Science, Medicine, and Anthropology
This month it was hard not to pay attention to what was happening in the world of Pharma, where several cases came to light illustrating just how murky and contested the role of one of the most powerful industries in the world is in shaping not just business practices, but collective social and moral consciousness as well.
A recent Gallup poll has highlighted the increasing wariness with which Americans view the pharmaceutical industry. According to the poll, Americans view the high cost of prescription drugs as the main reason for rising healthcare costs, and the pharmaceutical industry is consistently ranked in the bottom third of sectors since 2003, when Gallup expanded the list to 25 industries.
Among the many Pharma related concerns on the web this month, price hikes and profiteering have stood out with regards to the Daraprim scandal highlighting how a lack of regulation in this area can take its toll. The decision by Martin Shkreli of Turing Pharmaceuticals to raise the price of the drug, used to treat a life threatening parasitic infection often most apparent in those with compromised immune systems, from $13.50 to $750 overnight symbolized to many just how broken, and in need of regulation the system is.
The public response to the scandal from the medical community argued that boosting the price to $750 comes as a result of uninformed reasoning, noting that there is no dire public health need of new drugs to target Taxoplasmosis, but rather this is an issue of greed, plain and simple. The article presents the views of leading infectious disease doctors who set out to clear up the errors Shkreli has used to defend his decision, such as suggesting that patients only take the drug for four to six weeks, when in fact it often requires 6-12 months worth of maintenance, or another claim in which Shkreli hopes that Turing pharmaceuticals will ultimately eradicate the disease, an idea which falls flat in reality, as Toxoplasmosis is everywhere and isn’t an issue for most people. It only becomes a problem when a person’s immune system is compromised, so its not a disease that can be ‘cured’, rather one that can be controlled…with the right medication. It seems in the week since the scandal broke, pressure and public shaming have led Shkreli to change his mind, vowing now to keep the drug affordable.
A recent article by Philipp du Cros, an infectious disease expert with Medicines sans Frontieres, suggests that hiking up the price of drugs doesn’t work in the long run. Highlighting a similar case involving a drug used to treat Tuberculosis, Cycloserine, the article discusses how the medication was acquired by a pharmaceutical company who promptly raised the price from $500 for 30 capsules to $10,800, before returning it to the original owner in the face of a public backlash. The drug, known for its horrible toxic side-effects, alongside eight months of painful daily injections, is one of the only solutions for those with certain treatment resistant strains of TB, and as research and development stands now, there is no hope of new drugs replacing the less than ideal older set, or for shorter and better combinations of drugs, to reach a cure. Du Cros argues that there is no evidence to support the claim of pharmaceutical companies who say that profits are the only way to counteract expensive research costs and pay for innovation down the line. Instead he proposes that the idea that as long as we pay high prices, diseases that have until now been neglected will suddenly find the research backing they need is a false assumption. Better ways need to be found of moving forward to find cure, with du Cros favoring open, collaborative approaches to research, and incentives that reward collaboration paying for research upfront rather than relying on high prices.
The moral dilemma of healthcare investments is the perspective presented in an article noting that when dealing with serious illness, there is a fine line between profits that are essential to keep such collaborative research going, and the mere lining of pharmaceutical executive’s pockets. High prices have been used to justify the very real high cost of research and development for decades, however this article points out that the actual success rates of drugs released commercially which turn a profit is in fact quite low, leading to the revelations that the amount spent on marketing these new medications often goes well beyond the initial development costs. The authors write that the problem doesn’t solely lie with the US, presenting the idea that European pharmaceutical companies consider the US to be a “golden market”, wanting to market and sell their products there. The events related to drug price inflation in the recent news have pushed personal ethics need to the forefront of discussion.
This corruption related to pharmaceutical industry practices is not just an American problem, as mentioned. A recent piece in The Guardian presented the case of two former UN consultants now jailed by a UK court for rigging contracts worth £66m to supply life saving drugs to the Democratic Republic of Congo, with one joking that they were making money by selling overpriced drugs “to dying and starving Africans”. Another article focuses on a recent report revealing a deeply worrying trend in the dramatic extent to which lobbying and privileged access among pharmaceutical industry towards EU decision-makers, in an effort to mould EU policy to their own commercial benefit.
An article in Newsweek on pharmaceutical fraud and fake medications illustrates a growing problem in an increasing globalized economy in which one pill may pass through a dozen or more countries during its manufacturing process, providing no shortage of opportunities for criminals to put fake drugs into the supply chain. The piece goes on to cite studies suggesting that 90 percent of drugs purchased online come from a different country than what the website claims, and Internet pharmacies often buy drugs from countries with very loose systems of regulation.
While profiteering and corruption have been at the heart of the news this month, so too has been the uneasy position of children in these debates, and the possible mis-medication which has come to the fore, with many children being medicated for ADHD which they may not actually have, or the increasing practice of favoring profit over the science behind best use of the medication, as in the case of antipsychotics such as Risperdal for children with bipolar disorder and Autism, downplaying their tremendous, untested and unsettling side-effects.
The off-label prescription of untested pharmaceuticals to children, sometimes as young as three years old, shows that the contentious debates over the very delicate intersection between profit, essential research, development and innovation, marketing and prescribing of medications are ongoing and need to be kept alive.
Responses to the events of the last month show that the public is paying attention, as is the industry itself, and perhaps the power of a collective push towards greater responsibility will lead to increased attention to ways in which extreme, unnecessary profiteering can be reigned in to ensure continued innovation without the unnecessary cutting off of access to the most essential medications for those who would most benefit from them.