The Privatisation Myth and the Legacy of the NHS - 2

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Part 1

Big Pharma

In 2019, Ethical Consumer conducted a study of Pharmaceutical companies and the drug market. In this section I’m going to delve into some of the findings of the study in more depth.

We rely on pharma companies to provide us with drugs that can help us with our medical problems. In some cases they may be essential to help us lead relatively normal lives or even keep us alive. But Big Pharma is linked into the neoliberal system like everything else. Although some of company expenditure goes on research, a considerable amount is spent on marketing and lobbying. In the US, companies can’t give directly to the political parties, so they channel donations via their employees and other avenues.

In the UK, Global Justice Now has campaigned extensively on this issue. The publication Case Study: Big Pharma (2024), pointed out that huge amounts of funding is provided by the public sector. Over the years a series of mergers and acquisitions created pharma behemoths that have come to monopolise the market. As a result:

Big Pharma firms can then charge whatever they can get away with for new drugs. Even in countries with well-funded public health systems, the price of new medicines is putting an unbearable strain on services. Recent research suggests Britain’s NHS has spent £13 billion on just 10 super expensive drugs, with the overwhelming amount of that money taking the form of excess profits on the part of the companies that control the drugs.

Source: Global Justice Now

The situation is even more pronounced in the US. Typically a company will buy up the rights to a drug and then massively inflate the price. A key component here is intellectual property rights. Previously patent laws were much less stringent, which benefited the global south. But during the 1990s, Big Pharma pushed for more stringent rules. This led to the establishment of a global trade agreement, the Agreement on Trade-Related Aspects of Intellectual Property Rights (TRIPS):

The development of TRIPS was therefore a truly audacious and hugely significant move. In effect, TRIPS ensured walls were built around knowledge right around the world, protecting corporate profits and disadvantaging countries trying to develop their own industries.

The argument behind this was that it would stimulate innovation, but the complete opposite has happened. The result is that this has only bolstered the monopolisation of the market. As the study notes:

Intangible assets like intellectual property are nearly impossible to accurately value, but corporations nonetheless try to put a high value on these intangibles and spend a fortune protecting them. And precisely because they aren’t physical, these assets are much easier to register in tax havens.

Big Pharma have become gatekeepers of a powerful industry that has stifled competition. The paradox here is that much of the actual innovation and research on drugs is carried out by public institutions such as universities, at the expense of the tax payer. In short, it means that we’re effectively paying for these drugs twice. We saw this imbalance being played out during the pandemic, as rich countries became the benefactors of Covid vaccines, at the expense of the rest of the world. Far from being a global solution, this was the classic profiteering model of neoliberalism. This is summed up by GJN:

The situation got even worse when these same corporations, as a direct result of their legal monopolies, refused to share the knowhow behind the vaccines with countries that could have produced them. One group of experts discovered that at least 100 factories around the world could have safely made mRNA vaccines if they’d have the knowhow transferred. Supply was, instead, artificially constrained by the monopolies enjoyed by corporations like Pfizer and Moderna.

Pfizer’s vaccine apparently cost about £5 a dose to produce. In the US, they tried to pitch the cost at $100 a dose! To put things into perspective, only 4% of new drugs developed targeted diseases that affected lower income countries. Diseases such as Malaria kill mostly poor people. So no profit to be gained here.

Typically a patent has a 20 year life span. But Big Pharma has found a cynical solution to extending these rights, known as ‘ever-greening’:

One example is Asacol, used to treat Crohn's disease and other illnesses which involve inflammation of the intestines. When the medicine was reaching the end of its patent life, the producers created a new drug called Delzicol - an Asacol tablet inside a capsule. As one expert in innovation said “If the capsule was cut open, the original Asacol tablet fell out.”

Suffice to say, the pandemic was a gold mine for big pharma. It’s been estimated that nine new billionaires emerged during the pandemic. This deflates the myth that the free market stimulates innovation and that everything will fall into place. Medicine is overwhelmingly a product of the public sector. It’s all about risk. Companies don’t have to worry about risk if the research has already been done, thanks to the public purse.

This report from GJN, Bitter Pills: Why the NHS can’t swallow big pharma’s profiteering (2023), focuses on the impact of big pharma on the NHS, in particular the cost of the 10 most expensive drugs amounting to £13 billion over a period of 10 years. Overall, NHS spending on drugs is likely to run into hundreds of billions of pounds over the same period. However, through the Voluntary Scheme for Branded Medicines Pricing and Access (VPAS), the NHS can claim some of these costs back. This was an arrangement agreed between the government and industry in 2019 to cap spending on branded drugs at 2%. If spending goes beyond this, industry will pay a rebate to the government. Big pharma though is trying to undermine the scheme. The National Institute for Health and Care Excellence (NICE) is the body that negotiates pricing on behalf of the NHS. There has been cases where NICE has rejected overpriced drugs, which has created problems for patients in need of lifesaving drugs.

The costs of developing and producing drugs and eventual pricing by big pharma is opaque and shrouded in secrecy. Although:

It has regularly been found that actual research, development and production costs bear no relation to the final price of a medicine. Rather, thanks to the monopolies these corporations enjoy over new medicines, they can charge whatever they think they will be able to get away with.

Indeed research has shown:

that profits of big pharma companies are almost twice the average for publicly listed companies, with margins of up to 90%.

