Last night I watched a doco on SBS, Prescription for Survival - The Rise of the Superbugs, which was all about drug-resistant diseases. Not something particularly pleasant with dinner, but it’s an interesting topic — if by interesting you mean blood-freezingly awful.
One really disturbing fact presented by the doco was that up to one third of all people on the planet are infected with TB. That doesn’t mean they will all develop TB, but it’s a terrifying statistic. Another terrifying statistic is that after HIV/AIDS, TB is the second most deadly disease in the world, killing some two million people each year. Malaria is the third, killing a mere one million.
The development of antibiotics — TB is caused by a bacteria, whilst HIV is a virus and Malaria is caused by a protozoan parasite — was supposed to be the end of bacterial disease. Unfortunately, thanks to the whole ’survival of the fittest’ paradigm, nature has sidestepped even our most powerful anti-bacterial drugs and now a whole host of horrible diseases are multiple drug resistant (MDR). These are known, rather euphemistically I think, as Superbugs. (Superdeadlybugs might perhaps be more apt?)
MDR Tuberculosis, the focus of the show, is one of those really, really nasty diseases you just don’t want to catch. If you get the nastiest version of this you will die, and die quickly. If you already have HIV your chances of dying from it are even higher.
Garden-variety TB is still a huge killer in the third world — thanks to poverty, overcrowding, hygiene etc — but MDR TB is on the up-and-up, along with MDR staph infections and other nasties. Bad.
What alarmed me even more than all this information — and let’s face it, deadly, drug-resistant bacterial infections are terrifying enough without any additional alarming factoids — is that the drug companies don’t seem to be working very hard to find new drugs to fight these Superbugs. At the moment, the profits just aren’t there.
The profits are in fact in making things like anti-obesity drugs, cholesterol lowering compounds, erectile aids, depression treatments and so forth. Something like a new anti-bacterial drug is something people don’t take very often, and the profit margins just aren’t there in making a drug primarily for poor folks in Africa and Asia. Unlike say, an anti-depressant in the west that a wealthy person will take every day of their life.
While I’m not a raging socialist it seems to me that the unfettered free market is supremely unsuited to providing drugs that will work on MDR diseases. For a start, we may well be facing a serious problem with MDR diseases world-wide in the next few decades. Until then, like MDR TB, these diseases will mostly affect those who already live in poverty. So there’s no profit motive in making a drug that will be given primarily to people who can’t afford to pay for it.
The counter-argument to this is also quite sickening, and that is that because these diseases will affect the west in the next few years we should develop the drugs for our own good. This riles me precisely because it places the value of a life in the west above the value of a life in the third world. My life is worth more because I can pay for a life-saving drug.
Of course, I’m sure economic rationalists have an answer to this issue: namely that drug companies have to pursue profits so they can afford to subsidise those areas which aren’t profitable.
That’s a fair enough comment, too, but it doesn’t ensure that drug companies are actually following that course of action.
Thankfully there are many people around the world researching new medicines not out of profit motives but out of sheer humanitarian goodness, and let’s hope that with their hard work, we can manage to stay a couple of steps ahead of the mindless but deadly microbes that cause diseases like TB.
(Oh and before anyone starts accusing me of a double-standard with drug companies along the lines of “but you trust ‘em about RU486 why don’t you trust them on other things” I say, with utmost respect, that it is entirely possible to be suspicious of drug companies and their profit motives; and to appreciate advances in medical technology. That’s why all medications need to be thoroughly tested, evaluated, and long-term studies need to be done on their safety, efficiacy, and so on. An average drug takes 10 years of development and testing to reach the market; this is usually a good thing.)
Kate
That’s not true what you say. Drug companies have been great at finding better solutions. In fact most of us wouldn’t alive if it wasn’t for them.
The profit incentive works fabulously in getting them out there and finding new ways to combat diseases.
It costs close to US$1 billion to bring a new drug to market these days. A lot of that money is used to meet the very harsh requirements of he FDA, which delays introduction.
On top of that you the huge but potentially large burden of law suits to consider even if the drug is succesful.
Europe was once the best place for drug discoveries, however once that area was socialized almost all the ground was give to the Americans with India closing in.
The market hasn’t failed us with drugs. The opposite is true.
The vast, vast bulk of new medicines are not brought to market by non-profits. It is drug companies who are doing most of the solid work.
Love them, they keep us alive.
You didn’t read my post at all JC so don’t lecture me on how I should feel about drug companies.
Or rather, you read my post as one long criticism of drug companies when it was nothing of the sort. I do indeed thank my lucky stars for the numerous ways in which I am kept alive by medicine etc; but at the same time a purely for-profit initiative when it comes to making medications to treat diseases currently suffered by the poor and displaced is never going to be enough.
Yes, it is expensive, time consuming and difficult to bring new drugs to market, I appreciate this; also, sometimes, it’s worth doing things even if they are unprofitable.
Oh, you expect us to read your posts now, do you?
I’m reminded of the quote Sam uses in the West Wing about how if Government was in charge of directing scientific discovery, we’d have the world’s best iron lung, but we’d probably never have the polio vaccine.
There’s also the phenomemon that gave us RU486, where a drug developed for one purpose gave us a drug that’s very effective for an entirely unrelated purpose.
So my view would be that government/ societal intervention in this sort of issue would only be a good thing if it is in the sense of funding research labs to do, well, research, without setting goals or directions for them that are too specific. But it may be a good balance to profit-driven companies - giving us the best of both worlds.
Nah — just skim them and make up straw-woman ideological positions of THE LEFT and I’ll be happy.
