Big Pharma, profits and the value of a human life

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Shkreli: now having second thoughts over the price hike for Daraprim

We live in a world where everything can be reduced to the level of a computer game. For $24.95 you can set yourself up as a pharmaceuticals giant and play with people’s lives.

Big Pharma is billed as “part logistics puzzle, part business sim”. (Sim is short for simulation.) On its website there’s a trailer asking: “Can you profit in an industry where illness is good for business?”

Sadly, the answer can be found in the real world. Big Pharma is not just a game, it’s a multi-billion pound business where huge profits can be made on the back of human misery.

That was brought home this week with news that an American company, Turing Pharmaceuticals, had increased the US price of a drug for patients suffering from Aids.

Turing, a start-up established by former hedge-fund manager Martin Shkreli, acquired the rights to Daraprim last month in a deal worth $55 million.

The drug, developed more than 60 years ago, treats toxoplasmosis, a parasitic infestation affecting those whose immune systems are compromised. It is also used to treat malaria.

In the US it had been selling at $13.50, a reasonable mark-up given production costs are reported to be about $1. Over the years, it has more than recouped its development costs.

But Turing is interested in making big profits, and increased the cost of Daraprim to $750 a tablet. Defending the increase Shkreli said marketing and distribution costs had increased dramatically. Indeed.

In a television interview, he said: “There’s a company selling an Aston Martin for the price of a bicycle. We bought that company, and asked to charge Toyota prices. I don’t think that should be a crime.

“We’re simply charging the right price that markets missed, the prior owners have missed, and we’re doing something very good with those profits, we’re putting them right back in the patients’ hands.”

The final phrase is a cack-handed way of claiming the money will be reinvested in research for new medicines that Turing Pharmaceuticals can charge a fortune for.

In the United States medicine operates, more or less, on a free market basis. Companies charge what they can get away with.

In the UK, a voluntary scheme aims to keep drugs affordable while ensuring producers make enough profit. It’s a constant tussle, and many drugs are still just too expensive for the NHS.

Daraprim is marketed here by drugs giant GSK. It charges the equivalent of 66 cents in Belfast Northern Ireland, compared with the $750 Turing is charging in Belfast Pennsylvannia.

Turing is not the first company to buy a cheap drug and increase the price significantly, and no doubt it will not be the last. But the practice is questionable.

We used to live in a world where human life was valued for its own sake. But in the world of Big Pharma a human life is worth only what a company can make out of it.

This is just the latest controversy over drug profits. While it is true that companies need to make money to fund research into new treatments, the reality is that drugs companies spend more on marketing than they do on development.

Statistics from GlobalData last year revealed that every one of the top 10 drugs companies spent more on marketing than R&D. For example, Johnson and Johnson’s $8.2 billion R&D spend was dwarfed by its sales and marketing spend of $17.5 billion. UK company GSK spent $5.5 billion on R&D, and $9.5 billion on sales and marketing.

There’s no space here to get into controversies over dodgy sales and marketing tactics – including many examples of bribery and corruption; never mind the equally tricky area of drug trials where negative results are suppressed and benefits oversold.

As the Turing Pharmaceuticals’ controversy demonstrates, the development and pricing of drugs cannot be left to the free market. The common good needs to be recognised too.

The profits on drugs come from the taxpayer and the patient. And much of the ground breaking research which fuels the industry takes place in publicly-funded universities where pharmaceutical companies have privileged access through commercial agreements.

Citing the Turing case, Hillary Clinton has said she will act against excessive drug profits if she is elected President. Under pressure, Turing has said it will think again. But drugs pricing is a global problem that has not gone away. There must be a concerted international approach to ensure the right balance is struck between profit and the public good.

  • This article appeared in The Irish News on Friday September 25 2015

Building a future on the kindness of strangers

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Compassion as well as professionalism

My mum died last week. On the same day another friend lost her mother-in-law. Two weeks previously the father of another close friend died. And it’s a fair bet that many of you will have lost a loved one recently.

Globally, it is estimated that some 153,000 people die every day. Death is a workaholic; always busy harvesting souls.

I was once told: “You know you’re getting old when you get closer to the front of the church at funerals”. At the Mass for my mum, my brother, sister and I were in the first pew. It’s a lonely place to be.

Her death is too recent for me to be able to comprehend fully the enormity of it. I just know I miss her lots. A meditation on existentialism will have to wait for another day.

Human beings have been trying to grapple with the mystery of death and its consequences since the beginning of time. Philosophers and theologians have had a go. Poets and musicians too have explored the interface between life and death. But until we make the journey ourselves, we will never really know.

As a child I was always embarrassed when the story of doubting Thomas was read at Mass. “Unless I see the nail marks in his hands and put my finger where the nails were, and put my hand into his side, I will not believe.”

The older I get, the more I recognise that his refusal to believe was a natural human response. We like our knowledge to be evidence based, and there are just not enough hard facts about the hereafter to say with certainty what lies beyond.

Faith, for those who have it, fills the gap. My late father had it, and my mother too. He talked with pride of the confraternities in his native Limerick, and regretted their passing. My mum wanted to be buried wearing a blue ribbon that marked her out as one of the Children of Mary. The cheap tin medal was so precious to her that we found it in her jewellery box.

Before she died she received the last rites (a much more satisfying term than its post Vatican II alternative). By then she had lost her capacity to speak, and I don’t know how much she was able to comprehend. But I hope it brought her comfort.

