The Good, the Bad, the Ugly: Pharmaceutical Patents

The Society gathered on September 18th to debate Resolved: Pharmaceutical Patents do more harm than good in a slightly different locale—McShain Large. The President of Georgetown had unfortunately borrowed the Philodemic Room for the evening, but most Philodemicians were satisfied because he sent consolation chocolate chip cookies (the size of my face, might I add) to thank the Philodemic. The debate that ensued had all of the decorum of a debate in the Philodemic Room, with Ms. Caroline Egan (COL ’15) of New York affirming and Mr. Victor Wang (NHS ’15) of Maryland negating.

Ms. Egan began the debate by welcoming the Philodemic to the arena of bioethics—one of her specialties. She explained that pharmaceutical patents grant monopolies on drugs for up to 20 years that are often renewed with inconsequential tweaks, a process called “evergreening.” She specified that the debate should emphasize evergreening and not the patents themselves; a patent per se can’t do harm, but the way it is used can and does. More importantly, the floor should focus on the case study of India, which rejected Novartis’ second patent for a leukemia drug in 2013. Novartis and other pharmaceutical companies insist that they need patents because they invest so much money in research, but generic companies are able to produce the same drug for 10% of the cost. Additionally, Novartis justified its lawsuits against India by divulging that 95% of the patients receive their drug for free, leaving only 5% that actually pay. Yet Ms. Egan boldly asked the Philodemic whether people should rely on charity for life-saving treatments—she claimed that medicine is virtue based and, as such, so should pharmacy. In fact, it’s not enough that [companies] have instrumental goals, they must also have integral goals.” Moreover, by suing the government of India, Novartis is also sending a frightening message to other countries that want to join the World Trade Organization but do not want to adhere to their international patent protection. Ms. Egan closed with a powerful emotional appeal to “think of the people that get left out of these decisions…that aren’t worth the pharmaceutical companies’ money. Think of justice.”

Mr. Wang approached the debate from a much more empirical angle, explaining what goes into a pharmaceutical patent. The drug discovery process begins by finding one function compound out of millions. That compound then goes through animal testing—which costs approximately $1,000 per week per mouse (and think of bigger animals!) and then afterwards begins clinical trials if it is one of less than 1% of compounds that make it. Mr. Wang explained that humans are even more expensive, costing “about $50,000 to…keep intact” (I’m sure he was joking about that last part). In Phase One of clinicals, you have a small trial size, but then you expand that group to about 1000 people (95% of the compounds that have made it this far then fail), and then in Phase Three you must test for efficiency. Thus, companies put in 8-10 years solely in research, during which at some point they must apply for a patent. Therefore, patents only provide 5-10 years of exclusivity. However, patents first began in the 1990s, and are only for novel processes or compounds. Patented information is also forcibly disseminated, permitting the study of new drugs, just not the sale thereof. Furthermore, the TRIPS Agreement (of the WTO) makes patents of member countries universal while also balancing the patent protection against public health; a country that truly can’t provide for its people and demonstrates a reason not to have the patent is excused from the agreement. Mr. Wang ended his keynote with a question for the floor: “Is this justifiable, for countries like India to reject patents?” He stated that countries should be virtuous but, “if a country isn’t self-sufficient, how can it help others?”

The floor portion of the debate then opened with Mr. Diasti (NHS ’14), who posited that there’s no “crippling need” for exclusivity and that over 90% of drug sales are in the US, Europe, and Japan. He questioned whether public health is a right and whether it has dominion over a product. Mr. Schafer followed, wishing he could agree with Mr. Diasti, but acknowledging that his Canadian family sees the American healthcare system as better exactly because it’s run as a business. He was the first to say that “greed is going to be what drives innovation.” On the other hand, Mr. Kleinman said that “greed stifles innovation”, because some healthcare companies purely takeover others, and then stop all research. What succeeded was the capitalism speech, given by (naturally) Mr. Naft. He noted that there are only three ways to get ahead in medicine: getting there first, being smarter afterwards, or cheating. Mr. Eisen then continued the trend of a parent who worked in a pharmaceutical company, explicating that his mother was forced to leave Pfizer because they owned any compound she discovered and had the “right to refusal.” Not to mention that companies actually spend most of their money on marketing.

