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How Big Pharma and Big Tech Collude To Exploit Basic Human Needs

Adrienne Buller and Mathew Lawrence on the Monetization of Everyday Life

What makes technological change happen? How are technologies—the artifacts, systems, and infrastructures that intervene in and reshape the material world—developed? Contrary to popular imagination, it’s not merely the labor of cloistered geniuses working away on new developments, but the accumulation of knowledge and effort that has been passed down over generations.

This knowledge is a common and social inheritance, yet knowledge and its products are increasingly enclosed behind private intellectual property regimes: a unique set of rights and protections that applies to the creations of the human intellect. Originally intended to encourage innovation and risk-taking by protecting ownership of knowledge and creativity, the dominant approach to intellectual property has now, according to researchers Thomas Hanna, Miriam Brett, and Dana Brown, “increasingly become a central driving force for the accumulation and protection of assets by a narrow set of multinational companies and elite interests.”

The expansive, exclusionary forces of modern intellectual property regimes impose conditions of false scarcity where cheap and abundant forms of production and exchange could emerge, often with devastating results. Injustices that emerge from dynamics of enclosure and extraction are compounded by the fact the public sector plays a central role in many technological breakthroughs—innovation that is then habitually privatized and monetized by corporate actors.

Nowhere is this contradiction clearer, between collective knowledge and its liberatory potential against the constraints of private property regimes, of the tension between technologies nurtured to meet needs instead of being driven by the relative profitability of investment, than the development and use of medicines. Vaccine apartheid is only the latest, starkest manifestation.

One of the most notorious of such cases occurred in the autumn of 2015, when Turing Pharmaceuticals acquired the US manufacturing license for the lifesaving drug Daraprim. Under the leadership of its founder, Martin Shkreli, the company raised Daraprim’s price overnight by more than 5,000 percent, from $13.50 to $750 per pill. The consequences, for a drug the World Health Organization states is a critical medicine for any health care system, were predictably devastating. At a fiery House Oversight Committee over price gouging in February 2016, the smirking CEO was reprimanded in plain terms by Representative Elijah Cummings, a senior Democrat: “It’s not funny, Mr. Shkreli. People are dying. And they’re getting sicker and sicker.”

The expansive, exclusionary forces of modern intellectual property regimes impose conditions of false scarcity where cheap and abundant forms of production and exchange could emerge.

Shkreli, quickly nicknamed the “Pharma Bro,” and soon to be jailed on unrelated charges of securities fraud, made for a cartoonishly villainous figure. However, Big Pharma prioritizing profit over the needs of patients was hardly an aberration. The US opioid crisis, which has claimed nearly half a million lives in the US, is also a vast source of wealth for some of the richest families in America, providing billions of dollars of revenue from the sale of highly addictive substances to often impoverished Americans. Other drugs have similarly shot up in price, pumping money into the already bloated balance sheets of pharmaceutical companies.

Between 2007 and 2018, the list prices of seven branded insulin drugs in the US increased by 262 percent; this in a country where one in four diabetes patients experience cost-related insulin underuse. During the same period, the three manufacturers that dominate the insulin market, Eli Lilly, Novo Nordisk, and Sanofi, collectively distributed a total of $122 billion to shareholders in the form of buybacks and cash dividends. Their behavior epitomized the reorientation of the corporation in order to prioritize private owners, a shift from the model of “retain and invest” to “downsize and distribute,” whereby strategic focus is on distributing cash to financial interests, particularly shareholders.

Defenders of the status quo argue that profit is both an incentive for companies to invest and a source of cash to fund future innovative research. This is a generous interpretation of the sector’s business model, to say the least. Due in large part to the patent system that grants monopoly over production, pharmaceutical profits between 2006 and 2015 outpaced profit in nearly all other industries in the US.

Over the same period, the sector routinely spent more on advertising than research and development. Even if a small proportion of the sector’s profits are reinvested to develop new drugs, as political economist Rosie Collington puts it: “Fundamentally, if a funding model to develop new medical technologies requires higher list prices that reduce patients’ access to existing treatments, we have to question to what extent it is worth pursuing or even constitutes “innovation” at all.” Instead, what these episodes suggest is that the obscenity of vaccine apartheid did not emerge sui generis, it grew instead out of a fundamental dynamic not unique to Big Pharma, but constitutive of contemporary capitalism: the enclosure of public knowledge through property claims for the extraction of private profit.

