A Letter to “Pharma Bro” Martin Shkreli, and the Good Reason Why You Should Read it

Dear Martin,

Oh, Martin. Oh, Pharma Bro...no. You missed the memo on learning from your past indiscretions, didn’t you? That’s unfortunate for you, as you are poised to once again be the subject of immense public scorn. Frankly I’m not concerned about you, though. I’m concerned for the 6.5 million people in the world who are currently infected with Chagas disease. [Aside: For anyone who missed Round 1 of this nonsense, Shkreli earned his nickname and his notoriety by taking over the reins of Turing Pharmaceuticals and immediately hiking the price of daraprim, a medicine used to treat the AIDS-associated infection toxoplasmosis. “Hiked” is generous; he raised it 5,000% ($13.50 USD per pill to $750 USD per pill). If that seems egregious, keep reading. After initial bluster about profits being paramount, Shkreli sheepishly agreed to lower the price after an impressive public flogging].

But back to you, PB. Can I call you PB? One would think that an enterprising young fellow such as yourself would give it at least a year before trying this particular trick again. Not you, friend-you’re all about ambition! Just the other day, The Atlantic reported news of your new venture as CEO of KaloBios Pharmaceuticals: buying the rights to a drug called benznidazole and applying for FDA approval to sell it in the United States again. In fairness, I should point out that perhaps you are undertaking this in order to make it easier to treat US patients for Chagas disease (currently, physicians and patients must go through the CDC to obtain the medication). Anything is possible, of course, and what a lovely act of penance that would be after the whole daraprim debacle. However, it looks like you and KaloBios decided to go a different, more familiar route: pricing a course of treatment in the $100,000 USD range. If 5,000% was bad, a price hike of 150,000% is just…gaudy, for lack of a better term. While we’re on the subject, is it a happy coincidence that you’ve price hiked two treatments for neglected tropical diseases, or is it on the bet that no one would notice or protest? But I digress.

A fairly recent development that makes this story extremely relevant to we Americans is that Chagas disease transmission is now happening in the United States. It used to be that people could only become infected overseas, but not anymore. Following the infestation of Texas with the insects that transmit the parasite, the “kissing bug”, reports of US transmission began emerging. PB, I’m going to go ahead and assume you were already aware of that, hence your purchasing of the rights to benznidazole, the recommended treatment. Buy it cheap if you suspect there will be a sudden market, and then sell it high, right? Makes good business sense, I imagine. However, it shows how little you’ve learned about humanity. Chagas patients suffer immensely from fevers and potentially disfiguring swollen lymph glands, and many go on to develop scarring in the heart or digestive tract that ends in sudden death. Your actions will make it impossible or financially devastating for those people to be cured of infection. You are literally breaking hearts. A few months back I wrote that medicine was a precious and sacred responsibility, and that you and your colleagues were unfit to be associated with it. I stand by that assessment. I hope others do too, if for no other reason than because this time, it could be any of us you’re gouging.

Trypanosoma cruzi, the parasite the causes Chagas disease, is treated with benzimidazole [Image: Rubem Menna Barreto]

Yours sincerely, Dr. Meghan May

NOTE: The Atlantic seems to imply that this could potentially have been race-based by claiming that the decision “targets Latinos”. The statement stems from the fact that Chagas cases were, until very recently, exclusively contracted in Latin America. While I understand the origin of the statement because this action will disproportionately affect Latinos, and certainly understand the urge to malign those who made this decision, I suspect that the ethnicity and geography are irrelevant to our good friend Pharma Bro. There’s plenty to work with featuring greed and narcissism alone.