The report makes some recommendations. It sums up the predicament succinctly:

The VPAS stand-off between industry and government and the threat it poses to our health and the NHS should present us with an opportunity to step back and reassess the scientific, economic and ethical sustainability of the status quo in pharmaceutical drug development, access, and financing.

But what about the drugs themselves? One of the biggest scandals in recent years was the opioid crisis. It’s impact mainly affected the US. Ethical Consumer gives a brief overview of the crisis, noting:

Over two million people are estimated to be addicted, and tens of thousands are dying every year from overdoses. In 2017, the US government announced a nationwide public health emergency.

In May 2007, Purdue Pharma was found guilty of misleading the public about the addictiveness of Oxycontin, an opioid painkiller used to treat severe pain. The company was fined $600million in damages. Johnson & Johnson and Teva was also drawn into debacle. Some of these products were banned in other countries. This report from the OECD, Addressing Problematic Opioid Use in OECD Countries (2019), explores the issue further. The report indicates a link in the reduction of life expectancy in the US in 2017 to the opioid crisis. To put things into perspective:

Opioid overprescribing is considered one of the most important root causes of the crisis. In the United States alone, there were 240 million opioid prescriptions dispensed in 2015, nearly one for every adult in the general population. In North America, hydrocodone, oxycodone, codeine and tramadol are the main prescription opioids used for non-medical purposes, while methadone, buprenorphine and fentanyl are the most misused opioids in Europe. The influence of pharmaceutical manufacturers on pain management has been considered significant, by conducting marketing campaigns targeted mainly at physicians and patients, downplaying the problematic effect of opioids.

However the report does point out that carefully regulated prescriptions is critical in appropriate medical treatments of these drugs. Inevitably there is also the illicit drug trade, with the likes of heroin and fentanyl pushed by drugs gangs.

The marketing of drugs targets doctors, who play a role in engaging with these companies, as this article from the National Library of Medicine, The Company We Keep: Why Physicians Should Refuse to See Pharmaceutical Representatives (2005), outlines. It uses the analogy of someone dealing with an addiction, associating with people who may not serve the persons best interests. This points to the relationship of physicians to pharma reps, creating something of an ethical dilemma, framed as a potential conflict of interest.

The reps job is to represent their company’s interests. That will usually involve giving ‘freebies’, which may be drug samples or an invitation to attend a conference at an exotic location. Physicians may be oblivious to the marketing techniques employed by these reps. Indeed research has shown that increased engagement with reps influence their prescription rational. As the article notes:

The evidence available today, therefore, seems conclusive on 2 points—first, that we are indeed heavily influenced by reps; and second, that we ourselves are very poor judges of the extent of that influence. To the extent that we claim to be scientific practitioners, we would seem obligated to take this evidence into account in deciding upon our proper professional behavior.

Physicians may therefore be drawn into prescribing expensive drugs that may not necessarily be any better than cheaper generic drugs, out of an obligation to respond to the generosity of reps. Checking the veracity of what the reps are offering would of course be time consuming. As the article concludes:

As important as time management is, one would still wish that our profession cared even more about professional integrity and commitment to the well-being of our patients. Reps are honest business people, mostly, who have no power over our professional integrity; it belongs to us. Once we are firmly committed to regaining our integrity, we will have no trouble deciding that it is worth more to us than any number of pens, coffee mugs, and sandwiches.

Whilst this scenario may be more prevalent in the US, it’s what lies round the corner here in the UK. However change was on the way, through the introduction of the Affordable Care Act by the Obama administration in 2010, known more generally as Obamacare. As Newsweek reported, this included a particular provision called the "Sunshine Act," which came in in 2014:

this transparency clause in the Affordable Care Act allows the Centers for Medicare & Medicaid Services to publicly post all payments and other valuables given by Big Pharma to physicians and teaching hospitals.

The article outlines just how endemic the influence of big pharma is in US healthcare. Examples of the unintended consequences of the misuse of drugs are rife. One example cited here was Vioxx, marketed by Merck as a painkiller in 1999. It caused heart attacks in thousands of patients. The drug was recalled in 2004:

Merck pleaded guilty to both criminal and civil charges, paying the government $950 million to resolve all of them. Additionally, Merck settled a class-action lawsuit, paying nearly $5 billion to consumer claimants. (As large a sum as that is, it didn't hurt the company's bottom line. Merck recorded more than $11 billion in sales of Vioxx from mid-1999 to September 2004, according to The Wall Street Journal.).

In addition it emerged that the company was aware that the drug could cause side effects when it was released onto the market. Despite legal restraints around the fact that ‘the Supreme Court has ruled that state laws banning pharmaceutical gifts are in violation of the First Amendment,’ the Sunshine Act could galvanise greater awareness and restrictions on the influence of big pharma and their tempting gifts.

Clinical trials is another area where accountability is patchy. In 2013, the organisation All Trials was set up by key medical institutions, calling for increased oversight. It is:

an initiative of Ben Goldacre, BMJ, Centre for Evidence-based Medicine, Cochrane Collaboration, James Lind Initiative, PLOS and Sense about Science and is being led in the US by Sense About Science USA, Dartmouth’s Geisel School of Medicine and the Dartmouth Institute for Health Policy & Clinical Practice.

Lets now delve into the minefield of intellectual property, which underpins the availability of most products at some time or another. The book, Against Intellectual Monopoly (2008), published by Cambridge University Press, goes into the issue in depth.

