Defining Efficacy: The Pharmaceutical Industry and Access to Treatment

During the 1990s and 2000s, HIV/AIDS activism made huge strides in reducing antiretroviral treatment (ART) prices and making HIV treatment more globally accessible. Through extensive human rights campaigns, activism efforts, and support from a host of governmental and supranational bodies, expensive drugs that were once deemed not cost-effective to provide in developing nations were made available to many of the world’s poor suffering from HIV/AIDS. The authors of Reimagining Global Health note that “The lowest available annual per-patient price of the most common first-line HAART regimen in the developing world fell from $10,000-$15,000 in the late 1990s to $300 in 2002 to $87 in 2007” (Farmer et al., 2013). For many infected with HIV, these improvements meant that HIV/AIDS would no longer be a death-sentence, but could be managed as a life-long chronic illness.

Much of this price-drop was attributed to the increased production of generic forms of brand-name treatments. Through partnerships with governments of developing countries and adapted business models, generic drug manufacturers were able to sell generic antiretrovirals at set—and comparatively low—price points (Farmer et al., 2013). This new wave of generic antiretroviral drug production was spurred in part by the passage of the South Africa’s Medicines Act of 1997. This act gave the government the right to allow compulsory licensing of brand-name drugs in the case of a public health emergency, meaning that patented antiretrovirals could be made by generic drug manufactures without permission of the patent-holder. Although 39 pharmaceutical companies filed lawsuits against the act in South African courts, political and social support for the Medicines Act caused them to withdraw their complaint three years later. Indeed, later that same year the World Trade Organization recognized that South Africa had not violated trade agreements concerning intellectual property rights, further solidifying the precedent that public health matters could override intellectual property rights (Farmer et al., 2013).

While the HIV/AIDS movement for access to ART is a truly remarkable example of harnessing social and political forces to make life-saving pharmaceuticals available in resource poor settings, it stands as the exception to the rule. Indeed, as Nicholas King describes in his article “Security, Disease, Commerce: Ideologies of Postcolonial Global Health,” pharmaceutical companies continue to have little incentive in developing effective and affordable treatments targeted at populations of developing nations. Not only is the Western pharmaceutical industry ill-designed to cheaply produce and sell important medicines to developing nations, but these same manufacturers whose product is inaccessible in poor settings continue to fight against the production of cheaper generic alternatives in non-Western countries—despite the public health importance of the medicines and the low-purchasing power of developing nations.

The battle surrounding patent protection is far from over. Recent trade negotiations concerning the Trans-Pacific Partnership—a trade agreement that would link nations including the United States, Japan, Australia, Canada and Chile, among others—are rife with controversy over the issue of pharmaceutical patenting. Many countries in the partnership want the United States to reduce their patent protection from the current 12 years to allow generics to enter the market sooner, while members of United States Congress have asserted they will not support the deal without a strong intellectual property rights component (Weisman, 2015).

Incidentally, the timing of these trade negotiations coincided with another controversial case involving the pharmaceutical industry. In September, the American pharmaceutical company Turing Pharmaceuticals made headlines when they purchased the rights to the drug Daraprim—a drug developed 62 years ago that treats toxoplasmosis—and increased the price from $13.50 a pill to $750 a pill (Pollack, 2015). The increase in price was not due to increased manufacturing costs of the drug, but due to the desire for an increased profit margin on part of Turing Pharmaceuticals. Unfortunately, this case is not isolated, but only one of many in a series of similarly inexplicable price-hikes enacted by drug companies.

How did the precedent set by the successful price reduction in HAART due to generic manufacturing during the early 2000s fail to translate to other life-saving medications? Aside from cases of “public health emergencies,” the pharmaceutical industry has near complete control over the production and pricing of many crucial medicines. Advocates of the pharmaceutical industry argue that a system based on profit-motive supports industry innovation and the production of better, more effective drugs. And yet, how effective can a medicine really be when it is out of reach of those who it would help the most? The efficacy of a medicine should not be measured simply by its biomedical utility, but also by its accessibility. If a pharmaceutical treatment is not available to a population for social reasons, it cannot be available to treat or cure on a biological level—bringing into question how exactly pharmaceutical companies should approach creating “effective” medicines.

