At least, the title of this post is typical of the mantra against the practices of drug pharmaceutical companies, according to Peter W. Huber’s “Of Pills and Profits: In Defense of Big Pharma,” in Commentary magazine (HT: Arts & Letters Daily).
Huber, a senior fellow of the Manhattan Institute, summarizes in brief the anti-drug company argument, and then goes on to examine what truth there is in such claims. He says of the difference between creating and administering drugs, “Getting drug policy right depends mainly on getting that difference straight—the difference, that is, between ministering to the sick and making medicines—and grasping its implications from the start. Big Pharma’s critics do not even try.”
He goes on:
Pricing is indeed the key. Whether the first pill typically costs $100 million or $1 billion to develop, replicating it costs less—a thousand times less, or perhaps a million times less. This slope—precipice, really—is far steeper than most of the other hills and valleys of economic life. It complicates things immeasurably. It also largely explains the gulf between the industry’s perception of reality and that of the critics.
Huber gives some explanation of the function of the price mechanism in pharmaceutical markets, and says, “Economists have established—as rigorously as things ever get established by the dismal science—that there is no efficient price, no ‘right’ price. Any scheme is, from one perspective or another, inefficient, unreasonable, or worse.” He argues that the high prices for boutique drugs like Viagra in the developed world help fund the provision of desperately needed drugs in the developing world. This is the situation created by so-called “price discrimination”.
The situation he says, is similar to that of airline travel: “Business travelers get soaked, college students fly almost for free, and the jumble of prices in between drives most people nuts. But the planes are packed full, and that drives the average price of a ticket way down. The rich fly, and the much less rich fly, too.” There is, I would think, a similar model at play in the work of plastic surgeons who charge Hollywood millionaires huge sums to do face lifts and tummy tucks, and then use a portion of the money they make doing that to do pro bono work for burn victims and deformed children.
The complexity of the pricing situation is what critiques of drug companies tend to ignore. Concludes Huber, “This kind of behavior is not aberrant or anomalous—it is an inevitable and essential part of groping toward the right price where there is no right at the end of the tunnel. Somehow or other, the average price of the pill has to end up high enough to pay off the up-front cost.”
If Huber’s analysis is correct, it is interesting to see how a nonprofit drug company, like the one profiled in today’s New York Times article, “A Small Charity Takes Lead in Fighting a Disease,” fits into the picture. The NYT article itself exemplifies many of the criticisms against pharmaceuticals that Huber summarizes.
Huber points to the vagaries of government regulation and private insurance, which greatly affect the drug market. One explanation for the situation that a nonprofit drug company like OneWorld Health attempts to address is that “big drug companies shun some drugs and embrace others because, collectively, the FDA, doctors, patients, insurers, and juries push costs higher, and prices lower, on some categories of drugs and not on others, to the point where some make economic sense and some do not.”
Indeed, OneWorld Health is working with a drug for black fever that, according to the NYT, administered “a series of cheap injections was identified decades ago but then died in the research pipeline because there was no profit in it.” There is, effectively, a partnership at play between for profit and nonprofit drug companies. OneWorld Health didn’t develop the drug in the first place, but on that point is dependent on the work of for profits.
Universities and small biotechs license their innovations to Big Pharma because they lack the capital, scale, and expertise required for mass manufacturing, because they wouldn’t know how to sell the same drug five times in succession (to the FDA, doctors, patients, insurers, and juries), and because a vast and swampy system separates pharmaceutical innovation from the treatment of real patients at prices that will cover cost and earn a profit. The little guys just don’t have what it takes to finish the job.
But OneWorld Health, in the case of the drug mentioned above (paromomycin), “has conducted the medical trials needed to prove that the drug is safe and effective. Now it is on the verge of getting final approval from the Indian government. A course of treatment with the drug is expected to cost just $10, and experts say it could virtually eliminate the disease. If approval is granted as expected this fall, it will be the first time a charity has succeeded in ushering a drug to market.”
Huber concludes that in the future “we will fare better, much better, if we streamline regulation, curb litigation, and unleash prices to make vaccines as alluring to Big Pharma as Viagra and Vaniqa.” But in the meantime, it may be that efforts like OneWorld Health can help at least some of those who fall through the cracks. Says Dr. Ahvie Herskowitz, one of the backers of OneWorld Health, “We fill a gap pharma companies cannot because they have to make a profit.”
And on the biggest obstacle to getting vaccines and drugs like paromomycin to those who need it, for profit and nonprofit drug companies seem to agree: “The government will be the biggest challenge,” says Dr. C. P. Thakur, a former Indian health minister who oversaw a OneWorld Health trial of paromomycin.