A few years after 9/11, while the United States was at war with Iraq and fears about national security were at a fever pitch, the drug industry embarked on a short-lived literary venture. At the behest of a consultant, executives at the Pharmaceutical Research and Manufacturers of America (PhRMA) commissioned ghostwriters to pen a pulp fiction novel about Islamic terrorists using biological warfare against the American public. That manuscript, titled The Spivak Conspiracy, portrayed its villains’ plot to weaken our citizenry by poisoning the supply of drugs imported from Canada. It just so happened, when this narrative was concocted in 2005, that Congress was considering relaxing federal law to allow Americans more leeway to purchase medications from Canadian pharmacies. Then, as today, certain drugs cost as little as one-tenth the price over the border.
The novel never hit shelves because its authors refused drug executives’ zanier demands: lengthy polemics against the evils of government regulation and “dumbed down” prose, which they deemed critical in order to appeal to women readers. (Women are the primary consumers of Canadian drugs.) In a twist, the authors independently published a thriller of their own—about a pharmaceutical company that poisons Canadian-sold drugs and then blames terrorists.
That literary fiasco offers a particularly vivid example of Big Pharma’s century-long effort to exploit nationalist fears in order to protect itself against policies that could reduce profits. More recently, in response to measures to rein in drug prices and hold manufacturers accountable for the opioid epidemic, the industry has deployed racist tropes of dependency and invasion to distract from the need for sweeping regulatory reform.
It doesn’t surprise that President Donald Trump participates in the scapegoating of foreigners and “socialist” governments for the problems wrought by unfettered capitalism at home. Earlier this month, he assured supporters, “I will never allow [Democrats] to steal your health care and give it away to illegal aliens”—as if undocumented immigrants, rather than a broken, for-profit healthcare system, constitute the greatest danger to care-seeking Americans. What does raise eyebrows is that policymakers on the left seem reluctant to name the same prejudices deployed by the industry underwriting drug policies, missing the opportunity to unify individuals in a common fight for affordable medicines.
The drug industry’s tactics have been on full display in recent months, as curbing medication costs has become a national priority. In September, when House Speaker Nancy Pelosi unveiled the Lower Drug Costs Now Act, which would impose price ceilings on popular drugs, PhRMA swiftly summoned the specter of depressed innovation and warned of American jobs fleeing to China, should the bill pass. Industry representatives also claimed that drug prices are high because other countries “freeload” on American innovation, failing to pay their share of research and development (“R&D”) costs. By stoking fears that other nations will either outpace the United States or drain it of its resources, industry representatives can redirect attention from an inconvenient fact: drug prices are lower in countries like Canada and the United Kingdom because those countries regulate prices.
The rhetoric surrounding drug importation and the opioid epidemic is even more insidious, as it appeals to racially divided notions of “licit” and “illicit” drugs. This was suggested in July, when Health and Human Services Secretary Alex Azar announced efforts to create pathways to import certain drugs from Canada. Though many Americans think the plan is a gimmick to deflect criticism of the administration’s inaction on drug prices, PhRMA President and CEO Stephen J. Ubl raised alarm. “There is no way to guarantee the safety of drugs that come into the country from outside the United States’ gold-standard supply chain,” he warned. “Drugs coming through Canada could have originated from anywhere in the world…”
Translation: America supplies the best drugs, and we can’t risk importing ones produced under god-knows-what conditions.
Ubl doesn’t mention that millions of Americans already import medications and not one has reported harm from a Canadian-supplied drug. Nor does he mention that, to cut costs, suppliers import drugs from around the world using a tracking system that protects against unsafe and counterfeit products. His is an emotional appeal, rather than a logical one. By tapping into a decades-old racial paranoia of foreigners weakening the citizenry, Ubl not only redirects attention from drug makers’ price-gouging, he obscures the pharmaceutical industry’s role in creating the greatest counterfeit drug crisis that exists today—the opioid crisis.
These duplicitous appeals to the basest forms of nationalism have a long tradition. In the early decades of the twentieth century, when racial panic about the influx of foreigners prompted immigration restrictions and other eugenic measures to protect the perceived integrity of the American race, fledgling drug makers Bayer and Merck benefitted from stereotypes of opium-addicted Chinese immigrants by branding their aspirin and heroin as “safe” and “American-made.” In newspaper advertisements, Bayer advised readers to look for the “Bayer cross” in order to be assured of the drug’s origins, often alongside an image of a housewife or child nursing a headache in bed. Precisely by distinguishing its legal drugs for white people from the illegal ones used by non-whites, the two companies boosted sales and gained regulatory favor. This allowed both manufacturers to make a fortune selling heroin, cocaine, and methamphetamines to U.S. soldiers and citizens, all while authorities ramped up their surveillance of Chinese, African American, and Latinx communities, who were perceived to be spreading vice among the population.
