It’s no secret that UnitedHealthcare, a company infamously known for its high rate of healthcare claim denials, has recently been under attack. The CEO’s killing on December 4th raised questions on the nature of violence: Is it ever just to end someone’s life to make a statement? Does this violence expose injustice, and does violence ever lead to reform? Many online acclaim the killer, Luigi Mangione, and his actions, supporting his protest as necessary to bring attention to an issue that plagues low-income Americans. Most support the broader protest against greedy, unapologetic healthcare companies concerned with profits- not healthcare- but do not condone violence, in any way, deserved or not. Is violence, or violence bringing death, ever justified? Even to the most despicable of characters?  

None of these questions would be relevant if it weren’t for a case on the 1st Amendment, Sorrel v. IMS Health Inc., decided in 2011. This case considered the transaction of data- healthcare data- between doctors (prescribers) and the manufacturers (pharmaceutical companies). This data mainly included, but was not limited to, which doctors prescribed which medications, which areas purchased the most of a certain medication, and how much and to what frequency the medications/prescriptions were prescribed. Essentially, the data told manufacturers which consumers tended to purchase which drugs. Finally, having access to this information would allow pharmaceutical companies/manufacturers to craft more effective sales pitches, which, in turn, would boost their profits. And this is where the 1st Amendment issue arises. 

On its face, the 6-3 majority seems fair (they ruled in favor of IMS Health, agreeing that there was a violation of the 1st Amendment). The Vermont law in question prevented the transaction of information between the doctors and the manufacturers. By preventing this transaction, the manufacturers couldn’t properly pitch their “newest and improved” medications to doctors, and as the majority found, this was a violation of the 1st Amendment. 

I disagree and follow Justice Stephen Breyer’s concerns (who passionately dissented) regarding public health. We must examine why Vermont would make such a law, and we must ask if there was any other way Vermont could have applied a law, in the least restrictive means possible, to “protect the public health.” As a consequentialist, the Vermont law should stand. I think the Court did a poor job of weighing the law’s intended effects versus its observed outcomes, specifically, the Court failed to consider this information would reduce the effectiveness of sales pitches, not criminalize them, and, consequentially, the problems we see today might arise. In other words, the healthcare crisis, the CEO’s assassination, and Luigi Mangione’s anger were consequences of cases like Sorrel. 

Again, I cannot answer the “violence” questions. Ultimately, I believe lawful civil unrest or protest, devoted to a cause, should be (and is) commonplace in a democracy. But cases like Sorrel, which gives pharmaceutical manufacturers access to information, regardless of doctor’ consent, have no place in a democracy’s healthcare system. What about the rights of patients? 

At its most basic level, this Vermont law protects the most vulnerable of society. Do we not have an obligation to stand up for the ones who need healthcare the most? It doesn’t make sense to favor the manufacturers, who prioritize profits over health. The reason Luigi Mangione acted was because manufacturing companies, thanks to Sorrel, could convince doctors to sell medications (often with the same effect as general brands) for higher prices. They have access to personal information, making this “profit operation” possible. 

The 1st Amendment considerations, here, are out of place. As I’ve stated previously, the law didn’t prevent companies from making their pitches. It just prevented prescription information from unlimited access, protecting public health and lowering healthcare costs. This is a necessary and justified intention. The law- as the majority argued- needed heightened scrutiny. That would be true if the right to speech was threatened. Only certain, doctor-exclusive records, preventing future misuse, were withheld- companies could still offer their products to doctors with sales pitches. 

Finally, the Court also touched on the argument that this information isn’t simply reserved for patients and their doctors, but for pharmaceutical companies and manufacturers (as they prescribe doctors drugs). This idea, again, turns to profits, not health. What is the purpose of the Constitution? To protect the people, to provide a governing system in which we can all participate, through votes, and have all our voices heard. In one way or another, patients are forced to purchase higher-priced medicines, are often unable to get the treatment they need, and are ultimately not represented. At its most basic level, our country should protect those in need- if that means sacrificing the transaction of typically private information, then so be it. 

This decision effectively silenced our most vulnerable; Mangione’s actions might spark more violence, and as long as Sorrel exists, we might not see an end.