,
25 tweets,
7 min read
Read on Twitter
This thread from @francesweetman on the Labour pharma policy proposals got a fair bit of pick up, including from @nicolablackwood, the Minister for Innovation, so I thought it worthwhile flagging some issues with it.
LONG THREAD WARNING...
LONG THREAD WARNING...
The problems with the critique arise from a combination of mis-representation or misunderstanding of the recommendations, a failure to critically assess the reality of pharma talking points on innovation, and perhaps an acceptance of outcomes many think to be unacceptable.
First up, Frances reiterates the well used pharma line that it costs billions to develop medicines. It is expensive. But the oft cited evidence for it costing billions comes from industry funded studies which have been discredited by independent research.
Even accounting for failure, studies, including by the WHO, put drug development costs in the hundreds of millions, not billions, with huge returns on investment. Not for profit R&D organisations like DNDi have developed new medicines for just over £100m. jamanetwork.com/journals/jaman…
Basing policy making on such highly contested data, some would say belief in the mythology of R&D costs, without looking closely at the evidence is the kind of thing Frances advocates against in her book.
The lack of verifiable evidence of the costs of drug development is a massive problem - allowing companies to justify high prices which are completely disconnected from R&D and other costs. This problem was the focus of a WHO resolution on transparency earlier this year.
There is a global push by governments for openness. So it's great that Labour's paper includes a recommendation that would force transparency of these costs. It is a vital tool to overcome the information asymmetry benefitting pharma right now.
Frances also argues that companies only have around 5 years to recoup their costs before their patent monopoly runs out. But that theory of IP is totally disconnected from reality. Where SPCs extended monopolies beyond the life of the patent...
...and companies use a wide range of tactics known as evergreening (or in industry speak, patent lifecycle management) to secure monopoly positions way beyond the date the original patent expires - as detailed by @IMAKglobal and others.
Anyway, they keep generating profits long after the monopoly has expired, thanks in part to their spend on marketing, which outstrips spend on R&D.
Whilst clinical trials can be expensive, there is evidence to suggest that the increase in so-called 'precision medicine' which are effective in much smaller patient populations means trial sizes are getting smaller and cheaper.
And even if trials are costly, they are not what drives pharma decision making on price. As exposed by the Senate investigation into the $1000-per-pill hepatitis treatment, sofosbuvir, pricing is based on what companies think they can get away with.
finance.senate.gov/imo/media/doc/…
finance.senate.gov/imo/media/doc/…
Labour are not proposing to eliminate the monopoly period on medicines as Frances asserts here. They're simply committing to using the existing safeguards written into UK and WTO law designed to prevent companies abusing their monopolies.
If, as sadly happens quite frequently, a company refuses - despite consistent efforts by the NHS - to offer a medicine at an affordable price what should we do? Let patients die without access or act to prevent this immoral behaviour by the company?
Labour are simply saying we'll do the same as the NHS used to regularly do, the same as the US, Germany, Italy and over 100 countries have done since the early 2000s - we'll tell companies to price reasonably or they risk their monopoly.
Aside from the red scare refs to the Soviet Union which I could unpick but won't (there are lots of effective not-for-profit & state run pharmaceutical innovators), this claim that there will be no profits is based on a misreading/failure to read the paper
In fact some of the most exciting ideas in the paper propose a careful exploration of a shift to a different system of financial incentives for innovation, one which could generate huge profits for medical innovators.
Rather than profits coming from high prices which lock out millions of people around the world, they could come from prizes set as rewards for delivering specific medical or scientific breakthroughs.
These hold lots of advantages, but their particular strength's in ensuring you reward truly valuable activities. Big pharma is actual pretty terrible at innovation. We're rewarding the wrong people for the wrong things. Labour are talking about delivering profit where its earned
Yeah - the prices in the US are worse. Luckily we aren't about to enter an FTA negotiation with the US where removal of NHS price controls is high on their list of demands... oh, hang on...
In what sense are the companies selling medicines in America different to the ones selling medicines in the UK? These are multinational corporations, and that dysfunctionality is part of the global system.
If we want to stop young adults dying because they can't afford their insulin, if we find it morally reprehensible that cancer patients go bankrupt because of their co-pays then we need to solve the failings of the global R&D model. The UK is not separate from the US system.
Some of the most extortionate drug price abuses which have cost the NHS hundreds of millions in recent years have been generic medicines sold in an uncompetitive market with one or two suppliers.
The idea that democratically controlled, publicly owned manufacturing capacity could never usefully and reliably supply lower priced, quality medicines to the NHS is hard to believe. Indeed, US hospitals are undertaking just such an initiative. civicarx.org
Finally, the recommendations echo WHO, UN, Dutch, Italian, Austrian and US Democrats proposals to fix unsustainable drug price inflation.
In summary, don't believe the pharma myths, read the report, feel confident that in your belief that the right to life trumps IP rights.
ENDS
In summary, don't believe the pharma myths, read the report, feel confident that in your belief that the right to life trumps IP rights.
ENDS
