Skip to content
  • About
  • Contact
  • Contribute
  • Book
  • Careers
  • Podcast
  • Recommended
  • Speaking
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
    • All
    • Physician
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • Video
    • About
    • Contact
    • Contribute
    • Book
    • Careers
    • Podcast
    • Recommended
    • Speaking

Blame the system, not Martin Shkreli

Dr. Saurabh Jha
Meds
October 8, 2015
Share
Tweet
Share

Toxoplasma gondii is a parasite that causes opportunistic infection in helpless people. It may have met its match. The cost of treating toxoplasmosis, a rare but extant infection, just shot up exponentially. Drug-resistant strain, you ask? Have physicians in infectious disease gone mercenary, you wonder? No. A change in ownership.

Daraprim (pyrimethamine) is a nifty drug that kills parasites. It’s been around for eons. I still recall its name from my medical school pharmacology exam. The price of Daraprim, whose production barely costs a dollar, may rise from $13.50 a pill to $750 a pill, after the rights to distribute the drug were acquired by Turing Pharmaceuticals.

Why? The answer is best told by Martin Shkreli, the CEO of Turing, and former hedge fund manager. The reason why Shkreli has acquired a generic drug lying in a forgotten backwater, and raised the price of a magnitude more suited to the hyperinflation of the Weimar Republic, is to make profits. Lots of profit. If this answer seems inane, ask yourself why a former hedge fund manager would be interested in a rare disease of devastating consequences. Penitence is the wrong answer.

Shkreli was shocked that people were questioning his decision to raise the price of Daraprim. He is not the only one to have taken advantage of the asymmetric power in drugonomics, he protested. Compared to Sovaldi, which fetches a $1,000 a pill, Daraprim is a bargain, he reasoned. It is not his fault that the drug had been underpriced relative to the fair market value. And then, with nearly a straight face, Shkreli said that the price increase was for the good of patients. You have to admire the lad’s chutzpah. It’s either audacity or utter disdain for the proletariat.

Shkreli says the markup will be used for research and development (R&D) of new products, which will be more effective and less toxic than Daraprim. I’d hazard a guess that when Turing’s scientists discover the ground-breaking, me-too drug for toxoplasmosis, it won’t be cheaper than $750 a tablet. The trouble is that no one is screaming for new products for toxoplasmosis.

Usually, pharma justifies the markup on the drug by the R&D costs incurred. Shkreli, in a move of sheer brilliance, is justifying the costs on promissory research — research that hasn’t happened and may never happen and if it does happen may never yield anything useful.

Imagine you’re dying of thirst in Death Valley and this guy selling tap water for $100 a glass says, “I’ll be using the $100 profits to make safe water, safer than Evian.” You might say, “I don’t want Evian, tap water is good enough. I’m dying.” In health care good enough is not a virtue. There is no end to the potential of reducing human suffering marginally, and no bounds to the price we will pay for that marginal reduction. Shkreli knows that, as do others in this industry.

Seizing the day, Senator Hillary Clinton, who has been awfully silent recently, unveiled a bold proposal where she’d make sure pharma spent their profits appropriately on R&D. She’d hold them accountable. That’s really mighty, Senator. I can hear Shkreli quaking in his boots.

I understand why the price of the drug is more than the sunk costs of R&D, the cost of production and the cost of the CEO’s private yacht. I understand patents and intellectual property. I get that if pharma doesn’t enjoy monopoly, even temporarily, there’d be little incentive to innovate. But this logic has been extended to such a nonsensical level that any perturbation of the status quo, such as importing generics, leads to the threat that pharma won’t innovate.

(Incidentally, pyrimethamine costs 10 cents a tablet in India. I’m allowed to check in two pieces of luggage. Just saying.)

No innovation is a bald threat that hasn’t been empirically tested. The reason it hasn’t been empirically tested is because there’s a slim possibility that it may turn out to be true. This is a game of chicken, to borrow game theory, in which pharma doesn’t blink, and we’re too much of a chicken to call their bluff. We have made a Faustian bargain with pharma — we want to live longer, and they want to make more money. It’s win-win, until we see the price tag.