Indeed — I don’t think we should just have government run chemical labs supplying the happy populace with their soma. I do think private initiative is key.
My point was that a for-profit motive probably isn’t enough and that the classic fre-market paradigm tends to break down when we’re talking about making medicines for people who can’t afford to pay for them. Why do it otherwise?
Interestingly enough, the huge development in anti-biotic medicines were driven by WWI and WWII and the shocking loss of life from infection after both wars.
Like all Australians, I didn’t understand Beazley’s Knowledge Nation, but I think this was something to do with it - research in and of itself = good.
Oh, sorry, I mean: Why don’t you just piss off to China and munch on herbs if you hate the drug companies so much? You see, this is what’s wrong with The Death-loving Left.
Kate
You can’t have it both ways. You slammed Pharma LECTURING US on how markets have failed in areas and then tell us to be suspicious of drug companies. Oh yes, but you reminded us how private firms have helped.
Sorry if I am confused in figuring out if you are for big pharma or you’re against them.
By the way non-profit research is miniscule compared to big pharma. It wouldn’t be enough to copy a new corn med. Most of the research done say by the world’s non-profit is syndicated out by the pharma companies anyway.
Sorry to bust you balloon.
There was great story in the Wall Street Journ. recently about your partnership suggestion and what happens.
Most inoculation type meds are no longer made in the US and have to be imported from the UK. The reason is that the US govt. was screwing the pharma companies down to the bear bone and lawsuits have scared them off. In other words the risk reward ration was shitty for them.
Hence why there been little research done in this area. I would bet that the medicines you are suggesting fall in the same boat.
So don’t look at Pharma when there is a problem. The market works fine. Ask yourself if it is a good thing that the Australian system screws the companies to the bear margin and then ask the US Govt. why it allows Medicare and Medicaid to do the same thing in addition to allowing huge law suits in areas like inoculations where we know there is a tiny risk for some.
The reason way there are holes in certain areas of medicine is because of lack of incentives. A $billion is a lot of money to bring a drug to market for essentially poor people who can’t pay for it. That billion has to come from somewhere.
JC says: “That’s not true what you say. Drug companies have been great at finding better solutions. In fact most of us wouldn’t alive if it wasn’t for them.”
JCs world really is a simple back and white place. Big pharma good, socialised medicine bad. Muslim good, Christian bad.
Of course the real-world does not accord with the cartoonish dichotomies that occupy JCs mind.
Let me introduce four facts.
1/ The biggest gains in health and longevity are the result of good sanitation, nutrition and education. The claim that most of us would not be alive without Big Pharma is false.
2/ Black folk in socialist Cuba have a greater lifespan than black folk in America.
3/ As last night’s show revealed, most Big Pharma companies have opted out of the search for new antibiotics.
4/ Big pharma in America spends more money on advertising than on research and development.
In Australia it is illegal to generate demand for pharmaceuticals through advertising. If America adopted thye same policy the amount of money available for research and development would double overnight.
I can’t have it both ways? Says who? There’s such a thing as nuance jc. I can criticise big pharma for one thing and applaud it for another — there’s no inconsistency there.
Again, you haven’t read what I wrote, you’ve extrapolated entirely in your own imagination an argument I haven’t made. I’m not “slamming big pharma”, I’m suggesting fiscal gain is not always the best reason to do something.
“The reason way there are holes in certain areas of medicine is because of lack of incentives. A $billion is a lot of money to bring a drug to market for essentially poor people who can’t pay for it. That billion has to come from somewhere.”
Um so you realise you’re just echoing my point? That’s what I said. Der. I agree, the money has to come from somewhere — but I would politely suggest that the profit margins in the big pharma companies such as Pfizer (which made $11.3 billion US profit in 2005) could also do this. I’m not saying there isn’t r&d going on, far from it, but that there could be more.
In fact, there hasn’t been a new antibiotic released onto the market for 30 years.
And I’m not talking about non-profit organisations per se but rather organisations doing things not necessarily for an immediate profit. *shakes head*
Really, you’ve just made up in your head an entire post I didn’t actually write because you think I have this position on big pharma which I actually don’t.
And what is a bear margin? Is it like a bear market?
Helena
Please stay on the sidelines and correct peoples’ grammar, big gal, as that’s where you are needed most it seems.
Kate
You said
‘but I would politely suggest that the profit margins in the big pharma companies such as Pfizer (which made $11.3 billion US profit in 2005) could also do this“.
You can’t tell from their bottom line what the margins were as you don’t know from that alone. Parma companies have been trading at big multiples in the US because investors believe there is plenty of scope for them to hit the big one in terms of discoveries. Believe me, you wouldn’t buy Pfizer because of its dividend policy.
The 11 odd Bill Pfizer made last year is by taking big calculated risks. The dividend would be no bigger than 10% of that which would translate to about 3% as a return on an investor’s money. The rest of the profit is ploughed back into R&D.
Pfizer does a lot of non- profit donations- in the third world particularly. They would be able to do more if countries like Australia didn’t screw them on prices all the time.
There just isn’t room to be literally giving away any portion of that money because it is unlikely to be recovered.
The only way you will get the drugs you wnat for the diseases you prefer to see eradicated is if they had incentives to make them. It isn’t their fault and its not the market either, as you suggested it was.
I think Kate was raising the matter so that people could discuss who/what is to blame and come up with solutions?
Is that something you are capable of jc?
Kate, have you seen the Constant Gardener? It’s well worth a look and still playing at Luna or the Astor or one of those.
Steve Munn
Do you ever, ever think past your socialist garbage that you sprout out as though the soviet union still exits and is doing fine.
