The new drug war: Hard pills to swallow

Drug firms have new medicines and patients are desperate for them. But the arguments over cost are growing

LOUIS MACHOGU, the owner of a pharmacy near Nairobi, has noticed a change. In the past decade Kenya, like much of Africa, has seen a surge in foreign aid to fight infectious diseases. Thanks to antiretroviral treatments, HIV is no longer a death sentence. But the decline of one scourge means that people are living long enough to fall sick in other ways. “The same way we had HIV killing people,” Dr Machogu says, “we now have hypertension and cancer.”

Treatment often depends on the whim of pharmaceutical firms’ philanthropic programmes. Cancer drugs are particularly lacking. The Kenya Medical Supplies Agency buys medicines for public hospitals, but not those for cancer.

In Tampa, Florida, Marilyn Weisman also depends on charity for treatment. The 72-year-old thought she had a bad rash. She turned out to have cutaneous T-cell lymphoma, a rare cancer. Though she is insured, she could not afford her share of the payment for the drug her doctors recommended. So a pharmacist at her hospital, Moffitt Cancer Centre, helped her to apply for charitable aid. Mrs Weisman’s situation is surprisingly common for American cancer sufferers. Many insured patients in one of the world’s richest countries cannot afford their medicines.

A new drug war is looming. The market is growing: patients in rich countries are ageing and those in developing ones are getting richer and suffering from chronic diseases. But as demand for drugs rises, so does concern at their price. A record $1 trillion will be spent globally on medicines in 2014, predicts IMS Health, a research firm. “The costs of many new medical products are becoming unsustainable for even the wealthiest countries in the world,” said Margaret Chan, the head of the World Health Organisation (WHO), in August.

On every front

Skirmishes are breaking out from Brunei to New England. Negotiators for the Trans-Pacific Partnership (TPP), a giant trade deal that would cover 12 countries, including America, are battling over access to medicines. Health activists are trying to block a costly Hepatitis C drug from being patented in India. Brazil and South Africa are mulling over patent reforms that could make drugs cheaper.

Eli Lilly, an American pharmaceutical firm, is suing Canada for letting competitors sell copies of two medicines there, which it says violates the North American Free Trade Agreement. In October Maine became the first American state to allow drugs purchases from cheaper foreign online pharmacies. The drugmakers’ lobby has sued, charging that the policy is an attempt to circumvent federal law.

Meanwhile firms are crunching reams of data to prove their wares’ worth. But even as they try to justify high costs, they are testing new pricing models. “The starting point always is, what is the right price for a medicine?” says Severin Schwan, the chief executive of Roche, a Swiss pharmaceutical giant. “And there is no objective answer…At the end you are discussing, what is the price of life?”

Drug development is expensive, slow and chancy, so pharmaceutical firms charge a lot. But if drugs are too pricey, support for patents will collapse. Ian Read, the boss of Pfizer, an American giant, recently laid out the threat: “Unless we’re respected by society, unless we’re seen as good stewards of our resources, then we run the risk of both losing patents and losing the ability to price our medications.”

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