Big Pharma really has the 'spin' under control. Even here at Daily Kos, I've seen some commenters indicating that re-importation (from Canada, I presume), would be bad as it would support price-control.
I'm going to blow that argument out the water, probably as far as Toronto, and maybe a little further.
I should have written this diary 25 years ago, when it was fresh in my mind, and when public knowledge of its content could have resulted in action.
But now, all I have left is my recollection. Something tells me it's as true today as it was then. I'll tell my story.
For the period between 1976 and 1982, I worked in the UK offices of a Big Pharma company - I won't mention the name, it doesn't matter, they all do what I will describe.
Towards the end of my time there, I had risen to the position of Marketing Manager - Oncology Division, a position about which I felt somewhat proud, as I was very young for such a role.
My job was to set up a sales and marketing operation for a new range of anti-cancer drugs that the company had gained licenses to sell from a range of US academic institutions (mostly without royalties to the institutions, either - these institutions simply wanted wider usage of their innovations).
You will gather from this that the company had not spent a single cent on research and development, nor very much on clinical trials - as a general rule, oncologists are very keen on getting their hands on new anti-cancer agents and require little financial 'persuasion'. If such 'persuasion' was deemed necessary, the company might provide for free, the drug in question, or perhaps help pay the salary of a research assistant or two.
I was working very closely with the company's Medical Department, as marketing these types of drugs is very 'evidence-based' - i.e. if you can get an influence-leader to state that the results they'd seen were positive, it would greatly encourage the uptake of the drug. Note that I'm not implying any undue influence, nor any attempt to alter the results of clinical trials.
The point I'm trying to make is that bringing these drugs to market was a tiny investment for the company, compared to other classes of treatment. No research, no Phase I, II or III trials. Basically product formulation, a tiny bit of pharmacokinetics, getting the equivalent of FDA approval, and then, ready to go!
One day, I received a call from an oncologist I'd been working with and s/he enquired about the availability of one these anti-cancer products for an 'off-label' use (use for other than the licensed uses). So, I wandered over to the Medical Department office, and asked my good doctor friend in there how that would work. So, we went through the process, and managed to get the US offices of the company to let us have finished product at $0.01 per milligram - a typical dosage would be about 500mg every three weeks for a year or so. Keep that price in your mind.
Now, the UK is a country that does pharmaceutical price control. It's based on a maximum percentage amount of profit that can be made on a product based on it's 'landed' (purchase) price by the local subsidiary. So, if we bought the product for a dollar, we'd be able to sell it for, say, $1.13.
A little later, we got into negotiations with the equivalent of the FDA to discuss pricing, and this meant we'd have to get a 'landed' price from our international partners. Guess what it was? $0.79 per mg - that's right, seventy-nine times the the price we had previously been charged.
Obviously concerned about the viability of my marketing plans, which were somewhat based on previous asssumptions about pricing, I decided to do some digging.
It was all about Transfer Pricing. The way it works is that the raw drug is manufactured in one country, then shipped to another for turning into a formulation, then to another for packaging, to another for labelling, and another to be put into cartons, and another to be put into shipping boxes. And, guess what happens to the price, as the medicine moves from one country to another? Yep, you got it. Yasee it doesn't matter to the multi-national company where it makes it's money, just that it does.
In this particular case, the trail started in the USA, went to Mexico, Puerto Rico, Italy, Switzerland and France before arriving in the UK.
So, thinking about that, it came as little surprise when my General Manager said "That's OK, just do the best you can" when I presented a Plan that actually lost money for the local company.
(BTW, that's good, because the profitability limits are applied across the whole of the local company, which meant that we could 'gouge' more with other products.)
Slightly off-thread, but I'll ask you all a question: Do you have any idea where the meds you are taking have been on their travels? Just because it says "Country of Manufacture: USA" on the label, that might only mean that it visited the USA at some point in its manufacture.
Here's another: Do you think that only the USA knows how to make safe drugs? Let me point out that when the UK was devastated by the thalidomide tragedy, product licensing and manufacturing oversight was beefed up to the point that it was a joke when we were told that something we were considering for marketing in the UK was already FDA certified - that was in some ways a disadvantage, because we knew that the clinical trial and manufacturing standards would not be up to the more stringent UK requirements, and would have to be done all over again!
The EU basically adopted the UK standards, lock, stock and barrel. So, any facility in the EU will have at least the same ability as the USA to produce safe medicines. That is also true of many other countries. India, Canada and Japan amongst many others, come to mind.
I'll make 3 points out of this:
- Re-importation of pharmaceuticals is no more likely to re-inforce 'price-controlled' markets than eating a felt hat. Trust me, big pharma will always get its pound of flesh (and it just goes to show just how much we are being gouged in the USA).
- Think how many more patients could have been treated if a more reasonable 'landed' price had been charged. These drugs (especially in the case of the one I describe here), are literally life-saving, in fact this particular drug was solely responsible for reducing the mortality rate for one particular type of cancer from about 50% to 5%.
- Think about the Vioxx scandal. The FDA fell head-over-heels to grant a license for Vioxx in a process that lasted only 6 months (fast track). The potential for heart damage was allegedly known to Merck, yet no post-marketing surveillance was mandated by the FDA. In almost all other countries, I understand that Vioxx was not yet licenced for use at the time that the reports of heart attacks connected with it emerged here in a kind of thalidomide tragedy over here (please correct me if I am wrong on this point). Think FDA - think safe. Not so much.