E-DRUG: Pharmaceuticals: putting profit before patients. Oxfam
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An odd one out or part of the same system? By Mohga Kamal-Yanni, Senior
health policy advisor, Oxfam
'It was a business decision. It was about money. And screw you.' - A
journalist said after talking to Martin Shkreh the CEO of Turin, the
US-based pharmaceutical company. The company shocked the US when it raised
the price of daraprim, a 62 years old medicine by 5000% from $13.5 to $750
per tablet.
The US Pharmaceutical companies association (PhRMA) was quick
to tweet that '.@TuringPharma does not represent the values of @PhRMA
member companies.' So is PhRMA right?
In reality Turin represents a typical symptom of the same disease: putting
profit before patients. Otherwise how can we explain the escalating price
of new (and sometimes old) medicines not only in Europe and US but also in
low and middle income countries?
Take Gilead's medicine that cures hepatitis C as an example.
Sofosbuvir (marketed as Sovaldi) was launched at $1000/pill/day.
Even at the reduced price offered to some countries,
the price is too high. We estimated that treating just half patients
suffering with hepatitis C would have cost the Egyptian ministry of health
nearly two thirds of its budget.
New cancer medicines are reaching the market exorbitantly priced and
thus unaffordable in most countries even in Europe and the US. NICE, the
body that advises the UK's NHS on medicines rejected Roche?s breast cancer
medicine trastuzumab emtansine (Kadcyla) not because of ineffectiveness
but because of its high price. Needless to say the price is far beyond the
dreams of patients in developing countries.
Patients and advocates for access to medicines have been campaigning on
access to medicines in developing countries for years. Their success is
clear when the price of the anti-HIV cocktail dropped from US$ 10,000/patient/year
to around US $100. Now similar actions have started in
rich countries too. One of these groups sent a letter to Jeremy Hunt the
UK secretary of health urging him to issue a compulsory license that
enables the importation of cheaper versions of the same medicine so that
women are not denied a life saving treatment.
Having 'temporary' monopoly over pricing seems to be not enough for
pharmaceutical companies. Pharma lobbyists carry significant influence in
the corridors of power pressurising governments to design and enforce
rules that exceed what is already agreed at the WTO through the TRIPS[1]
agreement.
Intense lobbying to increase intellectual property rules in free trade
agreements has created global public anger. Last September a cancer
patient was arrested when she was accused of disrupting the negotiation of
the Trans-Pacific Partnership (TPP). The recently concluded TPP
negotiations were carried out over more than five years in secret and the
text will only be available for elected bodies and the public when it is
ready for signing.
Free trade agreements (FTAs) like the TPP are notorious for expanding
corporate powers at the expense of public health and the public interest.
For example, the FTAs allow corporations to sue governments over measures
to promote access to medicines (such as price controls, reimbursement
decisions, marketing approvals, and drug safety decisions, or stricter
patentability standards). Corporations argue that such measures would
damage their investments, which they insist must be protected by the FTAs.
This is already happening as Eli Lily has taken the Canadian government to
court over government action to make some drugs affordable.
Similar damaging FTAs are currently being negotiated - also behind closed
doors- between the EU and Thailand, India and the US.
Moreover, when developing countries try to use legal tools to control or
decrease prices, they are put under huge pressure from rich countries
under the influence of 'big pharma'. When Thailand issued compulsory
licensing for key medicines to treat HIV and cardiovascular diseases, 'big
pharma' launched intense pressure on the country to revoke the decision.
Under the influence of 'big pharma', the US trade representative put
Thailand on the Special 301 'Priority Watch list' of countries, which
subjects countries to extreme pressure from the US government. Pharma's
influence on the EC resulted in pressure from the European Commission on
the Thai govt to change its decision.
Recently some Members of US congress wrote to the US administration urging
it to put pressure on India to change its national intellectual property
law in order to strengthen monopoly protections on pharmaceuticals. The
law had previously been challenged in court by one pharmaceutical company
but the court turned the claim down. Changing the Indian law by increasing
intellectual property protection will deprive patients from access to
needed medicines not only in India but also in the rest of the developing
countries. India is considered 'the pharmacy of developing countries'.
The root of the companies' monopoly power and influence is the current
model for funding for research and development (R&D) of medicines.
Pharmaceutical companies justify the high prices of medicines by the need
to recover the R&D costs. Yet the actual cost of R&D is kept as a big
secret by the industry. In reality it is becoming increasingly clear that
medicine pricing is not determined by production costs and a profit
margin, but by what the market can bear.
Clearly the current R&D system is failing patients and health providers
all over the world. It is high time that global leaders work for an
alternative system that separates the financing of R&D from pricing the
resulting medicines. It cannot be left to the pharmaceutical industry to
cater only to those who can afford to pay high prices- practically
deciding who lives and who dies.
[1] Trade Related Aspects on Intellectual Property Rights
http://www.globalhealthcheck.org/?p=1835
Mohga Kamal-Yanni <mkamalyanni@Oxfam.org.uk>