 

 

Sources:

Farmer, A. Kleinman, J. Kim and M. Basilico, eds. 2013. Reimagining Global Health: An Introduction. Berkeley: University of California Press.

King, N. 2002. Security, Disease, Commerce: Ideologies of Postcolonial Global Health. Social Studies of Science 32(5-6): 763-789.

Weisman, J. (2015, July 30). Patent Protection for Drugs Puts Pressure on U.S. in Trade Talks. New York Times. Retrieved October 20, 2015, from http://www.nytimes.com/2015/07/31/business/international/pacific-trade-deal-drugs-patent-protection.html

Pollack, A. (2015, September 20). Drug Goes From $13.50 a Tablet to $750, Overnight. New York Times. Retrieved October 20, 2015, from http://www.nytimes.com/2015/09/21/business/a-huge-overnight-increase-in-a-drugs-price-raises-protests.html

 

Discussion Questions:

  • How much control should the pharmaceutical industry have on setting prices for life-saving treatments? If their control should be limited, which governing body should have the power to decide pharmaceutical pricing?
  • How likely is it that another massive activist movement, such as the movement for access to ART for HIV/AIDS treatment, will be able to drastically change the accessibility and affordability of important medicines?
  • Turing Pharmaceuticals argued that their price increase of Daraprim was justified because the drug is not commonly used anymore, and the increased profits generated from this price-hike will allow the company to expand research and development into other more effective drugs to treat toxoplasmosis. Do you agree with this justification? Why or why not?

15 thoughts on “Defining Efficacy: The Pharmaceutical Industry and Access to Treatment”

  1. Sabrina, thank you for your take on the increases of drug prices and the implications it has on access to effective treatment. It is unfortunate this day in age how many drugs are inaccessible to the people who need them most. I think this is especially the case in Western countries. Although this is where most of the drug manufacturing is being done, so the consequences transfer over to developing countries countries as well. As you discussed in your blog post, I think it is important to be weary of what is happening between the United States and other countries. The United States has the most power when it comes to this industry, because they also developed most of the drugs to begin with. I think the biggest problem is that most of these companies are not as concerned with saving more people’s lives as they are with making money. Most of the companies have gotten to a point beyond wanting to help people and now are simply a business looking to make money. I do not think it is right that they do this and it should be regulated, I just do not know how it would be regulated now that it has been going on for so long. One article I read entitled “Big Pharma ‘Repatenting’ Raises Prices of Top Drugs by More than 6 Times,” discusses the aspect of drug companies being able to raise the prices. This relates to Turing Pharmaceuticals raising the price from $13.50 per pill to $750 per pill for a drug that had been on the market for 62 years. The problem, as this article explains is that when mega pharmaceutical companies get their hands on old drugs, they can repatent them. Once the original 12 year patent is up, generic companies can start to make the same drug and sell it for much cheaper. These drugs can then be on the market for cheaper for years. Years later, other drug companies can then get a repatent of the drug, and therefore raise the price to essentially whatever price they want. While this isn’t acceptable to the public and ruins people’s abilities to get the treatment they need, drug companies can do basically whatever they want. I think that the ability to repatent drugs should be taken away. If companies cannot repatent, they therefore can’t raise the prices by hundreds of dollar.

    http://naturalsociety.com/big-pharma-repatenting-raises-prices-top-drugs-6-times/

  2. Hello Sabrina,
    You brought up some excellent points regarding the accessibility of treatments once they have been created. With many of the issues seen in this course, there has been no clear answer as to what the optimal approach to solving a particular problem is. In the case of the pharmaceutical industry, corporations typically have to make a decision about how they wish to ensure that they can get life-saving drugs to people in need while still having the ability to make a profit in the end. Unfortunately, many victims of the diseases that are in the most need of medical solutions cannot afford the high prices necessary to recover the high costs of drug development and research that go into the creation of many drugs that are needed to survive diseases such as HIV/AIDS.
    • How much control should the pharmaceutical industry have on setting prices for life-saving treatments? If their control should be limited, which governing body should have the power to decide pharmaceutical pricing?

