[Ip-health] UACT Blog: Prof Thierry Philip Interview in Liberation regarding cancer drug pricing

Manon Ress manon.ress at keionline.org
Mon Nov 13 01:39:35 PST 2017



- For the Chair of the Curie Institute in Paris, Prof. Thierry Philip, high
prices of cancer medicines will soon be unsustainable.
- What should be done?
- His suggestions: transparency, delinkage and patients’ involvement.

On October 24, 2017, Eric Favereau of Liberation interviewed the eminent
Chairman of the Board of Directors of the Curie Institute in Paris,
Professor Thierry Philip. The focus of the interview was how to control the
unsustainable increase of cancer drug prices. The journalist asked many
interesting questions that need to be asked, among them: was Prof. Thierry
Philip worried about the cost of cancer drugs today? What would he
recommend we do about it? What concrete actions could be taken now? What
should be done specifically about the expensive drugs that sometimes do not
add much time to the lives of patients? What to do regarding the ever more
expensive drugs of the future? What should patients’ involvement be? And
why are radical reforms possible or not possible now?

While Prof. Thierry Philip expressed some serious concerns and suggested
some ways to change the dangerous trend of spiraling high prices, he first
acknowledged that, at least in France today, the government is coping with
the high prices and access is sometimes delayed, but not threatened.
However, one of his concerns is the rapidity with which the prices are
increasing. He pointed to the fact that today, in France, the cost of
cancer is about 15 billion euros, but that this includes everything and the
drugs are “only” costing about 3.5 billion of that amount. But some
projections show that in 2025, the cost of cancer drugs alone could go up
to 10 billion euros and this, for Philip, will become quite unsustainable.

Philip makes three important suggestions to address the cost of cancer
treatment: 1) we need transparency of the real costs of research,
development and production, 2) based on this evidence, we need delinkage of
the R&D costs from the price of the medicines, and 3) we need to hear the
voices of cancer patients.

Of course, the devil is in the details.

When asked about the example set by the National Institute for Health and
Care Excellence (NICE) in the UK to not approve the reimbursement of some
innovative, but deemed too expensive, cancer drugs as the drugs “only add a
few weeks of survival”, Thierry Philip was diplomatic but clear. For a
patient, even 2 months of survival can be essential. Of course, it is all
quite delicate since there is “survival” and “progression free survival” as
well as the quality of life for the patient! Philip is also in favor of
continuing experimentation with new molecules and notes the difference
between drugs for first line use or for use later in the progression of the
disease. He mentions Keytruda, used for lung cancer, which resulted in 40%
of patients experiencing 3 to 4 years survival for inoperable cancer, while
5 years survival before Keytruda was at about 5%. According to him, for
some oncologists the progress is amazing, even revolutionary, and they tend
to say if it is expensive, it must still be available and thus paid and
that is someone else’s problem. In some situations, for Thierry Philip,
there is no real therapeutic improvement and we must ask questions.

The journalist asked Philip to talk about what is “fair pricing” and how to
go about making it happen. His suggestion, as we mentioned before, is to
separate the cost of the research and development of the drug from the cost
of its production. In his proposed solution, there would be one payment to
address the cost of the research at the time the drug is approved.

Philip explains that as it stands now, (basically) the publicly funded labs
make a discovery, apply for a patent, and create a startup, all with
taxpayers’ money. If it works, the private sector takes over, he says. We
need transparency regarding this process. According to him, firms state
that they have 10 molecules in the pipeline but only one will work. Perhaps
this is true, Philip states, but in that case it should be verifiable and
we should be able to check out how much it really costs so we can separate
the cost of R&D from the cost of the production. It should be common sense.
But this is not possible without transparency and we are not there yet.

For Philip there are two other possible solutions: one is nice, the other
less so. Imagine in 2025, society cannot pay the high prices. So we have to
pay on longer terms. Instead of getting a 10 year license, it’s for 20 or
30 years. The patent terms get longer and longer.

Another solution, more radical according to Philip, is to issue compulsory
licenses. The pharmaceutical industry is told that if the prices do not
decrease, the government will issue a compulsory license, authorize generic
competition and they will “lose everything”. Of course for Philip this is
the nuclear option.

As a patient myself, this does not seem like the nuclear option but the
option that puts patients’ lives first. Again, why is it so much easier to
say no to patients than to say no to the industry? And of course, the
interview continues with the call for getting more cancer patients
involved. Am I the only one seeing the irony here? Often cancer patients
are asked to endorse a system that sacrifices their survival either by
ensuring high prices and/or rationing. However, one correct observation by
the eminent Curie Institute Chairman regarding patients is that cancer
patients should look at the HIV patients’ example and require transparency
to get better prices and access.

The interview ends with a question about personalized medicines and gene
therapies. Are they disappointing? Not so, or not yet, states Philip, and
he suggests the therapies should be used earlier in the progression of the
disease. Furthermore, we have to be patient, as sometimes progress involves
uses that were not planned at first. We have to wait and see, he says, but
there is great therapeutic progress ahead.

Manon Ress, Ph.D.
Knowledge Ecology International, KEI
manon.ress at keionline.org, tel.: +1 202 332 2670

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