[Ip-health] Diarmaid McDonald and Dr Kieran Harkin - Irish Examiner: Wiser, not more, spending on our drug bill will save lives

Thiru Balasubramaniam thiru at keionline.org
Mon Mar 20 08:32:56 PDT 2017


Wiser, not more, spending on our drug bill will save lives

Monday, March 20, 2017

Paying up-front for medical research would encourage innovation and end
costly monopolies by allowing generic competition to flourish, according to
Diarmaid McDonald and Dr Kieran Harkin

THE stories are sadly familiar — a child, a mother, a grandparent desperate
to get access to a medicine that will give them hope, but denied it because
the price charged by the pharmaceutical corporation is too high.

In Ireland, we’ve seen it most recently with Orkambi, a treatment for
cystic fibrosis that is priced at an eye-watering €160,000 per patient per
year and with Respreeza, a treatment for certain types of emphysema at over

No one wants to deny a child — or anyone for that matter — a drug that
could save their life, but over the last five years the pressure on the
health budget from a range of new medicines has been steadily rising.

Spending more on medicines means less money to pay nurses, run diagnostic
services, deliver prevention programmes or hire home helps.

The tension is real and something has to give.

This problem is not unique to Ireland.

In the UK, debate is raging follow a draft decision to withdraw breast
cancer medicine Kadcyla (trastuzumab emtansine) from use on the National
Health Service in England, having been judged too expensive to be cost-

Across the world, the story is the same — unaffordably high medicine prices
crippling health services, and patients suffering, even dying, without

So what is going on? Firstly, it is important to note that these prices
aren’t high because the drugs are expensive to manufacture.

Hepatitis drug Sofosbuvir, which is sold in the US for $1,000 (€930) a
pill, is being made and sold at a profit in India for less than $5 a pill.
Rather, the prices are high because of patent-based monopolies which
prevent competition and allow the patent holder to charge whatever price
makes them the most money.

In 2016, Ireland had an annual budget of €35m to treat its estimated 40,000
patients living with hepatitis C.

At €55,000 for a 12-week curative course of treatment only 636 people can
be treated each year, leaving the majority of hep C patients on a very long
waiting list — a wait that puts their health at risk.

However, at generic prices all 40,000 patients could be treated with just
one year’s budget while at the same time saving over €20m.

It is argued by the pharmaceutical industry that these high prices are
necessary in order to stimulate innovation and the development of new

But this profit-driven system means that we get innovation many can’t
afford, or no innovation at all.

It is impossible to convince the families of the 1.8m people globally who
died from tuberculosis (TB) last year that the system is working.

TB predominantly affects the poor, meaning there is little prospect of
companies making big profits from new TB treatments.

As a result, it has been ignored by big pharma and only two new TB
medicines have been developed in the last 50 years.

There is a better way to pay for the development of new medicines than
through high drug prices.

Globally, we already spend $1 trillion a year on pharmaceutical products
but, at most, $127bn of that goes into research and development.

We don’t need to find new money — we just have to spend it more wisely.

By paying up-front for medical research — much like we do today through
grants to universities and institutes, and through prizes awarded to groups
that crack specific health challenges — we can encourage the innovation we
need. And as it’s paid for up-front, there is no need for monopolies; we
can allow quality- assured generic competition to drive prices down close
to the cost of production.

The €20m Ireland would save when switching to generic hepatitis C treatment
could be allocated for research into new treatments for diseases that
currently go without.

These ideas and many more have been proposed by international bodies
including the World Health Organisation, the UN Secretary General’s high
level panel on access to medicines, and the Lancet Commission on Essential
Medicines Policies.

The Irish punch well above their weight in medicines.

The country is home to nine out of the top 10 big pharma corporations.

The Government is well positioned to have an impact.

Unless we act, we will continue to be held to ransom by drug companies that
force us to choose between paying their sky-high prices, or watching our
loved ones die too soon.

Dr Kieran Harkin is a GP with Safetynet Primary care services for homeless
persons, Merchants Quay Project, Dublin and a founding member of Access to
Medicines Ireland. He is also a part-time lecturer at the Department of
General Practice, Trinity College Dublin, and RCSI.

Diarmaid McDonald’s career has focused on the global AIDS response and
equitable access to medicines. He has just established a new patient-led
campaign movement, Just Treatment, which is focused on access to medicines
in the UK.

More information about the Ip-health mailing list