Big Pharma’s Worst Nightmare

healthcare reformMy Comments: Over the past few years, I’ve developed a very cynical attitude about capitalism and the free enterprise system that is our economy. I have no issue with the idea that people are legitimately incentivised by the opportunity to make money.

But every society from the earliest days of civilization has imposed rules on it’s members to conform to certain standards that are determined to be in the best interest of its members. The easiest for me to reference is that we agree to drive on only one side of the street. It may be one side or the other, depending on where you live, but we are not free to make a random choice on any given day.

As I’ve aged, and health issues surface that demand a remedy, the existence of Medicare and supplemental health insurance has become a fundamental benefit to my wellbeing and that of my wife. It exists as a result of leadership in years past, representing members of our society, that such a benefit is in society’s best interest.

It’s OK to argue to what extent society’s best interest should prevail over the interest of individuals, but to argue that there should be no societal influence on health care outcomes is selfish in the extreme. This article talks to that.

Sarah Boseley January 26, 2016

On a hot August afternoon in 2000, four Americans arrived for a secret meeting at the central London penthouse flat of an Indian billionaire drug manufacturer named Yusuf Hamied. A sixth person would join them there, a French employee of the World Health Organisation, who was flying in from Geneva, having told his colleagues he was taking leave.

Hamied took his guests into the dining room on the seventh floor. The room featured a view of the private gardens of Gloucester Square, Bayswater, for which only the residents possess a key. The six men sat round a glass dining table overlooked by a painting of galloping horses by a Mumbai artist (Hamied has racehorses stabled in three cities). The discussion, which went on all afternoon and through dinner that evening at the Bombay Palace restaurant nearby, would help change the course of medical history.

The number of people living with HIV/Aids worldwide had topped 34 million, many of them in the developing world. Hamied and his guests were looking for a way to break the monopoly held by pharmaceutical companies on Aids drugs, in order to make the costly life-saving medicines available to those who could not pay.

Hamied was the boss of Cipla, a Mumbai-based company founded by his father to make cheap generic copies of out-of-patent drugs. He had met only one of the men before – Jamie Love, head of the Consumer Project on Technology, a not-for-profit organisation funded by the US political activist, Ralph Nader. Love specialised in challenging intellectual property and patent rules. For five years, he had been leading high-profile campaigners from organisations such as Médecins Sans Frontières in a battle to demolish patent protection.

Patents grant protection on inventions, guaranteeing those who hold them a period of monopoly to recoup costs – in the case of drug companies, this can be as much as 20 years. With no competition, pharma companies can charge whatever they want. Love, an economist and self-confessed patent nerd, had taken on politicians, civil servants and corporate lawyers, arguing against unfair monopolies on products from software to stationery. His overwhelming concern at that point was the many millions of lives cut short for want of affordable medicines. He had been asking everybody he could think of, from the United Nations to the US government, one question: how much does it actually cost to make the drugs that keep somebody with HIV alive?

“Watching Jamie with government officials who are sceptical is a thing of intellectual beauty, because there really is nobody who can rebut him when he gets under way,” said Nader in September on his radio show in southern California. “Jamie is a global hero. He has saved many, many thousands of lives by beating Big Pharma and reducing the cost of drugs for poor people overseas.”

Love had flown from his home in Washington to London with Bill Haddad, an investigative journalist who had been nominated for a Pulitzer prize for exposing a pharmaceutical company cartel that was fixing the prices of antibiotics in Latin America. Haddad was now the CEO of a company called Biogenerics, which made cheap copies for the US of expensive branded medicines, once they were out of patent.

The meeting was confidential, because their targets were the wealthy and powerful multinational pharmaceutical companies who were fierce in defence of their patents. For four years, a three-drug cocktail costing between $10,000 and $15,000 per year had been available to treat people with HIV in the US, and other affluent countries. But in Africa, a diagnosis remained a death sentence. In 2000, more than 24.5 million people in sub-Saharan Africa had HIV. Many of them were young, many also had children and could not afford life-saving treatment. Love had a word for this state of affairs: racism.

The month before the Gloucester Square meeting, 12,000 people from all over the world had convened in Durban, South Africa for a fiery and impassioned International Aids Conference, to demand affordable drugs. There were marches in the streets, and singing, dancing and the throb of drums in the conference hall. A white constitutional court judge, Edwin Cameron, took the platform to declare that he was HIV positive and to denounce a world in which he could buy his life but others had to die. A small boy born with HIV, named Nkosi Johnson, moved people to tears with a plea for acceptance and understanding. He died, without treatment, the following year, aged 12. Nelson Mandela, the former president, closed the conference with a statesmanlike appeal for action.

At the London meeting, Love had a question for Yusuf Hamied. How much, he asked, as they sat around the glass table in their shirtsleeves in the summer heat, does it cost to make Aids drugs?

Hamied had been making the antiretrovirals that hold HIV at bay for a while. In India, thanks to the 1970 Patents Act, in which his father had been instrumental, drug patents granted in the US or Europe did not apply – yet. (The World Trade Organisation’s trade-related intellectual property rights, or Trips, agreement requiring all nations to recognise international patents did not come into effect in India until 2005.) The cost of manufacturing a drug, Hamied told Love, is barely more than the cost of the raw materials.

By the time the visitors headed back to their hotel, a plan had been hatched. Hamied would make Triomune, a cheap, once-daily pill combining the three Aids drugs sold by different manufacturers for such huge sums in the US and Europe, and sell it in Africa and Asia for a fraction of the cost.

Fifteen years on, it is no longer just the poor who cannot afford the drugs they need. New medicines for lethal diseases such as hepatitis C and cancer have been launched on the global market at such high prices that the richest countries in the world are having to find ways to ration them. And Jamie Love is back in the fray.

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