Ben Goldacre, 5 September 2009, The Guardian
How do patents affect science? This week in India, US drug company Gilead lost their appeal to stop local companies making cheap copies of their Aids drug Tenofovir. They are not alone: in 2007 Novartis lost a lengthy case trying to force the Indian government into strengthening their weak patent laws. India remains the free pharmacy of the world.
Cheap drugs may not be the only benefit of India’s approach, but the drugs are certainly cheap. The cost of Tenofovir in developed countries is $5,700 per patient per year: the Indian generic version is available in the developing world for just $800. Because of this price difference, 75% of the 4m people in the world taking medication for Aids are using generic copies. Almost all of these are made in India, and in fact, about 40% of the world’s aids patients are taking drugs made by one company: Cipla, which is now the biggest manufacturer of antiretroviral drugs in the world.
Ignoring patent and licensing issues has allowed Dr Yusuf Hamied, director of Cipla, to innovate: even though each drug is officially owned by a different company, he could put a common combination of three treatments (Stavudine, Lamivudine and Nevirapine) into one simple, single combination pill. This increases treatment compliance – it’s easier to take your medication correctly – and that keeps you alive longer, while reducing the emergence of resistant strains.
Hamied calls his pill Triomune (he also offers “Antiflu”, a copy of Tamiflu for the developing world, and many more). In 2001 he was selling to MSF clinics for $350 per person per year, more than 30 times cheaper than the official versions of these drugs. Triomune is now only $87 a year. This is amazing. Hamied is a hero.
Richard Sykes, head of GlaxoSmithKline (and now now retired rector of Imperial College London) disagreed. He called Hamied a “pirate” and described the quality of Indian generic drugs as “iffy”. Hamied says GSK is a “global serial killer“ for charging high prices for their medication. So who is right?
Drug patents are a fascinating trade off between the benefit of incentive, and the harm to innovation. It takes about $800m and 10 years to bring a drug to market: during this time you make no money, and your drug could fail at any stage. As a sweetener, after this, you have 10 years of being the sole manufacturer to recoup your costs and make a profit.
There are other benefits for all of us. Instead of relying on obsessive secrecy to protect your idea (which is how Coca Cola protect their recipe) patents allow drug companies to safely disclose more information in public, which helps other people innovate. Protecting ideas also allows a smaller company negotiate outside investment and develop their theories.
But patents can also retard innovation. Even though your competitors may have greater expertise in the relevant fields, they will be hindered from doing research into derivatives of your drug, or other uses for it, or improvements to it. Thomas Edison managed to get a broad patent on his improvements to the light bulb, and this forced his competitors – who had made subsequent technical improvements of their own – out of business. It took a World War to cajole the Wright brothers into finally agreeing licenses for everyone else over their patent on the airplane.
And the other downside, of course, is the monopoly. With patents you are the sole provider of a drug, you get to set the price in each country, and if your drug is lifesaving then everyone has to pay it, or die. In lots of places, they just die. There are 33 million people living with Aids in the world today. 2 million die every year, and at the moment, despite heroic improvements over the last 5 years, 70% of those who need treatment do not get it.
Patents weren’t devised out of a sense of natural justice. They are there to incentivise innovation, to “add the fuel of interest to the fire of genius”, as Abraham Lincoln said. So how much fuel can you get from the developing world? According to MSF, Africa, for example, accounts for a non-massive 1% of the world’s medicine market.
If the global $550bn pharmaceutical industry are trying to make an economic case for patents in the developing world, then they must argue that the benefit to drug development from the financial incentives in these tiny corners of the world market is so significant – so vital, the final link in the incentive chain – that it is more important than millions of unnecessary deaths. I am not a health economist, but I doubt that is a fair swap, and this is not what patent laws were invented for.