Doing Injustice to the Just Price


An article in the Journal of Clinical Oncology on the just price of cancer drugs in the United States contains an odd reference to a nonexistent book by Aristotle. Unraveling the origins of this error reveals an almost farcical series of misinterpretations.

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Arguments from authority are generally a good thing. If claims come from people with a few letters after their names, it’s often safe to bet that those claims are backed up by years of invested study and expertise, especially when they’re published in peer-reviewed journals. Scholars want to protect the integrity and reputation of their discipline, which in theory should filter out any faulty arguments or unfounded claims long before they reach the public eye. But when scholars speak outside their sphere of proper authority, that system can fail spectacularly—hilariously, even.

Earlier this summer, I came across an article published in the Journal of Clinical Oncology entitled “Cancer Drugs in the United States: Justum Pretium—The Just Price.” As a student of economics with an interest in the history of just price doctrine, I found myself intrigued by the promise of a thoughtful application of the writings of Thomas Aquinas and other Scholastics to contemporary questions in the healthcare market. The historian of economic thought Raymond de Roover succinctly defines the just price:

According to the majority of the doctors [of the church], the just price did not correspond to the cost of production as determined by the producer’s social status, but was simply the current market price, with this important reservation: in cases of collusion or emergency, the public authorities retained the right to interfere and to impose a fair price.

With this understanding in mind, I expected an examination of potential collusion among pharmaceutical companies, or perhaps an extension of this “emergency” exception to life-threatening illnesses. What I got, however, was something I never thought I would see in a refereed journal.

Although the article bears the words justum pretium in its title, the phrase only appears once, in a paragraph that I had to reread several times for the absurdity of it to fully sink in:

Aristotle is credited to be the first to discuss the relationship between price and worth in his book Justum Pretium—the just price. Sixteen centuries later, Saint Albert the Great and Saint Thomas Aquinas refined Aristotle’s argument. Their conclusion: of moral necessity, price must reflect worth.

Initially, I was shocked to discover that Aristotle had written an entire book devoted to the just price. I had heard of his works on politics, ethics, poetics, and logic, but a complete work devoted to economics was news to me. Had these four medical doctors discovered a long-lost manuscript, perhaps one that had fallen behind a bookshelf in an old monastery, and thus made a ground-breaking contribution to the Aristotelian corpus (and written in Latin, no less!)?

Since Aristotle died in 322 BC, an entire prose work in Latin would predate one of the earliest surviving works of Latin literature, Plautus' Pseudolus, by over 130 years. This book Justum Pretium would not only revolutionize our understanding of early Latin, but also of the cultural network in the Mediterranean that would lead Aristotle to write an entire book in a language other than his native Greek. I desperately wanted to learn more about this book.

Unfortunately, the authors provided no footnote to support their revolutionary claim. Perhaps they assumed that knowledge of Aristotle's basic works was so common that it needed no citation. Clearly it's not common enough, else the authors would have known how outrageous their passing comment on Aristotle was. To be fair, the sentence on Aristotle contributes nothing to the actual argument of the paper, so it's understandable that it could glide under the radar of the peer-review process. But all this only raises the question: Why draw on a manifestly irrelevant and undocumented claim for the title of the paper? Perhaps the authors wished to appear sophisticated; instead, they revealed themselves as Sophists (and we all know what Aristotle thought about Sophists).

A friend alerted me to a possible source for this audaciously irrelevant claim about Aristotle: what appears to be a transcript of a public radio broadcast. As far as I can make out, this particular episode dates from January of 2013. Given the JCO article’s publication in May of 2013, it’s a plausible source for an otherwise inexplicable error. As the radio program transcript reads:

Aristotle is often credited as the first person to take an in-depth look at the relationship between price and worth, devoting an entire book of the Ethics to the justum pretium – the just price. A remarkable work in its time, the Ethics was reintroduced to the Roman Catholic Church sixteen centuries later by Saint Albert the Great and his student Saint Thomas Aquinas. Albert and Thomas in turn refined Aristotle's argument. Their conclusion? Of moral necessity, price must reflect worth.

The two passages, one from the JCO article and the other from a radio program, are strikingly similar, and the last sentence is even copied verbatim (punctuation excluded). Furthermore, one can see how “devoted an entire book of the Ethics to” could be corrupted to “wrote a book called.” It's understandable that the JCO authors would hesitate to cite a ninety-second radio blurb, but that apparently didn’t stop them from clumsily paraphrasing the content.

