Introduction to Global Health
10/28/2013
"Demythologizing the High Cost of Pharmaceutical Research"- Light and Warburton Demystifying the cost of pharmaceuticals- pharmaceuticals use this cost to justify high drug prices. Providing health care becomes an economic issue. How much do pharmaceuticals really spend on drugs? How much should they be compensated by the state? Lesson in the Construction of Facts: These facts are always constructed, and may or may not be true Development- locating a chemical entity, running clinical trials (testing drugs to see how safe and effective they are)
Four phases: They grow larger after each phase Safety and side effects Efficacy within a larger group Comparison in large groups to test efficacy against standard treatments Post-marketing (following the drug after it has been used in clinical settings) How are these done?: o Must find large groups of patients who are not already receiving treatment for their disease o This often pushes researchers into the developing world Researchers and data analysts must be paid to do the studies
and process the data
Conflict of Interest: Pharmaceutical companies investing money in chemical entities then investing in their evaluation, high economic incentive for the tests to be successful. Economic Incentive: You can get patents for drugs so that no one can use the same chemical, allowing them to keep prices incredibly high. DiMasi study: Came up with the cost of developing a drug ($802,000,000) that is not used almost universally. This figure is used to support patents- they need patent time to recoup their expensive investment.
Lots of blackmail- no one wants to compromise on health care, if
pharmaceuticals are not treated specially they will not innovate, everyone will get sick and die. Pharmaceuticals want their risk to be subsidized, while other types of companies accept risk when developing new products. Cost of Capital: If we hadn't done the study, we could have
rate of 11%. Therefore, we should be paid this money. Makes up almost 50% of the overall total. Major Objections: All data for the DiMasi study was provided by the pharmaceuticals- did they actually report unbiased data? Why should we trust them, if they are not legally forced to report it honestly? Big financial difference between developing a new chemical or a "me too" drug (derivative of an existing chemical). You can extend
illnesses they cure. DiMasi did not make this distinction. Lots of funding from the pharmaceuticals- definitely affected the outcome of the research.
No distinction between self-developed drugs (expensive), me too drugs (cheap), and variant (publically developed and privately bought) drugs (cheap). Pharmaceutical/DiMasi data: $802,000,000 Light and Warburton data: $43,400,000
EBM and RCT- Vincanne Adams
Discusses types of evidence that are admissible in scientific journals and funding applications. Hierarchy of evidence from 1-5 used to evaluate findings- the "gold standard" is an RcT (1). Descriptive studies are less valued (5). All based on scientific accuracy. Anecdotal evidence is seen as worthless, like stories.
Communities voicing their problems is also seen as worthless.
Makes it very difficult t