The pros and cons of IP is initially explored by using the example of James Watt’s steam engine invention, which sowed the seeds of the industrial revolution. Watt was savvy of the legal landscape surrounding his invention. He knew that if he patented his invention he would be able to control production and rights over the product, in short, a monopoly, with his business partner Matthew Boulton.

He started working on his idea in 1764 and applied for a patent in 1768. He managed to extend his patent until 1800. His design had its shortcomings. Ironically a significant improvement to his design could not be implemented as the modification available was patented. This effectively leads to the suppression of competition through the manifestation of a legal monopoly, known as rent-seeking. As the book notes:

This retardation of innovation is a classic case of what we shall refer to as intellectual property inefficiency (or IP inefficiency). Finally, there is the slow rate at which the steam engine was adopted before the expiration of Watt's patent. By keeping prices high and preventing others from producing cheaper or better steam engines, Boulton and Watt hampered capital accumulation and slowed economic growth.

Ultimately it boils down to striking a balance between protecting rights and allowing innovation to take place, although the book takes the general position that:

creators' property rights can be well protected in the absence of "intellectual property," and that the latter does not increase either innovation or creation. They are an unnecessary evil.

How does this pan out relative to the pharmaceutical industry? There’s the expense and time involved in getting a new drug to market. Therein lies the argument for running a monopoly on a new drug for a period of time. But there’s a paradox here. Whilst there’s no doubt that the availability of medical treatments has helped to increase length and quality of life for many, those who can’t afford to pay for expensive treatments loose out, especially in poorer countries. Even the NHS is limited in its access to new drugs that cost the earth.

Regulations on patenting has varied through time and across the globe. The general tendency was to patent processes. Some countries then introduced product patents as well. Interestingly countries that did not have patenting laws began to dominate the market. This was how Germany became a major producer and innovator after World War 1, at the expense of Britain. After WW2, German industry was effectively cannibalised by the allied victors.

There is also an international dimension to this. The European Patent Convention (EPC) (1973), attempted to harmonise the system in Europe, however patent regulations still have a national focus. Getting out of the starting blocks drew the attention of European industry lobbyists. However the WTO-TRIPS agreement noted above, has changed things. Indeed many countries that have not had patent systems have been forced to do so by TRIPS. The evidence is clear, that generic drug production suffers under patent systems, with innovation stymied. The real benefactors are foreign companies coming into a newly patented domestic market and benefiting from the system to protect their own products. And that usually means US companies, with a notable exception (see below). Although the global market isn’t a monopoly per se, as the book notes, ‘Price discrimination, made possible by monopoly power, does have its rewards’.

As has been covered before, most of the funding for research comes from public funding. Where does that money go? Typically tweaks are made to existing drugs, usually to extend the duration of a patent. A lot of money is also spent on marketing drugs that are often repackaged versions of existing drugs:

the only social gain from introducing a me-too drug is that the supply of the beneficial active ingredient increases, and average prices possibly decrease somewhat. But this could be achieved, much more rapidly and at a cost orders of magnitude smaller, by simply copying the old drug and improving upon it. Money spent in obtaining a me-too drug that can be patented is money wasted for society that will be charged to consumers: rent seeking and monopoly profits can be very costly for all of us, indeed.

As noted above, Teva was implicated in the opioid scandal. It is also the largest producer of generic drugs globally. But it has another distinction, it’s an Israeli company, and everything that that entails. On the UK website, it notes its major collaboration with the NHS and how the company is a huge supplier of generic drugs. Teva has also enjoyed preferential treatment from the Israeli government in the shape of considerable tax breaks and grants. Price fixing has also been linked to the company.

In March 2024, protests took place in UK against Teva, due to its close relationship with the Israeli government and the fact it supplies the IOF with medical support. Teva is listed by the BDS Movement because it:

benefits from Israel’s illegal occupation of Palestinian lands allowing the company to exploit the captive Palestinian market.

And as Peoples Health Dispatch reports:

The company faced potential blacklisting by the United Nations for operating within illegal settlements in the West Bank. Anonymous Palestinian activists working on access to medicines told People’s Health Dispatch that Teva remains a major medicine supplier in the West Bank.

Israeli restrictions make it difficult for Palestinian pharma companies to gain a foothold in the occupied territories. It has also been reported that Israeli pharma companies test products on Palestinian prisoners held in Israeli jails.

In 2015:

Riyad Mansour, Palestinian ambassador to the United Nations, accused Israeli authorities of harvesting organs from Palestinian bodies possibly for medical experimentation – an accusation that continues to be made during the height of the current conflict.

Given the fact that Teva is a major supplier to the NHS, this should be of concern to campaigners. A full list of Teva products on the US market can be found here. For the UK, here.

Data protection?

In the UK, personal data is protected by the Data Protection Act (2018). That includes NHS data. But in November 2023, this seemed to come under threat. This was when NHS England agreed to a £330m NHS Federated Data Platform (FDP) deal, run by the highly dubious US company Palantir. Foxglove has been running a major campaign against the deal. The FDP is a UK government project to centralise NHS data. Whether data will be protected and safeguarded isn’t clear. Given the way Palantir ended up with the contract, it’s not surprising there’s great concern. As Foxglove noted:

Palantir is a US tech company with no track record with the NHS until the pandemic.

They got the contract to run the NHS Covid Datastore without competition. The contract – for a tool meant to help the health service manage data during the pandemic – was handed over in secret – until we and openDemocracy forced the contract to be published.

