Sunday, April 28, 2013

The Price of Leukemia Drugs: 100 Doctors Protest

I generally try to avoid posting on the price of drugs, as I see that as less directly related to the ethical issues at the interface of medicine and the pharmaceutical industry. However, to the extent that physicians interpret their medical professionalism as requiring patient advocacy, and drug prices prevent patients' access to needed drugs, then the issue moves front and center. And when prominent physicians push back against the drug industry, that's also news.

--we have a statement in the journal Blood, the organ of the American Society of Hematology, signed by 100 prominent physicians from around the world who all treat leukemia, objecting to the price of newer drugs for that disease.

In HOOKED, I wanted to start the book with a couple of narratives about drugs, one showing the pharmaceutical industry as knight in shining armor, the other showing the dark underbelly of drug marketing--just to try to set a tone of even-handedness at the get-go. I selected the drug Gleevic as my Exhibit A for Pharma good behavior. In order to do that I had to soft-pedal one of the problems with that drug for chronic myelogenous leukemia (CML)--the way Novartis set its price, guaranteeing a very high profit margin and exceeding considerably (as it turned out) their investment in research. (One of the signatories to the new statement is Brian Druker, whom I discussd in HOOKED as an early advcate for the drug and who tried to push Novartis to do clinical trials in early days when the company was reluctant.)

Since Gleevic entered the market, a number of related compounds, all in the class of tyrosine kinase inhibitors, have come on line, and are priced even higher--in excess of $100,000 per year. (Gleevic came on the market in 2001 at a price of about $30,000 annually and has now risen to $92,000.) These drugs are the nearest thing to the proverbial magic bullet in cancer treatment--they are highly effective at suppressing cancer cells but cause very few side effects. When I wrote HOOKED, the long-term story of CML therapy with these drugs was unknown--would they keep working year after year? Could a patient stop taking them and be cured, or would the patient need routine maintenance, maybe for life? As things have worked out, as best as I can tell from the Blood paper, it's the drug industry's dream come true--the drugs keep working but the patients have to keep taking them forever. So those big bucks just keep rolling in--if the patients can afford to pay.

The 100 leukemia physicians object to these prices preventing many patients, especially in poorer nations, ever having access to these drugs, and they protest that there's no justification for the high prices based on the true costs of R&D.

The article begins by referring to the concept of the "just price." This, the authors explain, is based on "moral necessity" where "price must reflect worth." The cynic would wonder what planet these folks live on. Everyone knows that on this planet, prices reflect one thing and one thing only--what the market will bear, and morality be damned. If the drug industry actually started thinking like these physicians recommend, one shudders at the consequences.

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