such as race, ethnicity and gender’ (Rawlinson and Yaalvendan, 2015, p. 9). The global industry in clinical trials for drugs tends, therefore, to distribute harm across the poorer countries of the Global South.
According to one estimate, in the US it costs on average US$10,00per person tested to conduct a clinical trial, in Russia US$3,000, and in the poorest parts of the world, much less (Corpora Watch, 2006). Clinical trials are now a growth industry in the Global South, where weaker regulation and lower standards of living make them less expensive.
Rawlinson and Yaalvendan (2015, p. 19) focus on the trials industry in India, ‘one of the leading sites for clinical trials ‘which saw ‘a frenzy of offshore testing by western companies’ after global guidelines on such testing were weakened at the start of the21st century.
This period also saw the mushrooming of contract research organisations, referred to as ‘data production sweatshops’ (Rawlinson and Yaalvendan, 2015, p. 14) since they place significant demands on early career researchers for speedy and favourable results.
Indeed, the process of Big Pharma increasingly subcontracting the clinical testing of new drugs to contract research organisations which are disproportionately located in the Global South is termed a form of ‘medical colonialism’ (Rawlinson and Yaalvendan, 2015, p. 17).
Part12
These authors describe how, in India, the combination of a poor, under-employed, and poorly educated population, weak regulatory structure and a compliant (and at times corrupt) government keen to attract foreign investment created what they call a ‘conducive environment for clinical trials’ (Rawlinson and Yaalvendan, 2015, p. 8).
The result waste deaths of 2644 subjects from clinical trials between 2005 and 2012– which in turn led to the Supreme Court of India tightening the regulatory regime somewhat in 2013 (Rawlinson and Yaalvendan, 2015, pp. 8–9).
The ethics of drug trials on paid human subjects might raise moral doubts. But whether you accept that it is ‘right’ that such trials should take place – in effect, targeting the poorest and most vulnerable populations, not least across the Global South (an effect of the global scale and reach of the industry),
it remains the case that there are regulations and laws with which such trials must adhere. Where these are either unwittingly or knowingly violated then we can refer to crimes of negligence or intention More generally, trials of potential new drugs can often lead to crimes.
IN both pre-clinical (not involving humans) and clinical (involve mans) trials, crimes range from negligence to various forms of fraud and falsification of data in the safety testing of new products. In many cases data collection and interpretation is simply dishonest halidom idea classic, historic example of fraud and falsification of data in the safety testing of new products is Thalidomide – a drug to treat morning sickness in pregnancy, developed by the German compactified-
Grünenthal in the early 1950s.Initially available over the counter in Germany, the drug Thalidomide, produced in 1956 as a sleeping pill and then marketed, from October 1957, as a treatment for morning sickness in pregnant women, was subsequently licensed for use in over 50countries.
Once in widespread use, Thalidomide became linked to significant birth defects (particularly the absence of limbs), and premature deaths. As early as 1957, Chemise-Grünenthal had begun to uncover test results about the detrimental effects of the drug on the foetuses of pregnant women, results which were covered up while pressure was put on the Food and Drug Administration to agree to its approval (Ross, 2005).
Only in 1961, after evidence of the effects of the drug mounted, did its withdrawal begin. However, 50 years later the drug was still being sold in parts of Latin America, on prescription, where babies continued to be born with malformations similar to the survivors from the 1960s.
Thalidomide is estimated to have caused significant physical disabilities in 20,000 babies, within estimated further 80,000 dying (Evans, 2014). Given that Chemise-Grünenthal had evidence of the effects of Thalidomide on foetuses prior to the sale of the drug, criminal charges against executives were drawn up.
Part13
However, the nine senior corporate executives prosecuted for involuntary manslaughter eventually agreed an out of court settlement of overUS$30million (Ross, 2005). In 2010, the UK Government issued a formal apology for its treatment of Thalidomide victims, and in2012, the Grünenthal Group issued a statement to express the company’s ‘sincere regrets’ regarding the consequences of the drug (Press Association, 2012) Summary.
The pharmaceutical industry is routinely associated with the production of crime. Determining when harm is legal or illegal is often difficult, as highlighted through the safety testing of drugs and the case of Thalidomide.
The pharmaceutical company as drug dealer? As part of his work on the pharmaceutical industry, Braithwaite discusses the ways in which the pharmaceutical company is a drug dealer or what he calls a ‘drug pusher’ (Braithwaite, 1984, pp. 204–44).
Braithwaite compares a typical pharmaceutical company to a typical international border. maximising profits is its key motivation. the organisation is hierarchical, owned and controlled by faceless men at the top who for the most part don’t get their hands dirty in the day-to-day business of sales. sales are increased as dependency on the product is increased. getting the product to market, selling it and making a profit might involve crimes being committed along the way – such as bribing officials or using dirty tricks to undermine competitors.