Subsequently, legal action begun after the Government finally spilled the beans over the controversial contract. As part of the wider process, Foxglove has set up a No Palantir page and a crowdfunder, to fund the legal action, which is being pursued by the Good Law Project. So, what is Palantir? The name is derived from one of the crystal balls from Tolkien's The Lord of the Rings.

A comprehensive resource was set up by Medact, in conjunction with other campaign groups. It notes that:

Palantir is a US tech company, initially funded by the CIA, which specialises in AI-powered military and surveillance technology and data analytics. Palantir describes its military technologies as offering customers (which include the US military, ICE, the UK Ministry of Defence and the Israeli government) “mission-tested capabilities, forged in the field” to deliver “a tactical edge – by land, air, sea and space”.

Its track record speaks for itself:

• Operation of predictive policing services to US police forces, shown to disproportionately target Black communities

• Provision of services to the US military for wartime operations in Iraq and Afghanistan

• Support to the USA to develop artificial intelligence software for war drones, continuing this with the Pentagon’s Project Maven

• Support to the US government to track and deport migrants at the Mexico border, including in forcibly separating children from parents

• Support to the US spy-agency NSA and UK spy-agency GCHQ in software for mass surveillance of populations

• Links with Cambridge Analytica in its operations to collect data on Facebook users and interfere in the Brexit referendum.

There could not be a greater conflict of interest here - a corporation that works hand in glove with the military industrial complex getting involved with a huge healthcare service provider. Given the massive databases of concentrated data within the NHS, its no surprise there’s so much outrage. But Palantir’s military links go even further, with its close association with Israeli Occupation Forces, as Medact points out:

Palantir is currently openly supporting the Israeli military and government in their genocide on Gaza. It reports being “proud to support Israel in every way [it] can”. It says it is working with Israel to keep them “armed and ahead”.

Palantir entered into a deal with Israel to provide technical support in January 2024, at the same time the International Court of Justice found it plausible that Israel’s acts amounted to genocide. But palantir’s links with Israel go much further back:

It has operated its own research and development centre in Israel since 2013. It is also closely linked with Carbyne, with shared investors including Peter Thiel and Palantir employees on the board of advisors. Carbyne is an Israeli tech development firm developed by former Mossad and special Unit 8200 IDF members.

Palantir has dark connections through Quadrature, which is a major shareholder in Palantir. These include holdings in arms companies such as Northrop Grumman ($31m) and Lockheed Martin ($6m), as well as US healthcare outfits, UnitedHealth ($31m) and HCA Healthcare ($16m), along with the notorious Blackstone asset management company ($22m).

Palantir’s road to the NHS was signposted by the likes of Dominic Cummings and Simon Stevens (then NHS CEO), who appointed Palantir as one of the companies assisting in creating a Covid-19 database, a steal for just £1, before finally winning the lucrative FDP deal. This is how Palantir saw the deal:

Senior Palantir staff infamously described the company’s NHS strategy as “buying our way in” and “hoovering up” small businesses working with the NHS to “take a lot of ground and take down a lot of political resistance”.

Other people linked to Palantir’s incursion was Peter Mandleson, through Global Counsel, a strategic consultancy and lobbying organisation, of which he is President, and the former British Ambassador to Israel, Matthew Gould:

While Gould was CEO of NHSX he oversaw the creation of the UK-Israel Tech Hub in 2011. This Hub – based in the British Embassy in Israel – is a unique government partnership that fast tracks business for Israeli tech companies in the UK in areas such as cyber and health. It has deep links to the Israeli military and intelligence services. The chair of the Hub is Haim Shani, who until recently was a director of Cellebrite – the Israeli intelligence company involved in international hacking scandals.

Palantir had developed close relationships with senior NHS staff and government officials, and provided funding to think tanks such as the Policy Exchange and Institute for Government. Meanwhile, our current health secretary Wes Streeting:

is a vocal advocate of the FDP, with strong links to the Israeli med-tech industry and the Israeli lobby. In a recent speech bemoaning the slow adoption of the FDP he said “when I’ve heard people say ‘I’m not sure about Palantir’, or ‘I’m not sure that the NHS has a really good track record on this sort of project’, I’m sorry, but that doesn’t wash with me”.

Would your data be safe with Palantir? Make up your own mind:

• Previous contracts with Palantir and the NHS have involved data sharing including dates of birth, postcodes and detailed medical histories. Despite claiming that Palantir would not have access to “identifiable medical records”, NHS documents obtained by openDemocracy admitted that the company will “collect and process confidential patient information”.

• This dishonest or inaccurate communication about its historic access to patient data significantly undermines trust in the NHS’s current assurances that Palantir won’t have access to this data in the FDP. There are multiple inconsistencies and gaps in information communicated to the public about the way data will be held, for what purpose, and with what safeguards over its use.

• NHS England has hired a second company to support the processing of the data and confidentiality. Documents shared with the FDP board in March show that NHS England had received legal advice showing a vital aspect of the program – its privacy-enhancing technology (PET), to be provided by IQVIA – lacked a legal footing to proceed.

Indeed the entire process has been a complete sham. There’s a chronic lack of transparency, and NHS England has been compelled to admit ‘that patients will not be able to opt-out of having their data used in the FDP’.

Given Palantir’s wider influence within the government and its links with mass surveillance, there are concerns surrounding access to migrant health data and the tracking of their location.

