In 2012 a relative living in Canada tipped me off to a drug called 'Yervoy' which was getting some good results with malignant melanoma. Over the course of a fortnight I researched the drug online. I learned more in that two weeks than I had learned in the two years I had spent as an Oncology patient.
The National Centre for Pharmacoeconomics conducts the health technology assessment (HTA) of pharmaceutical products for the Health Service Executive (HSE) in Ireland in collaboration with the HSE Corporate Pharmaceutical Unit (HSE-CPU). Basically, this centre decides the price of your life. They had added up the X and Y of giving stage 4 melanoma patients a final throw of the dice and come up with X + Y = You Die. My life wasn't worth saving.
At the quoted price of 80 thousand euro, ipilimumab (Yervoy) was a price too far for an Irish Government throwing a million euro an hour at bank debt. 80k is steep, on that we can all agree but it doesn't have to be that expensive. All of the complex reasons behind expensive drugs boil down to one issue - Intellectual Property. Once patented, the Intellectual property owner of the drug enjoys a 20 year right to charge any price they want. Profit is the primary motivator for multinational drugs companies. The CEO of Germany’s largest pharmaceutical company Bayer AG said that their oncology drug Nexavar was being created for “Western patients who can afford” Nexavar rather than “the Indian market”.
Several years ago thirty-nine companies took the South African government to court over a law that made medicines more affordable. The South African government resisted. In 2001, owing to pressure from the public and from European governments, the companies dropped the case.
Patent reforms are currently being discussed by the South African government. The SA Trade Minister was recently reported as saying that his government was “striking a balance between innovation, affordable medicines, and to modernise our IP regime”.
WHO Director General Margaret Chan strongly supported South Africa. Director Chan stated that “no government should be intimidated by interested parties for doing the right thing in public health”.
Ireland, like many other countries suffering under imposed austerity, is demanding a better deal from large pharmaceutical companies. Patients are caught in the cross fire between profits and austerity.
A dozen years ago, the Indian pharmaceutical company Cipla produced generic HIV/AIDS drugs that treated a patient for 300 dollars a year. The branded product’s cost was more than thirty times more expensive at 10,000 dollars per patient a year. Today the Indian generic version is below 80 dollars. India supplies 70 percent of the HIV/AIDS drugs obtained by the United Nations Children’s Fund (UNICEF), the Global Fund and the William J. Clinton Foundation for developing countries.
India has managed to keep the exorbitant prices of drugs down by either denying a patent (as in the case of Novartis’ Glivec) or by issuing a compulsory licence for a patented drug (Bayer’s Nexavar). India has a vast, largely home grown, pharmaceutical sector specializing in the reverse engineering of expensive drugs and selling generic versions at affordable prices. In recent times India has felt the full force of big Pharma, six Indian companies were recently bought up by large foreign firms. The Indian drug market may yet be dominated by multinationals again. It is uncertain whether they will continue to supply the developing world with cheap generic medicines when this may be in conflict with their own branded products.
India is the main supplier of affordable medicines to Africa and other developing countries.International health organisations such as UNAIDS, UNITAID and Doctors Without Borders have raised their serious concerns that these recent trends may threaten this role which has serious and far reaching consequences. Millions will die if India cannot produce the new HIV/AIDS medicines in the future. Three years ago during a visit to India, Michel Sidibe , executive director of UNAIDS said that it was a matter of Life and Death.
The pricing of life saving drugs in Ireland has recently come into focus again. Ipilimumab was made available following intense publicity of the situation by Joe Duffy on his Liveline radio show and heartbreaking stories from brave people like Cathy and Peter who have since passed away. Some health insurance providers have made the decision to exclude ipilimumab as a treatment option. In the drive toward Universal Health Insurance more and more drugs will be denied.