You are either ignorant or totally dishonest. I would suggest you are both.
Steve Munn
The biggest gains in health and longevity are the result of good sanitation, nutrition and education. The claim that most of us would not be alive without Big Pharma is false.
Me
This is simply dishonest and doesn’t derserve an argument. Love to see how you would live without drugs when you needed them. How about you have your shower each day, wash your hands after going to the toilet. If you get a serious disease follow that advice. Don’t worry, I am sure you’ll be fine just showering and handwashing if you get ill.
Steve Munn
Black folk in socialist Cuba have a greater lifespan than black folk in America.
Me
This is an insane statement
In steve Munn’s world let’s do away with pharma as we don’t need it. We’ll just do a black magic song and dance with the local witch doctor and presto, the black cuban’s lymphoma will just go away.
Cuba does not have the money to spend on drugs. Read it again. Their stats are a lie!
Steve Munn
As last night’s show revealed, most Big Pharma companies have opted out of the search for new antibiotics.
Me
They have been hounded out of it because countries like Australia would refuse to buy new anti- biotics as they force us on 30 year old retreads- generics.
They have been told that new versions of anti-biotics will not be bought at higher prces that are needed to justify research. In addition the authorities that determine what comes into the markets have told the pharmas that resistence hasn’t built up enough with generics to justify on patent anti-biotics. In other words their incentive has being blown away.
Steve Munn
Big pharma in America spends more money on advertising than on research and development
You are being dishonest or ignorant.
Looking at it from a financial side of things. If this were true Pharma would not be trading at big multiples and henc a low divident because investors would shun companies that behaved that way. R&D is what is giving these companies high valuations……. It is not advertising! This is hilarious.
Day’s too short to start up on your grammar, jc.
Bear with a sore head?
Anna
Most of the diseases Kate was talking about like TB exist in the third world.
The solution is pretty dull and boring.
Get these countries growth rates up so that their medical systems are able to afford and signal the market they can afford to pay for new medicines.
It is also not true that there are no on-patent anti-biotics. There are a few. However a doctor has to call Canberra to get the ok before he can write a script.
Dear third world
Start contributing to the economy, or die.
Love, jc.
Anna
Not very funny so try again.
And your solution is, what exactly?
Anna
How do you think Australia is able to afford its medical system? Do you think its free? Do you think the 12 bucks you paid for those anti-biotics is not subsidized by the taxpayer? You think that’s free?
I would have have thought that the only way we can afford these drugs is….. because we are wealthy enough to be abe to afford them. Am I on the wrong track here?
JC, so you’re opposed to any possible humanitarian activities by drug companies then? Say subsidising the costs of developing new antibiotics from the profits of something like, I dunno, Viagra?
Anyway it’s a stupid argument you’re having with yourself because no-one here is opposed to helping third world countries become economically independent. In the meantime, lots of people are dying and its possible increased r&d spending could result in drugs that could save lives.
I think that part of the problem, Kate is that sometimes big pharma doesn’t get the credit for the good stuff that they actually do when there isn’t much of a profit motive.
There is an interesting post at Chris Lawson’s blog on exactly this topic - the development of a couple of rotavirus vaccines which have only a limited commercial value to the companies concerned.
This is not to say that I’m defending big Pharma, by the way.
I think that they are a bunch of evil minded bastards who’d have paying 10 bucks a go for aspirin if they thought they could get away with it.
But even evil minded bastards occasionally get it right.
Did you read that bit jc? There’s hope for you yet.
Nick
Thanks for the post, Kim. TB used to be a terrible scourge in Western countries up until the 1950s but its reduction to a very minor health issue in them was not through the development of antibiotics, used to treat the active disease, so much as the development of vaccines, given before infection, to provide immunity from infection through a vigorous public health campaign. Reduced poverty, improved sanitation and improved nutrition also paid a significant part, as Steve Munn has noted.
In the 1950s and 60s there was a concerted campaign to eliminate tuberculosis. Mass X-Ray screenings were conducted and the Mantoux test was given to kids. Those with active TB were treated. Those who tested negative got a BCG inoculation (around 80% effective in providing long-term immunity) while those who tested positive but had latent, rather than active TB, got twenty years of compulsory annual X-Ray check-ups to see that they hadn’t developed the active disease. If they did then they were treated with antibiotics.
By the 1980s the campaign had been so effective that the disease was almost eradicated. Currently there are about 1000 cases of active TB reported in Australia every year, 85% of which are in persons who have come to Australia as migrants or long term-visitors.
A 90% percent inoculation rate of an 80% effective vaccine means that 72% of the population will not get the disease, will not be carriers of it and will not spread it. Of the remaining 28%, because of the high level of population immunity they will be much less likely to be exposed to it and therefore to have it in either its latent or active form. That leaves a smaller population to monitor than would otherwise be the case without high levels of immunity, and correspondingly smaller numbers to treat with drugs to cure infection.
This is important because, as you will be aware, the treatment regime to cure TB is problematic as it requires the patient to take the drugs over several months under observation to ensure they complete the treatment regime, so that they achieve a cure and they don’t give up too early, leaving them uncured and possibly with a drug-resistant form of the disease
One of the really frustrating things about TB and other infectious diseases in Third World countries is that the methodologies for their elimination or suppression are a cheap and extremely cost-effective and have been around for a very long time. They rely upon a pretty basic primary health care network but then the primary health care network in Australia back 50 years ago was pretty basic. However such campaigns have not been effectively executed in many of those countries. Our concern about TB shouldn’t be so much with the cost of new drugs to treat MDR TB as with getting effective public health delivery in place for the inoculation of the vast majority so they won’t get TB at all and monitoring and treatment of the rest, the great majority of whom are infected by non-MRD TB strains.