I am more certain about the impact of others who ministered to her. She was first taken ill in June, and treated at home and in Lurgan’s day hospital.

A ‘re-ablement’ team visited her four times a day to help get her back on her feet. Her GPs checked on her progress. Physiotherapists patiently worked to improve her stability. Ambulance men came twice, once after a fall at home, and once to bring her to hospital. They were amazing. Nurses took blood, sampled urine, checked and re-checked blood pressure. Support staff kept her clean and made her comfortable; young doctors tried to find out what was going wrong and how to treat it. She was X-rayed, scanned, and examined by people trained in the mysteries of modern medicine.

Many of you will have seen similar levels of support for relatives and friends – perhaps you will have experienced it yourself. Today we expect the health and social care service will have systems, processes and treatments in place to deal with our needs.

What I was unprepared for was the depth of compassion shown to her by people doing a tough job in an area where the demand on their services outstrips the resources available. You expect family to step up to the plate, and they did. But strangers?

I witnessed countless acts of love from those who cared for her – women and men who had no blood ties to motivate them, and who could have done their job effectively but clinically and dispassionately.

Like doubting Thomas, I wouldn’t have believed it if I hadn’t witnessed it with my own eyes. I should have known better of course. My mother lived her life by countless kindnesses – a fact brought home to me by the words of many at her wake. But there are none so blind as those who will not see.

In a real sense that is a metaphor too for our society. If collectively we were more aware of the kindness of strangers, we might find it easier to create the type of society we want for ourselves and our children.

  • A version of this article appeared in The Irish News on August 28 2015.

 

NHS funding: there’s not enough money to cure all our ills

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David Cameron: over-promising on health

David Cameron knows that the Tory treatment of the NHS is one of the issues that is toxic for his party. It was no surprise then that during the General Election campaign he went out of his way to neutralise it.

Cameron is not afraid to use his personal life story to cement his political credentials, and he makes much of the support the NHS gave him and his family during the fatal illness of their young son. No doubt he is sincere when he talks of the help they were given.

Whether he was wise to promise more significant investment in the NHS during the forthcoming parliament is another matter all together. No matter what resource is poured into the NHS, it will not be sufficient to meet its needs. Its hunger knows no end.

With his party returned with a majority, Cameron will have no choice but to implement his promises in England and Wales, and what happens there will have a knock-one effect in the rest of the United Kingdom.

Responsibility for health is devolved to the regional parliaments and assemblies, but what happens at Westminster feeds through. It certainly sets the tone for the debate about the health service, how we fund it, and how it meets our expectations.

Much of the focus is on things the NHS doesn’t do that well – managing accident and emergency, coping with ‘new’ pressures such as diabetes and dementia, and the refusal of the National Institute for Clinical Excellence to allow the use of expensive new drugs and treatments that may prolong life.

In our national life, the NHS is sacrosanct.

Such is the reverence for the NHS, that we have the spectacle of a Tory prime minister outdoing Labour in stating his passion for the service. Gone are the days when the Tories worshipped BUPA and private health care. Only the Royals now feel safe being seen to go private.

We all want an NHS that is bigger, better and cures all ills. Such is the orthodoxy of this message, that it is taboo to suggest otherwise.

Like the little boy who pointed out the nakedness of his emperor, I’d like to suggest that we think again about our expectations of the health service.

Why should it be protected when other areas of public spending are being cut? Why should it be given what amounts to a blank cheque – £8 billion from Cameron during the campaign – when some of the poorest in our community are being forced to endure the indignity of food banks? Why should we spend billions buying back months of our lives, rather than focusing on how we can die with dignity?

I have no difficulty with us investing in research for cures to life-limiting ailments; but that energy would be best directed at finding cures for diseases which afflict the poorest in the world (HIV-Aids, Malaria, and TB among many others) rather than those caused by affluence. In 2013 6.3 million children under five died – the vast majority of them of treatable diseases in developing countries. Almost one in 10 died as a result of diarrhoea. Where’s the morality in that?

Our attitude to health care is another example of the self-centred bubble we have created for ourselves. I know it sounds harsh, I wince as I write this, but there comes a point when we must say enough is enough. At an individual level, that’s cruel. I know I cannot lose sight of the fact that the people I am talking about here are dearly loved: mothers, fathers, brothers, sisters, children.

But we have a moral obligation to take a wider view.

The sanctity of human life sits rightly at the heart of the moral and ethical principles that underpin our society – but even those most opposed to abortion and euthanasia recognise that death is an intrinsic part of what makes us human.

As the good book says: “To every thing there is a season, and a time to every purpose under heaven: a time to be born, and a time to die; a time to plant, and a time to pluck up that which is planted.”

But in our post-Christian world we have made life a commodity, and forgotten the value of death.

We have done some marvellous things in the cause of science – vaccines, antibiotics, retroviral drugs – but in our insatiable demand for progress we are in danger of creating a zombie generation. People whose lives are measured by the phrase “never mind the quality feel the width”. (I declare an interest here, I am old enough to be heading there sometime soon.)

Frankenstein would have been proud of what we have created. Yes, by all means let’s have a debate about how the NHS can better meet our needs. But let us start talking about the morality of how we deal with health – on a global, not just a national or local scale; and let us face up to our mortality and embrace it.

* A version of this article appeared in The Irish News on May 8 2015