The Earth Hearing

by Daniel Plonix

  To finalize her decision, she was going to print some pages from Darr’s manuscript.

  A whole range of black hues existed, each designed to impart a different mood or provide a better match for a particular paper. These subtle variations were essentially black ink with green, red, blue, or white additives—­producing pleasing black colors with all but imperceptible undertones of one hue or another.

  Lee’chelle instructed Agni how to ink up the rollers of the proofing press. The little apprentice weighed the black and magenta inks he had scraped from the jars, keeping a close watch over the black-to-red ratio. Aldabara had told Lee’chelle that none of the children who had occasionally walked resolutely into their shop stayed longer than a few days—at most. It’s just wasn’t the kind of craft kids connected with; it had too much of the subtle and the understated.

  In short order, Agni printed a number of print samples, and Lee’chelle contemplated them. This was what she had pictured. With an almost imperceptible red tint, the severity of the font went away, and the characters became lively and organic.

  Lee’chelle has made her decision. The book was to be typeset in Dela Rubia.

  She kept on working long after Aldabara and Agni left.

  Down below, on the street, a pair of children was wheeling a loaded cart with fastened glowing paper lanterns, loudly inquiring if any of the people toiling late needed dinner brought up to them.

  Lee’chelle was grateful. She waved at the two. And moments later, she was eating a warm sandwich wrap, frowning in concentration and frustration at the growing pile of text samples on her desk. She had covered all the bases, and it was not working.

  Darr’s manuscript was now set in Dela Rubia. The size of the letters was 11 points; the line spacing was 13.25 points; the linewidth was 305 points. So far so good.

  Dela Rubia was a very organic typeface. It looked funny with the left margin straight and stiff. This was taken care of; she had created very gentle slopes and jaggies on the left margin, giving the body of text subtle, natural line endings—on both ends.

  She had optimized the letter size, linewidth, line spacing, and line endings. Yet something was still off. Any time she closed her eyes, she could see the rightness. And when she opened them, she saw the reality. There was a gap between the two.

  It was apparent this lovely typeface still had some kinks in need of adjustment. The lower case “s” of Dela Rubia appeared caved-in. Capital letters, notably the “T” and “H,” were too wide. The question mark was too dreamy, while the other punctuation marks were too harsh for their own good.

  More hours passed as she made some alterations. And after further infinitesimal stretching of all the letters, she considered the galley proof. Things did look better. Alas, the sense of wrongness lingered. Something was still eluding her.

  Lee’chelle logged on to the typesetter network and accessed the file on Dela Rubia. Only half a page was written about that font. She read through it quickly. Evidently, someone had started working on this typeface prior, but the project was aborted. The typesetter had pointed out the overly wide caps. “There is something else. I will have to re-visit it,” he had noted. No help there. She added her entry and attached the character variants she had created.

  Lee’chelle turned back to the large work table.

  She studied the groups of letters she’d marked earlier. The problematic letter combinations were different each time. An “e” was a problem in one group, but not in another.…Then it was the “h” causing trouble but only on one occasion. Then she saw it. It was in the combinations. Whenever letters like “e” and “a” stood next to airy ones, like “h” and “u” there was a spike—a sudden jolt of color. She could see it now. She could see it.

  Chapter 52

  The Reservation, Deep Underground, the Commission Building

  “What do you do when you reach market saturation and seek additional profit opportunities?” asked Ms. Hill rhetorically. “You grow the market of course. You sell illness. Hence, plain ol’ heartburn is re­packaged as ‘acid reflux disease’ and, presto, you get the public to buy your medicine rather than just drink milk. Pharma has also expanded the definition of what conditions could benefit from medications. It used to be that a high cholesterol was considered two-hundred and eighty milligrams per deciliter, now it is anything over two-hundred. As a result, the pool of potential paying customers is that much larger. Same thing with what is construed as high blood pressure. Needless to say, some of the experts on the panel making the recommendations have financial ties to pharmaceutical cartels.”

  It was the last round of presentations and testimonies by the Survey Group to the Man-Made World. Aratta, Puddeck, and the Chief Examiner, Rafirre, were in attendance. And so was the second Earth person who desired to stay for the remainder of the hearing.

  Unlike the other Terranean, Ms. Hill did have something to go back to on Earth. But she had an ax to grind. Or at least some bitter, firsthand experience on which she wished to testify. It had something to do with her long years as a pharmaceutical sales representative. Back home, she was a whistle-blower and got interviewed several times on radio talk shows. Predictably, her podcasts and interviews changed nothing. But then those people whooshed from the sky, or from wherever. She reasoned that if anything or anyone could undermine the stronghold of Big Pharma, they were it. Ms. Hill had a personal score to settle and wanted to stick it up to the drug manufacturers.

  “Pharma invests in what brings in the most profit not what may do the most good,” Ms. Hill was saying. “In developing countries, the demand for better, cheaper drugs for treating malaria and schistosomiasis may be there, but the money is not. Far more sensible to focus on the less serious ailments that are of interest to the middle class. I’m just being honest. In fact, the best kind of maladies to invest in are those requiring lifelong treatment and are common. So you can appreciate why children are recognized as the most lucrative market niche. You get’em young and may have clients for life.”

