Reddit Users Debate the Pricing Game Of The Cancer Drug Industry

When the Indian pharmaceutical company Cipla announced last month that it would cut the cost of three drugs used to treat cancers – one used for lung cancer and two for breast cancer – people around the world responded. Some of the most lengthy conversations took place on the news commenting site Reddit, including a thread 420 comments long in response to a news report in The Economic Times (India).

The conversations and debates centered on why these specialized drugs are so expensive, as well as what pharmaceutical companies’ rights and responsibilities are to make sure life-saving drugs are available in the developing world.

“Misterrespectful” wrote:

This isn't about Cipla being ‘nice’. This is about Cipla trying to earn a buck, exactly like every other company in the world. It just so happens that in India, the way for a cancer drug company to earn a buck is to make their drugs cheaper, so more people can afford them. That sounds good, right?

Strangely, the reason for this is not just that the population is so great, but that they don't have insurance, and the government doesn't have a lot of money to spend on drugs, either. When everybody is sufficiently poor, you have no choice but to cut prices and go after volume.

Reserved for Handicapped and Cancer Patients

“Reserved for Handicapped and Cancer Patients” by Cory Doctorow in Mumbai, 2008, on Flickr Creative Commons

India’s system is different from most other countries in that it doesn’t recognize foreign pharmaceutical companies’ patents when drugs have been slightly altered for the purposes of patent renewal. The effect, as explained by the German newspaper Spiegel, is that Indian pharmaceutical companies can capitalize where others cannot, but also that Indian drugs have become very important to many parts of the developing world because of their affordability.

“_No_idea” commented on the issue of cost, patents and licensing in India:

The only reason some companies can slash prices on drugs like that is because they are usually not the one's spending millions in trying to develop it. Most likely the company that did develop it, no longer has a patent on it.

“mionendy” quipped:

in honor of this, i will cut prices on my ripped DVDs also by 63%.

“KING_UDYR” wrote:

Corporate social responsibility done right.

The cost of cancer treatment, however, is still out of reach for many Indians, commented “nummakayne,” whose mother was treated for ovarian cancer:

Each round of chemo (including overnight stay in the hospital) came out to about $480 (includes the chemo drugs, overnight admittance in a general ward, doctor's fee). That is not copay – that is what anybody would pay out-of-pocket.

It's still a decent chunk of change when you factor in that $480 would be considered a decent monthly salary for a fresh-out-of-college computer grad. But for a lot of folks here it's still out of reach.

My Dad died of cancer before my Mom was diagnosed – Stage III colon cancer. Five years – two surgeries (ileostomy, later followed by a reversal of the procedure), 12 rounds of chemo, 45 sessions of radiation, all kinds of experimental drugs and procedures that I can't even remember the names of…my Mom estimates it came up to around $50,000 in total medical expenses. May not seem like a lot of money to someone in the US but believe me when I say what we got him was nothing short of world class treatment, at least to my layman eyes.

Commenters discussed marketing campaigns as one potential reason these kinds of drugs are so expensive. “Jonnysunshine” wrote:

This is the sort of thing that should be commended. Time and time again we see adverts on television and in magazines telling us about this or that new miracle drug, but at what cost to the consumer?

To which “calibos” replied: “If you want the new miracle drug which presumably offers some benefits to you, then you pay for it.”

“Cocktails4,” who identified as a pharmaceutical researcher, explained that the process of drug design as lengthy and expensive:

Drug designers such as myself take the basic research done at universities and attempt to apply it towards the goal of curing a disease. I might, for example, find promising research pointing towards the importance of a specific protein kinase in a specific type of cancer. I can then attempt to find an existing drug compound that can inhibit that kinase using something like high-throughput screening assays using extensive corporate compound databases or I can use structure-based small molecule design methods using a protein kinase crystal structure if I am lucky and such a structure actually exists. At that point I've either discovered a promising compound or designed a compound and then begins the drug optimization process wherein one works with medicinal chemists and biologists to improve the drug while juggling a myriad of problems such as insolubility, organ toxicity, high serum binding, low oral bioavailability, lack of potency, etc. This process can take several years and has no guarantee of success. Most drugs are abandoned long before they ever are tested in man. Fewer still make it out of clinical trials.

“Cocktails4” continued in the thread:

Science is very expensive. I think a lot of people from the tech field don't realize what it's like to have a burn rate over a $1 million per month at a startup.

Conversations on Reddit about cancer have recently been dominated by discussions of the cost of cancer drugs. A thread of 917 comments on an article in The Hindu began last June when Cipla slashed prices on drugs that treat brain, kidney and lung cancer. Cipla’s chairman, Yusuf Hamied, said then that it was “a humanitarian move.”

In that thread, “TheGreatEnt” wrote:

As a person, it makes me happy to see that more people can afford medication.

As a chemist, it makes me sad to see people not understand the R&D costs of these drugs.

I think that the government needs to spend more of its money on supporting R&D costs and supplementing the cost of drugs (universal healthcare, public option) which will lead to both drug developers and consumers to benefit.

Angilee Shah is writing about cancer around the world in conjunction with Public Radio International's special coverage of “Cancer’s New Battleground — the Developing World.”

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