    The pharmaceutical industry should have some degree of control over the pricing, because this control is often a powerful incentive to encourage corporations to continue investing time and resources into the process of discovering novel solutions to diseases. I think that the control should be limited by an organization such as the WHO or the WTO, as these bodies both have perspectives that can provide a solution that is more likely to be suited towards populations in which access is a primary concern. It is disturbing that in spite of the availability of many resources targeted towards diseases of all kinds, populations still face a great deal of trouble in trying to harness resources critical to treating some of the deadliest diseases in their communities because they are unable to afford the high prices associated with using such products. Besides the time and resource it takes in the manufacturing and marketing of a drug from the time of its inception to the time it hits the shelves in enormous accounting for the high price of products. Additionally, in the U.S. there is a big tendency to sue anyone and everyone for everything so the companies always need to have extra resources tucked away for such situations to fulfill the demands of class action suits and others, the cost of which is naturally transferred to the end consumers in the form of high prices. So if there is going to be any type of regulation there has to be one to govern and restrict frivolous law suits and caps on settlements.

    • How likely is it that another massive activist movement, such as the movement for access to ART for HIV/AIDS treatment, will be able to drastically change the accessibility and affordability of important medicines?

    The success seen in activist movements in the past is very encouraging, because it appears possible that appealing to the humanitarian aims of people will potentially cause pharmaceutical companies to shift their thinking when it comes to determining how to price and sell drugs for which access is either severely limited by pricing or inhibited by the lack of adequate distribution methods.
    • Turing Pharmaceuticals argued that their price increase of Daraprim was justified because the drug is not commonly used anymore, and the increased profits generated from this price-hike will allow the company to expand research and development into other more effective drugs to treat toxoplasmosis. Do you agree with this justification? Why or why not?
    The important issue to address here: Why is the use of Daraprim declining? If it is because the incidence of toxoplasmosis is also on the decline, then where is the need for investing in R&D for the treatment of the same disease? On the other hand, if the use is declining because of lack of efficacy of the product because of drug resistance, etc., then why increase the price of a product by 2000 times, when it is not worth its value even at the lower level? Either way, the price increase is not entirely justified. If Turing Pharmaceuticals is so concerned about the well being of society, starting an initiative to increase awareness about toxoplasmosis and available treatments in indigent populations and donating some of the earnings from the sale of a drug for this cause is a more justifiable solution, which may then justify a moderate increase in price depending on the magnitude of the service provided.

  3. Hello Sabrina,

    I really liked your post as it allowed me to grasp the broader circumstances through specific examples. You raise important questions regarding the control of pharmaceutical pricing. As Western biomedicine has become the dominant paradigm in healthcare around the world, pharmaceuticals have assumed an immense importance. When it comes to pricing, I feel that while the pharma companies cannot be allowed to set prices willy-nilly, nor can their prices be dictated entirely by an external institution. As the previous comments have acknowledged, price control provides pharmaceutical companies incentives to invest in R&D and research. I think there should be some regulation of pharmaceutical pricing though, especially the essential and commonly used ones, so that people in need are able to access them. Like Shreya, I think that an international organization will have to be given powers to oversee this as big corporations often hold sway over national governments. Procuring such agency though is itself a challenge.

    Proceeding to your second question, I think mass activism and awareness are the most powerful tools that can alter and impact the affordability of medication. The corporate world is sensitive to ‘public relations’ and therefore can be influenced via this avenue. Especially in the case of life-saving drugs, I feel this could be very effective.

    Lastly, coming back to Turing, I think there are many alternative ways to increase awareness about an issue than to raise the price of a company prescribed HIV related medication. Also, thinking about research I wonder why there are so many ‘developing world’ diseases that don’t have proper medication even though many companies have the resources to conduct research. If the betterment of society was their primary aim, I think pharmaceutical companies would’ve made radically different choices.