If all of these apply to so-called organised crime networks which operate in the heroin trade – and whether they do or not, this is how drugs organisations are often portrayed – then these are all also features which can accurately characterise pharmaceutical companies.
Hence, they can be seen as dealers or pushers like those working with illicit drugs. Indeed, having set out the comparison, Braithwaite goes on to provide numerous examples of drug pushing which implicate many of the then household names associated with BioPharma – the leading companies and some of their products (Braithwaite, 1984, pp. 206–30). In calling pharmaceutical companies ‘dealers’ or ‘pushers’, Braithwaite and others challenge the power of language.
The discourse of dealing or pushing drugs is a wholly negative one – it condemns, it labels as criminal or deviant. This is quite distinct from the representations that pharmaceutical companies enjoy and promote – cutting edge, science-based companies, continually striving to rid the world of disease, to help us sleep more easily and even improve our sex lives. When companies try to increase sales, this is seen as marketing not pushing whether the products being marketed are tobacco, alcohol or medicines.
All companies want to sell their products and there is no reason why companies should be any different. But some argue that pharma cortical companies create demand themselves – for example, for addictive pain-killing drugs such as the opioids which it is claimed have killed over a quarter of a million Americans since the 1990s (McGreal, 2018, p. xiii). They may also use their status as scientific experts to make exaggerated claims to health professionals and the public. And this is an industry where products gain a licence only after years of research and development – so the incentives to maximise sales, to recoup expenditure through revenue, is heightened.
Part14
Further, the very size and reach of Big Pharma means that it can affect the lives of hundreds of millions of people. Of course, the same might be said about companies that sell smartphones. But there is quite a difference between Apple, Huawei, Nokia and Samsung trying to create a market for a new handset –talking up its advantages and downplaying glitches and faults – and a pharmaceutical company doing the same.
A mobile phone that has an irritatingly low battery life or lack of access to particular networks might be disappointing – but a ‘disappointed’ drugs user will have put something into or onto their body, in the expectation that it would have a beneficial physical effect, such as treating eczema or headaches, preventing malaria or sickness in pregnancy, moisturising skin or enhancing breast size Targeting the female body Within the broader literature on the crimes of the pharmaceutical industry is a focus on the ways in which women are specifically targeted by the industry.
This area of research is relatively small, burrowing. For example, Morton Mintz (1985) detailed the case of headlong Shield, an inter-uterine contraceptive device which caused inflammatory pelvic disease as well as having a significant failure rate, leading to disproportionate numbers of miscarriages.
Then, a decade later, Patricia Peppin, a Canadian legal scholar, examined the industry in relation to victimisation of women. She documents the ‘serious adverse reactions, involving harm on a mass basis, [which] have occurred when women’s health needs have been targeted by drug companies’ (Peppin, 1995, p. 90).
She notes that ‘devastating harm’ has resulted from: inadequate warnings of the risk of stroke and death from contraceptives; poor labelling pertaining to the risk of toxic shock syndrome from tampons; the marketing of the synthetic oestrogen diethylstilbesterol (DES), marketed to treat morning sickness in pregnant women; AH Robins
Company’s ignoring of warnings about the Dalkin Shield; and ‘perhaps the best known example’, Thalidomide (Peppin, 1995, pp. 90; Finlay, 1996).Among the body of literature is significant research that documents both how and why women are disproportionately affected by crimes of the pharmaceutical industry. The reasons are related to the following facts.
That woman: take responsibility for using the most invasive forms of contraception (the pill, the diaphragm and so on). are the child-bearers and still take most child-care responsibilities. are highly sexualised and subject to discourses around appropriate body image in ways that men are generally not. work disproportionately in certain sectors of the economy which are poorly paid and poorly protected and where, for example, exposure to products of pharmaceutical and chemicals companies cause significant levels of disease and ill-health.
The lack of protection for women in these contexts – the failure of testate to develop or enforce regulation – has recently prompted critical criminologist Helen Baker to refer to the ‘State-corporate facilitated harms of the pharmaceutical industry’ (Baker, 2019)
Part15
Breast implants In March 2010, French health inspectors – acting on a tip-off –made a three-day visit to the headquarters of Poly Implant Protheses (PIP), a leading international maker of breast implants. In December 2011, the French Government recommended that women who had received the PIP breast implants, filled with industrial-grade silicone rather than the approved medical grade, should have them removed, in what soon became widely known as the ‘breast implant scandal’.