Put simply, Palantir is a dangerous entity, complicit in human rights abuses. The danger to the NHS is summed up:

Locking the NHS into a single monopoly supplier holds severe risks, especially when Palantir itself has stated its intention to monopolise government contracts with its technology. Palantir’s software cannot be transferred to another company or back onto NHS systems easily. This means that the whole of NHSE’s integrated data system will be stuck on Palantir’s systems or will need to be rebuilt from scratch. This exact issue played out when the NYPD tried to end its use of Palantir’s technology. This is neither democratic or competitive, and will result in one private provider dominating the data management systems of the NHS.

In addition an Op Ed from the BMJ has made it clear that:

If NHS England is to recover its own reputation and maintain public trust in health data systems, it must cancel the contract with Palantir.

It also notes:

The fact that NHS England still considers Palantir an appropriate partner raises serious questions about NHS England’s integrity. The multiple contracts awarded to Palantir over recent years have brought with them allegations of favouritism by NHS executives, backdoor meetings, donations to the Conservative party, ministerial directives being used to override patient confidentiality rules, and Palantir’s Peter Thiel’s own confession that the company is “buying its way in”' to the NHS.

We live in an interconnected world (Source: Medact)

The personality behind Palantir is Billionaire Peter Theil, who has his own shady track record. As well as founding Palantir he was also the co-founder of PayPal. So who is Peter Theil? Alan McLeod exposes him in a Mint press News article.

Theil has a close relationship with Donald Trump, to the extent that through his bankrolling of Trump’s previous campaign, he was tagged the “shadow president.” This time around:

Thiel will enjoy even more influence in the White House, as Trump has selected Ohio Senator and Thiel protégé J.D. Vance as his vice president. Thiel – who has previously stated that freedom and democracy are incompatible- bemoaned the extension of the vote to women and denounced the public as an “unthinking demos” – took Vance under his wing when the latter was still at college. From there, Thiel secured Vance his first job in 2013. Two years later, Vance joined his venture capital firm, and in 2020, he provided the seed money for Vance to start his own investment group.

As noted above, Palantir is complicit in the Gaza genocide, which uses AI to surveil Palestinians, generating kill lists for the Israeli military, through software called Lavender. The aim was to identify people linked to Hamas, however tenuous the connection. Controversially:

Lavender also gave children a score of 1-100 and recommended many for execution. Israel was delighted with Lavender’s performance, with one commander explaining that human targeting produced “bottlenecks” that limited the IDF’s capacity for violence.

Theil took his co-executives to Tel Aviv to hold a board meeting that would show “solidarity” with Israel. But it’s not just Israel being propped up by Palantir, the company is also embedded in Ukraine’s defence, offering similar capabilities, including kill lists. Thiel sees his company as engaged in a moral crusade:

“We believe that when we can make a difference in the service of a just cause, such as in the defense of Ukraine, we carry a moral responsibility to do so. And so, we are proud to provide our technical experience and technology to Ukrainian forces defending their homeland, national sovereignty, and personal freedoms.”

But a more nuanced perspective sees the company as an extension of the CIA and the U.S. national security state. Indeed it was the CIA that rescued Palantir when it appeared to floundering at its inception.

Another concerning angle is Palantir’s whistleblower profiles. ‘It has developed complex software to ensure leakers of classified information can always be caught’. This reached its peak in 2010:

when Palantir published a plan to undermine, attack and destroy WikiLeaks and its supporters. The document, entitled “The WikiLeaks Threat,” recommended that the U.S. government carry out cyberattacks and spread “disinformation” about the organization by creating a “media campaign to push the radical and reckless nature of WikiLeaks activities.”

As noted above, Theil’s initial success came through PayPal. He became known as as the “don” of the PayPal Mafia, so called because of PayPal’s domination of online payments systems globally. Out of this ‘mafia’ came YouTube, Yelp, and business social network LinkedIn. An early investor of PayPal was a certain Elon Musk. And just to get into Theil’s head:

Thiel also had ulterior motives in founding PayPal, seeing the project as an attempt to use the power of money to overturn democracy as we know it and allow him to implement his deeply conservative agenda. “The initial founding vision was that we were going to use technology to change the whole world and basically overturn the monetary system of the world,” he said. However, he knew his ideology could never stand up to public scrutiny and would never be accepted by society.

His fantasies extend to ‘building floating towns in the ocean where people can finally be free from government interference and the woke agenda’, and discovering and occupying new planets. He is also:

On a quest to live indefinitely, he follows a strict anti-aging routine, including taking human growth hormone pills and reportedly harvesting the blood of poor but healthy teenagers and injecting it into his body to boost his immune system. “Peter Thiel Is Very, Very Interested in Young People’s Blood,” reads one headline from American Business magazine, Inc.

He also thinks immortality is possible. To that end he plans to have his body cryogenically frozen, if he doesn’t cheat death.

Ironically Theil and Vance have invested in the freedom of speech orientated video platform Rumble. It appears that Theil is full of contradictions, as McLeod sums up:

Ultimately, Thiel is a walking contradiction: a libertarian who got rich from fat military contracts, an immigrant working with ICE and a free speech advocate who attacks media outlets. He presents himself as an outsider. Yet he is a mainstay at many of the world’s most elite institutions and conferences, including the Bilderberg Group, the Munich Security Conference, and the World Economic Forum in Davos, Switzerland.

In many ways, his persona is almost out of a comic book, a real-life Lex Luthor. From aiding an Israeli genocide in Gaza to using AI to surveil immigrants at home to spearheading a war against whistleblowers, Thiel’s story perfectly encapsulates how Silicon Valley has been folded into the national security state and works to maintain the American empire well into the 21st century.

