Although it intended otherwise, a recent report from the Institute of Cancer Research (ICR) further proved how free market capitalism is failing cancer patients. This time it’s children, who are being denied potentially life-saving cancer drugs due to the cost of testing being a disincentive to the drug companies. Of 26 recent drugs that could work in children, drug companies have sought European Commission exemption for 14 of them to avoid the cost of implementing Paediatric Investigation Plans which would confirm their suitability for use in children. The ICR argue that this results in significant delays in new drugs becoming available for children, and that some drugs may never be licensed for paediatric use. Simon Fuller, of the Teenage Cancer Trust, argues that, “Access to new cancer treatments is critical to improving survival and outcomes in young people. As the cancers that affect young people are rare there is a serious lack of drug development for this small patient group. Allowing waivers for drugs that could benefit young people through the mechanism of action must stop.” By the logic of capitalism, although around 1,600 children in the UK get cancer every year, that’s not enough for the pharmaceutical industry to justify the expense of testing. To the pharmaceutical industry, it is not worth their while to save the lives of those children. Perhaps we should just pause for a moment to let the reality of the capitalist mentality to really sink in…
The ICR’s response is to call for stronger financial incentives for the drug companies to make drugs available for children – but we only have to look at their approach to adult drugs to see how that will end up! The largest pharmaceutical companies are reported to have profit margins of over 70%. According to research by Macmillan Cancer Support and the National Cancer Intelligence Network cancer patients in England are a third less likely to be alive five to ten years after diagnosis if they are from the most deprived areas. One hundred international cancer specialists recently criticised what they termed the profiteering of the pharmaceutical industry. 11 of the 12 drugs approved in the US by the Food and Drug Administration in 2012 cost more than $100,000 (or £65,000) per patient per year, while the price of existing proven drugs has risen threefold. In the UK NICE (National Institute for Clinical Excellence) is put under pressure to approve new drugs. But the money to pay for highly priced drugs will siphon money from funds meant for other aspects of healthcare. Many drugs repay their development costs many times over. For example in 2001 Novartis’ successful drug Glivec produced revenues $900 million per year. According to their website, the charity Cancer Research played a part in developing Glivec. Novartis had covered its development costs within two years but the cost per patient per year has now increased to £21,000. It makes Novartis $4.7 billion per year. New drugs to the market are reported to cost up to $138,000 per patient per year. In the US high drug prices are the most common cause of personal bankruptcies, where even if insured patients are expected to find 20% of drug prices.
While it may be legal to charge these sums, by any moral code it is extortion. Is it using one’s position for financial gain? You bet! Is it obtaining money through threats? Yes it is. If my loved ones were ill I’d literally give my right arm for a cure – or sell my kidneys – or sell my arsehole for that matter – anything to make them better. But it wouldn’t be enough. It’s never enough. Marijn Dekkers, CEO of Beyer recently let slip that some cures are only targeted at wealthy westerners – not the poor – not in any part of the world. In this instance he was referring to Sorafenib tosylate marketed as Nexavar at a whopping £42,000 per patient per year. Manica Balasegaram of Medecins Sans Frontieres (MSF) argued that, “Bayer is effectively admitting the drugs they develop are deliberately going to be rationed to the wealthiest patients.” If you haven’t got a state health service (which we soon won’t) or health insurance (which will not insure pre-existing conditions and has payment ceilings) then sorry mate, the products of science and technology are out of your price range! So it’s back to the sponsored run and the bottle of coins at the end of the bar. But it’s not enough. It’s never enough! So please go and die quietly – and keep working till the end or we’ll cut your fucking benefits!
Cancer Research UK have launched their own development and commercialisation company called Cancer Research Technology Limited. Together they have then launched a joint initiative called Clinical Development Partnerships (CDP). CDP “works with leading pharmaceutical and biotechnology companies to identify more promising new treatments that otherwise may not be developed and progress them into clinical development at no cost to the company.” Furthermore the company retains intellectual property rights throughout clinical trials. In the case of successful trials the company has the option to acquire the rights of the clinical data but if the company is not interested then the IPR transfers to Cancer Research Technology and they will look for another partner. The revenue share split will depend on a wide range of factors. The Cancer Research website doesn’t say what they do with their percentage of the revenue or indeed how much revenue is generated in this way. It is probably fair to assume that it is reinvested in similar schemes. This is all well and good – but remember this is another expense that the pharmaceutical industry is relieved of – and in this instance the people picking up the tab are cancer patients, their friends and families who will be out raising money to combat cancer.