Kate
Look who’s arguing with themselves? Did you bother reading this comment I made:
“Pfizer does a lot of non- profit donations- in the third world particularly. They would be able to do more if countries like Australia didn’t screw them on prices all the time�.
Or is it just better to ignore it and then make this rhetorical statement, which is really not an honest question at all:
“JC, so you’re opposed to any possible humanitarian activities by drug companies then? “
Which surprises me in a way because it doesn’t seem you understand much about it at all other than the program you watched last night.
Kate, you know what the problem is? The problem is that there are far too many poor countries in the world that aren’t able to fund 1st world health care systems. Ours costs about 8% of GDP. The US costs about 13% of GDP. Poor countries could spend 50% of GDP and still not be able to match our system in terms of what is on offer. They need to get richer before that can be achieved unfortunately, despite the fact that Anna chooses to ignore reality.
Hey Nick
You want to explain this:
“But even evil minded bastards occasionally get it right.
Did you read that bit jc? There’s hope for you yet.”
It’s pretty cowardly and weakminded of you to make a comment like that without backing up your shiity comments.
Then again abuse on this site is fine as long as it’s directed to non-cult members.
Screw you, Nick.
Kate, first my sincere apologies for mistakenly calling you Kim.
One other thing, I didn’t see the SBS program but I wonder about your statement:
That is truly surprising and I have to treat it with extreme scepticism. While I can understand how it might be true for MDR TB, I can’t see how it could be true for other MDR strains such as MDR golden staph. That is very much an endemic First-World hospital problem and has been for over 25 years. It has huge cost implications for hosptals because of its effects on the risks to surgery caused by untreatable post-operative infections.
It’s not considered a good medical outcome when a patient has successful quadruple bypass surgery (not widely performed in the Third World) but the dies of a staph infection a few days or weeks later, having occupied a hugely expensive bed in Intensive Care. There would have to be a huge and lucrative market for drugs that eliminate that outcome.
Nick, also
If you are going to plagarize properly, I would suggest you don’t link to the site. That way you can pretend they are all your ideas and when you throw abuse out it may actually seem it’s based on original thinking rather than a cheap shot on “borrowed” themes.
Nick, jc,
Stoushing is a fine art especially when done in the spirit of rational disagreement and civil interchange. You are both stepping outside the bounds of civility. Disagree by all means but keep it civil.
Hey Shaun
I suggest you direct your comments to the plagarizer, not me.
I didn’t start it, he did!
I have been posting on the site for a while and you would be aware that I have never abused anyone on this site. Take a look and please correct me if I’m wrong.
However, the cowardly palgarizer decided he was going to get at me. Take a look.
So, I would suggest you tell it as it is rather than how you think it should look.
jc,
I don’t care who started it. I assume you and Nick are both adults so tone it down and be all civil like. And I have no idea what you mean by accusation of plagarism. I can’t see any lifting of text from the link verbatim in Nick’s post without acknowledgement.
Shaun
Read his link. After that read his comments. Then tell me with a straight face it wasn’t a lift while adding the abuse directed to me (that may have been copied from somewhere too). The guy was so stupid he linked the lifted summary.
You should! care who started it because a stoush gets going when the first guy throws a punch. So direct your comments to the Plagarizer and not me please.
If a creep like that says that to me it deserves and will get he same response.
jc,
If we were to censure people for linking to posts that reflect thier opinions or for edification’s sake there would be no-one left commenting on blogs. Nick has done nothing wrong I can see with regards to offering the link to support his opinions.
The attack on you was not warranted. However responding in kind doesn’t help life the tone either. Get back to debating Kate’s post in civil disagreement or agreement if that be the case.
Shaun
I’m not suggesting you censure him. He can lift anything he likes and present it as his own. I’m not going to stop him from plagiarizing. But then you can’t stop me from bringing out in the open.
Read this again:
“I think that part of the problem, Kate is that sometimes big pharma doesn’t get the credit for the good stuff that they actually do when there isn’t much of a profit motive.
There is an interesting post at Chris Lawson’s blog on exactly this topic - the development of a couple of rotavirus vaccines which have only a limited commercial value to the companies concerned.
This is not to say that I’m defending big Pharma, by the way.
I think that they are a bunch of evil minded bastards who’d have paying 10 bucks a go for aspirin if they thought they could get away with it�.
Now read the link. The plagiarizer has simply shortened what the link was saying and then pretends he is using the link as support for his comments.
He doesn’t say anything that suggests his views were taken from the link. He simply purports to use it to support his comment. That’s plagiarizing in my book. You can differ but it doesn’t change reality.
I don’t abuse people on this site and would be happy to see you can prove me wrong. But I am sure you can’t.
So stop treating the situation equally. It isn’t and you know it.
You could have treated it differently by warning that coward while suggesting I ough not respond. But you didn’t and treated us equally. My repsonse was as a result of a provocation and therefore you oughtt to direct your comments to the copycat.
JC, I don’t believe you know what you are talking about. I protest your accusation that I am a liar when each claim I have made is a matter of public record. Let me contest some of your claims and provide references.
JC Myth No 1. “In fact most of us wouldn’t alive if it wasn’t for them [drug companies].”
