Sick Money by Billy Kenber

Author:Billy Kenber [Kenber, Billy]
Language: eng
Format: epub
Publisher: Canongate Books Ltd

CHAPTER NINE

The drugs we get

With hundreds of billions spent on pharmaceuticals each year, and tens of billions of that used to fund drug research, it is worth considering what we get for all that money. The new drugs which emerge are not necessarily those with the most clinical value, they are the ones which can command the highest prices and the largest profits. At the moment this means cancer patients and those suffering from some rare diseases are in luck. For schizophrenics reliant on outdated medicines with harsh side effects and patients with antibiotic-resistant infections, the message from the industry is tough luck; the financial rewards just don’t look as good.

It hasn’t always been this way. In the first decades of the industry, similar profits could be made across an array of therapeutic areas. Today, the industry spends more than £130 billion on research and development each year, funding thousands and thousands of clinical trials. From this, perhaps forty or fifty novel drugs will emerge onto the market each year. Each one is the product of countless choices made along the way. For the scientists these are often practical: selecting the biological target to go after, for example, and the type of assay to use. For those on the corporate side there are different considerations: what are the commercial prospects for this promising new compound? How does a particular disease or therapeutic area fit with the company’s existing strengths?

Given such a vast spend, and the enormous number of diseases and conditions identified in humans, it might seem natural to assume that the drugs that emerge would treat a diverse range of therapeutic areas. Instead, the net result of all these choices is an astonishingly narrow range of new medications. If you were to randomly select a drug launched in the last five years, it would be more likely than not that it would fall into one of two categories: either a treatment for cancer or an orphan drug for patients with a rare disease. Many fall into both camps. In 2018, cancer and orphan drugs accounted for nearly two-thirds of new treatments.1 It is no coincidence that drugs in these two fields dominate another list: they are among the highest priced in the world.

When the Orphan Drug Act was signed into law by US President Ronald Reagan in the first days of 1983, Abbey Meyers, the self-described ‘housewife from Connecticut’ instrumental in pushing for the legislation, shared the view of US health and human services secretary Margaret M. Heckler who had declared that orphan drugs ‘will make nobody rich, but will help treat a small group of tragically handicapped people’.2 When the legislation passed, these drugs cost the modern equivalent of $1,600 a year.3 For those launched today, the average is around $150,000.4

In the decade before the US Orphan Drug Act came into force, there had been only a handful of treatments for rare diseases developed. This soon turned into a steady trickle of new treatments and Japan was persuaded to adopt its own incentives for rare diseases in 1993.

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