The implants had been produced for12 years, and some 300,000 had been sold across 65 countries in Europe and South America. They were more likely to rupture than the medical grade silicone implants, and there were concerns that the silicone would have toxic, even carcinogenic, effects. Women were expected, at best, to have to undergo the trauma of trying to finance their removal and, in many cases, replacement (Saget al., 2012).
The case has very clear parallels to the toxic silicone-gel breast implants which were sold to hundreds of thousands of women who wanted breast augmentation or reconstruction in the United States for some 30 years up to the mid-1990s (Dodge, 2005)
Overall, criminological research on Big Pharma adds up to a significant, indeed unique, body of literature on the crimes of a particular industry. This might indicate that the industry is, as some have argued, especially criminogenic, not least due to its international reach, the scale of the companies involved and their symbiotic relationships with states, and the opportunity structures to commit crime which come from this combination of factors Summary.
The pharmaceutical industry has an in-built propensity to maximise the use of drugs and, as such, it resembles illegal drug markets in its search for profit. In seeking to maximise sales and revenues, BioPharma may harm groups of consumers, such as women. Regulating the pharmaceutical induct rye What, then, to do about the criminal corporation? Or, more precisely, how can corporations be prevented from causing harm through law-breaking?
Of course, in general when thinking of law enforcement, the Ke agency is some form of police force, but where the business world is concerned, regulatory agencies undertake most of the law enforcement. These bodies form part of, or are established and empowered by, testate.
pART16
They tend to enforce discrete areas of law – such as the US Environmental Protection Agency overseeing pollution control, SafeWork Australia as an enforcer of health and safety law, or the Commission on Human Medicines which regulates pharmaceutical safety in the UK.
This invites a focus on regulation – the attempts by state bodies to develop and enforce laws designed to constrain the activities of private organisations – and the nature of regulation and regulatory agencies Regulation not policing
Any discussion of regulation must begin with a statement of the obvious: namely, to speak of regulation is to speak of something other than ‘policing’, conducted by enforcement officers in regulatory agencies (for example, the Competition and Markets Authority; Trading’s Standards) not by police officers in police forces (the Metropolitan Police; the Serious and Organised Crime Agency).
This means there is always a taken-for-granted, socially constructed reality that the kinds of crimes that regulators deal with are viewed differently by government, the law and perhaps by society than Thos subject to the attention of the police and policing.
In other words, ‘real’ crime is dealt with by the police; business crime is not dealt with by the police; therefore, business crime is not real crime Regulation is a much-studied and documented area of criminology androecia-legal studies. Four basic observations stand out across the literature and are of relevance to Big Pharma When the regulations that affect business are being developed and considered, businesses are routinely consulted.
So, the organisations which are subject to law have a great deal of say in the nature and shape of that law. This is unlike the law when it deals with real crime and is enforced by the police.2 Enforcement of law against businesses also differs from ‘policing ‘in that regulators tend to enforce law through persuasion rather than resort to prosecution.3 non-or under-enforcement of law is the most frequently found characteristic in studies of regulation (Snider, 1993).
4 Virtually all studies of regulation share the assumption that regulation is essentially a matter of how best to control business On this view, the regulated (the business), stands ‘in opposition to the regulator (the state agency) (Tombs, 2015) Regulation through state-corpora interrelationships different way of looking at regulation is to see it as referring to a variety of state-corporate relationships. Many of these are not conflictual but co-operative, interdependent or symbiotic, that is close some ways mutually supportive and dependent (Tombs, 2012).
These co-operative relationships are sometimes difficult to observe and may, literally, unfold behind closed doors. Such is the case when large businesses, like pharmaceuticals, lobby against new regulations at national government or, for example, European Union level. Influencing policy and lawmakers is a permanent preoccupation for large companies, not least pharmaceutical companies, even if this irately subject to public scrutiny or even knowledge.
State-corporate relationship 1: The East India Company the close relationship between the state and the corporation became most apparent after the formation, in 1600, of the world’s first-ever multinational, the East India Company. Its formation was the product of a contractual ‘bargain with the state’ (Robins, 2006, p. 27) Ostensibly a profit-seeking trading company, it was at the same time central to the colonisation of India by the British state at the end of the 18th century.
More generally, through its armed naval presence, the company was crucial in maintaining parts of the British Empire fortwo-and-a-half centuries. During this period, it was implicated in countless atrocities as part of an ongoing military suppression of local peoples. Its proxy colonial role on behalf of the British government extended to the outlawing of many customs and religious rites of both Muslims and Hindus.
The Company’s private army also waged war against its French, Portuguese and Dutch counterparts to protect its access to raw materials and the factories and warehouses set up along the Indian coastline.