FACT: Vietnam has a per capita GDP of just $US 2,847 and a life expectancy of 68 for men and 74 for women. Per capita health expenditure is just $US 148. Obviously widespread access to pharmaceuticals is not possible in such a poor country with minimal health expenditure. In the USA, which has a GDP more than 15 times Vietnams, life expectancy is 75 for men and 80 for women. This is hardly an enormous difference. As I previously said, sanitation, education and good diet have contributed more to life expectancy than drugs. (1)
JC Myth No 2 “The market hasn’t failed us with drugs. The opposite is true.”
FACT: Big drug companies are not an example of the free market at work as you claim. In truth you have a handful of large companies that constitute an oligopoly. In the US they corrupt the political process and restrict true competition through massive lobbying and political donations. (2)(4)
JC Myth No 3. “The vast, vast bulk of new medicines are not brought to market by non-profits. It is drug companies who are doing most of the solid work.”
FACT: One-third of new drugs in the US were developed in public institutions or small private research bodies. 75% of new drugs produced by the private sector are simple adaptions of generics which offer little or no health gain. Some are actually worse than the generics. (2)
JC Myth No 4. Drug companies don’y make huge profits- “The 11 odd Bill Pfizer made last year is by taking big calculated risks. The dividend would be no bigger than 10% of that which would translate to about 3% as a return on an investor’s money.”
FACT: The top 10 US drug companies make bigger profits than all other fortune 500 companies combined. The profit margin is a massive 17% of sales. This compares with a median profit figure of 3.3% for fortune 500 companies. (2) (3)
JC Myth No 5. Drug companies spend less on advertising than they do on research and development.
FACT: Drug companies in the US spends 2.5 times the amount on marketing and admin that it spends on R&D. The two largest companies spend more on advertising than Coca-Cola, McDonalds and Toyota. (2) (4)
As I said previously, all you need do is ban the advertising of drugs and you would immediately double the research and devlopment budgets of the big drug companies.
(1) WHO website data for Vietnam at http://www.who.int/countries/vnm/en/
WHO website data for the USA at http://www.who.int/countries/usa/en/
(2)Mother Jones article at http://www.motherjones.com/news/qa/2004/09/09_401.html
(3) http://counsellingresource.com/medications/discount-drugs/
(4) http://72.14.207.104/search?q=cache:vEivDEY4hmAJ:www.citizen.org/documents/Pharma_Report.pdf “marketing costs” drug company profits United States &hl=en&gl=au&ct=clnk&cd=3
Steve Munn, for Vietnam you might alsomention that it has a pretty efficient public primary health care system. That means that kids get inoculated against the common infectious diseases and thos e with active TB get treated with proper protocols (DOTS) and with proper follow up.
That’s not (entirely) due to the system of government they have. They hugely respect the work of Alexander Yersin, a protege of Louis Pasteur, who laid the foundations of their public health system in the 19th century while they were a French colony.
You left out Cuba’s wonderful medical system yet seemed so happy to bring up and then switched over to Vietnam. Wonderin’ why?
Vietnam life expect. Australia life expect
male 68 78
female 74 84
Three points
1. If you don’t think 10 years isn’t a long time, then I don’t know what to say to you.
2. There are more people with a history of smoking in Australia than Vietnam, which would make life expect. Longer if they didn’t smoke or eat bad stuff.
Researchers are saying that the big wall (the barrier) that is hard to brake through is 85 years. We are reaching that now in Australia and await continued research to improve this. I somehow doubt Vietnam is going to get there first.
Munn says
Big drug companies are not an example of the free market at work as you claim. In truth you have a handful of large companies that constitute an oligopoly. In the US they corrupt the political process and restrict true competition through massive lobbying and political donations
I say
They have in order to get through the massive obstacles of regulations.
Munn says
One-third of new drugs in the US were developed in public institutions or small private research bodies. 75% of new drugs produced by the private sector are simple adaptions of generics which offer little or no health gain. Some are actually worse than the generics.
I say
Bullshit. Pharma most often funds non-profit research. In fact almost always, otherwise US research would be in the same sinkhole as European research, which was once leading the world until they got screwed.
Steve Munn says
Drug companies don’y make huge profits- “The 11 odd Bill Pfizer made last year is by taking big calculated risks. The dividend would be no bigger than 10% of that which would translate to about 3% as a return on an investor’s money.�
I say
Read my comments again. I said they trade on large multiples as investors are buying a lot of blue sky. Return on present value investment in a pharma company is small unless investors factored in the hope of new products. Most of that money IS NOT GOING BACK TO SHAREHOLDERS. It’s being reinvested in R&D.
Steve Munn says
The top 10 US drug companies make bigger profits than all other fortune 500 companies combined. The profit margin is a massive 17% of sales. This compares with a median profit figure of 3.3% for fortune 500 companies. (2) (3)
I say.
That’s great. So more R&D will be spent on stuff that can make us live longer.
Steve Munn says
Drug companies in the US spends 2.5 times the amount on marketing and admin that it spends on R&D. The two largest companies spend more on advertising than Coca-Cola, McDonalds and Toyota
I say
That’s bullshit and would come out of Mother Jones, I’m sure. Johnson& Johnson through recent acqusitions is now treated as a pharma company and trades on the same mutliples. It also makes nappies and tissues that are purely consumer items. Mother Jones takes that ad $ into the mix and then tries to slam thte industry. It’s bullshit and disgraceful. Sure they advertize things like anti- smoking devices and so they should to try and convince people to stop smoking.
They don’t advertise life giving drugs all that heavily like oncology pharms. So your point is milsleading at best or deliberately dishonest.
I stand by what I said earlier. Your early comments were crap and your new ´facts’ are nonsense as well.
Steve Munn says
“The top 10 US drug companies make bigger profits than all other fortune 500 companies combined”.