As historians have shown, the highly racialized division between licit and illicit drugs—epitomized by the verbiage of “white” and “black” markets—became even more pronounced in the Reagan Era, paving the way for the opioid epidemic of the present.
During his presidency, Ronald Reagan launched a “War on Drugs” that aggressively targeted members of poor, urban populations for incarceration. He also launched a “Second American Revolution” that eliminated government oversights, relaxed FDA review processes, and permitted direct-to-consumer advertising of drugs for the first time. The anti-drug hysteria and the deregulation and mass marketing of legal pharmaceuticals were co-constitutive programs, writes Donna Murch. By vilifying one kind of drug user, the pro-privatization government sanctioned another.
Recognizing that the difference between “dope” and medicine depended upon the profile of users, Purdue Pharma focused marketing efforts for its opioid OxyContin upon rural regions after 1996, when the drug was introduced—the better to keep regulators, who might have blanched at the prospect of expanded sales of opioids in urban markets, at bay. By distinguishing its white, rural patient from the dark-skinned law-breaker in cities, Purdue both exploited and reinforced the racial logic driving the policing of minorities. (In the 1990s, President Clinton expanded Reagan’s crusade with a “War on Gangs” and even proposed the death penalty for drug traffickers.) When the Drug Enforcement Agency eventually found high rates of opioid abuse within states like West Virginia and Kentucky in the early 2000s, the agency elected not to tackle opioid abuse, allowing Purdue to continue to profit from OxyContin, which sales representatives falsely claimed was not addictive. High demand for prescription painkillers spawned the market for synthetic opioids, which now account for almost half of all opioid overdoses.
Despite the fact that white, rural areas are, by design, most impacted by opioid abuse, conservative lawmakers continue to place the blame for the epidemic on urban areas that welcome undocumented immigrants, with the tacit approval of the drug industry. As Trump maintains, “Ending sanctuary cities is crucial to stopping the drug addiction crisis.” Such a claim reflects the longstanding narrative that foreigners are the cause of public health crises, while absolving the actual culprits and forestalling systemic reforms.
Those on the left have not done enough to undermine this fairy tale. When it comes to opioid abuse and high drug prices, Democrats may point the finger at pharmaceutical companies; but they reinforce the drug industry’s power by prioritizing biopharmaceutical solutions to health crises and, in some cases, fail to appreciate the connection between anti-racist reforms and health reforms.
Nearly all of the Democratic presidential candidates support increased funding for opioid addiction treatment, including expanding access to naloxone, buprenorphine, and methadone. While these medicines are critical in combating the epidemic, this policy nevertheless financially and symbolically benefits the very industry that created the crisis—without necessarily addressing the racially bifurcated system that prosecutes only certain drug users. Pete Buttigieg and Andrew Yang want to decriminalize opioids, but neither has offered a concrete plan for scaling back the broader War on Drugs. And while Kamala Harris, Joe Biden, and Amy Klobuchar have unveiled plans to undo the War on Drugs, they all have a record of fighting for it, raising concerns about their commitment to challenging this industry-abetted form of racial injustice.
The Democratic candidates have also failed to counter the myth that America is exceptional in terms of the quality or safety of its drugs. Not long ago, Senator Cory Booker, who has taken a lot of money from the drug industry, opposed a measure to import drugs from Canada, claiming there was no way to guarantee the drugs met “American safety standards.” He willfully ignored evidence to the contrary, as well as the fact that most Canadian-imported drugs are already manufactured in the U.S. (He has since changed its stance.) And those candidates, like Senator Bernie Sanders, who have whole-heartedly supported importation and measures to cap drug costs, such as the use of a national pricing index, have done so on the grounds that Americans shouldn’t be disproportionately impacted by high costs. The last point may be true, but what if, in addition to asserting Americans’ rights, progressive candidates highlighted the collective need to resist the drug industry’s increasing power?
Unbeknownst to many Americans, essential drugs are still priced out of many individuals’ reach in countries with price caps, such as Canada. In fact, one in ten Canadians ration or skip medicine due to costs, just as one in ten Americans do. This reality should highlight the vulnerability on both sides of the border, as well as the need to enact collaborative reforms and not fall under the spell of the nativist tropes the industry uses to secure its capital.
The last century has shown that the drug industry depends upon the stoking of invidious divisions—between “patients” and “criminals”; citizens and non-citizens; whites and minorities; Americans and foreigners—to maintain its wealth and influence. Progressives ought to challenge this tactic both by calling it out by name and by more purposefully uniting people across both national borders and within our own communities in the struggle against an industry bent on profiting from the harm it inflicts across the globe.