The evil of big Pharma

Ben Goldacre appears to be running a series on how pharmaceutical corporations contribute to the high cost of health care in the Guardian: Evil ways of the drug companies Spectacularly expensive cost of trial and error

In this post I will discuss the first article where he gives three reasons for thinking that Big Pharma are unethical,

1.

They spent only 14% of that money on research and development, but 31% on marketing and administration. They are very careful not to let anyone see how much goes on marketing and on administration. Whenever you hear the drug companies explaining why they have to charge so much for their products - perhaps as they are denying their lifesaving Aids drugs to the 20 million HIV-positive people in Africa - the plea is that they need money to develop new drugs. That's not true if they spend twice as much on marketing as on research and development. This unhappy collision of facts makes them look very evil indeed.

2.

They also charge this money in slightly evil ways. Drugs have 10 years "on patent." Loratadine is an effective antihistamine drug that does not cause drowsiness. Before the patent ran out, the price of this drug, by Schering-Plough, was raised 13 times in the US in just five years, increasing by over 50%. This is not a price rise in keeping with inflation. This is evil.

3.

Me-too drugs are an inevitable function of research driven by a market: they are rough copies of drugs made by another company, but they are different enough for a manufacturer to claim its own patent.

They need to be tested and marketed just like a new drug; but for all that effort they generally don't represent a significant breakthrough in human health. They are merely a breakthrough in making money. Again, you have to admit, that is reasonably evil.

What Goldacre really seems to be reacting to is the running of pharmaceutical corporations as profit making companies. I'm happy to agree, there seems to be something troublesome about profit making from human misery, which inevitably is what Pharma companies are doing. But there is something powerful to the idea that we need profit making and taking to give incentives to take the risks inherent in developing new medication. I'm more inclined to think that what we need is a different incentive structures along the lines suggested by Pogge, rather than removal of pharma as profit making companies. Of course there is the bigger question as well, how much new medicine do we really need?

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Novartis loses India Patent case

This is almost certainly good news for those of us who are concerned about global justice, and the availability of medicine to those in the developing world. The New York Times reports in this article: Setback for Novartis in India Over Drug Patent

Novartis sought to determine whether an Indian court had been right to deny a patent on a modified form of the Novartis leukemia drug Gleevec, known in Europe and India as Glivec. The application was rejected on the grounds that the new drug was insufficiently different from the previous version.

In effect what the ruling does is uphold Indian law which prevents very minor 'innovations' or changes to an existing medication being used as a basis for a new patent application.

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Pricing Pills by the Results

Interesting article in the New York Times on pricing pills by their results. The basic idea is rather than pricing the drugs on cost + profit, they will be paid for only if they are actually beneficial for particular patients. In principle this means the drug company shares the risk with the purchaser. This has been suggested to the UK National Health Service by Johnson & Johnson in relation to one of their cancer drugs.

While I like the principle, I am not convinced that this will genuinely save money, since logically the pharma companies will have to raise their prices to ensure that they are still profitable. This may allow for more drugs to be tried, which ought to increase efficiency. However this could place increased pressure on National Health Services to provide coverage for far more marginal and very expensive drugs for the few patients they are effective for, regardless of their cost effectiveness.

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The Ghost in the Machine

A very interesting read about the ethical issues in ghost writing can be be found over at medical humanities

As Daniel points out that up to ten percent of articles in medical journals may be ghost written is outrageous. But it is a natural conclusion of market driven health care, if your business is selling medication, then you want to ensure that people are prescribing your medicine... In a perfect world that will be because your drug is the best drug for the patient. In the real world though there are plenty of short cuts to ensure reasonable sales even if your product is perhaps not the best... While it is radical, one way to reduce this corruption of science would be to reform our health care systems and in particular the funding and creation of pharmaceuticals.

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