Drug-fueled pharma

Capitalism and human health — is this an oxymoron or a symbiotic petri dish for growth? In the advent of commoditizing both diseases and cures — including in the translation industry — is there space for researching the complex ailments of the mind?

Can clinical studies ever truly compensate for the infinite complexities that make us human? The philosophical causes of anxiety cannot be randomized into a trial and produce a neat 95% confidence interval. So, billions of dollars follow the highest level of return on investment, seeking the holy grail of a phase-three pass against placebo, a pill for the masses, easily produced and reproduced across humanity. The more generalized the cure and widespread the ailment, the better the return on investment.

A sedative might reduce all feeling for humans and thereby reduce anxiety, having little effect on the root cause. My worries are not the same as your worries, but a strong sedative will no doubt reduce both of them, and also reduce the chance of us tackling them head-on.

Why does more research go into prescription and over-the-counter medicines rather than prevention or improving patient quality of life through research of the mind? Currently 33% of countries allocate less than 1% of their health budget to the mind. The pharmaceutical industry is similarly shy about investing in this field. In the August 2016 article “Pharmaceutical Innovation in the Treatment of Schizophrenia and Mental Disorders Compared with Other Diseases,” in Innovations in Clinical Neuroscience, the authors write that “The level of investment and pharmaceutical innovation in mental disorders was comparatively low, especially relative to the burden of disease.” For mental disorders, according to the latest available data at the time, investment was $3.1 per $1,000 burden invested in research and development for schizophrenia, $1.8 for major depressive disorder and $0.4 for bipolar disorder. Compare this to cancer ($75.5), chronic obstructive pulmonary disease ($9.4), diabetes ($7.6), cardiovascular disease ($6.3) and rheumatoid arthritis ($5.3). Pharmaceutical innovation was also low for mental disorders.

Our lives are experienced totally through the mind, so should this not be a primary focus for humanity? We have pillars of industry devoted to transport, health and even entertainment. But the one arena for improving our main perception of quality of life seems surprisingly sparse.

We have a single tool through which humanity experiences life and one another. And yet due to the mind’s perceived unprofitability or complexity, science, governments and the pharmaceutical industry spend proportionately much more in other areas — areas that appear to have a more promising monetary return.

Results-based medicine works well in the physical realm. However, for the mind, outcomes are harder to measure. But this should not deter us from looking. It would be comparable to painting a wonderful picture, only to realize we are unable to see.

While cost should not be a reason to take a course of action, in our profit-driven world, dollar signs can motivate institutional, company and government action. According to the National Alliance on Mental Illness, serious mental illness costs the United States $193.2 billion in lost earnings per year.

That is 11 times the total US translation industry budget, every year. But the economic loss to the individual is one of the less harsh consequences when the individual’s suffering is considered as well as that of families, partners and friends.

According to 2017 statistics from Medical News Today, the tenth leading cause of death in the US is suicide. Nearly all suicide victims are suffering from mental health disorders, underlining that much of humanity’s suffering of the mind is so intense that it causes drastic consequences. How much higher up the list this would need to climb for more resources to be directed toward it is not clear.

Suicide is more common than homicide in the United States — that is, you are more likely to kill yourself than be killed. From a pragmatic standpoint, 23.4% of US death is from cardiovascular disease, and 22.5% from cancer, and these are more easily targeted than the 1.6% of deaths from suicide. In any case, suicide victims can be discounted as troubled individuals rather than passive victims of a random disease.

But is this really the case? How much do we choose our lifestyle, our thoughts and physiology? How much do we choose to self-destruct though alcohol, smoking, poor diet, our social life, our high stress and lack of exercise? Are some poor life choices a result of poor mental health and choosing to self-medicate through destructive means?

If you introduce the concept that perhaps the top 15 leading causes of death in the US may be the result of poor mental health or less than optimal choices, the investment case becomes more appealing — treating the cause and not the symptoms. Preventative medicine starts at the individual’s choice, and the choice starts with the mind. If you expand poor mental health to include damaging lifestyle choices, poor diet, addictions, obesity, stress, criminality and violence, you start to see that cardiovascular, liver, cancer and cerebrovascular disease often start in the mind. Yet this is precisely the area government and industry shy away from, choosing to treat symptoms over the root cause, as they have better “results” and profitability.

In a world where we understand so much profound detail of the external, and ignore the internal, perhaps that is to be expected after all.

However, is it the role of the pharmaceutical industry to research mental health? Having understood the importance of mental health as a central arena for human quality of life, and also its inherently unprofitable nature, it raises the question: which institutions are responsible for its development?

The central goal of any company is to maximize long-term shareholder returns, and often this tends to align with goals that may or may not be beneficial to humanity. There is a void not readily filled by Western materialism or mindless pursuit for profit, and so the individual becomes a breeding ground for mental health disorders, addictions and behavioral problems.

Mental health research

To date, the pharmaceutical industry has done what it does best, and focused on profitable, commoditizable methods of alleviating some of the mental health symptoms that Western life tends to breed, potentially further exacerbating the situation.

Anxiety, depression and hallucinations can now, theoretically, be cured with a simple pill. Pharma has found its niche in the market of the mind and produces success for its shareholders. 

Alongside drugs, counseling and psychotherapy have long picked up the less profitable pieces of the mental health puzzle.

Typically, heavily-trained and often expensive specialists work on an individual human level to provide the complex assistance troubled minds require. However, with industry lacking a profit motive, and only the rich with easy access to experts, who is supporting the lower income masses of humanity wading through modern capitalism without a spiritual guide or mental support?

According to the World Health Organization (WHO), mental health disorders are exploding, affecting one in four people globally, a statistic that is likely conservative. Depressive disorder ranks among the fourth leading cause of global disease. Additionally, says the WHO, “the poor often bear the greater burden of mental disorders, both in terms of the risk in having a mental disorder and the lack of access to treatment.”

The principal role the pharmaceutical industry can take is to work to reduce cost and increase access to basic psychiatric medicines globally. However, the long-term solution to the global mental health crisis is for humanity to move away from a body-planet paradigm toward a mind-planet paradigm.

We are unable to live in peace with good mental health while continuing without purpose or direction in the pursuit of material gain at the cost to the planet and its fellow inhabitants. Many Western illnesses, both psychological and physiological, are linked to this internal void.

As the complexity of humanity’s problems increases so do its solutions. A global revolution and paradigm shift would be needed in order to allow humanity to have global mental peace. A simple pill will no longer suffice.

Medicine, progress, industry and our focus on the external have allowed us to reach this fortunate position to be able to have the resources to look inward and focus on studying the mind. The pharmaceutical industry has eradicated countless diseases and improved the lives of millions. All the while creating jobs, science and medicines for the world. It seems now, however, that we have reached a turning point that requires a new approach if we are to tackle the modern world’s problems.

Translating the future

How does this all affect demand in the translation industry? Currently most medical translation requests are linked to clinical trial documentation, with psychology including small psychometric testing projects, usually related to qualifying patients or monitoring adverse events during a trial.

Indeed, at our company we can count the number of mental health projects translated on a single hand. The high-demand translation areas for pharma can been seen in the structure of the translation vendor base, with a large number of companies focused on regulatory, medical devices or clinical trials — key areas for pharma and therefore translation budgets. It remains to be seen if now or in the future there would be both demand and capacity in the industry for a mental health focused language service provider.

If alongside adverse event reports, patient information leaflets and investigator brochures, our medical translation industry can expand to encompass mental health education in schools, emotional awareness and government research initiatives, we can be hopeful regarding this challenge currently facing humanity.