Sunday, June 13, 2010

Cancer and politics

(Note: this is my article for, June 12, 2010)

Cancer is among the top killer diseases in the world and in the Philippines. Personally, this disease is impossible to brush aside because a number of people close to me have died of it.

My elder brother, the eldest in our family, died of prostate cancer a few years ago. His wife and my sister in law, died of colon cancer several months before him. My mother’s first cousin in Cebu also died of prostate cancer. One of our wedding godmother died of cancer early this year. Another godmother is undergoing chemotherapy with a rare type of cancer.

The latter is very close to us, especially to my wife. News of her having a cancer made us very sad. But news that she is fighting back and doing well also cheers us. Sometimes she is weakened and has to be hospitalized, on most days she is doing well and following the medications given by her physicians. Nonetheless, we only wish that the cancer cells in her body will be gone and defeated, we wish nothing less than that.

Thus, I really wish that this killer disease will be killed someday too, or be significantly neutralized and controlled. The role of innovator pharmaceutical companies is important here because they are the only ones – not the generic manufacturers, not the tobacco or alcohol or automobile or energy companies – which do serious and very costly research and development to find more powerful, more disease-killer drugs and vaccines.

While some cancer cases are due to genetics, many cancer cases are lifestyle related. Like lung cancer due to over-smoking and liver cancer due to over-drinking. Thus, the first defense or “cure” against the latter type of cancer is to have healthy lifestyle. This highlights our main argument explained several times in this column, that health is first and foremost, personal and parental responsibility, not government responsibility.

Once cancer cells have grown, whether due to genetics or unhealthy lifestyle, the next line of defense will be by medications and physician intervention. It is important of course, to keep – or go back to – healthy lifestyle in order to help keep one’s body have stronger immune system.

When medications and medicines come in, that is where politics also come in. The immediate concern of many sectors in society, especially the health NGOs, patient groups, media, politicians and other political groups, is to pressure innovator pharmaceutical companies to significantly bring down the price of their new, more powerful, more disease-killer, but still patented drugs. The fact that all innovator companies are multinationals and are based in rich countries make them even more “devil-looking” in the eyes of such activist groups.

That there is huge cost in both actual R&D work and in complying with various requirements of various government drug regulatory agencies like the Food and Drug Administration (FDA) is less important to the different activist groups. The point is to use politics and political pressure to demonize the innovator companies. There are several tools to achieve this, like compulsory licensing (CL), parallel importation and drug price control. CL on some anti-AIDS and anti-cancer drugs has been used by the government of Thailand while the outgoing Philippine government has used drug price control for a number of drug molecules ranging from anti-hypertension, anti-cancer, anti-cholesterol, antibiotic, anti-diabetic and anti-thrombotic.

The high cost of new medicines is indeed a valid issue. This is no different from the higher prices of new models of mobile phones, flat tv, laptops and cars. New models are seen to be more revolutionary and contain qualities that are more powerful than the older models. But the availability of new and more powerful drugs and vaccines is sometimes a more basic issue than their price. There are many drugs that are deemed powerful but are not found in drugstores.

Desperate patients and their families and friends are willing to forego certain material things in their lives – like selling the second car, selling other properties – just to save a beloved person’s life. For this type of people, the price of more powerful drugs is secondary to their availability. The typical argument is that they can earn money later on, but they cannot bring back to life once a beloved person and friend has died.

Politics should step back in areas where science and medicine have the dynamics and incentives to find treatment to killer diseases. Where there is profit to be earned in this sector, more pharmaceutical, biotechnology and research companies will sprout and compete with each other in developing more powerful drugs and treatment to cancer and other killer diseases. The public’s desire for more powerful but more affordable drugs will be assured by a healthy competition among innovator and research companies. Once the patent has expired, the next line of competitors, the generic manufacturers, will further introduce off-patent drugs at a lot lower price.

The important thing is that new, innovator drugs from innovator companies should be allowed and encouraged to come on stream regularly. Patients’ lives are more important than politics.

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