There are obviously far firms more than the “top ten”. So then, how do you make this comment:
“In truth you have a handful of large companies that constitute an oligopoly”.
So there are more than a handful of firms according to you, which hardly makes the business and oligopoly as you state.
Steve One last thing
Patents have a legal life of about 5 years in the US after which they go generic and profit margins get slashed.
These companies wouldn’t be making huge profits as you called them if they weren’t innovative because their patents would have run out.
That means they are constantly coming out with new stuff underpinning these “huge profits” you accuse them of making.
It means they are spending oodles of cash on R&D in order to support their high profits and hence high multiples.
Well JC, you certainly have a talent for swearing and calling people liars, even when they furnish evidence. I’m glad I don’t live in your household.
I chose to highlight Vietnam because I am most familiar with that country, having been there four times. Also, my partner is Vietnamese. Satisfied?
Your claim about smoking and Vietnam is untrue. Men in Vietnam are very heavy smokers.
R&D expenditure is outstripped by profits. The references I gave you make this clear. You can say “bullshit”, “crap”, “liar” if you like but it is a matter of public record.
Life expectancy in Cuba is women 75 and men 79.
In America it is women 75 and men 80.
In other words, it is practically identical. My claim that blacks have a longer life expectancy in Cuba than in America is simply a non-contentious matter of public record. I also thought it was common knowledge among erudite folk that the US health system is a shambles and blacks die at a relatively low age. I’m surprised you don’t know this.
You can check that I am telling the truth by going to the WHO website at http://www.who.int/countries/
The Mother Jones article you have labelled bullshit without reading is written by a doctor who wrote a book on the issue of drug companies and their rackets entitled “The Truth About Drug Companies: How They Deceive Us and What to Do About It”. It isn’t simply made up.
Literally hundreds of Google websites mention the fact that drug companies in the US spend more on marketing than on R&D. Some of them directly reference drug company financial disclosures as the source of the information. If you have information that these financial disclosures are innaccurate the American stock exchange would love to hear from you.
Also, I am not and never have been a socialist. Don’t make childish accusations.
How about you stop swearing and provide a reasoned case backed up by references?
Yours with respect.
Steve Munn
The Truth About Drug Companies says Mr Munn is right.
Steve Munn says
“My claim that blacks have a longer life expectancy in Cuba than in America is simply a non-contentious matter of public record”.
Yes, that’s right, let’s use the most endangered group in the US as a result of violence and hard drugs and compare that group to…..errr Cuba to see how life expect. compares. Good one Steve.
What happened to Vietnam, now? You’re back in Cuba.
Steve Munn says
R&D expenditure is outstripped by profits.
I say
Of course it is. Otherwise how would these companies pay salaries, dividends and stationary? Profits have to outstrip other costs and R&D.
Steve Munn says
The Mother Jones article you have labelled bullshit without reading is written by a doctor who wrote a book on the issue of drug companies and their rackets entitled “The Truth About Drug Companies: How They Deceive Us and What to Do About It�. It isn’t simply made up.
I say
So what if he is a doctor. That’s a meaningless point. Docs know sweet f…. a how Pharma works other than getting notified about drugs.
Steve Munn says
Literally hundreds of Google websites mention the fact that drug companies in the US spend more on marketing than on R&D. Some of them directly reference drug company financial disclosures as the source of the information.
I say
Tell me how Johnson& Johnson ad $ are shown. Are they broken down between consumerables and pharma. No they are not. I ahve said this before. Heavily adverized products are consumerables. This is dishonest portrayal as to how Pharma spends its ad$
Ok steve, so what you are really saysing is that we ought to do away with our lifesaving grugs and live like all those healthy Vietnamese. Who gives a crapper about another 10 years life expect., right?
And don’t forget to wash your hands every time you go to the toilet.
And the Wall street journal ays he’s wrong
MRSA is resistant to antibiotics because it puts up an impenetrable film around itself. No matter what antibiotic is developed, it won’t be able to pentrate the biofilm. There is only one thing that can pentrate these biofilms, and that is silkworm enzyme (serrapeptase). It’s the enzyme that the silkworm uses to break out of its tough cocoon. Its been around in Europe and Japan for 20 or so years but for some reason it’s off the medical radar in the US and Australia. Its not even on the TGA register. What do we have to do to get this substance tested and approved in Australia?
I’ll take my right of reply, I think, folks.
jc, if you were genuinely offended by what was intended to be a light hearted crack about evil minded bastards then I apologise. The tone of of comments on this blog has been, in my experience, one where throw away lines like that one don’t cause substantial offense. If I have, however, I apologise unreservedly.
Having said that, I’m not impressed with the tone of your response, jc. If you were genuinely offended by my comments, a ‘calm down, mate’ would have done the trick. As you can see, I don’t have a problem with apologising and retracting earlier comments.
Your accusation is of plagiarism is manifestly false - I stated an opinion, and linked through to another blog in support of that opinion. The wikipedia definition of plagiarism is (in part)
At what point did I pass Chris Lawson’s writing as my own? I expressed a similar opinion as Chris, because I happen to agree with him. I linked to his post (deliberately, jc, I rarely accidently indulge in html coding, however simple) because he supported my view, and because I thought that his post might be interesting to other readers of LP.
That isn’t plagiarism, jc, it’s supporting an argument with a more authoritative source. It happens all the time in universities, and almost no-one gets thrown out for it - even if other people don’t agree with their argument.
Now, jc, you’ll notice I linked to wikipedia before quoting their definition of plagiarism. That isn’t plagiarism either.
