This week we reviewed the topics of the profit motive and the idea of noxious markets. These ideas both introduce problematic, often critiqued, elements of a free-market and capitalist system. Both concepts come under heavy criticism for the harms they produce, which often leads to ethical concerns about their nature.

TheCase of the Price Hike (see below)expressed these concerns relative to the pharmaceutical industry. Critics of this industry claim medicine is among other basic survival needs such as shelter, food, and water. Where these other needs are often met by government or civil society in at least the most basic form (e.g. food banks, public water, homeless shelters), life saving medicines often stress the ability average citizens to attain them. Often these medicines are not attainable because of legal protections, such as intellectual property rights, patents, etc. Consider the information from this week's material and respond to the following prompt:

• PART 1: Taking the information you reviewed about the ethics of the profit motive this week, craft a position about whether such motive is inappropriate for some industries/services. Here you are exploring whether the profit motive makes a market noxious (either potentially or actually).
• PART 2: Explain this position and then apply that reasoning to the pharmaceutical industry to determine if a profit motive is appropriate or if it makes the market noxious. Consider both theoretical and practical applications of your position (i.e. how it looks on paper and also in practice).

Case of the Price Hike:

In 2015, Turing Pharmaceuticals purchased the American marketing rights to Daraprim, the branded version of the drug known generically as pyrimethamine. The drug is on the World Health Organization's List of Essential Medicines because it is used to treat the parasite infection toxoplasmosis, malaria, and is often used for people with compromised immune systems, including AIDS patients, as well as some cancer patients and elderly patients. After Turing purchased the rights to Daraprim, the company increased the price from $13.50 per tablet to $750 per tablet, raising the annual cost of treatment for some patients to hundreds of thousands of dollars.

The price increase sparked widespread criticism. The Infectious Diseases Society of America and the HIV Medicine Association sent a joint letter to Turing, claiming the increase to be "unjustifiable for the medically vulnerable patient population" and "unsustainable for the health care system." Dr. Judith Aberg, of the Icahn School of Medicine at Mount Sinai, said that Daraprim will be too expensive for hospitals to keep in stock and that use of the drug would require special review, possibly forcing hospitals to seek "alternative therapies that may not have the same efficacy." She stated, "This seems to be all profit-driven for somebody," adding, "I just think it's a very dangerous process."

Turing founder and CEO Martin Shkreli, a former hedge-fund manager, defended the price increase. He claimed that many patients use Daraprim for less than a year, bringing the price more in line with other drugs for rare diseases. Shkreli stated, "Daraprim is 0.01 percent of healthcare costs in the U.S.," and promised that Turing would negotiate volume discounts for hospitals. He also claimed that a tablet would only cost $1 for patients without insurance. He noted, "I'm like Robin Hood... I'm taking Walmart's money and doing research for diseases no one cares about." He claimed that the money from profits would be used to develop new and better drugs.

Dr. Wendy Armstrong, professor of infectious diseases at Emory University, said in response, "An old drug is not necessarily a bad drug... This happens to be an incredibly effective drug and has been cheap and well tolerated by patients for years." Armstrong and Aberg both noted that some patients who take Daraprim must use the drug indefinitely. Writing for BloombergandThe Washington Post, Max Nisen described how the price increase was indicative of larger issues in the pharmaceutical industry. He stated, "Old medicines are still sold at inflated prices because there's no mechanism to compel drugmakers to lower them." Nisen added that pharmaceutical companies "justify drug prices by reminding the public that developing drugs is costly and failure-prone. That's a fair point. But drug companies also announced more than $50 billion worth of share buybacks and dividend hikes after the new [2017] tax-cut law passed."

In 2018, Shkreli was sentenced to seven years in prison for defrauding investors of $10 million. But as Nisen points out, "Shkreli's fraud conviction stemmed from his hedge-fund days -- everything he did with drug prices remains legal." In May 2018, the price of Daraprim remains $750 per pill.

Similar concerns exist regarding the soaring cost of the EpiPen, which has undergone a 400% price increase since being acquired by Mylan N.V. in 2007. While this device was originally developed as a nerve gas antidote, it was discovered shortly thereafter to be exceedingly valuable as a treatment for life-threatening allergic reactions. The dosage delivery mechanism found within the EpiPen has also been patented, making it the only immediate anaphylactic treatment with the capability to calculate the exact dose needed to be injected into the victim. This patented mechanism and the device's life-saving value provide grounds which Mylan can use to further increase the price of the device as they are able to market this unique, life preserving device. However, in the event of a life-threatening allergic reaction, two EpiPens are needed if the victim has not entered medical care within 15 minutes of the first dose. Due to not being able to predict the situation in which one will be at the onset of anaphylaxis, it is imperative that two EpiPens are always carried to prevent an event more serious than the onset of anaphylaxis, doubling the cost of an already expensive device so widely needed. For families with one or more anaphylactic children, an even larger amount of devices are needed so that one is always within reach when the victim is exposed to an anaphylactic trigger. The price for a two-pack of EpiPens has increased from $57 to $608 in the decade that it has been owned by Mylan.