Medical Monopoly: Intellectual Property Rights and the Origins of the Modern Pharmaceutical Industry

Drugs and money in the United States might resonate as a current crisis, but the two have been intertwined, in one form or another, since the writing of the US Constitution, where Congress was given the right “to promote the Progress of Science and useful Arts, by securing for limited Times to Authors and Inventors the exclusive Right to their respective Writings and Discoveries” (article I, section 8). Joseph M. Gabriel has braided together four histories to provide insight into the current medical system in the United States. Readers follow him, mostly in the 1800s, through the evolution of patent legitimacy, the growth of the pharmaceutical industry, the influence of capitalism, and the practice of medicine—with ethics at the cross-section of the four. This interdisciplinary exploration of patent law, the pharmaceutical industry, and the medical profession serves to at least partially explain how our health care system became the most expensive in the world. Many familiar companies are mentioned that trace to the origins of the US pharmaceutical industry, which now claims such influence on Capitol Hill [1, 2]. Medical Monopoly demonstrates how health care slowly evolved from a social good to a simple market where profit-making naturally matters most. The establishment of health as a market commodity through the slow acceptance of patenting represents a fiercely guarded wealth that continues into this era. The primary focus of this book is well reflected in its subtitle—the book is about the evolution and effect of patent law. Physicians in the early years of the United States objected as much to the secrecy of what were called patent medicines as they did to the actual drugs sold by salesmen as branded potions promising miracle cures (some of which worked) because that secrecy interfered with physicians' ability to dispense medical assistance. In Great Britain, patents belonged to the monarchy, which assigned medicines gravitas and protected knowledge. In the United States, the secret formulas and their direct promotion to the public under branded names (that hid the formula) disturbed the medical profession most. After the US Civil War and near the end of the nineteenth century, standards, trademark law, and even the expression “patent” evolved in meaning through the work of Francis Stewart and Parke-Davis, and through court cases such as Bayer's patent of aspirin that made acetylsalicylic acid therapeutically useful. Physician opinion slowly came to accept patents as a means of recording the ingredients of remedies. Gabriel demonstrates how science, law, and profit have long been intimately interwoven with health in the United States. While accurately reporting that the potential of a market and its vested interests frequently fund research, the book continually surprises the reader and makes history relevant. Gabriel quotes William J. Schieffelin from nearly 100 years ago as saying, “inflated demand which we have so often experienced for drugs with very moderate merits and often very dangerous properties, a demand created by skillful propaganda and advertising” (p. 244), an assertion that resonates as if Schieffelin were talking about today. The problem of marketing medicines directly to the public as an end run around the medical profession remains, and in fact may be even more, harmful to patient health today [3]. It seems, at times, that we have become primarily consumers, more than patients, to the pharmaceutical industry [4]. In the end, Gabriel has made the case that the separation of profit and medicine might be as important to our country as the separation of church and state. Health disparities stem most frequently from unaffordability of health care. On the surface, the medical and pharmaceutical industries appear to peacefully coexist in a mutually profitable endeavor. Gabriel writes the story of how that was not always so. Truly a scholarly work, the book is compelling reading and includes a list of archives consulted, extensive endnotes, and an index. Readers of Paul Starr's The Social Transformation of American Medicine (New York, NY: Basic Books, 1982) will recognize some familiar history in the formation of the medical profession and its battle with the ethics of patent medicines. There are many histories of the practice of medicine in the United States and a few of the pharmaceutical industry [5–9] and of the history of patent law, but Gabriel has written a critical history of the interwoven nature of the three and the underlying influence of treating health care as a commodity. Anyone interested in how our health care system devolved to dispensing drugs and promoting them through direct advertising to the nonmedical consumer will appreciate this book. Medical libraries serving doctors and pharmacists or colleges and universities with schools of pharmacy or medicine will particularly value this book as an impetus for ethics discussions. Those with medical humanities programs, law, political science, public health, or undergraduates studying the making of the modern world will also benefit from this thoughtful and deeply researched work.