  “Care to give us an example?” asked Rafirre. Per her request, he was providing her with leading questions. The dynamics of the pharmaceutical industry in themselves held little relevance for the hearing. However, he was using it as a peephole into the moneymaking paradigm on Earth—in all of its grotesqueness.

  “Sure. Antipsychotics prescribed in childhood often become a lifelong habit as they don’t cure illness but mask symptoms.” She reflected. “It’s hard to quit the drugs. What’s more, antipsychotics tamper with neurotransmitters. This can give rise to multiple adverse effects, which in turn require treatment and hence the purchase of additional drugs.

  “As it turned out, stimulants such as ADHD medications and antidepressants may trigger manic symptoms with some regularity among children and adolescents.

  “Overnight, we had this new disorder looking for a drug. Not saying it was by design. All the same, pediatric bipolar disorder was born, and it provided a new market for expensive antipsychotic drugs.” A cold light came into her eyes. “This is typically the point when pharma’s prop­aganda arm shifts into high gear.”

  “Propaganda arm?” asked Rafirre.

  “Yes,” Ms. Hill said. “Public service announcements raise awareness about a newly christened disorder, and celebrities are paid to mention the ailment seemingly in the spur-of-the-moment—and plug the relevant drug when they are on the air. Masquerading as grassroots patient groups, front organizations decry the growing problem and the need to increase the availability of treatments. TV commercials and stealth ads promote the new drug, and just as importantly, stoke the fear of the related medical condition. In the case of pediatric bipolar disorder, lobbyists helped congressmen to propose legislation that would manage the screening of school children and infants for the potential malady. Credentialed individuals affirmed its existence in prestigious peer-­reviewed journals. None of it is authentic; it’s a manufact
ured reality.”

  “I don’t follow you,” said one of the commissioners. “Aren’t research scientists the ones who author academic papers?”

  “Sure. Sometimes. Other times, pharma has its own people produce research papers, then get the credentialed folks to put their names on these. Not surprisingly, the studies will discover that the prevalence of the medical condition is higher than previously imagined. Or something along those lines.”

  “What happens if some papers call into serious question a given product?”

  Ms. Hill sighed. “These days, the industry—whether the vaccine industry or the GMO industry—employs people to sniff out any problematic studies in the pipeline. They send nasty letters to the universities and journals in question.” She ran a hand through her hair. “A recent tactic is to let the hazardous paper get published—and then put the squeeze on the journal, which often accepts industry money. Subsequently, the problematic article gets retracted. This saddles the authors with an ethical-wrongdoing taint, and their professional reputation is in tatters. After that, well, good luck getting in front of a grant review panel ever again. Other researchers get the message and stay clear of any studies that may seriously undermine corporate interest.”

  “What of clinical trials?”

  “Your Honor, pharma conducts the trials of its drugs.” She smiled derisively and added, “This is a bit akin to assigning the burglar to dust for fingerprints as a part of the police investigation.

  “There are tons of ways pharmaceutical companies spin clinical trials, massage the data, and obtain the results they need,” Ms. Hill told them. “A clinical study may compare the new drug to a placebo, which says nothing about its efficacy in relation to existing drugs. Or set up a trial with too short of a follow-up to manifest any possible neurological side effects, as they do with pediatric vaccines. Or conduct multiple trials, publishing the ones with favorable outcomes. Or dilute the adverse results by averaging it with data lacking active monitoring. Or use a small, unrepresentative patient sample. Or compare a drug to an older one, but have the older drug administered at a high dose, so it yields more adverse effects. Or orally so it is less effective, as they did with amphotericin B.

  “A while ago, the government commissioned a large, long-term clinical trial for the treatment of high blood pressure. It turned out diuretics were as good as the newer drugs in lowering blood pressure and, more to the point, better at preventing heart disease and stroke. However, the diuretics had a serious flaw: they carried no patent, so they were cheaper. As you can imagine, no company had a financial interest to promote them. Not surprisingly, the far more expensive, albeit less effective, patented drugs got pushed—and overwhelmingly prescribed.”

  “What if a newspaper is coming out with a story unfavorable to a new drug?” Rafirre asked.

  “This rarely happens, as pharma advertisements pay the bills. At any rate, in such an eventuality, the drug manufacturer may threaten to pull some of its ads. Alternatively, their lawyers may make some threatening noises. If neither tactics work, they are likely to try to discredit the story and ruin the reputation of the reporter, via a barrage of tweets and hit pieces in newspapers.”

  “What about innovations?”

  Ms. Hill grimaced. “Innovation is a crapshoot; Big Pharma usually goes with what are safe bets. Once the patent monopoly for a lucrative drug is about to lapse, the company can tweak the product in question ever so slightly and, presto, there is a new patented drug. If all works out, it is another twenty years of robust sales with a healthy markup.”

  “What about competition from generic-drug manufacturers?”