Ms. Hernick then interceded to refocus the debate on the question at hand: “is it the patent, or the environment in which it is functioning?” It isn’t the patents that are harmful, she asserted, but the pharmaceutical pipelines. Mr. Fletcher disagreed though, responding that patents ensure that you only get good care if you pay for it, and that the rewards for drug production are only with expensive and high-selling drugs (for the ills of the rich). At this point, Vice President Wilson stepped in to again confirm that the debate was on patents and not on an alternative universe in which we won’t have patents; the debate should concentrate on the case study of India and whether evergreening is harmful. Ms. Coccia seconded Mr. Wilson’s speech, but added that companies shouldn’t be trusted to give people in developing countries’ valuable medication when they are charging Americans an arm and a leg for treatments. Mr. Perez-Reyes disagreed though, saying that the Philodemic was forgetting the researchers behind pharmaceutical companies, those that invest their entire lives into producing life-saving drugs and then deserve compensation. “Patents are labor and the right of the researcher” he proclaimed.

Then the non-member speaking time began with a striking anecdote by Ms. Xinlan Hu (COL ’18) about her mother’s struggle with expensive medication, concluding that because only 10% of a company’s benefits come from developing countries, it’s not necessary to patent a drug there. Mr. Anebi Adoga (COL ’16) quickly responded that although there is a lot of poverty in developing countries, there is still very much poverty in the US. However, Mr. Philip Ma (SFS ’17), put ideas into perspective by revealing that there are ways to reduce research costs for drugs without patents, such as grants, public finance, and open source development. Yet, Mr. Jack Musgrave (COL ’18) replied that regardless, making money from patents creates an incentive to produce the best drugs in the same way that making money drove Ford’s invention of the assembly line (pun intended J). Mr. Mitchell Tu (SFS ’17) didn’t contest that making money is a good thing, but instead said the problem lies with the government granting a monopoly to certain companies. Nevertheless, declared Ms. Zoe Sun (SFS ’18), there is a net good to companies producing drugs even with the patents, especially considering that patented products do eventually become cheaper.

With the end of the non-member speaking time, seven speeches remained, beginning with Mr. Whelan, who proclaimed (singing!) that the key to this debate is that pragmatism must yield to compassion. On the other hand, asked Mr. Musgrave, where does that leave us? In a world without patents, innovation would die. Then, President DiMisa stepped in to assure the Philodemic that the world did indeed have innovation before patenting began in the ‘90s, and that patents disincentivize research on diseases like malaria. Ms. Grace quickly followed, questioning what it means to provide quality healthcare. Mr. Willis then reminded us that it is both practical and possible to make money without patents—think about your run-of-mill wart medication that doubles as a keyboard cleaner. Then Ms. Burke reminded us about the drug market in the horse industry—something that’s necessary if we want to maintain a system able to fund research on low-income diseases. Finally, Mr. Greco summed up the affirmation by reminding the audience that the issue at hand is secondary patents and that any monopoly is a bad one.

Mr. Wang was the first to close, explaining what the big questions of the debate were. First, whether developing countries specifically should decide the legitimacy of a secondary patent. Second, if it’s ok for a country in the WTO to reject a patent once all other member countries have approved it. And lastly, can the pharmaceutical industry produce better drugs without the process of evergreening. Ms. Egan rebutted Mr. Wang my refocusing the Philodemic on the strategies employed during the patenting process. She also turned many of the arguments about greed driving innovation to the affirmation, positing that generic companies are the product of capitalism and the free-market. Lastly, she said this debate was about individual countries being able to hold pharmaceutical companies accountable—no one should have to rely on the whims of a pharmaceutical company” for their medication.

The resolution was firmly decided with 35 affirming, 4 abstaining, and 22 negating.

ELD,

Rosa Cuppari

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