The Effect of Pharmaceutical Companies on the Accessibility of Drug Treatments
Updated: Jun 6, 2020
November 20, 2019 ⋅ 7:30 P.M ⋅ Faaizah Arshad⋅ Editor: Guadalupe Sandoval
Since the 1970s, there have been great advances in medicine. The Polio vaccine reduced 99% of cases around the world, the “triple drug, anti-retroviral (ARV) therapy” treated AIDS, 17 million patients gained access to HIV treatments, manufacturers produced medicine for lymphatic filariasis, and antiviral medication cured “almost all hepatitis C patients⁵.” Yet, while there have been great outcomes worldwide, things are not picture perfect. In fact, “400 million people worldwide” lack access to healthcare because they are disproportionately poor or low-income⁵. Two reasons for disparities in access to health care are inadequate investments in R&D and hiked prices for drugs treating rare diseases.
R&D stands for research and development. Investments in research and development can come from either the public sector or from for-profit private sectors. However, for-profit private sectors are more likely to invest only in products that increase sales⁶. This means that for-profit companies and individuals often prioritize financial return over the health needs of the public. Essentially, they only invest where they can earn. The way they get away with this is by “evergreening” and abusing the patent system. “Evergreening” is a strategy in which drug manufacturers make minimal changes to profitable drugs that are about to expire to extend the drug’s presence in the market and retain the financial benefits of the drug³. The longer the drug is sold in the market, the more money drug companies earn. So, by making minor changes to drugs, they can extend their patent for the drug, discourage competitors, and make money³. As someone who learned about this only after researching more about how drugs are manufactured, I assume that a majority of the public is unaware that pharmaceutical companies engage in such activity. Regardless, this activity should be intolerable!
An example of pharmaceutical companies intending to profit from drugs is bacterial antibiotics. As bacterial infections grow, companies should invest more in the research and production of new antibiotics; however, the opposite is being seen. Since increased use of antibiotics leads to increased antibiotic resistance, there has been “lower consumption” of antibiotics, which “signifies reduced sales” for companies who produce antibiotics⁵. Thus, fewer people are willing to invest in the R&D of antibiotics, making individuals who are in need vulnerable to disease and death. R&D research should be needs-driven, not profit-driven. If drugs are eventually manufactured, many of those drugs are too pricey for poor populations. In fact, according to a poll by Kaiser Health, 72% of Americans argue that “drug costs are unreasonable,” and 33% of individuals have a “difficult time paying for their drugs².” So, are pharmaceutical companies really fulfilling their job of improving the lives of Americans if they are increasing the financial burden that patients endure? I don’t think so.
When R&D does result in the production of pharmaceutical drugs, low-income individuals face challenges in accessing drugs that treat rare diseases because prices for those drugs are extremely high. Consider cystic fibrosis (CF), a life-threatening, hereditary disease caused by a mutated CFTR gene that leads to a build-up of sticky mucus in the lungs. Approximately 70,000 people worldwide are affected by CF⁷. People in the United States must pay an outrageous “$294,000 per patient per year” for the ivacaftor drug that treats CF¹. Table 11 below shows a list of drugs that treat CF and their unreasonable prices. How can individuals below the poverty line ($25,750 per year for a family of four) possibly pay over $200,000 annually¹? They can’t! That’s 8 times their annual income! Not to mention, even for a middle class family, paying over $200K is insane!
Let me give you a more familiar scenario. If I told you that I went shopping last night, loved a pair of shoes that I’ve had my heart set on for a while, saw the price tag, and put the item away because it was beyond my spending budget, what would you tell me? I suppose you would say something like, “The item would break the bank, so maybe you should get something else. It’s too bad.” But, imagine if I told you that I depended on the item (drug/treatment) to live. What would you say then? Would you tell me that it’s too bad I don’t have the money to afford it? Would you tell me to helplessly hope that I somehow live longer without the drug? Think about it: what would you tell a low-income family who needs a health service but cannot afford it because monopolistic companies shamelessly care more about their bank balance than human lives?
I’ve personally interacted with cystic fibrosis patients and families from a variety of economic backgrounds, and regardless of their financial status, families agree that prices need to decrease. For all the reasons discussed above, many low-income and middle-income individuals with rare diseases that are costly to treat do not receive the healthcare they need. No one should have to weigh their health versus financial capability. Instead, pharmaceutical companies should think about vulnerable populations when they invest in the production and distribution of drugs.
Ultimately, the medical industry has accomplished a lot in the past half-century, but there are still improvements that should be made. As students, we should encourage decisions that are equitable and reasonable.
1. Amadeo, Kimberly. “Federal Poverty Levels Guideline and Chart.” The Balance, 16 Nov. 2019, thebalance.com/federal-poverty-level-definition-guidelines-chart-3305843.
2. DiJulio, Bianca et al. “Kaiser Health Tracking Poll: August 2015.” Kaiser Family Foundation, 20 Aug. 2015, kff.org/health-costs/poll-finding/kaiser-health-tracking-
3. Elkins, Kathleen. “52% of Americans Are Considered Middle Class— Here’s How Much Money They Earn.” CNBC Make It, 21 Sept. 2019, cnbc.com/2019/09/21/
4. “Facts and Figures.” Hepatitis B Foundation, 2019, hepb.org/what-is-hepatitis-b/what-is-
5. “Report of the United Nations Secretary-General’s High-Level Panel on Access to Medicines.” United Nations, Sept. 2016, static1.squarespace.com/static/562094dee4b0d00c1a3ef761/t/57d9c6ebf5e231b2f02cd3d4/1473890031320/UNSG+HLP+Report+FINAL+12+Sept+2016.pdf.
6. Viergever, Roderik F. “The mismatch between the health research and development (R&D) that is needed and the R&D that is undertaken: an overview of the problem, the causes, and solutions.” Global health action vol. 6 22450. 10 Oct. 2013, doi:10.3402/gha.v6i0.22450.
7. “What is Cystic Fibrosis?” Cystic Fibrosis Foundation, cff.org/What-is-CF/About-Cystic-
About the Author
Faaizah Arshad is an undergraduate student at University of California - Los Angeles