Last year, Martin Shkreli— CEO and founder of Turing Pharmaceuticals—became notoriously dubbed as the “most hated man in America.” The once unknown entrepreneur, rapidly gained America’s detestation when his company obtained legal rights to Daraprim, a medication crucial for the treatment of toxoplasmosis (protozoan infection) in immunocompromised patients. The company hiked the price of this medication from $13.50/tablet to $750/tablet. Shkreli claimed this price increase would in part help fund medical research; however, there lay a lot of public mistrust with his use of these profits. The actions taken by Turing Pharmaceuticals under the control of Shkreli lead to national uproar.
In December 2015, Shkreli was indicted on seven counts of fraud. His congressional hearing was notable for his refusal to answer questions and his seemingly taunting smirks. His arrogant attitude led to the ire of congress with Representative Elijah Cummings reprimanding him by stating, “it’s not funny Mr. Shkreli. People are dying and they’re getting sicker and sicker.” Shkreli’s Twitter response to this was: “Hard to accept that these imbeciles represent the people of our government.” He failed to accept any accountability or responsibility of his actions.
Shkreli’s case became a topic of discussion between my Pediatric preceptor in Pune, India and me after I found out how inexpensive certain medications in India were compared to the U.S. I was shocked that uninsured Indians who made a humble salary were able to afford crucial medications that their sick children needed.
For example, last week, a 4-year-old child was diagnosed with Acute Lymphoblastic Leukemia at the clinic. The family, much like most Indian citizens, did not have any sort of medical insurance. Despite this fact, they were able to find affordable, proper care for the ailing child.
A large part of this has to do with the fact that chemotherapy and other essential lifesaving medications are relatively affordable in India compared to the U.S. The Indian government has a lot to do with the affordability of essential medications. India has a drug price cap law that is controlled by the Indian National Pharmaceutical Pricing authority. This entity has established a National List of Essential Medications, which includes a myriad of antimicrobials, chemotherapeutics, cardiac, and respiratory medications. Any medication listed has a cap price at which it could be charged.
The Indian government also restricts certain essential medications from becoming patented. For example, in 2013, the government prohibited the patenting of Gleevac, a common chemotherapy drug used to treat certain types of pediatric and adult leukemia’s, and Januvia, which is used to treat diabetes. This led to a controversy where large companies argued that this was against the right to maintain and own intellectual property. The Indian government’s justification for not allowing pharmaceutical companies to patent certain medications was to keep these meds generic, and thus, at a much lower cost.
Below is a brief list comparing the price of certain medications in the U.S. vs. India. (Note that these are estimates. Prices may vary depending on the supplier).
Sovadil (tx of hepatitis C)
Gleevac (tx of leukemia)
Humira (tx of autoimmune diseases such as rheumatoid arthritis)
Advair (tx of asthma)
Lantus (tx of diabetes)
Many of these medications are those that I have seen commonly used in children to treat various forms of illness. Though it is true that profits can be used to help fund important medical research, it is also important to ask how much profit is too much? Some of these medications cost 50x more in the U.S. than they do in India and in other countries. Justifying that big of a price difference is very difficult. We owe it to our little, big fighters to ensure easy, affordable access to crucial medications.
Please share your thoughts on this important matter! Let’s start a healthy, friendly debate about the pros and cons of medication price caps. Until then, I leave with this quote:
“The pharmaceutical industry is the third rail of politics and if you go against them, they will cut you off at the knees.” —Matt Salo, Executive Director of the National Association of Medicaid Directors.