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Global Trends

Monday, 3 March 2014

Of cancer and high drug prices

As cancer cases and deaths shoot up, doctors and patients are outraged by the exorbitant cost of medicines and call for action to be taken.

MY Global Trends article last week on the effects of the Trans-Pacific Partner­ship on access to cancer medicines came out at almost the same time as The Star’s report on the Health Minister’s reaffirmation that Malaysia wants tobacco to be excluded from the TPP.

Datuk Seri Dr S. Subramaniam, who was opening the World Cancer Day Conference stressed that Malaysia’s position was “not negotiable from the health perspective as smoking is a clear threat to health”.

The Minister said there were 21,700 cancer deaths in Malaysia in 2012, and smoking was linked to 20% of these.

Worldwide in 2012 there were 14.1 million new cancer cases, 8.2 million cancer deaths, and 6.3 million women living with breast cancer, according to a New York Times article.

In response to my article, I received an e-mail letter from Dr Lim Teck Onn, a consultant in clinical research, and formerly a Ministry of Health staff.

Dr Lim says: “I appreciate very much your efforts to bring to the public attention the crucial matter of affordability of life saving medicines.

“My own research has shown that much of cancer deaths are avoidable in Malaysia and half are attributable to lack of access to treatment. You mentioned that Indian companies are leading the fight to make medicines more affordable. There are also Malay­sian companies engaged in a similar battle.”

A journal article that Dr Lim wrote with four other Malaysian researchers estimated the number of deaths due to breast cancer that would be avoidable if all Malaysian patients had access to the care provided by leading centres in Malaysia.

They found that of the reported 2,572 deaths due to breast cancer, 1,299 (50%) were avoidable.

Of these avoidable deaths, 647 (50%) were attributable to late stage presentation while 652 (50%) were due to lack of access to optimal treatment.

“Avoidable deaths were equally attributable to lack of early detection and access to treatment,” said the article.

Thus, a conclusion one can draw from this study is that in Malaysia, a quarter of the people who died of breast cancer could have been saved or had their lives prolonged if they had better access to treatment.

This brings us back to the high price of cancer medicines, and the TPP negotiations. There are in­­­­­­­­­creasing complaints that many new cancer drugs are much too expensive, usually more than US$100,000 (RM327,750) for a course of treatment for a patient.

Last April, more than 100 cancer specialists from 15 countries wrote a joint comment in the medical journal Blood denouncing the high prices of cancer medicines and calling on drug companies to bring prices down, according to another New York Times article.

The doctors specialise in the deadly blood cancer, chronic myeloid leukaemia. In the commentary they said that the prices of drugs used to treat that disease are astronomical, unsustainable and perhaps even immoral.

Charging high prices for a medicine needed to keep someone alive is profiteering, akin to jacking up the prices of essential goods after a natural disaster.

“Advocating for lower drug prices is a necessity to save the lives of patient,” they said, adding that the cost of drugs for many other cancers were just as high.

They gave an example of the medicine Gleevac, used to treat chronic myeloid leukaemia. The New York Times noted that among the critics is Dr Brian Druker, who was the main academic developer of Gleevac.

The doctors wrote that Gleevec entered the US market in 2001 at a price of about US$30,000 (RM98,325) a year, and that since then, the price has tripled even as Gleevec has faced competition from five newer drugs, which are even more expensive.

“If you are making US$3bil (RM9.8bil) a year on Gleevec, could you get by with US$2bil (RM6.6bil)?” said Dr Druker in an interview. “When do you cross the line from essential profits to profiteering?”

Gleevac also became well-known because the Indian government decided not to grant a patent for the drug because it was not sufficiently “novel”, a decision upheld by the Supreme Court. This opened the way for cheaper generic medicines to be produced.

In fact, there are now several generic medicines for treating various type of cancer in India either because they did not get a patent, or else a compulsory license was issued on a patented drug. The prices of the generic medicines are a fraction of the prices of the branded original products.

Tags / Keywords: Opinion , martin khor

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