It wouldn’t take a huge stretch of the imagination to consider Palantir as threat to an emerging major campaign to save the NHS and prevent privatisation (see below).

But this could be just the tip of the iceberg. Corporate watch has exposed the UK Israel Tech Hub (touched on above). The Hub serves to fast-track Israeli technology firms into the NHS. As CW notes:

Matthew Gould, former NHSX CEO, oversaw the Hub’s foundation. He was key to Palantir getting contracts in the NHS.

Many Israeli companies involved have their roots in Unit 8200, a notorious military unit that focuses on surveillance technology. The increasing presence of Israeli companies in the NHS has become significant:

The 2023 UK government paper, 2030 roadmap for UK-Israel bilateral relations, stated that one in every seven medicines in the health service comes from Israel. There is also a growing presence of Israeli tech companies in the NHS, and the report stated that 250 partnerships have been facilitated by the publicly‐funded UK Israel Tech Hub, based at the British Embassy in Tel Aviv. It is by far the longest running of all the UK Tech Hubs, and of any government-backed initiative to enable access to the public sector for companies from other countries.

The Hub was initially founded by the UK government in 2011, through an agreement between David Cameron and Benjamin Netanyahu. It claims ‘that Israeli companies can complement the health service in key areas, including electronic medical records, AI and machine learning, medical imaging, diagnostics, and cyber security’. Suffice to say the Hub has deep links to Israeli military and intelligence services and therefore linked to the ongoing genocide in Gaza. CW lists programmes and partnerships linking the NHS to Israeli companies:

• TeXchange 2020: which links key influencers to the UK Government.

• The Northern Health Science Alliance (NHSA): an organisation that works with several NHS Trusts in the North of England, since 2018. ‘Within four years of this government-supported partnership, over 150 Israeli companies were helped to gain a foothold in the North’.

The NHSA is linked to other initiatives, ‘including the 2023 Healthtech Pilot Project that linked NHS trusts in Sheffield, Manchester, Liverpool, Newcastle, Rotherham, Doncaster and South Humber, Hull and Leeds, to six Israeli tech companies that receive funding from the Israeli Innovation Authority (IIA). The IIA works with the Israeli military, notably on drone projects, such as it’s collaboration on Operation Guardian of the Walls – an attack on the Gaza strip in May 2021 – as well as with the Israeli police’.

• The International Health-Tech Partnership Program: ‘a £6m scheme funded by IIA, and run with the NHSA, which sets up Israeli companies at leading NHS trusts to develop and run health technology pilots’.

• The Leeds-Israel Innovation Healthtech Gateway: ‘established in 2022, the Gateway was designed to support Israeli healthcare companies to develop their tech for work in Leeds and further afield. It’s a partnership between the Tech Hub, the Leeds Local Enterprise Partnership (LEP), the University of Leeds, NEXUS, Leeds City Council, and The Yorkshire and Humber Academic Health Science Network (YHAHSN)’.

• The UK Israel Dangoor Health Initiative: ‘funded by British millionaire and ‘philanthropist’, David Dangoor, it aimed to fast-track Israeli digital health startups into British care by supporting them via the DigitalHealth London facility – an NHS-backed business that claims to be able to help tech companies ‘penetrate’ the NHS market, specifically in London. This programme, and the companies, were also supported with development by IBM in Israel. Dangoor stated that this partnership could help push back against BDS in the UK’.

It is likely that Palestine and NHS campaigners alike are oblivious to the increasing penetration of Israeli companies into the NHS. CW sums up the situation perfectly:

The relationship between Israeli tech companies, the military and the NHS is disturbing. One is a deadly state machine, accused of breaching internationally recognised laws, on trial for war crimes and enacting the world’s first AI-powered genocide; the other exists to enhance health, care and quality of life for people in the UK. Their aims and values are totally at odds, yet they are becoming increasingly entangled, notably when it comes to these firms getting contracts for health services. With the IDF systematically targeting health workers, bombing hospitals and decimating the health infrastructure in Gaza, these companies have no place in our NHS.

Has the Revolution Started Yet?

We have now come round full circle from the initial introduction to this 2 part piece, where I mentioned the assassination of UnitedHealthcare CEO Brian Thompson. In response to his killing, Luigi Mangione has been arrested and charged with 11 counts, which include first-degree murder and second-degree murder as a crime of terrorism. Why the latter charge? Al Jazerra notes:

Under New York law, a terrorism charge can be brought when an alleged crime is “intended to intimidate or coerce a civilian population, influence the policies of a unit of government by intimidation or coercion and affect the conduct of a unit of government by murder, assassination or kidnapping”.

Brian Thompson

Whilst one does not condone extreme violence, its has been perfectly clear that Thomson’s death has hardly been mourned, judging by general reactions from the public. But it is nevertheless interesting that the above quote seems to imply that Thomson has high level connections with government. Could it be that in reality this is seen as an attack on elite power, and that the terror indication feeds into the paranoia of power? Writings from Mangione have described health insurance companies as “parasitic”, driven by corporate greed.

Luigi Mangione

Certain elements, particularly politicians, have criticised those who celebrated Thomson’s death, but as Owen Jones pointed out:

the Israeli prime minister Benjamin Netanyahu was loudly cheered and serenaded by US politicians back in July when he addressed them, after having exterminated tens of thousands of Palestinians.