  “The patent owners oftentimes buy out the competition, making sure the generic, cheaper drug never enters the market, or they may enter a pay-for-delay agreement with the generic-drug manufacturer.”

  She added, “When the disease is rare, and the affected population is too small to attract competition, the firm owning the related drug gains a license to print money.” She noted the quizzical looks on some of the faces. “A company acquired the patent to trientine hydrochloride, a drug invented in the 1960s to treat the rare Wilson’s disease,” she explained, “and it raised its price from $652 to $21,267. Another company acquired a drug used to treat the rare toxoplasmosis and jacked up the price of one tablet from $13.50 to $750. My favorite story, though, has got to be the adrenocorticotropic hormone, which was developed in the 1950s from pig pituitary glands. A company bought the rights for $100,000. Immediately, it jacked the price of a vial from $40 to $750, then to $1,600, then to $23,000. Currently, it’s $39,000 a pop. It is used for infantile spasms, and the parents must decide just how badly they want their children not to suffer, at least temporarily. Enough to sell their home and mortgage that of their own parents?

  “I’m not the only one to have noticed how lucrative those things are. Out of the twenty-five drugs with the fastest-rising prices, twenty are associated with hedge funds, private equity, or venture capital firms. There must be some pretty happy stockholders out and about.”

  Ms. Hill helped herself to some water.

  “Each year, tens of thousands of well-compensated sales reps give out billions of dollars’ worth of free samples. I say ‘free’ but whose cost—­along with the entire immense marketing budget—is really paid for by the end-consumer in the form of jacked up drug prices and fat insurance premiums. What pharma found out is once the physicians and patients got into the habit of using the medication, they’ll want more of the stuff after the samples ran out. I suppose these things are called drugs for a reason.

  “Friendly, attractive drug reps frequently visit doctors and interns, buying them lunches, giving them sports tickets. The industry is most obliging and eager to cement lifelong relationships, gifting practitioners with anything from Christmas trees to paid-for vacations.

  “Speaking of physicians. The majority of states require doctors to receive continuing medical education. Most of them earn the necessary credits by attending numerous meetings and lectures. Practically every dinner program, symposium, and medical convention are underwritten by pharma. As they pick up the tab and host posh parties during the night, they get to set the agenda and hold the microphone during the day.

  “Your Honors,” she said, “pharma permeates and dominates the entire ecosystem. It has co-opted every aspect of medical education, medical research, and medical practice. It steers the media and pulls the strings of many legislators. It’s not a coincidence that Medicare was ordered not to negotiate down prescription drug prices.” She shook her head in amused wonder. “Follow the money. Just follow the money.”

  She nodded toward the commissioners, and some nodded back.

  Ms. Hill exited the hexagonal bamboo flooring area.

  “Thank you, Ms. Hill,” said Aratta as, along with Puddeck, he took to the stage. “Your testimony was most fitting,” he added, “as it does encapsulate many of the defects in the existing system.”

  He was going to lead the testimony on the economic setup on Earth.

  As he saw it, this was to be the single most important testimony, one that delved into the primary engine of their world.

  Chapter 53

  “Presiding chair, members of the commission,” Aratta opened. “A sound, beneficial economic system contains three elements. One, it generates high-quality life and material well-being via its end products and services. Two, it operates within ecologically sustainable bounds—without major degradation of the natural world. Three, it gives rise to professional pursuits that are worthy. This may mean professional pursuits that rouse a sense of ownership and pride, engender meaningful human interactions, promote self-actualization and a measure of originality.

  “Keeping these things in mind, I will review the current economic system. But first, let’s get one thing out of the way.

  “China, the Soviet Union, and a handful of other countries estab
lished at some point an economic system that underpinned the routine operations of hundreds of millions of people. This system is referred to as an administrative command economy. Controlling raw materials and the means of production, the central planners set concrete goals and priorities. They established quantitative production targets and allocated resources.

  “But a centralized, top-down arrangement does not scale.” At least in the absence of machine learning algorithms and ubiquitous AI. “Such a decision-making procedure is made at a remote location with no feedback mechanism to adjust for various needs, desires, and demands of countless people. Such a setup does not allow for any innovations and local initiatives to bubble up; it breeds apathy, cynicism, and self-serving agendas. And such a setup cannot accommodate the complex open system that the marketplace is.

  “For these reasons, administrative command economy functions dismally. At different decades and across different countries, life under this economic setup ranged from the drab and stifling to the downright calamitous.

  “I will restrict the rest of my presentation to the existing, dominant economic system. By and large, it is vastly superior to the economic setup I have just alluded to. Alas, that’s not saying much. The existing, dominant system is open-ended and dynamic; it does accommodate the complex network that is the marketplace. Alas, that’s about all genuinely good about it.”

  Aratta continued, “One needs to give credit to the feats of engineering, supply chains, and logistics that have improved the lives of countless people. However, this is more of a testimony to the human spirit and intellect than to the toxic pipes through which they have been flowing. Genuine advancements have taken place in spite of the economic setup rather than as a result of it. People have been doing the best they can operating from within an economic system that gums things up, taints, or corrodes what flows through its arteries.