Ten bullet points on the upside down world of pharmaceuticals, prices and access


Notes from introduction to “Can we afford our medicines?” event in EP, 12-11-2014

1. Transparency: Today there is no transparency on prices EU states pay for medicines(taxpayers often don´t know what their state health service is paying for each medicine), no transparency on scientific research/clinical trials or safety and efficacy, nor on R and D costs nor is there clear traceability of the costs of producing a new medicine, We´re in the dark, middle ages. Doctors don´t know, Patients don´t know, Politicians don´t know, Taxpayers don´t know.
2. How many times do we pay? Three is a massive privatization of public investment in research. “I already paid for this drug!” is a reality. Where is the public return on investment in research if there are there no strings attached to our investment as far as IPR, affordability or knowledge exploitaiton? We often re-buy taxpayer research at an astronomical cost and end up paying for a medicine 3,4 or 5 times (taxes, co-payment, medical insurance, tax evasion of pharmaceutical companies, paywalls around public research results, ..)
3. Public Good, not just a commodity: Health is a public good, health knowledge is a public good, part of the global commons. Is access to medicines mainly a competitive business issue or a public health question?
4. Is the present system efficient? Marketing costs dwarf research, most new drugs have little therapeutic value (me toos, evergreening), cost of not sharing data of clinical trials, overprescription and underprescription are two sides of same coin. Safety and efficacy of medicines are often hidden. There is great over-lap and waste in research, marketing and deception.
5. Corruption or unethical practices are massive: Pay to delay practices to prevent generics on market cost public health systmes billions. Massive perks for doctors, unethical lobbying by paid pseudo patient groups, massive tax evasion by big pharma (where is the so called “trickle-down” benefit for all?) and thousands of lobbyists in Brussels that work to place pharma profits ahead of affodable public healh needs.
6. Monopoly and Malice: Patent monopolies do not fuel innovation but often prevent it- thickets, scientific enclosure, fear of sharing, scientific manipulation. In Energy and Telecom: measures for structural unbundling of dominant positions have been proposed or taken in market in favor of consumers, competition and lower prices; but EU patients have no such advantage. There are clear dominant positions in the pharma market: Direct or indirect control of R and D, production, IPR portfolios, marketing and sales- end up moulding and manipulating of whole cycle.
7. It is the EU´s competence!: It is often said that health and pharmaceutical pricing are not direct EU competences but indirectly they are. Fiscal austerity, Transparency, IPR policy, EU innovation and research, non-discrimination..
8. Evidence based EU policy: No econometric studies on different innovation models No impact evaluation of EU promoted austerity cuts in health budgets, No provision of how Europeans will pay skyrocketing medicines expenditures of an aging population and more expensive drugs, No EU project to share health technology assesments. No price caps considered, No socially responsible licensing proposals for EU research..
9. De-linkage and open source dividend: Separate R and D costs from final costs of medicines through prizes, patent pools and open medical research. Fund an open source dividend to incentivize sharing of scientific research. Promote socially responsible licensing when public money is involved.
10. If it is not good for the majority, it is not good. Marginal costs of producing medicines are very low, universal access is possible if there is political will to break monopolies. Access is the best policy: If it doesn´t work for the majority, it simply doesn´t work.