  4. Sabrina,

    I really enjoyed your post and I absolutely agree with you that the efficacy of medicines should not be measured based only on their biomedical utility, but on their accessibility and affordability. I recall how Farmer discussed in Infections and Inequalities that supplies to medicines are frequently interrupted in poor communities, even in fully-staffed clinics and hospitals. This seems to me to be completely senseless: shouldn’t it be easier to get medicine to communities all over the world than to get physicians and health workers to communities? There is something incredibly maddening about the fact that we celebrate new technology with the ability to cure and manage the diseases of millions worldwide, but that the technology is not made available to those who need it. Intellectual property rights seem a weak response to such blatant injustice.

    In addition to the high prices of drugs making it difficult and impossible for patients to buy drugs in the first place, high prices have also contributed to significant global health crises of drug resistance that require additional resources. For instance, expensive and inaccessible TB drugs often mean that patients will only be able to buy a small portion of their treatment, and so will develop resistance to the cheapest and most accessible drugs. As Farmer illustrates, resistant strains of TB are far more difficult and expensive to treat such that many global health leaders consider treating MDR TB to be a futile cause in poor communities.

    I agree with others, though, that a large-scale social movement could potentially make real change in this issue of the prices of medicine, as was seen with the reduce in price of HIV drugs over the past few decades. A governing body is needed not only to regulate the pricing of drugs by pharmaceutical companies, but the direct availability of medicines to people in need. We must make wide and consistent availability of medicines a priority, and to do this, we must make wide and consistent availability profitable to pharmaceutical companies.

    Thank you,
    Mira

  5. Sabrina, thank you for your insightful and thought provoking article. You pose some important questions regarding the dangerous power pharmaceutical companies have over our access to essential drugs and medicines.

    In an ideal world, the production of essential drugs and medicines would not be privatized. Rather, taxpayer funds would allow governmental agencies to produce drugs to benefit all those in the population who needed it. However, this model does not have a strong financial backing. Researching and developing cures to diseases requires high levels of monetary support- support that may not be available from solely the government. A balance between private and public ownership must be used in the case of pharmaceuticals. The government should offer subsidies to those who cannot pay for drugs and set quotas on how long pharmaceutical companies can hold onto patents.

    HIV/AIDS was an instance in which many people in positions of power were negatively affected. This, along with widespread media coverage, made it a phenomenon in which pharmaceutical companies were pressured to lower prices. However, even if another movement did arise, it is unlikely that it would create widespread change. The fundamental question is- what do we constitute “important” as. Are “important” medicines, ones that the greatest number of people require, or medicines that will help alleviate the worst of conditions? In the summer of 2013, I interviewed several people with rare genetic diseases, who argued that it was fundamentally unfair that no research was being done to help alleviate their conditions. They were ignored in the health care system, simply because it was not profitable to create drugs to help them.

    With regards to the third question, I do not believe that this is justified. Who is there to ensure that the extra profit made is really being used to develop new cures? Who is there to ensure that pharmaceutical companies are being held accountable? The WHO and WTO ultimately have no power over pharmaceutical companies. I think the example of “Turing Pharmaceuticals” calls for greater governmental regulations to ensure that pharmaceutical companies are being held accountable.

  6. I really like that you brought up in your discussion the recent issue of Turing Pharmaceuticals increasing their prices in order to up their profit. We’ve talked about the success of AIDS activists in making ART drugs more affordable, but as you point out with this contemporary example, inflated prices and corporate greed still play a huge role in the pharmaceutical industry and access to life-saving drugs. In regards to your second question, I think as long as pharmaceutical companies continue to prioritize making huge profits, there will be activist groups demanding more affordable drugs… I think the HIV/AIDS movement is likely to be one in a long line of many. Unfortunately, having to focus so much energy on just accessing life saving drugs likely takes away from making other important advancements in health. I don’t know the best way to prevent this, but I definitely agree that governments should put price ceilings on drugs, or otherwise offer subsidies to make them affordable to everyone.

  7. Thank you for your thoughtful blog post. Western countries such as the US having access to the research and funding to support the production of live-saving medicines is very similar to the power dynamic facilitated by medicine in the colonial era. European countries then had the power to save lives through the efficacy of their medicine, which proved to be more useful in combating diseases in their colonies than native medicines, and they used this as a “tool” of the empire.