We ALL have friends and family who have fought hard against cancer so like it or not this affects all of us. We have all participated in fund-raising events. Why??!? In the context of such obscene profits being made on the back off cancer drugs, it is fair to ask, what is the point of cancer research charities except to provide more money and publicity for the drugs companies while the drugs their research produces continues to be out of the price range of most people? A spokesperson for Beating Blood Cancers admitted as much, “There is no point in us investing in research if the pricing policy means drugs won’t be available to patients.” Michelle Childs of Medicins Sans Frontieres argues that, it is increasingly difficult for people in any country to afford the high price of cancer drugs. This she says is an indication that the innovation system is failing.
It has reached the point where what we need is a campaign that fights for the rights of cancer sufferers – not just a charity that raises money for research and perpetuates the lie that it is a collective scientific endeavour when in reality it is just another aspect of capitalism where cancer patients are being exploited and allowed to suffer in the name of profit. It increasingly appears that those who raise money for research are being ripped off – and that rather than devoting our time to raising money we should be devoting our time to raising hell! If all the people who campaigned to raise money for cancer instead campaigned to take the profits out of medicine then everyone could have the treatment they needed. I have no doubt that this is true – yet some people will say this is naïve. They will say either that
- Governments cannot afford to fund universal treatments or
- That we need the incentive of profit to drive innovation to develop new treatments.
These are both false arguments,
- Cancer and other major diseases will affect us all, either directly or through our loved ones. If we organised ourselves to campaign as effectively as we organised our fund-raising efforts we would form a pressure group that no government could ignore – and finding funding for health treatments would be as unquestioning as governments ability to find the funds for warfare.
- Humanity does not need the profit motive to drive innovation. It is a constant of human evolution and the speed of progress is not driven by profit but the increase in processing power. There is even the counter-argument that the profit motive actually stifles progress as it distorts the focus to be purely on profit – as we saw with the disincentive to invest in children’s cancer treatments which inspired this article. It also fails to recognise that the same process will incentivise secrecy and a focus on intellectual property rights instead of the sharing of knowledge that ultimately drives progress.
The approach taken by many of the cancer charities to put pressure on the government or NICE to make drugs available on the NHS is a partial answer – after all, the government will find money for Trident, bankers bonuses etc. But it does nothing to address the profiteering of the drugs companies – which is at the core of making cancer drugs affordable for all. Beyer’s admission about Nexavar came out in response to actions by the Indian government who, arguing that they had a responsibility to ensure its citizens had affordable access to the drug, granted a compulsory licence clause, allowing another company to manufacture the therapy, even though it is still under patent. This reduced the cost from £3,500 per month to just £84 per month.
Medicins Sans Frontieres support the suggestion by the World Health Organisation that we need to move to a system where drugs are priced close to the cost of production, while innovation is rewarded separately. This seems a legitimate strategy which still allows the pharmaceutical companies to profit from innovation but at a more realistic level. But the US, UK and EU are among countries opposing this. With ageing populations and increasing pressure on health budgets you have to wonder why they would do this – unless these governments are more interested in securing rich pickings for their friends in the pharmaceutical companies than securing the health of their populations! That is a legitimate area for the cancer charities to campaign on. That they don’t might give rise to a few questions about the charities own close relationships with the pharmaceutical industry.
There is of course another answer. We accept that the pharmaceutical industry has been given the chance to show that can be such a thing as responsible capitalism that can work hand in hand with science and civil society. And we accept that it has failed. Worse it has become a monster that feeds on the sick. It claims IPR on research that is part funded by charities, universities and governments and threatens with litigation those who seek to make treatments affordable for the poor. Maybe it is time we realised that IPR is a misappropriation of collective endeavour. There comes a time when IPR has to lose its legal protection and that we realise as a global society that we all benefit when we all work together. The problem isn’t that we don’t want it enough. The problem is that we’ve forgotten that we hold the power to make it happen.