Bribery, marketing budgets, and the true cost of drugs
An article about the true cost of drugs and how the argument that there is a high cost in R&D which justifies the final (and high) price is secondary to the monies spent on marketing and even bribery.
We are repeatedly told that the cost of a drug reflects the massive costs of research and development. Sometimes this even puts the drug out of the reach of mere mortals with cancer. However, the R&D cost argument may not be entirely true. Some companies are determined to charge what they feel a drug can demand, while others spend a fortune in their marketing budgets, seeking the goodwill of doctors. You or I (and in one case the District Attorney in a US State) could call it bribery.
The high cost of cancer drugs rules them out of the NHS
Many of you may have seen articles such as the following in the press in the last couple of years. The first was that a lady with breast cancer, chasing "wonder drug" Herceptin, lost her battle with the local authority in court, unlike the lady in our last issue where the local authority "gave in". According to the court in this second case, the local health authority does not have to hand it over if they can’t afford it, thus "condemning thousands of women to death" to quote but one national newspaper. This local authority cannot afford the cost of the drug.
Herceptin only stands a chance of working if a woman is
HER-2 positive
As we pointed out in the last issue, Herceptin only stands a chance of working if a woman is HER-2 positive. And although some claims suggest that 40 per cent of women are, the true figure is about half that, and Herceptin seems to be effective in roughly half of those. Mind you, 10 per cent is still a lot of happier women. The drug is also not licensed for early cases of breast cancer so it came as no surprise to receive a PR release from the makers last month saying that they were going for just such a license. Whether that has any bearing on future court judgments remains to be seen.
We will be able to increase your survival - can you afford to pay?
The other well-covered news item was that of Professor Karol Sikora’s "take" on the future of cancer treatment in Britain.
Let me say right up front that I really like Karol. He speaks his mind in a world where we tread on PC glass. He is one of our patrons and is a major and active force in cancer in Britain. I like the way he "stirs things up". But then that’s my style too.
To summarise his views in a nutshell: In twenty years time professional scientists and medics will have cancer "cracked" and be able to make it a manageable (though of course serious) disease rather like diabetes. A new breed of excellent drugs will be available to achieve this. The problem is that the UK government and the NHS won’t be able to afford them.
I could get picky and express a view that he is really talking about "mainstream" cancers - I worry about brain tumours, pancreatic, liver and the less public cancers receiving the right levels of research funding to get them to the state of the art of breast cancer treatment.
I worry that important developments like HIFU or Photo Dynamic Therapy are playing tenth fiddle to this "drug" culture we seem to be caught up in
I worry too that important developments like HIFU or Photo Dynamic Therapy - both of which can be much, much cheaper - are playing tenth (not second) fiddle to this "drug" culture we seem to be caught up in, in the UK. Why, we still don’t teach our doctors such topics as "diet/nutrition, the role of toxins, or the effects of mental state" in their seven years at medical school, yet all can be linked to cancer.
The Health Authorities of the UK are preoccupied with drugs
I was recently on a golf course playing with a couple of strangers. Asked what I did, I mumbled something about being an "amateur cancer expert" to receive a tirade from one man. He turned out to be a 78 year-old Italian doctor, past professor, having worked in Italy and America and his "beef" was that the UK medical system is increasingly going in the opposite direction to other countries - it’s pre-occupied with drugs.
He spent two minutes haranguing me, saying that the drugs don’t "cure" anything and just make fortunes for certain companies. He’d cured his own cancer with diet, supplements, exercise - you know the rest! Fortunately for my golf he calmed down.
Next, I was reading the international edition of Newsweek, and a fascinating article by Fareed Zakaria called "The Decline and Fall of Europe", in which he argued that protectionism (farm policies, labour laws, labour movement, working hours etc) was creating such a mess in Europe that a current per capita GDP deficit against the USA of 25 per cent would become far worse over the next twenty years.
He went on to say that we would be only half as wealthy per head of population as the US, and that would have significant effects on certain things - like healthcare: we would simply not be able to afford the levels of care that the US, or even emerging countries like India and China, would have.
So back to Sikora, who is blatantly right! The way things are going we simply won’t be able to afford the wonder drugs. I discovered that even now where we spend just over five per cent of GDP on Healthcare, if we had all the drugs we need it would be 15 per cent, so goodness knows what the real figure would be in twenty years time!
The way things are going we simply won’t be able
to afford the wonder drugs
The high cost of drug marketing!
Now, the argument always runs that drugs are expensive because the up-front research and development costs are huge and these poor companies have to get their money back somehow. But is that really the case?
Take this piece in the Chicago Tribune of February 11th 2006: "Drug companies spend upwards of $20 billion a year in the United States marketing directly to health professionals, which is more than five times what they spend on television ads."