I’m going to be charitable and assume that the reason you defined plagiarism incorrectly is that your poor spelling meant you couldn’t look it up yourself before posting your original reply.
But I linked direct to wikipedia for another reason. If you still don’t agree, and you want to continue the argument, you can have a go at changing their definition to better fit your own reality and see how far you get.
jc says
“Marcia Angell is a Senior Lecturer in Social Medicine at Harvard Medical School. A physician, she is a former Editor in Chief of The New England Journal of Medicine. Her latest book is The Truth About the Drug Companies: How They Deceive Us and What to Do About It. (October 2005)” http://www.nybooks.com/authors/10553
Seems like you ‘mouth’ off without checking the most basic facts every time I bother to read your comments, jc. Is this a deliberate ploy? I only ask because it’s bloody annoying to have commenters buzzing around with such nonexistant credibility.
DK
Thanks for proving my point. She’s a doctor and probably a good one. The NEJ of M is a medical journal not a pharm periodical as you must know.
Thanks for truncating two very separate comments I made. The Wall Street journal comment has nothing to do with the other comment preceding it in your post. Yet you showed it as though it was joined.
So I repeat your comment to me:
Is this a deliberate ploy? I only ask because it’s bloody annoying to have commenters buzzing around with such nonexistant credibility.
I would add dishonesty somewhere it would make sense in realtion to what you were trying to do.
Nick
Thanks for the apology.
However I don’t accept your explanation in what you did. Your comment was summary of the link you provided. You didn’t attribute that summary to the link. People who read your post would consider what was said as coming from you.
It wasn’t as t didn’t originate from you if one read the link.
Thanks for the Wiki standard though and appreciate the spelling correction. Next time I’ll ask you how to spell that word as you seem to know it well.
I’m not adjudicating this one, but I’d add my support to the voices calling for civility. It should be possible to disagree without using epithets. I’d also ask people to read what the post and what other comments say before responding. If you want to post thoughts on the issue which are your own, and even slightly tangential to the post itself or the previous discussion, that’s more than welcome, but if you want to respond to others, it’s a courtesy to accept their characterisation of what they are trying to say.
DK
Thanks for the link. Glanced at it and found three probs already
1 Clarityn’s price was raised several times over the years the corp. held a patent. Well swing me over the mountain! A company brings a new drug onto the market isn’t sure at first what demand is like. Finds the drug sells like hot cakes but according to her it shouldn’t raise the price, which is totally at odds with how free markets are supposed to work. Ever heard of profit maximization? She hasn’t obviously. This is evil according to her, right? Both of you are dreaming. The initial launce was a process of price discovery. It was a good drug and lot’s of people bought it.
2. Not much innovation she says. Yet with the same breath she says that lots of discoveries are made by small biotech firms and research institutes.
As though small biotech isn’t part of the industry, right? It so happens that when they are successful big pharma buys them out at big multiples. I know, as I have owned shares in a few of these companies. As shareholders we pray to get taken over. She also “missed� the collaboration that usually goes into big pharma and the “littlies� and the research groups that are often funded by pharma to do the work.
3. She makes out that patents are not an intellectual right not just for pharma. She pretends it is a privilege. It’s not a privelege, it is a right fro anyone.
It’s late and hope these 3 three are enough for now.
“I’m not adjudicating this one, but I’d add my support to the voices calling for civility”.
Why not? They’re swarming me like flies. So maybe go read the bloody thread and apportion blame the way it ought to be.
I’ll heed your call for civility, Mark.
If you want to continue this exchange, jc, I’ll open up a thread on my own blog, and you can display your ignorance of basic academic standards there.
Crikey! One goes away for a few hours and all hell breaks lose. (In my defense, I was asleep, ok?)
JC, I’d appreciate it if you toned down the righteous indignation a tad. I posted this not as an attack on big pharma — well, not entirely — and if you weren’t so busy acting offended on their behalf you might have noticed that I did write about all the good research that is being done.
(Though I think it’s sweet that you’re defending huge multinational billion dollar companies against ohh, one or two lefties who raise some concerns about the free market and how drugs are developed — I hope you’re on Pfizer and GlaxoWelcome’s Christmas Card list).
Now, it would be nice if we could discuss this in a civil and adult manner. Thank you.
Steve,
I’m disturbed by the thought that simply banning pharmaceutical advertising would double big pharma R&D budgets. I can only assume you’ve crunched the numbers on how many sales would be lost as a result (that is, the total negative revenue effect of banning advertising), and how R&D budgets fluctuate according to overall revenue? If you didn’t do the numbers yourself, a link would be great.
Cheers
ab
Just to clean up a few misapprehensions about my views on medical research that popped up: I’m all for it. And I’m all for big companies doing it. And I know that Big Pharma does good work, and I also know that their primary motivation is profit — but that doesn’t mean that profit-making is incompatible with innovation.
My point was that the search for new antibiotics has stalled, and one of the big reasons for this is that they aren’t profitable medicines to make, especially in comparison to “lifestyle” pharmacueticals sold to wealth first-world customers. I never claimed that Big Pharma isn’t doing any research at all, or that Big Pharma is evil, or that Big Pharma wants poor people to die.
This is not a dig at Big Pharma specifically but rather at the idea that the free market can provide solutions for all problems. The problem is that if something isn’t profitable, what’s the reason to do it? And selling drugs to poor people isn’t terribly profitable — so under a free market paradigm why bother?
My answer, and the answer of numerous other individuals and research bodies around the world, is “because it’s a good thing to do nonetheless”. And there are lots and lots of people, institutions and companies doing good worth JUST BECAUSE it’s a worthwhile goal to try and reduce the numbers of people who die from diseases like TB and malaria and HIV.
