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Killing me softly

Killing me softly

Fourteen years ago, my mother succumbed to cancer. She died eight days short of her 60th birthday. That was more than a decade ago, and since then billions of dollars have been spent on cancer research worldwide. And yet, today we are nowhere nearer to finding a cure for cancer than we were 14 years ago. And cancer medicines have remained just as expensive.

To be shot in the head can mean almost instantaneous death. Cancer, on the other hand, can mean a “slower” death. But, dealing with the high prices of cancer medicine is what I refer to as “killing me softly.” It is bad enough that you are dying of cancer, but why do you have to suffer from “profiteering” as well in the hands of unscrupulous “legal” drug merchants?

I am fully aware of the enormous amount of money spent by pharmaceutical companies and the effort they put into cancer research, and the development of new medicines — without any assurances of success. I understand that RD can make or break a pharmaceutical company, and flush down the drain millions if not billions of dollars coming from their investors.

A pharmaceutical company may tend to prioritize the interest of shareholders above other stakeholders like customers, who may be cancer patients. Business is business, after all. And unless it operates at a profit, a drug maker can simply fold tent. My concern, however, is the lack of transparency in determining fair as opposed to excessive profit for drug makers.

If ensuring profitability means keeping prices high, then this limits access even to life-saving drugs particularly for poorer cancer patients. How then do we balance the interests of both the drug maker and the drug user? Who gets to decide whether or not a drug maker is making too much profit from a particular cancer drug? Do we leave everything to market forces?

To cite an example, I was informed that about a year ago, a particular cancer drug was retailing for about P100,000 for a box of pills good for a month. The medicine, while made by a foreign drug maker, was available from an exclusive distributor in Metro Manila. The distributor’s price later on went up to P120,000, and then to almost P150,000.

The high price was actually unsurprising to me, having been left with the impression since my mother’s time that cancer medicines have always been expensive. What surprised me, however, was how the price for this particular cancer drug was rising significantly over a relatively short period of time. Perhaps a case of high demand + low supply?

Now, if you are a retiree living on a pension, and given the paltry sum that you receive from the Social Security System (SSS), and despite your membership in PhilHealth, and even with senior citizen’s discount on medicine, how can you possibly afford to sustain a life-saving medical intervention that costs you roughly P150,000 a month?

And then you learn, rather belatedly, that a similar cancer drug — a generic version of it, so to speak — is available in India at only a fraction of the Philippine price? Maybe at just 25% of the Philippine price? And while there may be concerns about the Indian version’s efficacy, you just have to ask yourself how India can sell a similar drug at just 25% of the branded version’s cost?

Perhaps this is one of the reasons why the drug’s branded version sold in the Philippines, just recently, reportedly lowered its retail price (from the distributor) to about half of the original price. The cancer drug, I was told, now retails for less than P70,000 when at its peak several months ago, it was selling at almost double that.

The price drop, I am sure, is a welcome development for Filipino cancer patients. But, what gets me riled up is the fact that the drug can actually be sold at half its original price, and yet, for the longest time it was selling at a high. Or, is it now on “sale” and sold at a bargain? High inventory + low demand = lower price? Is the price cut meant only to move inventory?

If the price goes up again in the near or even distant future, then there is really something wrong with the way the government is regulating — or not regulating — retail prices particularly for cancer drugs. This is precisely my point regarding lack of transparency in drug pricing. Cancer patients are at the mercy of pharmaceuticals, and lack recourse against profiteering.

About a month ago, President Duterte made public his opinion against the Trans-Pacific Partnership (TPP) trade agreement proposed by the United States. He was quoted as saying that his concern about the TPP was how it would affect the Philippines’s access to “generic medicine,” given the agreement’s provisions on the stricter protection of patents.

If under the TPP we would be precluded from selling unbranded or generic medicine, he said, then this would a great loss to our people. “We are promoting generic because we are a poor nation and we can buy the medicines at [cheaper] costs [from India and Pakistan],” the President told media.

And by medicine, I believe, this can refer not only to generic “maintenance” medicines for hypertension and diabetes, for example, but also to cancer medicine. And, while I understand that drug makers need to be sufficiently prosperous to continue their work, there has to be a way to protect the interest of patients who need but cannot afford life-saving medicine.

In this line, we need to put in place a better system, perhaps with government intervention, than simply relying on market forces for balancing and protecting the interests of both drug makers and poor cancer patients, especially retirees.

Marvin A. Tort is a former managing editor of BusinessWorld, and a former chairman of the Philippines Press Council