Gosh!!!
Why did they publish this piece? Well, the article starts, "Sales representatives for Abbott Laboratories paid for lap dances, dog track entertainment, Wimbledon tickets, and other favors for health professionals"
Where was this? - in the UK.
Regular readers will recall that this is not the first such incident - a couple of years ago we covered the court case and fine (running to over $300 million) of AstraZeneca who in the USA had been trying to "bribe" doctors (the District Attorney’s word not mine) to use their prostate drug rather than a rival’s. urprisingly little has been mentioned about either case in the UK.
In the The Sunday Times (February: Thomas, Templeton) "undercover" reporters found that "Nurse Advisors" were currently given access to GP’s NHS patient records to look at whether the patients were using the most up-to-date drugs. Who were they then "advising"? These nurses were employed by nursing agencies, but actually paid by pharmaceutical companies, and supported by their sales forces that then paid a visit to the GP’s surgery. This is almost certainly against the Nursing and Midwifery Code of Practice.
Apparently, GPs say there are no incentives to curb drug bills
But the article raised a further important point - apparently GPs say there are no incentives to curb drug bills, which can vary by up to 50 per cent between similar sized practices. The NHS drugs bill is currently running at 7 billion, and 80 per cent is spent on branded products.
Charging what the product demands!
But if such profligacy is not enough take this piece from the New York Times (February 15th 2006): "Avastin, a drug currently used to treat colon cancer, could be an important new treatment for breast and lung cancer, as well. But its manufacturer, Genentech, intends to charge roughly $100,000 a year for the treatment, a price usually only found on obscure drugs that treat rare diseases.
"Usually, drug makers justify high prices by pointing to the costs of research. But Genentech is instead arguing that life-saving drugs are inherently valuable, and should therefore be appropriately costly.
"Genentech sold more than $6 billion worth of drugs in 2005. If Avastin is approved for expanded use on breast and lung cancer, their sales are expected to reach $18 billion a year."
Clearly if these scenarios are adopted by all the drugs companies, beating cancer will become a rich man’s sport. And it won’t be the fault of the NHS or the Government if we can’t afford the drugs in the UK. It will be due to sharp marketing practices, happy tennis-loving medical professionals, nurses moonlighting or profit margins that defy gravity. Oh, and an NHS that finds it impossible to set cost cutting incentives for GPs.
Meanwhile, Cancer Research UK is fuelling my fellow golfer’s fury and adding to the drug companies’ potential profits. Markham, their CEO said in this very magazine that they want to get more people on clinical trials than in any other country of the world. I don’t know about you, but if I got on a train and then someone told me it was heading over a cliff in twenty years time, I’m not sure that I’d be trying to make it go faster in the same direction!!?
Isn’t the issue then to stop this myopic focus on expensive drugs?
So doom and gloom for the NHS and for mere mortals like you and me. If we can’t persuade these companies to be slightly more "conservative" or "frugal" with their marketing budgets, isn’t the issue then to think "outside the box"??... to stop this myopic focus on expensive drugs?
Why cannot we fund non-drug research?
The problem is that there appears to be no money available to fund non-drug research. (Professor Pilkington’s team at Portsmouth cannot get any funding to test out six natural products on brain tumours, when all have shown serious promise against a backcloth of failed drugs). Doesn’t the government have to step in - NOW???
I’ve said it before - we need an independent body with proper Government funding to explore the cheaper non-drug areas like natural compounds and therapies, or Ultrasound/PDT alternatives or the efforts of scientists in the East. An equivalent body exists in the USA, why not here?
But we are also complacent. We repeatedly ignore and belittle treatments from other areas of the world like the Far East (Do you remember our story of Reishi Mushrooms and their clear Japanese evidenced anti-cancer effect? Evidence not good enough for the West!). Back to Zakaria who commented, "Talk to top-level scientists and educators about the future of scientific research and they will rarely even mention Europe. The centre for Biomedical research is becoming India".
So, our myopia won’t just pauper us in the future, it will leave us behind as well. Great!!
The same copy of Newsweek featured an article on "Exercise and Ageing. How to stay fit longer".
It was all about how the "grays" in the USA are turning to exercise, top quality equipment, supplements, etc. And I couldn’t help but think about the European Codex legislation. Whilst the powers that be in Europe are trying to belittle natural vitamins and minerals leaving us with a few, synthetic and quite possibly worse supplements, can you really imagine that the USA public is going to "buy into" this mess we are creating for ourselves and our health in Europe??
What are we doing? Let’s turn the bloody train, while we’ve still got a chance!!!
Brilliant cancer treatments you can’t afford to have.
Aye - there’s the rub.