But perhaps most revealing of all is Theil’s highly flustered response to the killing… :

The overall message here is that under the current neoliberal system, everything that exists is commodified. Everything has an economic value, including people. Anything that has a low economic value is effectively worthless. Palestinians have no economic value, except when they are being killed. Then they bring value to arm companies, who make a financial killing, literally. Similarity in health care, as we have seen, the same logic plays out. The Assisted Dying bill that has been making its way through Parliament has generated controversy. A paper from the World Family Medicine Journal looks at the ethical concerns from a medical perspective. This article from the Conversation makes some important political observations. In particular:

The bill has faced intense criticism and debate, not only on policy grounds but also due to the procedure through which it has been introduced. As a private member’s bill – that is, put forward by an individual MP rather than the government – it has not been subject to the same policy processes as a government bill, and faces some limitations on its parliamentary scrutiny.

This is important given some of the historical observations made by ADF UK. It outlines the roles of Utilitarianism and in particular Social Darwinism, which argues:

that humanity could be “improved” by selecting desirable traits and eliminating “undesirable” ones from the gene pool. This meant encouraging the procreation of the “fit” and preventing or ending the lives of those deemed “unfit”.

We have seen this concept being weaponised throughout history, Nazi Germany being a classic example. This gave rise to eugenics. But today we have seen economic factors playing a role in assisted dying:

In fact, economic influences on euthanasia are already visible. In Oregon, for instance, financial constraints have been cited as a reason for choosing euthanasia. In some jurisdictions, the practice has even created a pathway for organ harvesting.

As these trends develop, the risk of economic pressures overtaking compassionate motives in the practice of euthanasia is a very real and pressing concern.

With that in mind, this Lancet article, examines the Legacies of ableism and the pursuit of disability justice in medicine. It provides a thoughtful background to ableist views, which are particularly relevant in view of the widespread disability cuts being implemented by the government. The Canary has been following the assisted dying debate.

The NHS represents a massive commodity in many ways. How do we then save the NHS from becoming another neoliberal casualty? Over the past few years a major campaign has been building up steam. In 2019 the EveryDoctor campaign group was set up by it’s current chief executive Dr Julia Patterson*. As it notes on its website:

EveryDoctor is a campaigning organisation fighting for patients, staff and the future of the NHS.

In order to promote the campaign and bring the plight of the NHS into sharp relief, Patterson launched a Substack Newsletter in February 2023.

She also wrote a book, Critical: Why the NHS is being betrayed and how we can fight for it (2023). She charts her career journey and the events that finally led to the creation of EveryDoctor. She laments the scapegoating of medical personnel by the media, of ‘Weaving narratives of almost-truths and never-truths’, and creating a ‘tapestry of nonsense.’

Patterson outlines how austerity cuts increasingly eroded the NHS budget as well as real time wage freezes across the board. Medical staff were doing more for less as well as working unpaid hours. Eventually changes in Patterson’s personal life provided the space to contemplate the formation of a campaigning organisation that would stand up for patients and doctors alike, and challenge the spectre of privatisation.

The campaign came into its own during the pandemic. EveryDoctor provided a medium through which doctors could relate their experiences in dealing with the pandemic, revealing some of the high level corruption that took place during this period, an issue that I have have covered extensively.

Patterson summed up the sentiment:

The government wholly failed to protect NHS workers during the pandemic or to properly support them to safely care for patients. It has left deep scars for UK doctors; I don’t think they will ever forget how profoundly the government failed NHS staff and patients during that dreadful time.

The pandemic galvanised the campaign, giving it the impetus to take on the establishment, countering a culture that has been misdirected for too long. She pointed to the NHS Constitution that includes the seven key guiding principles that underpins the NHS in England:

1. The NHS provides a comprehensive service, available to all

2. Access to NHS services is based on clinical need, not an individual’s ability to pay

3. The NHS aspires to the highest standards of excellence and professionalism

4. The patient will be at the heart of everything the NHS does

5. The NHS works across organisational boundaries

6. The NHS is committed to providing best value for taxpayers’ money

7. The NHS is accountable to the public, communities and patients that it serves

In Scotland there’s a Charter of patient rights and responsibilities.

As Patterson points out, successive governments have systematically violated the constitution, from Thatcher to Starmer. The consequences of this is a weakening of interconnected links with other areas of care within the system. To sum up:

The NHS model of healthcare is based on tenets of collectivism and of taking responsibility as a society for the health of everyone, to the benefit of all.

As the service declined, many left, going elsewhere, weakening the service even further, prompting the Red Cross to declare a ‘humanitarian crisis’ within the NHS. Successive governments were warned about the dangerous decline, but those warnings were systematically ignored. The end result has been serious fragmentation of the service. But most galling of all has been the pretentious waxing of many politicians about brand NHS, as if it was a soap power that washed whiter than anything else and that if you vote for us at next election, we’ll deal with all the dirty laundry. Then there was the ‘vote leave’ debacle, where Brexit would deliver ‘£360 million a week in NHS funding’.

To improve the situation within the NHS, governments have tried what can only be described as window dressing. During Covid, volunteers were drafted in the help with various measures, e.g. volunteering at vaccine centres. But another curious entity had emerged. Apparently the NHS requires charity support. NHS Charities Together appeared at the beginning of the pandemic. But as Patterson notes:

The NHS was set up in the first place to do away with the reliance on philanthropy in the delivery of healthcare for our society. The existence of a charitable organisation propping up the service through corporate partnerships clashes with the very premise of our public health care system.