The radio source has its own share of problems as well. On the factual side, Aristotle did not devote an entire book of the Ethics to the just price. Instead, he handles justice in exchange under a single subheading in Book V and never conjoins the words “just” and “price,” much less their Latin equivalents. On the credentials side, the “guest scientist” on the program is not a historian, a philosopher, or an economist—he’s an industrial engineer. What does an industrial engineer know about the just price? All he needs to, apparently. Notice how he introduces and concludes the article:

As a child I once asked my father, “How much is something worth?” A practical man, he answered without hesitation: “Something is worth exactly what someone else is willing to pay for it.” . . . Apparently the great scholars who preceded my father were able to add little to his offhand insight.

All those “great scholars” (read: Aristotle, Aquinas, and the countless canonists, jurists, and theologians who came between) know little that your ordinary “practical man” does not. The high-flown efforts of theologians to determine the just price (“many solutions have been proposed”) are contrasted with the “practical” and “obvious” solution of the jurists that the just price is simply the current market price. There is only one remaining problem—he’s wrong.

The online transcript notes that the program’s material is drawn from John W. Baldwin’s 1959 essay, “The Medieval Theories of the Just Price: Romanists, Canonists, and Theologians in the Twelfth and Thirteenth Centuries.” Published in the Transactions of the American Philosophical Society, Baldwin’s article (in marked contrast to the previous two specimens) is a well-researched, thoroughgoing treatment of the history of the just price from Roman law to Thomas Aquinas. Baldwin finds that, far from “many solutions” having been proposed, a single definition of the just price has been shared at every point in its development: the current market price. Even Thomas Aquinas himself, often touted as a progenitor of Karl Marx because of his alleged “labor and expenses” theory of value, in the Summa Theologica adhered incontrovertibly to the understanding of the just price as the commonly determined market price. This comes as no surprise given that his teacher, Albert the Great, is quoted in the radio program as holding the same view, even though he was earlier mentioned as one of the high-flown theologians.

If “many solutions have been proposed,” they were certainly not proposed by any of the Romanists, canonists, and theologians in the twelfth and thirteenth centuries. But to find another proposed solution we need look no further than the JCO article with which we began. Immediately after the paragraph quoted above, the authors contrast the just price with current practice:

In the context of cancer therapy, the prices of new anticancer agents seem to be decided by pharmaceutical companies according to what the market will bear. There is little correlation between the actual efficacy of a new drug and its price, as measured by cost-efficacy (CE) ratios, prolongation of patient life in years, or quality-adjusted life-years (QALYs).

Well, yes. After all, the just price is precisely “what the market would bear,” insight that more careful attention to even the radio program, much less the Baldwin article, would have provided. They provide a supposedly incriminating “example of a drug being worth as much as it can be sold for,” which for them highlights a “disturbing trend.” Apparently the just price itself is a disturbing trend, because that is precisely how it was formulated by the medieval Canonists—as mentioned in the radio broadcast. In place of actual just price theory, the authors propose “linking price to a true measure of quality” and “encouraging prices based on real value” to be determined by an objective measure. Good luck finding that in Aristotle’s book Justum Pretium.

This is not to say, however, that the problems mentioned in the JCO article do not exist. There may very well be an element of corporate collusion that needs to be addressed. People are in fact driven to bankruptcy by paying for their cancer medications. A judicious application of just price theory to the current cancer drug market would need to examine any cases of price discrimination or taking advantage of emergency situations in light of over a thousand years of scholarly discussion. Such a treatment is the stuff of which peer-reviewed articles ought to be made, but regrettably can’t be found in the Journal of Clinical Oncology piece.

To understand just how odd this article is, consider everything we’ve seen. An article in a medical journal justifies its title with a claim that Aristotle wrote a book that he didn’t write in a language that he didn’t speak. They draw this claim from a misunderstanding of a public radio broadcast, which itself misunderstands the only scholarly source it relies on. Not only do they paraphrase and even quote this article without citing it, they proceed to ignore what it actually says about the just price and instead substitute their own definition. This can only be construed as either abject laziness or a pernicious attempt to root their claims in a historical tradition backed by some of the biggest names in philosophy while misrepresenting what they said and failing to properly credit their sources. This is not just bad scholarship—this is intellectual robbery. If just price should be related to “true value,” this article is worth less than the government bonds of Greece.

John B. Shannon is an economics and Latin major at Hillsdale College and an intern and editorial assistant at the Journal of Markets & Morality at the Acton Institute for the Study of Religion & Liberty. He wishes to thank Chris McCaffery for the link to the radio broadcast.

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