The effects of Big Pharma’s enclosure of knowledge, so devastatingly evident during the pandemic, were recently summarized by Mike Davis:

Big Pharma, the monopoly of monopolies, epitomizes the contradiction between capitalism and world health. Extortionate prices and proprietary patents for medicines often first developed by university and other public researchers are only part of the problem. Big Pharma has also abdicated the development of the life-or-death antibiotics and antivirals that we so urgently need. It is more profitable for them to produce palliatives for male impotence than to bring on line a new generation of antibiotics to fight the wave of resistant bacterial strains that is killing hundreds of thousands of patients in hospitals across the world. Big Pharma claims protection from antitrust laws because it is the major engine of drug research, when, in fact, it spends more on advertising than R&D. The cutting-edge pharmaceuticals and vaccines that it markets are usually developed first in small, dynamic biotech companies, which in turn capitalize research from public universities. Big Pharma, in essence, is rentier capitalism, a fetter on the emerging revolution in biological design and vaccine production.

Bursting through the fetters imposed by existing property relations will require transforming ownership so that technological development is organized to serve our shared needs. It is time to reclaim our common inheritance.

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A short distance from the Brooklyn courthouse where Shrekli was convicted is Amazon’s only warehouse in New York City, JFK8. The size of fifteen American football fields, it is the site for the technological consolidation of a modern caste system. In 2019, more than 60 percent of associates were Black or Latinx, while over 70 percent of management were White or Asian. This is scarcely unique to JFK8; the majority of the company’s warehouse associates in the US are people of color. Subject to technologies that track every minute of their shift, and under the constant threat of automated dismissal if their productivity slackens, workers are commanded, monitored, and disciplined by mass-management technical systems.

What these episodes suggest is that the obscenity of vaccine apartheid did not emerge sui generis, it grew instead out of a fundamental dynamic not unique to Big Pharma, but constitutive of contemporary capitalism.

The result: work has intensified, and workers have been rendered disposable. Injury rates are double the industry average. Indeed, despite working for a company that is one of the largest private sector investors in the world, Amazon warehouse workers have a higher injury rate than coal miners in the US. Even before Covid-19, Amazon lost an extraordinary 3 percent of hourly associates each week, a turnover of the workforce of 150 percent a year. In 2020, this staggering rate, twice that of the retail and logistics sector as a whole, accelerated.

As online shopping surged, warehouse shipping records were smashed and three years’ worth of profits were rolled into one; in the process, as a New York Times investigation into JFK8 found, “Amazon’s system burned through workers.” To what end is this brutal and brutally effective system oriented? In whose interest is this oppressive panopticon of digital Taylorism operating, extracting enormous value from labor while treating it as expendable? Ultimately, Amazon is a machine for the enlargement of the wealth and power of its major shareholders. It is extraordinarily successful at that goal.

During the first year of the pandemic, Jeff Bezos, founder and executive chairman of Amazon, saw his wealth nearly double from $110 billion to close to $200 billion. Returning from his maiden space flight in July 2021, he bluntly, albeit unwittingly, described the extractive processes that made this extra-terrestrial excess possible: “I want to thank every Amazon employee and every Amazon customer because you guys paid for all this.”

The 24-hour hum of Amazon’s warehouses exemplifies the uneven and unequal ways in which technology has shaped the present crisis. New digital tools work alongside older forms of technology and labor discipline, with the experience of consumer ease enabled by the sweating of insecure workers. Inside the warehouses we see the ubiquity of surveillance technology across value chains, the intense imbrication of race and capitalism, articulated through unequal working conditions and health outcomes, and the entangled web of disciplinary tools that bear the imprint of class power.

This entanglement has helped sustain the relentless rise of “superstar firms” and the monopoly power of the digital platforms that control both frontier technology and precarious labor. Their extraordinary scale and logistical feats attest to the power and efficacy of non-market planning within the corporate form, even as they are organized in ways that amplify unjust hierarchies; a “socialist Amazon” might share some of the same technical apparatus but would be fundamentally different in operation and purpose, investing in technologies that deliver radically divergent outcomes for its workers and users.

Above all, the phenomenon of Amazon exemplifies the innate tension of capitalism: a social and economic system built on injurious class distinction where the working majority labor to enrich a wealthy ownership class, its generation of poverty amid plenty, technological development in service not of shared emancipation but private accumulation, with risk and reward structured through property relations that manifest in intensely racialized, unequal outcomes. Our common inheritance is leveraged toward the consolidation of vast private wealth.

*

Digital platforms such as Amazon now occupy the commanding heights of the contemporary economy. There is nothing new, of course, about the platform business model. From Renaissance banking houses and early modern stock exchanges, to the strip malls of the post-war years, our economies have long hosted companies whose business is intermediation and the siphoning of rent from suppliers or users of their space. What’s new though is the scope and scale of intermediation, now facilitated by digital technologies.

Acting as gatekeepers for everything from social networks and rental apartments, to consumer commodities and taxi rides, platforms dominate an increasing range of sectors, generating revenue from subscription fees, commissions, and the monetization of the “attention” of platform users. Rapidly scalable, they trend strongly toward both standardization and monopoly due to a combination of powerful network effects, winner-take-all markets, anticompetitive actions, and economies of scale.