One only has to look at the corporate partners involved to be struck with immediate concern. Two particularly stand out (from Charities Together):

Our partnership with Starbucks embodies Starbucks’ mission to “inspire and nurture the human spirit, one person, one cup and one neighbourhood at a time”.

Starbucks is not a company to inspire anyone. It has a history of racism, union busting, and is linked to controversy over the Gaza genocide.

Then there’s Amazon, who’s appalling track record on workers abuse, tax avoidance and relentless monopolisation of the market should need little further introduction.

One of the reasons governments have got away with the decimation of the NHS is lack of accountability, especially from the media, which doesn't hold the government to account, full stop, at least rarely. Legacy media is just another manifestation of the neoliberal cult. Click bait, shallow reporting, career reporters, who don’t want to rock the boat so that they can get preferential access to power. If a story about the NHS carries enough sensationalism, it might be published. Patterson outlines the issues in some detail in the book. Some of the NHS institutions are supposed to hold power to account and in some cases they do. But its an uphill struggle.

Another important issue raised by Patterson is the increasing criminalisation of dissent and protest. Legislation such as the Police Crime Sentencing and Courts Act 2022 and the National security Bill, will make life more difficult for protesters. This represents an abuse of power. It could also be argued that it obfuscates political corruption. As a result, monitoring organisation, Bulletin of the Atomic Scientists, has waded into the governments draconian measures to stifle protest. It remains to be seen how this will impact campaign groups such as EveryDoctor.

Governments over the years have engaged in a persistent ideological purge of the NHS, following the neoliberal playbook. In this inverted reality, evidence becomes largely irrelevant. Patterson outlines the rich resource of expertise, professionalism and symbiotic bodies within the NHS. But:

those experts, those bodies, with their rich knowledge base and expertise, have been largely disregarded by the government in recent years.

And the government is well aware that the NHS is crumbling, with people leaving in droves, and that this has an adverse impact on patients, even threatening their lives. But remember, people are commodities and this goes for medical staff as well. All this was exposed during the pandemic. The political response was to scapegoat and gaslight everybody else, except the government itself of course, which was riddled with corruption and cronyism. As Patterson pointed out, this represented a massive betrayal from the government.

The steady infiltration of private entities into the NHS has had a negative impact on patient care. But despite the impact of this Lancet study and clear evidence of public support for NHS, the government instead has cynically pushed obfuscation and misinformation by twisting the reality of what’s really going on. As Patterson notes:

The government is clever with its messaging, and its strategy. It holds enormous power through its ability to communicate with the public through the media, and it is seeking to capitalise on a crisis of its own making, to destroy a public service that does not belong to it. …and has a great deal of money behind it; it is able to run expensive political ads across social media, for example, and politicians regularly dismiss concerns and even attack the campaigners who are attempting to hold them to account.

Patterson goes on to outline what needs to be done to salvage the damage that has been done to the system, from investing in infrastructure, built and technological, investing in staff, supporting those that remain and bringing new staff into the system. She sums up the overall predicament:

We have ended up where we are, with a dysfunctional and poorly managed service, heavily infiltrated with privatisation, because decisions from one government that do not serve the public are stacked onto the decisions of previous governments,which also did not serve us. The reforms have been enacted gradually, in a stepwise manner, to bring us where we are today.

However she does take an optimistic view that if people come together and fight for what they believe, change is possible.

At the time of writing, Starmer’s Labour government has announced the abolition of NHS England. Is this the end of the NHS as we know it? And what will the ramifications be for the devolved institutions?

This response from Keep Our NHS Public, outlines the main concerns. It explains how NHSE was set up as an arms-length ‘quango’, one of many that was supposed to outsource the administration of former publicly owned services. Whether or not NHSE was a success is open to debate. It has had its critics. In short:

In practice, the Secretary of State for Health and Social Care is now taking back the duty to provide comprehensive health services, abolished by the 2012 Lansley Act. Campaigners have demanded the return of this accountability to Parliament and the electorate ever since 2012, but Streeting’s new powers do not give cause for celebration.

Indeed the people running the show at the DHSC are former pro-privatisation Blairites. As the article sums up:

It is difficult at present to see the abolition of NHSE and thousands of redundancies as anything other than a move to facilitate Labour plans for ’reform’. The bad news is that ‘reform’ looks like another reorganisation where the beneficiaries will be private companies as an increasingly fragmented NHS is opened up to commercial interests. It’s no surprise that NHSE staff are ‘in shock and awe’ at the scale of the job cuts, which have spiralled from 2,000 just weeks earlier to 6,500 last week to now, with 10,000 job losses said to make £500 million savings.

Has the revolution started yet? This is how Patterson ends her book:

As William Beverage said in his report in 1942, the report that helped give rise to the NHS in the first place: ‘A revolutionary moment in the world’s history is a time for revolutions, not for patching’. From this global pandemic we face another revolutionary moment. It’s not a time for more concessions, small changes or compromises. It’s time for the bold transformative ideas that will help us build the NHS to thrive for the next 75 years. It’s time to fight for the NHS.

Lets not beat about the bush. Career politicians are a pretty odious bunch. They are sociopathic acolytes wedded to the neoliberal gospel, driven by myopic vision, constricted by group think. Maximum pressure needs to be brought to bear, whatever shape or form that takes.

Update

Everydoctor has published a report showing the connections between private healthcare companies and MPs.

*Declaration of interest: I support the EveryDoctor campaign.