Medicine is expensive, sure, but have you ever asked yourself why? The pharmaceutical industry will have you believe that without high prices, we don’t get new drugs. The reality is, with high prices we don’t always get new drugs we need either. If a new drug is developed and nobody can afford it, where is the benefit from it?
Limiting access to the products of pharmaceutical innovation is nothing new to me. I’ve seen it for the last 15 years as a doctor with Medecins Sans Frontieres. In one of my first field missions in Uganda, I watched young children with malaria die because the best treatment to give them – artemisinin – was not available and I was forced to use less effective drugs. It was tragic to witness.
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I was outraged at remarks made in December, but widely reported only in late January, by the CEO of German pharmaceutical company Bayer, on one of the company’s cancer drugs. CEO Marijn Dekkers said that Bayer “didn’t develop this product for the Indian market; we developed it for Western patients who could afford it.” I was shocked at his candour: Dekkers’ comments sum up everything that is wrong with the pharmaceutical research and development (R&D) industry today.
As it currently stands, patents create long monopolies, which allow pharmaceutical companies to charge the maximum price they can without fear of competition. Patients and health providers are put in a near-impossible predicament: Either they pay the market rate, or they wait until the maximum profits have been squeezed out of a drug and its patent expires. Waiting in many cases means dying.
The current system also means some drugs just don’t get developed at all; there are some diseases for which there have been no new drugs developed for half a century or more. It’s because – while the need is there – these drugs just aren’t profitable for the pharmaceutical companies to do research on them.
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The reality of this was painfully illustrated in January, when British pharmaceutical company AstraZeneca announced it was pulling out of R&D for malaria, tuberculosis and neglected tropical diseases. They’re all diseases that occur, for the most part, in poor countries. Instead, they’ll be concentrating on drugs for typically rich country diseases: cancer, diabetes, and high blood pressure.
But this lack of R&D into areas of need is beginning to hurt the developed world, too. Just as we’re facing superbugs that can’t be killed with existing antibiotics, there are no new ones in the development pipeline. We’re seeing people die of infections we can no longer treat with the antibiotics we have. But the pharmaceutical companies don’t want to pour their R&D into a drug that people only take for a couple of weeks; they want to develop drugs you need to take for a lifetime.
As taxpayers, we are in essence paying for drugs twice. First, a lot of the R&D behind successful new drugs is heavily subsidised by the tax payer: Globally, at least 40 percent of all R&D is paid for from the public purse and by philanthropic organisations; for some diseases, such as tuberculosis, it’s over 80 percent. Then we have to pay again the high prices for the patented medicines when they are produced. The only people satisfied by this current system are the shareholders of pharmaceutical companies.
It is critical that innovation is rewarded. But there are alternative models than high drug prices and long monopolies for supporting useful medical R&D. What we should have at the end of the R&D process, is medicine which is effective, safe and – most critically – affordable for everyone who needs it. The current system not only fails patients in India, it fails the uninsured and underinsured worldwide.
We need to find new ways of paying for research that do not force a choice between developing a drug and making it widely available. This idea is nothing extraordinary; there are already alternative ideas out there – models such as prize funds – that reward new discoveries through substantial financial payouts, paid on the condition that the drug is immediately open to price-lowering market competition.
There comes a time when we need to collectively look at a system and realise that it is no longer fit for purpose. Current R&D models for new medicines are not working; not for the world’s poor, nor for you and I. It is time to get angry, to demand change. The poor are no longer far away, passive and prepared to die slowly of an illness we can cure. They demand change and so should everyone.
Dr Manica Balasegaram is the Executive Director of Medecins Sans Frontieres’ Access Campaign; based in Geneva, he helps campaign for better tools and access to medicines, particularly for the developing world. He has worked as a doctor in MSF field projects in Uganda, Sudan, Republic of Congo, Ethiopia, India and Bangladesh.