    I have a rather extreme opinion, which is: if lives are being saved, who cares whose intellectual property it is that is saving lives? Sure, credit is due, but if the technology and medication exists it is beyond me that people continue to suffer because of lack of access. I loved your point about the efficacy of a medicine also needing to be measured by its accessibility. I wish there was some, non-monetary way to incentivize easy accessibility to the medicines that pharmaceutical companies make – apparently common decency and humanity are not incentive enough.

    Obviously, the comment that Turing Pharmaceuticals made about using the profits from the medicine to drive further research is circular and idiotic. They already have a drug that can provide relief to people suffering from toxoplasmosis, it’s absolute nonsense to say that they are making the drug inaccessible now so that they can create another drug later that might be more effective but will probably still be inaccessible. The drug will still be useless to the vast majority of people suffering from HIV/AIDS who cannot afford it.

  8. First of all, I would like to thank you for bringing up such an important topic!
    Indeed, the risk that the Trans-Pacific Partnership could actually extend patent rights is frightening, to say the least. As you pointed out, the efficacy of medicines should also be judged by their accessibility, and the TPP runs the risk of decreasing their efficacy in that sense.
    Like my peers who have commented on your post, I also believe that international bodies such as the WHO should have the legal right to limit the control pharmaceutical countries have over pharmaceutical pricing.
    However, I also believe that an effective way to break down the monopoly pharmaceutical countries have would be to invest more in pharmaceutical research in the countries that need it most. By convincing large donors to invest in developing research in medical schools in developing countries, locally produced medicines would be fair competition to those provided by (greedy) international suppliers. Cuba is actually an excellent example of this. As a result of the US embargo, Cuban health facilities were left without access to a lot of medicines, and thus had no choice to invest in research in their health institutions. Earlier this year they were recognized as the first country (by the WHO) to eliminate HIV/AIDS.

  9. Hi Sabrina,

    I thought that your post was very well-written, and that you were able to consider this subject from a relatively fair standpoint–your questions gave weight to both sides of the argument, and effectively placed me at the crux of the dilemma surrounding pharmaceutical companies and public health. There are no right answers to your questions, I believe, because there are so many factors at play when it comes to the interaction between health and economics. That being said, as angry as we can get with corporations and their frequent unwillingness to take a path of altruism, they are still, at the end of the day, businesses. And without the sudden nationalization of the industry and a governmental shift to communism, the pharmaceutical sector is an important part of our economy. Only due to its profits can it be a center of innovation for many aspects of health.

    I appreciate your question of what is considered an “effective medicine.” It calls for a reevaluation of what we put a value on–monetary or moral. “Effective” could refer to the extent to which a medicine helps an individual recover or it could mean that the medicine has reached many people, and helped cut down the incidence of a disease. Though not as frequently as we would like, pharmaceutical companies do participate in philanthropy. They have foundations attached to their for-profit sectors, and they regularly make small donations of medicines to those in foreign countries who need them. However, as I have said, they are still businesses, that intend to return some kind of profit, not to be philanthropic organizations.

    Just as we have seen when looking at global health initiatives on the whole, there are many ways of measuring success, but the usual favorite in the Western world is through numbers and statistics that define improvement as well as the advent of sexy new technologies. For pharmaceutical companies, it often seems that their measure of success is purely selfish. However, they are, as is obvious, an industry. In a country, and an era, that is almost militantly capitalist, it is hard to advocate for any serious kind of comprehensive control that would effect the kind of change that South Africa’s Medicines Act of 1997 made, except over the entire line of products. There are many industries for which the case could be made that some level governmental control would be beneficial to reducing inequality. On the same token, as businesses that strives to be economically feasible, returning enough profits, as you wrote, to be able to improve and enhance their research and development for new drugs, pharmaceutical companies must be able to have some control in terms of setting their own prices.

  10. Firstly, thank you all for some very thoughtful and thought-provoking comments. As some time has passed between the original blog posting, there have now been several relevant updates in the news and we have also since discussed the pharmaceutical industry and global implications of pharmaceuticalization.