Compounding this, is the runaway logic which prohibits CMS from price fixing. The logic, endemic in conservative circles, is that price fixing is socialism, and obviously if we fix prices we are a short step to gulags. The logic is getting tedious. Not least because what is being defended is not free market capitalism, but a political economy that is the union of the ugliest wart of capitalism — greed — and the most sterile part of socialism: lack of competition. Drugonomics is not Adam Smith’s invisible hand. It is Gordon Gekko’s visible middle finger.

Pharma is not evil. It is the mythical homo economicus. It does what a rational agent would do in a monopoly — it fleeces as much as it can fleece. It knows that payers will blink — case in point, those alleged penny pinchers at Britain’s National Institute of Clinical Excellence yielded to Gilead and will cover Sovaldi.

ADVERTISEMENT

Pharma innovates on the condition that it can price freely. Pharma also delivers the goods. If a bacterial strain went rogue, greedy pharma would have more chances of finding a cure, than Buddhist Monks, or tenured Ivy League scientists.

Shkreli may be a particularly virulent strain of homo economicus. But remember, he is not doing anything illegal. The media is portraying him as an unsentimental money maker. I couldn’t care less if he boiled his neighbor’s bunny. The demonization distracts us from the most important question, which is not why Shkreli is raising the price of Daraprim by 5,500 percent, but how.

Saurabh Jha is a radiologist and can be reached on Twitter @RogueRad.  This article originally appeared in the Health Care Blog.

Prev

Terminal dehydration: A gentle way to die?

October 7, 2015 Kevin 7
…
Next

Nurses save more lives than opera singers

October 8, 2015 Kevin 7
…

Tagged as: Infectious Disease, Medicare

Post navigation

< Previous Post
Terminal dehydration: A gentle way to die?
Next Post >
Nurses save more lives than opera singers

ADVERTISEMENT

ADVERTISEMENT

ADVERTISEMENT

More by Dr. Saurabh Jha

  • Masks are an effigy of American technocratic incompetence

    Dr. Saurabh Jha
  • False negative: COVID-19 testing’s catch-22

    Dr. Saurabh Jha
  • Why the Lancet’s editorial on Kashmir is unhelpful

    Dr. Saurabh Jha

Related Posts

  • GOOP and Gwyneth: Blame mainstream media

    Arthur L. Caplan, PhD and Timothy Caulfield, LLM
  • Who’s really to blame for the obesity epidemic?

    Peter Ubel, MD
  • Blame the pain, not the opioids

    Angelika Byczkowski
  • Don’t blame doctors for outrageous emergency department prices

    Peter Ubel, MD
  • The triangle of blame for the opioid epidemic

    Sangrag Ganguli and Uche Ezeh
  • 3 ways health plans can help providers

    Martin Lustick, MD

More in Meds

  • Why does rifaximin cost 95 percent more in the U.S. than in Asia?

    Jai Kumar, MD, Brian Nohomovich, DO, PhD and Leonid Shamban, DO
  • A world without antidepressants: What could possibly go wrong?

    Tomi Mitchell, MD
  • The truth about GLP-1 medications for weight loss: What every patient should know

    Nisha Kuruvadi, DO
  • The hidden bias in how we treat chronic pain

    Richard A. Lawhern, PhD
  • Biologics are not small molecules: the case for pre-allergy testing in an era of immune-based therapies

    Robert Trent
  • The anesthesia spectrum: Guiding patients through comfort options in oral surgery

    Dexter Mattox, MD, DMD
  • Most Popular

  • Past Week

    • The silent toll of ICE raids on U.S. patient care

      Carlin Lockwood | Policy
    • Why recovery after illness demands dignity, not suspicion

      Trisza Leann Ray, DO | Physician
    • Addressing the physician shortage: How AI can help, not replace

      Amelia Mercado | Tech
    • Bureaucracy over care: How the U.S. health care system lost its way

      Kayvan Haddadan, MD | Physician
    • Why does rifaximin cost 95 percent more in the U.S. than in Asia?