Sitting at the heart of the transactions and engagements of the digital, and increasingly, the physical economy, they are rentier giants of our age, warding off or buying out potential competitors and batting away public policies aimed at curtailing their power. Taken together the reason for staggering market concentration is clear: “monopolization is a feature, not a bug.”

To what end is this brutal and brutally effective system oriented? In whose interest is this oppressive panopticon of digital Taylorism operating, extracting enormous value from labor while treating it as expendable?

The pandemic is driving the ongoing consolidation of Big Tech’s position as a central organizing force of our societies. This centrality has made them unprecedented engines for the generation of revenue and shareholder wealth. Alphabet’s net profit, for example, jumped by 162 percent to a record $17.9 billion in the three months to March 2021 as advertising revenue grew by a third. Indeed, the S&P 500’s record year was fueled by the five “FAAMG” companies—the behemoths of Alphabet, Amazon, Apple, Facebook, and Microsoft—five companies that alone now represent a full quarter of the value of the index.

Strikingly, since the end of 2017, with the S&P 500 up 23 percent, FAAMG accounts for about 72 percent of that performance. More broadly, just fifteen companies in the index account for approximately 96 percent of the gain, meaning strong index performance increasingly conceals important information about which sectors are surging and which are stagnating. What is masked by the spectacular gains of the digital giants, though, is a struggling corporate sector and increasingly cannibalized social realm. Indeed, as political economist William Davies argues,

the appreciating asset value of the platform occurs through deteriorating social prospects elsewhere: what Facebook does for journalism, Spotify does for musicians and Uber Eats for independent restaurants. In each case, the basic means of access to a market or a public is privatized, and becomes an opportunity for rent extraction. This represents a new phase of what David Harvey terms accumulation by dispossession, only it is the infrastructure of civil society that is being seized, and it is rapidly capitalized start-ups doing the dispossessing, without the direct intervention of the state.

In light of this, it is unsurprising that the dominant platforms are linked to negative social, economic, and political outcomes, both independently and in conjunction with their collection and use of data. From ubiquitous surveillance and the concentration of economic power, to the rise of algorithmic management (and bias) that hardwires discriminatory outcomes into core features of our economic system, our economic and social challenges are inseparable from the design and operation of the dominant digital platforms. Whether the coordinating power of digital platforms can be transformed from the vanguard of corporate power into infrastructures of socially useful calculation is therefore an epoch-defining question.

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In early June 2021 GP practices in England were given an urgent instruction. They were told to hand over their patients’ entire medical histories to NHS England with just six weeks’ notice. Unparalleled in its scope, this vast data grab was justified on the grounds that pooling information would help improve care and develop new medicines. Yet the lack of transparency raised concerns: was the public’s health data being forcibly turned over to be exploited for corporate profits?

Medical data is only one frontier among many in ongoing processes of “datafication.” The platforms are transforming society into one vast digital factory. The impulse to collect, analyze, and monetize data drives an ever-expanding dragnet of digital surveillance and corporate accumulation of data. As a result, as Shoshana Zuboff argues, the largest platforms possess “configurations of knowledge about individuals, groups and society that are unprecedented in human history… The problem is that all this knowledge is about us, but it is not for us.”

Rather than helping us to create planning and automating systems that can abolish unnecessary toil, this knowledge is used to fine-tune the manipulation of our behaviors, psychologies, and desires to create predictable human subjects—all to better generate income for the dominant platforms.

Yet data, despite being enclosed behind the walled garden of the platforms, is relational, and its value is in its aggregation. As the legal theorist Salomé Viljoen argues, its inherent relationality means we should view “data not as an expression of an inner self subject to private ordering and the individual will, but as a collective resource subject to democratic ordering.” Moreover, as a collectively created resource that becomes valuable in the aggregate, it defies typical classification as an asset class; indeed, what is striking is how far we are from the vision of some technologists of data being a tradeable asset class in its own right.

Private, properterian logics, whether individualized or corporate dominated, are unhelpful guides for data governance. Nor is data dematerialized; the infrastructures that generate data are resource intensive, dependent on immense energy use and the consumption of resources derived largely from extractive industries. In this context, if we want a more egalitarian production and use of digital knowledge we must both re-politicize data and reclaim data infrastructures and their supply chains for the commons.

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Excerpted from Owning the Future: Power and Property in an Age of Crisis by Adrienne Buller and Mathew Lawrence. Copyright © 2022. Available from Verso Books. 

Adrienne Buller and Mathew Lawrence
Adrienne Buller and Mathew Lawrence
Adrienne Buller is a Senior Research Fellow at Common Wealth. Adrienne’s writing and work has appeared in the Guardian, Jacobin, the New Statesman, New Left Review, and Financial Times, among others.

Mathew Lawrence is the founder and Director of Common Wealth, a UK-based think tank that designs ownership models for a democratic and sustainable economy.





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