    Many of you responded to the third discussion question and argued that Turing’s justification for the drastic price increase of Daraprim was flimsy and illogical. It seems you were not alone, but even another pharmaceutical company had ethical issues with Turing’s arbitrary price-hike. Some time after Turing announced the price increase of Daraprim, the company Imprimis Pharmaceuticals said that it would offer a different version of the same drug for only one dollar per pill.* This shift of events undoubtedly brings relief to many doctors who would be prescribing Daraprim and many patients who may need the drug, and stems from what seems to be self-regulation of the free market. Yet, based on this example alone I am not willing to change my belief that the sale and pricing of pharmaceuticals should not be regulated in the same manner as other commodities, but should have more governmental intervention to create affordable and accessible drugs. What do you think of this example of free-market regulation of affordability of pharmaceuticals?

    In class, we have also recently discussed the global implications of the pharmaceutical industry and how the “right to health” has in some cases translated to the “right to pharmaceutical medicines.” For example, Brazil’s right to health encoded in the country’s constitution has opened the door to access for life-saving drugs via litigation on part of the country’s citizens. Yet, the fact that the country must provide pharmaceuticals to its citizens has also placed it in a vulnerable position in terms of pharmaceutical pricing: because the government must acquire these drugs for its citizens, pharmaceutical companies can charge increased prices that the government has no choice but to pay. As Professor Mason noted, drug prices in Brazil are about 13.1 times higher that the world index. This again indicates the needs for some regulatory supranational body that can ensure fair pricing and end the exploitation of governments who provide universal healthcare to their citizens.

    *Source: http://www.nytimes.com/2015/10/23/business/drug-compounder-offers-1-alternative-to-750-pill.html

    1. Thanks for the update. It’s interesting and super cool that another company would come in to make the drug accessible after Turing increased the price. I wonder how that will affect Turing as a business…

      But..it’s the invisible hand and I can’t say I trust it, especially having learned about structural adjustment…And all the scary parts of the free market (i.e. advertising medications, essential medicines lists that can act as another form of advertising, and your third point about the governments having to pay higher prices) are not somehow eliminated for me by this one example of the free market doing something positive for access.

      I agree that taking a neoliberal approach to pharmaceuticals is not enough (there needs to be more legislation, price controls, etc. involved than with other commodities), especially because drugs are so much more expensive than other commodities and health is literally an issue of life and death, unlike cola or kleenex…(sorry those are just the first two commodities to come to mind).

  11. Hey there Sabrina,

    The pharmaceutical industry, ideally, would be checked when it comes to setting prices for their treatments. The free market clearly does not solve everything (trickle-down/structural adjustment/neoliberalism) when it comes to (global) health related initiatives. Price controls and subsidies for certain medications have been attempted (WHO essential medicines list), but I think that there’s still a lack of transparency and lack of a clear plan that includes political/institutional support in making the medicine accessible.

    As far as possible checks, One “check” should come from consumers–that is to say that drug companies should be more transparent and there should be some form of legislation to demand total transparency from drug companies and the doctors who prescribe those drugs and the costs of drugs in places where there is free healthcare. I think transparency is a really important place to start, especially because there are no institutions at present that would have enough clout to control price at the global level. What I wonder, however, is how to get people (regular people) talking about these problems and in a way that could lead to some productive activism, which you mention in the 2nd question.

    The World Trade Organization *should* be the one to regulate price, but given how TRIPS worked out…can’t really claim that the WTO would decide pricing in a just way. An institution at the national level is also problematic, as you mention Sabrina, in the case of Brazil.

    To address your second question, the transparency that I suggest earlier makes an activist movement much more likely. I think the fact that borders are becoming less important and because we can communicate with so many different voices would lead to more popular outrage about diseases, even if it is not some disease (emerging/re-emerging) that threatens the “western world” in the same way. Although perhaps I’m being a little too idealistic. Unless there is some movement to get people aware and talking and communicating on the streets about these issues, it seems really unlikely that there will be any strong activist outrage comparable to the response to HIV/AIDs.

