Drugs for the rich versus drugs for the poor: should some consumers pay more and some pay less: the world’s love and hate relationship with the pharmaceutical industry

The world has a ‘love and hate’ relationship with the pharmaceutical industry that is often responsible in bringing new drugs into the health arena. Although the industry operates under strict regulations in countries like the US, pharmaceutical companies are often viewed as pushing new products on healthcare providers across the globe. Nevertheless, the truth is that we do need the pharmaceutical industry, which invests heavily in the Research and Development (R and D) of new drugs, conducting clinical trials with them and passing products through regulatory bodies and eventually marketing them for the end-users. The industry, from their own perspective argues that they need to continue making profits from sales to stay in business and actively seek monetary gains for implementing further R & D. The question is whether the industry should continue to primarily target the paying users in the developed world? Should the development of new drugs be motivated only by the markets of the rich and wealthy nations that can afford to pay? Or, can there be a more shared payment with the not so wealthy nations, thereby allowing all consumers access to new drugs? Perhaps a differential pricing market model with higher prices for those that can afford to pay and lower for those that cannot. Do the benefits of the new drug discoveries really trickle down to the poorer nations as soon as data from clinical trials demonstrate efficacy or is there a significant lag time before it reaches the poorer nations (possibly when the drug is off- patent and a generic form can be synthesized at a cheaper rate)? What about the imitation of drugs in countries like India, who till recently were not following international patent laws and freely creating their own cheaper versions of drugs that were more affordable in both local and some international markets? Should there be a mandate for pharmaceutical investment into development of new drugs for diseases that afflict mostly the poorer nations of the world and if so should the international health community and governments in developed nations be a part in instituting this mandate? Do these companies aside from their primary profit making agenda owe anything to the poorer nations of the world or are they correct in protecting their own interests? Should they be given/offered subsidies for drug development for diseases primarily found in poorer nations? How can drug distribution be more equitable throughout the world, rich versus poor, developed versus developing countries? There are many more questions than there are answers to these conflicting points of view, some of which were dealt with in our readings.

Michael Reich’s article “The Global Drug Gap” addresses some of these dilemmas. He proposes some possible answers. Looking into procurement of WHO labeled “essential drugs” via competitive tenders by local governments to get medicines at cheaper and better rates, improving local infrastructure capacity of national pharmaceutical companies and distribution of drugs with appropriate warehousing, decrease in corruption, methods to maintain supplies and a rational use of drugs by health care providers are some of the possibilities he delves into which requires strong local governments. These solutions should first apply to the process of making available “essential drugs” that will requires local governments, private-public sector partnerships and international organizations to team up together. He points out that most “essential drugs” which are usually “off patent” are still not available to one third of the world’s population. Before bringing in patents of new drugs and controversies surrounding pharmaceutical industries , local governments and world health leaders should focus on ensuring availability of “essential drugs” to all people.

John. H Barton’s article addresses the controversies in patent laws and how new regulations such as TRIPS, the 2001 Doha Declaration and the 2003 Cancun meeting try to overcome these without necessarily addressing the financial issues of developing countries as they try to access new and potentially more effective drugs from the world market. Compulsory licensing in developing countries may force down drug prices and further deter companies trying to enter the ‘poor paying developing world’ market. Nonprofit partnerships such as Medicines for Malaria or Global Alliance for TB Drug Development thus play an important role in trying to solve issues of access of drugs for areas of the world where they are most needed and where it may not be profitable for pharmaceutical companies.

Frost and Reich’s “The Access Framework” is an interesting and logical analytical framework that is divided into four ‘A’ s: architecture, availability, affordability and adoption that the authors propose are critical pieces for any new technology adoption by a country. In the their opinion the key elements of the framework may help identify “critical bottlenecks” ’and strategies that may serve as ‘facilitators’ to circumvent these “bottlenecks”.

Finally, Jishnu Das’s article on the quality of healthcare in Delhi that is based upon residential neighborhoods and not the patient’s economic paying prowess rings a familiar bell after having spent about 10 years of my own life living observing healthcare in Delhi. The general perception of most people in Delhi is that poorly staffed, poorly run and very overcrowded public sector hospitals are not able to provide care to all those who need it even though the providers in these settings are often better qualified and better trained than in the private sector. People in general in Delhi, even the poor who may not always be able to afford it, prefer not to travel long distances and wait in lines and instead seek ‘fee for service’ primary care providers- several of who practice at walking distance from people’s homes. These providers may not provide the best quality care nor are they able to provide high specialty care but are often the first point of contact for most people seeking health care in Delhi.

Submitted by Shipra Kaicker

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