Out of Reach

by Dr Benjamin Cheah Tien Eang, Consultant Physician & Rheumatologist

The saga involving Martin Skreli unearthed some dark truths about the pharmaceutical industry. Skreli, as the then CEO of Turing Pharmaceuticals, increased the price of an existing antiparasitic medication by 5,556% and there was nothing anybody could do about it but only to hate him.

However, it did expose the lack of drug pricing regulations in the pharmaceutical industry. Till today, no one has any idea how drug prices are decided upon. Justifications for pricing a medication more steeply ranges from the high cost of research to manufacturing. Hence, many newer treatments are placed out of reach for the average Joe without an insurance plan.

Science and technology has allowed us to now develop targeted treatments for many diseases. Picking off a sole target responsible for the causation of disease, can not only provide superior results versus conventional treatments, but with less side effects. Unfortunately many of these ‘smarter’ drugs are expensive and hence unavailable in many parts of the world.

For developing countries, the average household income is hardly sufficient to survive the rising cost of living. The price of some medications can be more than the monthly income of most households. Pricing based on the gross domestic product (GDP) or the gross national income (GNI) of a country is hardly a consolation as it is not reflective of the average disposable income of a family. Governments struggle to cope with escalating drug prices as it creates a significant constraint on their budgets.

Keeping innovative and superior treatments out of reach to those that need them the most is a betrayal to Mankind. As profits for pharmaceutical companies sore annually, patients are left poorer and in dire straits. Something must be done to justify drug prices in a more transparent manner. It can literally be a matter of life and death.

In rheumatoid arthritis for example, a new class of medications called “biologics” has revolutionised the treatment of this once debilitating disease. Preventing irreversible joint damage and relieving debilitating pain is now an achievable dream for these patients. Or so we may think.

Unfortunately, “biologics” are priced so steeply that it keeps it out of the hands of the majority of patients. Moreover, they are needed on a long term basis. Imagine spending all your savings on a medication that is suppose to make one’s life better. As patients reach deep into their pockets to solve their physical pain, another equally paralysing menace emerges. I call it the ‘financial pain’. Make no mistake of its equally destructive force.

So we spend so much money thinking that we are making a difference to the lives of patients, only to realise all we did was to shift the dust.

This conundrum raises the question of what constitutes an advancement in Medicine. A true advancement is when we can develop an innovative treatment that can be enjoyed by all of Mankind. It is not to enrich certain quarters but is to be shared by all that inhabit this little planet.

Perhaps it is wishful thinking, but there is little harm in dreaming.