    As far as your third question, I understand that justification, but I don’t agree with it. At what “cost” (pun intended) would they get that extra profit? Making a medicine more expensive for the sake of creating a better one recalls two things for me: 1) that proton/protein beam thing that is super expensive yet won’t see much use 2) the cases in Biehl and Petryna of individuals who participated in clinical trials as a way to access a drug, then continuing to receive access by litigating the company. Which would be a cost to the company, as well as a challenge for those who participated in the clinical trial yet cannot afford the toxoplasmosis drugs afterwards because that same company priced them so high. Maybe the profits/money for R&D should come from something else…but I don’t know what that would be >.<

  12. Hi Sabrina!

    Thank you for your post. I found it infinitely interesting! I’ll try and answer your first question: “How much control should the pharmaceutical industry have on setting prices for life-saving treatments? If their control should be limited, which governing body should have the power to decide pharmaceutical pricing?” I think pharmaceutical companies should have as much control as the market allows for them to have. Though morality should come into play, I do not think it is the role of the government to tell a company how it should price its drugs. With that said, I do believe the government has enough power to get costs down within reason without having to resign to using force–revoking that particular company’s patent. If a company is going to gouge the very customers whose lives depend on their drug, then the government should step in and revoke that company’s patent so as to allow for another company to mass produce that drug to be sold at a fraction of the price. This would give the government leverage that doesn’t rely on price controlling, which can be a slippery slope in a country that depends on making profit quarter after quarter.
    With regard to “How likely is it that another massive activist movement, such as the movement for access to ART for HIV/AIDS treatment, will be able to drastically change the accessibility and affordability of important medicines,” I can’t say. I suppose once we find a cheaper alternative to expensive treatments, like electron-beam radiation tools that I recall costing something like over a billion dollars, we’ll see more activist movements that can build off the workable blueprint already provided by the movement to make more affordable the access to HIV/AIDS treatment.
    Finally, I disagree entirely with Turing Pharmaceuticals. The price-hike was beyond acceptable and deserved to be undercut by a generic brand version shortly thereafter.

  13. Hi Sabrina,

    Thank you for your blog post! It truly highlights the consequences from the profit-based incentives of pharmaceutical companies. One of your discussion questions centers around the idea of how effective can a medicine be if the people who need it most lack access to it. This question really grasped my attention, as I feel this is one of the most major underlying issues in global health. In ways, pharma companies are trying to alleviate the sufferings of those in resource-poor settings, but these companies, as well as others, fail to address the biggest issue, structural violence. Essentially, these medicines will have little to no effect if companies do not work to alleviate this social suffering.
    I would also like to address the issues surrounding the profit-motives of the pharmaceutical industry. With these motives in place, pharma companies will be more drawn to a monetary focus, as opposed to a focus on those sufferings. This will inhibit their ability to truly have an effect on those suffering.

  14. Hey Sabrina! Thank you so much for your post, which focused on a scarcely addressed topic for this section — the impact of the pharmaceutical industry. I believe other governing bodies need to have input on prices for live-saving treatments, such as those like Paul Farmer and individuals from the communities in, say, Haiti or Rwanda Those individuals have worked on the ground and know/understand (better than big pharma) what a reasonable price or, or what the average community member can afford. In addition, it is unlikely to think that the pharmaceutical industry has any major interest in saving lives (as opposed to making money). By representing multiple opinions and perspectives, it is more likely that a fairer price will be decided upon.

    In response to your second question, you are absolutely correct – the most successful changes occur after massive activist movements as opposed to common knowledge, or governing bodies who are forced to engage with their work on a realistic level. Since HIV/AIDS is fairly controlled in the ‘modern’ world, I believe it is highly unlikely that another massive activist movement will occur and alter the accessibility of these medications. I think the various groups that exist now will continue working towards these goals, but I am unsure if it will reach Ebola-level attention.

    Finally, in response to the Turing question, I don’t believe this is an either-or question. There are many other ways to try and obtain funding for more research and development, and the bodies and lives of individuals in developing countries should not have to pay for that to happen.

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