      Jai Kumar, MD, Brian Nohomovich, DO, PhD and Leonid Shamban, DO | Meds
    • Why medical students are trading empathy for publications

      Vijay Rajput, MD | Education
  • Past 6 Months

    • What’s driving medical students away from primary care?

      ​​Vineeth Amba, MPH, Archita Goyal, and Wayne Altman, MD | Education
    • Residency as rehearsal: the new pediatric hospitalist fellowship requirement scam

      Anonymous | Physician
    • The broken health care system doesn’t have to break you

      Jessie Mahoney, MD | Physician
    • Make cognitive testing as routine as a blood pressure check

      Joshua Baker and James Jackson, PsyD | Conditions
    • A faster path to becoming a doctor is possible—here’s how

      Ankit Jain | Education
    • The hidden bias in how we treat chronic pain

      Richard A. Lawhern, PhD | Meds
  • Recent Posts

    • How conflicts of interest are eroding trust in U.S. health agencies [PODCAST]

      The Podcast by KevinMD | Podcast
    • Why young doctors in South Korea feel broken before they even begin

      Anonymous | Education
    • Measles is back: Why vaccination is more vital than ever

      American College of Physicians | Conditions
    • When errors of nature are treated as medical negligence

      Howard Smith, MD | Physician
    • Physician job change: Navigating your 457 plan and avoiding tax traps [PODCAST]

      The Podcast by KevinMD | Podcast
    • The hidden chains holding doctors back

      Neil Baum, MD | Physician

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

View 9 Comments >

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

ADVERTISEMENT

ADVERTISEMENT

ADVERTISEMENT

ADVERTISEMENT

  • Most Popular

  • Past Week

    • The silent toll of ICE raids on U.S. patient care

      Carlin Lockwood | Policy
    • Why recovery after illness demands dignity, not suspicion

      Trisza Leann Ray, DO | Physician
    • Addressing the physician shortage: How AI can help, not replace

      Amelia Mercado | Tech
    • Bureaucracy over care: How the U.S. health care system lost its way

      Kayvan Haddadan, MD | Physician
    • Why does rifaximin cost 95 percent more in the U.S. than in Asia?

      Jai Kumar, MD, Brian Nohomovich, DO, PhD and Leonid Shamban, DO | Meds
    • Why medical students are trading empathy for publications

      Vijay Rajput, MD | Education
  • Past 6 Months

    • What’s driving medical students away from primary care?

      ​​Vineeth Amba, MPH, Archita Goyal, and Wayne Altman, MD | Education
    • Residency as rehearsal: the new pediatric hospitalist fellowship requirement scam

      Anonymous | Physician
    • The broken health care system doesn’t have to break you

      Jessie Mahoney, MD | Physician
    • Make cognitive testing as routine as a blood pressure check

      Joshua Baker and James Jackson, PsyD | Conditions
    • A faster path to becoming a doctor is possible—here’s how

      Ankit Jain | Education
    • The hidden bias in how we treat chronic pain

      Richard A. Lawhern, PhD | Meds
  • Recent Posts

    • How conflicts of interest are eroding trust in U.S. health agencies [PODCAST]

      The Podcast by KevinMD | Podcast
    • Why young doctors in South Korea feel broken before they even begin

      Anonymous | Education
    • Measles is back: Why vaccination is more vital than ever

      American College of Physicians | Conditions
    • When errors of nature are treated as medical negligence

      Howard Smith, MD | Physician
    • Physician job change: Navigating your 457 plan and avoiding tax traps [PODCAST]

      The Podcast by KevinMD | Podcast
    • The hidden chains holding doctors back

      Neil Baum, MD | Physician

MedPage Today Professional

An Everyday Health Property Medpage Today
  • Terms of Use | Disclaimer
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

Blame the system, not Martin Shkreli
9 comments

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...