Intended for healthcare professionals

Editor's Choice

Say no to the free lunch

BMJ 2005; 330 doi: (Published 14 April 2005) Cite this as: BMJ 2005;330:0-g


Dear Editor,

It was in the year 1492 AD that Christopher Columbus left the shores of Spain in search of a new sea route to India with the hope that the world is round. Exactly 513 years later I am asking this curious question if the world is flat now after reading a recent book on the topic. The reader’s first impression is to rubbish this, as there is “scientific” proof to show that the world is round. One will, at most, agree that the world has shrunk into a global village, thanks to the new revolution in communications. Today a child sitting in Timbuktu could access something happening in San Francisco with the flick of a button! Doesn’t that make the world flat-level playing ground for everyone in the world? That is exactly what I meant by saying that the world is flat now.

The world runs on a curious logic of consumerism today. Any commodity that could be sold will make the world rich. Drugs and pharmaceuticals are no exception here. Doctors today have become sellers and the patients the buyers. In this world justice is the convenience of the powerful and the rich. Injustice becomes justice. Plato expounds that philosophy very well in his The Republic-- a totally different word compared to the modern word Democracy. The question of free lunch does not arise at all. While everything else is built to last only for a short time, to increase profit for the producer, the philosophy of altruism can not exist in the pharmaceutical field. If doctors do not invent newer diseases to sell drugs they would be considered unproductive. If doctors confine themselves to treating only the sick the consumer society does not survive. Wealth is more and more consumerism. So, we have to invent newer indications for drugs by inventing newer diseases in the apparently healthy, the so called “doctor-thinks-you-have-a-disease syndromes.”

The Patents Bill, recently passed by the Indian Parliament, to get a pat from the WTO, will, I hope, not make matters worse for the poor. Essential drugs will be beyond the reach of the poor, but the Govt. said in the Parliament that they will not allow that to happen. I want to believe the Minister. It might help the country, indirectly though, even if the prices went up, to contain the burgeoning population! Adverse Drug Reactions are the fourth important cause of death even in the US, according to the Institute of Medicine Report for that country (JAMA 2000; 284: 483-485). Some of those drugs kill more people than they save, anyway. May be that is the intention in the first place. In the US, according to the same IOM report, Adverse Drug Reactions (ADRs) are the fourth important cause of death following heart attacks, cancers, and hospitals and doctors’ interventions! Have the do gooders in the world read the British House of Commons Report on the maneuverings of the large Pharma. companies released this week?

If one wants to get to the bottom of the real flat world one only has to read the following book, just published. This is a book on the New York Times best seller list. The blurb tells you that it is CONFESSIONS OF AN ECONOMIC HIT MAN, BY John Perkins, a former employee of an International consulting firm, published by Barrett-Koehler. He talks about the corporatocracy which would be an eye opener to all those that are interested in human welfare. Corporatocracy is a new addition to the long list of words like democracy, autocracy, plutocracy, monarchy and the other economic isms. Long live human kind on this planet bereft of all cracies except humanocracy (economic humanism).

The world still is round with less than five percent of the population sitting on the top with 95% of the wealth and, the rest of the 95% poor people hanging on at the bottom without knowing where their next meal comes from. “The Mathew Law” still works in this world. He who hath shall be given. While the rich sit on the top the poorest of the poor drop down from below to the bottomless pit to perish for ever due to hunger, malnourishment and disease. Fifty years ago Gunnar Myrdal, a Swedish sociologist, coined the word “underclass” to describe the African Americans. The world in every field today tries to create an underclass. The patients today are an underclass used by the powerful to increase consumerism and their wealth. This produces the vicious non-linear feedback loops. The ability to buy wealth to buy political power is how the lobbies today run their business! Science has been proven right in that the world still is round! Yours ever, bmhegde

Competing interests: None declared

Competing interests: No competing interests

19 April 2005
Retd. Vice Chancellor