A sick state of affairs

A charity for men with prostate cancer says many face a "titanic" struggle to be prescribed an approved drug. Taxotere can improve the quality of life of patients in the later stages of the cancer, and prolong their lives. It was approved in June by the National Institute for Health and Clinical Excellence (NICE) for use in the NHS in England and Wales. But each course costs about £7,000 and the charity says some men are denied it on cost grounds. Some doctors have been told by primary care trusts struggling with limited funds to ration the number of courses of taxotere that they prescribe.

One obvious question is: why are drugs so expensive? And why has the NHS drugs bill grown by almost 50% in the last five years to £10 billion a year? You just have to examine the tactics of the major drugs companies, or the Big Pharma as they are known collectively, to find the answer. According to Drug and Therapeutics Bulletin (DTB), efforts to cut the bill by using generic drugs rather than their more expensive brand-name equivalents are undermined by Big Pharma. A generic drug can only be introduced once the patent on the brand-name drug has expired. Ways the industry gets round this include:

• introducing a new brand-name drug that is very similar chemically to the original but marketed as being in some way better
• presenting an old drug in a different form, for example as a capsule rather than a tablet
• combining the original drug with another old established drug to form a new product.
  

The DTB explains: "Companies may also withdraw the original brand-name drug before its patent actually expires, and around the same time, introduce the new brand-name product. Because the old patent protection is still operative, no generic equivalent can be released onto the market. So, by the time a generic eventually enters the market patients may already be well established on, and very unwilling to switch from, the new-brand drug."

That’s not all. An NHS doctor believes that Big Pharma has additional methods to boost profits:

• re-invent and re-design the treatment by getting eminent doctors to produce "research" showing that new drugs are better
• re-define the disease so that more people will need to be treated. Diabetes, hypertension, high cholesterol and obesity have all been redefined
• invent new diseases that also need to be treated. Hypertension "experts" created a disease, "prehypertension," when they revised a US treatment guideline for high blood pressure in May 2003.

Another strategy is to make as many people as possible believe that they have a particular disorder and to imply that medicines are the best, if not only, solution. To assist this process, companies initiate "disease awareness campaigns", benefiting from association with patients’ groups. In the UK in 2005, there were six disease awareness months, eleven disease awareness days and 48 disease awareness weeks. Selling cures for imaginary diseases is another tactic. Glaxo Smith Kline took the antidepressant Seroxat and had it approved to treat shyness, now reclassified as "social anxiety disorder". And that’s just in Britain. Meanwhile, in poorer countries, infectious diseases such as diarrhoea, pneumonia, malaria, measles and tuberculosis kill millions of children each year, according to the World Health Organisation. Big Pharma has, of course, also tested new drugs on unsuspecting people in African and Asia who are desperate for treatment. So while NHS staff lose their jobs, and patients from Britain to Bangladesh are denied vital drugs on costs grounds, Big Pharma is smiling all the way to the bank, courtesy of their sponsored government, New Labour. What a sick state of affairs.

Paul Feldman, communications editor.