The torture, decapitation and burning alive of corporate rivals was not unusual, in many cases merely for breaking mutual trade agreements (Tombs and Whyte, 2015). These were just a subset of a wider range of lawful harms perpetrated under colonialism, as you saw in Ch, 2
They also indicate the close relationships formed between state and private companies. State-corporate relationships 2: IG Formentera are now numerous histories of the intimate relationships between large corporations and the emerging Nazi regime in the 1930sand among these one of the world’s leading pharmaceutical companies frequently appears.
The role of IG Farber, a chemicals and pharmaceuticals conglomerate, formed in 1925 from six German companies, including Bayer, is an example of corporate collaboration which was indispensable to the Nazi regime.
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There were numerous dimensions to IG Farber’s relationship with the Third Reich, which included using labour from Auschwitz concentration camp. Without business collaboration, the Third Reich’s war probably could not have been launched.
Ethyl GmbH was a subsidiary formed by Infare with US companies Du Pont, General Motors and Standard Olof New Jersey to build the plants that would supply the German armies with synthetic tetraethyl fuel at the request of the Third Reich (Higham, 1983).
Further, IG Farber used slave labour from Auschwitz and supplied gas to the concentration camp. One of its subsidiaries manufactured Zyklon B, a poison gas used in the chambers. In 1942Standard Oil of New Jersey (now Exxon) entered into a huge cartel agreement with IG Farber which essentially carved up the global oil and chemical markets.
Standard Oil agreed not to develop processes for manufacturing synthetic rubber, crucial for the war effort in exchange for the IG Farber agreement not to compete in the American petroleum market After the war, the company was seized by the victorious Allies; 13 Infare directors were convicted of war crimes at Nuremburg, and Bayer was re-established as one of three separate companies when Infare was broken up in 1951 (Mintz and Cohen, 1977).
Bayer is no-one of the world’s largest pharmaceutical and chemical corporations; its strapline is ‘Advancing life – that’s what we at Bayer are all about. We put ourselves to the test day in, day out. All together. All over the world. With enthusiasm for new ideas.’(Bayer, n.d.)The case of IG Farber indicates that corporations and states have Lon existed in an interdependent relationship, one of mutual symbiosis. Such is this relationship that it is difficult to think of the state acting as a neutral regulator of such companies and an enforcer of law against them.
Through this lens, the process of regulating corporate activity appears as a process that does much more that than simply (or even) controlling corporate harms and illegalities. Rather, it is a means of ensuring that an economy functions and develops. On this view, state regulation of business can best be understood as ‘social order maintenance’. Regulation maintains the steady rate and function of the machinery of industry and commerce (Whyte, 2004). As such, its purpose is to seek stable and uninterrupted system of production, distribution and consumption.
The consequence of looking at regulation from this perspective is to accept that while the regulation of corporate activity by government may ameliorate its harms, this is by no means its primary purpose. Andi is by pursuing its primary purpose – to maintain the current situation – that regulation produces and reproduces corporate harm and, in a variety of ways, prevents such harms being identified, processed or formally recognised as crimes.
As you have read in this chapter, the pharmaceutical industry can generate significant benefits in terms of health and well-being– many diseases which historically have been major killers or blighted lives, such as smallpox, have been virtually eradicated through its innovatory products. But these benefits are not distributed equally across the globe. The companies themselves – among the largest and richest companies in the world – have their headquarters in the states of the Global North.
It is in the North where the most lucrative markets for ever-more niche treatments exist; where governments are more likely to provide publicly subsidised health care for their populations; and where there is greater demand, or ability, to pay for related pharmaceutical products such as beauty treatments. For these reasons, many eradicable diseases are still the source of significant harm across the countries of the Global South. This partly reflects the most basic fact of corporate life: the primary rationale for the companies is to maximise profits. The need to maximise profits is a key explanatory factor in understanding how and why pharmaceutical companies create harm and engage in crime.
This situation – basic inequalities across the globe – is not criminal. As you have seen, the relationships between harms on throne hand and legal or illegal practices on the other are complex and itis often difficult to determine where the border between legality and illegality is crossed. Further, you should also recognise these legal and illegal harms are not the product of ‘evil’ individual men or women. They are the effect of a global industry where: there is a high cost in bringing products to market. companies operate across borders while regulation tends to be nation-state specific. there is an imbalance in knowledge and expertise between consumers and state officials, and industry experts
These harms and crimes are also the effect of structural power. Pharmaceutical companies are immensely powerful organisations. Allstate’s need the products of the industry for the health and well-being of their populations. This latter observation partly explains why the regulation of the industry is weak – a characteristic of virtually all business regulation, certainly when compared to the ways in which real criminals are policed
