Freedom, Prescription Drugs and Social Irrationality

Since the late 18th-century, individual freedom has ranked among the highest of our social values. Although it is strongly asserted in the U.S. Constitution and the Bill of Rights -- the founding documents of our republic - John Stuart Mill gave it its clearest expression: "That the only purpose for which power can be rightfully exercised over any member of a civilized community, against his will, is to prevent harm to others. His own good, either physical or moral, is not a sufficient warrant . . . Over himself, over his body and mind, the individual is sovereign."

Modern societies, however, have chosen to breach these principles of freedom, usually in the cause of what Mill so clearly proscribed -- the individual's "own good." The late Milton Friedman and other libertarians on both the right and left have taken considerable pains to awaken us to the mistake of violating Mill's norm, reminding us that such violations of this fundamental freedom are generally in someone else's interest.

A flagrant instance of such a violation in the interest of a third party is the case of prescription drugs. Our lack of free access to these drugs is justified on the grounds that presumably we are incompetent to make good judgments and thus would harm ourselves. The constraint on our freedom to be sovereign over our bodies and minds is justified as protecting us from ourselves, exactly what Mill found objectionable. The pharmaceutical companies strongly support the restrictive prescription system since it enables them to charge exorbitant prices, 78 percent of which are paid by insurance companies, whereas freely-available inexpensive over-the-counter (non-prescription) drugs are not generally covered by insurance.

Our policies toward prescription drugs not only violate Mill's freedom principle, they are also absurdly irrational. Pharmaceutical companies are permitted to advertise their prescription drugs to clients who are not legally permitted to freely purchase them. The media is saturated with prescription drug ads which bombard consumers not judged competent to decide for themselves whether these drugs are in their self-interest. The consequence is that, persuaded by advertising that they need these drugs, consumers badger their doctors to prescribe them. While it might be appropriate for patients to pressure their doctors to provide proper health care, it could hardly make sense for them to pressure their doctors to provide them prescriptions for drugs that by law they are judged incapable of freely consuming. Not only does this waste doctors' time, but should they refuse, doctors risk losing patients who can shop around until they locate a compliant doctor. The restriction on drug use, combined with the freedom of pharmaceuticals to advertise to consumers, undermines doctors' roles. It challenges their authority and credibility.

High prescription drug prices are ever in the news. In 2013, expenditures for prescription drugs constituted 9.3 percent of national health expenditures. That works out annually to about $1000 per U.S. citizen. Pharmaceutical companies claim their high prices are necessary to fund the basic research and development that brings forth our cornucopia of disease-fighting medications. However, a 2012 report in the British Medical Journal found that rather than investing in new groundbreaking medications, pharmaceutical companies find it far more profitable to craft products that are only slight variations on existing drugs. Yet more striking, the authors find that they spend $19 toward promotion and marketing for every dollar spent on "basic research."

Since much of this product promotion is spent on convincing consumers deemed incompetent to freely purchase these products, shouldn't such advertising be made illegal, freeing up the monies to be spent on research? Ah, but that would violate the pharmaceutical companies' freedom of speech.

Heavens, what a mess! What a glaring example of social irrationality. The freedom of individuals to do what they choose with their bodies and minds is restricted while pharmaceuticals are permitted to seduce them into pestering their doctors to prescribe them medicines that they, the patients, are not deemed competent to freely choose. Corporate freedom trumps citizen freedom!

Why does this social irrationality exist? The answer is simple -- corporate political clout is due to the fact that corporations are now armed with most of the rights of citizens, as we were recently reminded in the U.S. Supreme Court's 2010 decision on Citizens United v. Federal Election Commission which essentially removes constraints on corporations' ability to advertise the political interests of their owners.

But what stands behind the ability of corporations to acquire and exert such extraordinary political power? The answer here is also simple. They are controlled by the very rich. In 2007, the last year in which data are available, the wealthiest one percent of Americans owned 49.3 percent of stocks and mutual funds, the richest 10 percent, 89.4 percent, leaving the bottom 90 percent only 10.6 percent. Corporations' freedom of speech leverages the political power of the elite.

Thus, in the end, the root of the irrationality of pharmaceutical drug advertising is the same as the root as most of our social irrationalities -- the extreme inequality of income, wealth, and privilege. What is irrational for society is not irrational for the rich elite who use their resources to craft political policies which not only bring them yet greater shares of essentially everything, but which restrict the fundamental freedom that Mill so clearly enunciated.

So, returning to Mill. Mill did not stand for a cold, uncaring society. Human freedom requires a clear definition and Mill provided it: An individual's freedom cannot be validly constrained on the grounds that it protects the individual or that "it will make him happier, because, in the opinions of others, to do so would be wise, or even right." But Mill didn't preclude that we should show care and compassion for the free but perhaps careless individual: His well-being and happiness "are good reasons for remonstrating with him, or reasoning with him, or persuading him, or entreating him, but not for compelling him, or visiting him with any evil, in case he do otherwise."