Big Pharma is the NHS ugly sister
From Brother Ivo:
The Times' Sam Coates put his finger on it very succinctly when he tweeted this week: "The Department of Health press release on antibiotics chilling. Not often gvt release says something is 'catastrophic threat' in headline."
Brother Ivo may be especially sensitive to this problem having recently taken himself, coughing and wheezing, to his bed. But long before that, he had acquired an unfashionable sympathy for that much maligned industrial sector, Big Pharma.
We could debate which industries have proved the greatest benefactors to humankind, but few would disagree that the drugs industry would credibly make any rationally constructed short list. His Grace's erstwhile communicant Henry VIII would have willingly given away half his kingdom during his latter days in return for that for that which the lowliest subject takes for granted today, and, moreover, feels entitled to sue if the dosage should be less than perfectly titrated.
How extraordinary it is, therefore, that we are so swift to criticise and slow to praise such an important benefactor, and valuable industrial and research sector.
We need to take the advice of the Chief Medical Officer seriously, but unfortunately we tend to deceive ourselves as to how short the time frame is to ensure the next generations of antibiotics arrive on time. It is far too grave a situation to leave to chance. Were the problem limited to Brother Ivo's sniffles, it would be bearable, yet the success of the NHS, which we are constantly expected to eulogise, is underpinned by a lengthy and complex supply chain which conceives, develops, tests, refines and manufactures the drugs that make so much of the NHS viable. Effective infection control is the sine qua non of all modern medicine and surgery.
Big Pharma is the NHS ugly sister.
Nurses can neglect patients in their beds and still retain their reputation as ‘angels’, but the people behind the cures are anonymous techies and, worst of all, their successes are partly quantified by profits. They never receive our thanks, still less the flowers or chocolates. As for those deferring present gratification in favour of investing in the sector, what worthless souls they are, profiting from human misery.
The development of anti-microbial drugs is a colossal and expensive business. It needs a constant throughput of money and talent.
Plant materials are randomly gathered from the most far flung quarters of the world, and tested on cultures of the target bacteria/virus which are then minutely studied and recorded to identify potentially winning variations. The Human Genome will be consulted and molecules computer generated, so that processes can be understood and viable research leads can developed. Dosages and treatment delivery needs to be considered in multiple forms and once sufficient confidence has been established, the lengthy and expensive business of clinical trials and securing patents throughout the world has to be undertaken. The latter is the aspect which often offends those who have never thought about the problem in depth.
The number of drugs that make it successfully to market is tiny. It represents a triumph of hope over experience, not least because whatever skill judgment and technique is brought to bear, there remains a high degree of chance involved. Every non-viable drug represents a very expensive time-consuming and disappointing failure.
Yet here lies the oddity. For all this massive, chancy, expensive and vital development work, Big Pharma enjoys a limited exclusive patent period of just 20 years before all that effort is turned over into the public domain to be manufactured generically in Brazil, India or China - none of whom contributed a penny towards the development costs.
That is not 20 years of pure profit taking however. Pharmaceutical companies need to begin the protection some years before the product comes to market and one adverse reaction during clinical trials can cause delay and potentially prove a catastrophic blow to the financial viability of the product. A typical window for securing a return on investment is 8 -12 years.
The absurdity of this kind of dis-incentivising of scientific endeavour can be put into perspective with one simple illustration. The estate of the author of ‘50 Shades of Grey’ will enjoy copyright protection for 70 years after her death.
We appear to be more keen to incentivise the intellectual input involved in writing a female masturbatory fantasy than rewarding those who might save countless millions of lives.
We have heard the Government response. It is to ‘call upon’ the drug companies to put in more efforts. We need much more than that. The Chief Medical Officer warns: “Antimicrobial resistance is a ticking time-bomb not only for the UK but also for the world. We need to work with everyone to ensure the apocalyptic scenario of widespread antimicrobial resistance does not become a reality."
She asks that we place this threat in its proper place of priority alongside the threat of international terrorism.
The last new class of anti-biotic was discovered in 1987.
To her immense credit, Professor Dame Sally Davis is prepared to think the politically unpopular and call for better incentives for the pharmaceutical industry to develop new drugs. She knows that if we are to develop the drugs to maintain anti-microbial safety, the window for start-up is perilously small. If the major players cannot put the resources into this project within this period, it will not happen.
This is the time to advance on two separate but linked fronts. It will involve international agreement and that is notoriously slow so there is not a moment to be wasted.
We need to give the pharmaceutical companies a greater period of exclusivity for their work: if a labourer is worthy of his hire, then so are research scientists.
We should also consider legislating for a flexible period of exclusivity to assist the sufferers of rare conditions. Tragically, the development of treatments for such people is financially unviable within the current legislative framework. Yet if we were to afford the producers of such cures the same period of intellectual protection currently afforded to EL James, some hope may well appear on the horizon. It will not happen any other way.
Doubtless there will be those who think that none of this is necessary; the running dogs of capitalism will swiftly be eclipsed by the combined philanthropic scientific might of Venezuela, Cuba and North Korea. Brother Ivo will not hold his breath… which he struggles to do pro tem.
(Posted by Brother Ivo)