On Medicine, the Common Good, and Pharma Bro


[Image: Getty Images]

The overnight price change of pyramethamine (Daraprim) in the United States raised eyebrows and ire last week. Long story short: the manufacturing rights to Daraprim, a drug used to treat the AIDS-associated disease toxoplasmosis, were purchased by the company Turing Pharmaceuticals, and the price was increased 5000% ($13.50 to $750 per pill) literally overnight. Turing CEO Martin Shkreli was initially unapologetic, insisting that the price increase was justified because it was comparable to standard practices in the industry. Shkreli later insisted it was necessary because the increased revenue would bankroll new research and development advances, and then eventually agreed to drop the price (as of this moment, we're not sure what the new price will be). First, a few realities need acknowledging. Production and quality control of medications are expensive. Clinical trials are essential for new medications to apply for US FDA licensure, and clinical trials tend to be extraordinarily expensive. Not every experiment works every time, and often times a scientific hypothesis about what a good drug target would be are either wrong, nuanced, or correct but hampered by toxicity of a designed drug. In other words, many years and tens of millions of dollars go into the successful design of a single medication. That said, the company selling the drug is not necessarily the one who spent the millions. The basic science often is done at universities, and frequently funded by Federal, state, or foundation grants. Another relevant factoid would be that pharmaceutical companies are perfectly eliglible to apply for research grants, and often do. Translation: you and I are already on the hook for much of the cost of drug discovery. The stock defense of companies when questioned about their pricing of revenues going back into research is frankly a bit hollow. With Daraprim in particular the defense was curious, because it is not the type of drug that is usually modified and refined. Shkreli himself made this story particularly notable. A former hedge fund manager in his early thirties, he makes for a delicious villain. As a colleague so eloquantly put it, "his face is so...punchable." It was beyond the images of Shkreli, which led to the quintessentially perfect nickname "Pharma Bro", that invoked public ire. It was his demeanor. He was an unapologetic capitalist, until it became clear that keeping the price at the 5000% markup was going to hurt Turing's bottom line. The thing is, Shkreli isn't unique among CEOs in anything other than his being foolish enough to be so blatant. A company is a company; its purpose it to generate profit. A company that is not profitable ceases to exist, and a CEO that does not maximize profits ceases to be employed. Most of us get that. That does not, however, mean that we should accept it when it comes to medications that save lives. Some things should be immune from capitalist pressure. Hands down, medicine is one of them. As scientists and clinicians devoted to the advancement and healing of humanity, most of us find medicine to be something for the common good: an inalienliable human right. Shkreli's right to make a buck is none of my business; I just wish he and his colleagues chose to focus their particular skill set on another industry. To quote a different colleague, "we use magic to fight evil." That is a precious and sacred responsibility. The Shkrelis of the world? They're unfit for it.

Pharma Bro [Image: M. Shkreli, via Twitter]