Unfortunately, add to the mix these so-called Superbugs and things become even more complicated — another reason why antibiotic research stalled was because the medical profession genuinely believe we had the war on microbes won. But as HIV in the 80s and now MDR resistant strains of old diseases like TB indicate, we had a minor victory in a small skirmish, and now nature is rearming.
There aren’t any simple solutions, but with other potential disease threats sich as Avian Flu and those exotic African haemorraghing viruses, the need for ongoing research and development is paramount.
I don’t think you need worry about people misunderstanding your post, Kate. It was very well written, and I think all but one person understand clearly what you meant.
Kate
“JC, I’d appreciate it if you toned down the righteous indignation a tad”
Tell that to the swarming files, thanks very much. And I’d appreciate it if you toned down your own self-righteous comments towards me.
Go read the read the thread and then tell me if I am the only one not living up to your standards. Shaun, at least was even-handed. You don’t even pretend to be.
“I think it’s sweet that you’re defending huge multinational billion dollar companies”
I’ll defend them if I consider the criticism leveled towards them is unfair and ignores reality. Your comments fall in that category
I know enough as an investor in small Pharma to have some awareness how it works and your criticisms along with that program were unfair and simply incorrect. I clearly explained to you why little work has been done in the area of antibiotics but you chose to ignore. I will repeat again if you want.
Nick
I couldn’t give a crap whose work you copy. It would just be nice to see attribution.
Which is what Anna, that big pharma is only a little evil rather than lucifer in disguise?
There is nothing remotely evil about big Pharma. They earn lot’s of money because they introduce life saving products and the work they do is intellectually difficult.
Rather than criticise these companies they ought to be celebrated for their achievments.
JC, you didn’t read my original post AT ALL which is why I am frustrated. You completely misunderstood me and my subsequent efforts to point out my meaning. Again you ignore my comments about the state of of medical research.
I don’t see that accusing people of plagiarism is exactly fair play, or calling people liars, and so on.
jc, go and look over here - there’s a post dedicated entirely to you, where you may be as insulting and stubborn as you wish.
You’ve made your point to Kate, move on now.
Anna
He comments were a summary of the link. They weren’t his ideas. Call it what you like, it’s copying.
He was rude to me first without provocation. I didn’t know who he was until I read his idiotic swipe at me. See this:
“Did you read that bit jc? There’s hope for you yet.”
No explanation, no nothing. Just this rude comment, which goes to show that he doesn’t understand what he is saying and “copied” the link through his summary.
Metacomments and disputes over “who said what first” are inevitably tedious. If you want to continue it, jc, or anyone else, I invite you to follow Anna’s advice and go over to Nick’s place on a thread that is directly about this stoush.
jc, Mark, et al, I apologise for the (drunken) snark last night.
I do wonder, jc, if an academic doesn’t know about how pharma works, what qualifications do people need to talk about pharma? Do you have them?
I’m very wary of uncritically celebrating big pharma companies for reasons I’ve raised here before; namely that science doesn’t work properly when researchers don’t have access to their colleagues results. Making ‘dead ends’ of knowledge like that should be minimised. Also, I’m not convinced that poor sick people = no profit motive. NGOs and governments pay for medicine too.
dk.au, no need to apologise to this et al. I thought your snark last night was fair enough.
The line of the thread took us away from the point that interests me, that it doesn’t matter what miracle cure Big Pharma produced for MDR TB it would be a waste of time unless at the delivery-end health care providers can ensure that it’s delivered effectively, something that Big Pharma is not responsible for.
Big Pharma did, in fact, develop effective drugs to cure TB. They had a 90% cure rate if correctly administered. According to the WHO MDR TB strains arose because of a failure to deliver the drugs to the point of achieving that cure by the delivery providers.
I do not (entirely) criticise the delivery providers for this. As I commented earlier:
However if I were a Big Pharma executive I would wonder what the point would be in developing another miracle drug when it won’t provide a cure because of faulty delivery and I knew that there would be a chorus of harpies in the background criticising me for that failure of the drug because in their minds its always Big Pharma’s fault and never their own.
On your question;
An academic at a Business School, with significant business experience would be qualified to talk about how Big Pharma works and should work. Other academics, in general, would not.
GregM,
I think dk’s snark was about jc’s writing off a doctor with significant industry experience as unqualified to comment on working of big pharma.
Without reading her book, it’s difficult to judge how well researched it actually is - but I think you’d agree GregM that, on the face of it, the former editor of the NEJM is in a position to add to the debate on the developement of medicines.
But your own point is a good one also - it probably would take an economic analyst with significant industry experience to make sense of the decisions that big pharma make.
But I think that this reflects the tension that Kate was originally trying to highlight. It’s difficult to know on what basis these decisions are being made - it’s easy to read conspiracy theories in to the decisions that the big corporates make, particularly when you have the proven cases of tobacco, asbestos and others as a point of reference.
I don’t think (despite my earlier, ill judged, crack) that every decision made by big pharma is necessarily wrong and evil. I do think, however, that they make the bulk of their decisions based on their economic needs, and that this doesn’t always lead to the best outcome from a social health basis.
The challenge is for Government, and the international community, to set policy which achnowledges their profit motives whilst still leads to the best general outcomes for disease control.
And I’d suggest that, in doing this, international Intellectual Property Law is one area we need to be paying real close attention to.
Sorry too Mark
This is a brief explanation of what Big Pharma does.
There is a grain of truth that it is not very innovative. That’s because big institutional investor