I am ill.
Not like the rappers are[1], but actually physically ill.
Last week, I woke up feeling my uvula – a part of my body I am typically, blissfully unaware of. It was a night of mandated corporate camaraderie, and at first I assumed that this was simply the result of my drunken reveries; that I had fallen asleep, and given my inebriated state and a nose clogged from a lifetime of pugilism and sinus problems, I had been mouth-breathing, snoring, and snorting for the fitful few hours I slept.
But no. I disproved this thesis when I went to drink cool, life-giving water only for it to turn to fire in my throat. The guttural groan of pain I instinctively released caught short, stopped in its tracks by my swollen tonsils. This was no good.
I struggled through the rest of my work trip, an experience that was spent floating in a cough syrup haze with at least two throat lozenges in my mouth at any given time. I would describe it as “ethereal but unpleasant.”
Upon completing my travels, I tried to ride things out. This is my natural instinct as a tough[2] person. Then my fiancé demanded to look down my throat, and once she got my dumb, fat tongue out of the way, she said, “You need to go to the doctor immediately, there is shit growing in the back of your throat.”
I am not one to disappoint my betrothed, and I was in a significant amount of pain while eating, drinking, and talking[3], so I relented and went to my general practitioner. He prescribed azithromycin, a broad-spectrum antibiotic to murder whatever microbes that had made my last week so miserable.
With a heavy heart and a conflicted conscious, I took my medicine. Despite my deep and abiding love of drugs, I despise taking antibiotics. I avoid it wherever possible, preferring to train my own body and immune system to be as vicious and inhospitable as possible to antagonistic bacteria. But more than that, I feel that taking antibiotics is a selfish act: I feel like though I speed my recovery through my particular illness, I am kneecapping humanity in an ongoing arms race between our antibiotics and the microbes.
It is an arms race we are losing. I am perhaps more cognizant of this arms race due to my hero, my brilliant big sister and her PhD in microbiology. I am acutely aware that it is the microbes’ planet, and that we only live on it[4]. I am also aware that while individual human activity is part of the problem (always finish your round of antibiotics; don’t just stop because you feel better, you absolute fucking cretins), a larger problem is that the structures of capitalism are uniquely unsuited to the challenge of antibiotic-resistant microbes.
One of the major problems is due to factory farming and industrial animal husbandry, where animals to be culled for food production are kept in close quarters, and to avoid the spread of disease, are pre-emptively treated with antibiotics. Though there is little evidence that the antibiotics affect us downstream in the food chain, this prevalence of antibiotics in the food supply contributes to the growth of antibiotic-resistant bacteria.
Bacteria reproduce quickly and mutate quickly, and the combination of these mutations and natural selection mean that even our best antibiotics will eventually be ineffective against these existing and coming super-bugs. My sister studied MRSA - Methicillin-resistant Staphylococcus aureus – a type of staph infection that is already resistant to most antibiotics, and is the bane of hospitals and grapplers alike. As a grappler who likes our hospitals to work well, you see why I am concerned. Do yourself a favor and never google MRSA. Or, go for it, if you’re into gaping, sinkhole-like orifices opening where no orifice should be, I’m not going to yuck on your yum.
All this is to say that MRSA is just one incidence of a broader medical and scientific problem, and one that the structures of capitalism seems incapable of addressing. As Oliver Thorne of Philosophy Tube puts it, “…in capitalism, stuff gets done because it is profitable, not necessarily because anyone needs it to be done.” A corollary of this is that things that are not profitable are left undone, even if they are necessary, and this is the challenge we run into with antibiotics.
The big money in pharmaceuticals is not in antibiotics, in part because of the losing nature of this biological arms race. Researching drugs is difficult and expensive, and the market incentives push pharmaceutical organizations towards more profitable research.
Imagine working for 10 years to bring to market a new, powerful antibiotic, spending massive wealth and energy to create a new wonder antibiotic. This drug, being remarkably effective, becomes widely used. But, because microbes continue to divide and reproduce, in a matter of years, the drug becomes ineffective. Now we’ve spent a fortune on something that we’ll never make money on, because it is now ineffective.
Or, maybe it is sparingly used. We’re already rationing and reserving the strongest antibiotics we have, for fear of making them futile. And because it is used infrequently, you don’t make much money off it, or at least you don’t make enough money off it while your pharmaceutical patent is in effect; after that, competitors can create the generic drug, edging further into those sweet, sweet profit margins.
Either way, the market incentives work against the pharmaceutical companies, which need to make money, either to keep the doors open or to maximize shareholder value. It would be a foolish business model to focus on these important drugs that humanity depends on. No, much better to work on an antidepressant or some other type of drug that treats, rather than cures. Something that is taken on a recurring basis, that’s where you can really make a killing, even as superbugs make a killing.
As usual, I have no great answer to this. One notion I like is to have governments use tax money to subsidize research into antibiotics, then assume ownership of the patents and make the resulting drugs as generics. I am sure there are others I don’t have the vision to see. I’m better with diseases than cures, more diagnostician than pharmacist.
What I do know is that the structures of capitalism and the incentives of markets are unsuited to issues of human health.
Allow me a diversion, if you will: lately I have been playing The Outer Worlds. It’s an outstanding sci-fi role-playing game. I’ve written previously about the unique features of science fiction and video gaming that allow them to teach lessons through translation and transference. The Outer Worlds made me consider this again with its opening town, Edgewater. Edgewater is a company town, built around the Saltuna factory. It is also ravaged by a plague. The corporation has medicine, but medicine is only apportioned to those that can work. Martin Abernathy is older resident of Edgewater who will not be provided with medicine[5]. When I spoke with him, I remember thinking, “Wow, what a fucked up society where they have medicine, but you can only get it through working.” Then I went, “Awww shit, I’ve clocked what they’re up to.”
I’m lucky enough to have insurance. I don’t like using it, but I’m lucky enough to have it. I don’t have to worry about if I can visit a doctor and get medicine. When I was filling my prescription, the woman in front of me was declined her medicine, because Medicaid would not cover it without a recommendation from a specialist – just one of the many aspects of our Byzantine system. Luckily, she was able to get her insulin. But the whole ordeal made my heart hurt.
As it stands now, I’m getting better. I’m completing my round of antibiotics, and my uvula is as it should be: out of my conscious awareness.
I’m not sick anymore, but this encounter has made me consider how sick our society is, and how sick we all may someday be if we continue operating medicine by markets.
[1] Although, also, exactly like the rappers are.
[2] Read: Stupid
[3] Surely, my favorite activities.
[4] Indeed, in my spacier moments, I consider the notion that my body and my consciousness may just be a means for trillions of my gut microbiota to live and thrive. I call this the “Osmosis Jones” hypothesis.
[5] As an additional aside, you’re sent to Martin Abernathy by the town’s grave-keeper, who rents the dead their burial plots and wants to make sure that Abernathy is paid up. This is how marketized and commoditized the Outer Worlds are: death is no escape from microtransactions.