Tag Archives: Allergan

September 25, 2019 · 13:23

Mental health or Medication

We have seen the premise in a few stages in the last decade and for the most people lean towards one or the other and that is fine, it is a hard choice to make and there is no real evidence which of the two is better in the long run. Mental health needs treatment, medication is at times not a cure, merely a way to create a timeline for treatment, or to minimise the impact of the situation. Yet there is also a medial state that is not mental health based, for example treating people with cystic fibrosis who have two copies of the F508del mutation, for them there is Orkambi. Yet, what is the status when this involves a politician? How delusional is a public speaker allowed to become before he is considered unhealthy and unable to perform his function?

That question came up when the Guardian gave me ‘Labour pledges to break patents and offer latest drugs on NHS‘ (at https://www.theguardian.com/politics/2019/sep/24/labour-pledges-to-break-patents-and-offer-latest-drugs-on-nhs). So not only is he making claims, he is basically pronouncing war on the World Trade Organisation, abolishing the TRIPS agreement and throwing it all overboard. As we realise that the World Health Organisation gives us: “As of February 2005, 148 countries are Members of the WTO. In becoming Members of the WTO, countries undertake to adhere to the 18 specific agreements annexed to the Agreement establishing the WTO. They cannot choose to be party to some agreements but not others“, the UK and the EU are both signatories, so Jeremy Corbyn is stupid enough to set a stage of war that endangers millions. To give a little consideration to the metrics, we get the numbers on Cystic Fibrosis, not merely those with these two mutations (a specific subset), we see that more than 70,000 people worldwide are living with cystic fibrosis. Approximately 1,000 new cases of CF are diagnosed each year. More than 75 percent of people with CF are diagnosed by age 2. More than half of the CF population is age 18 or older. Now this is not a good thing, we admit, yet we are looking to a population that is less than 0.001% of the entire population, more important the people that need Orkambi are a mere subset of that. And for the UK it would linearly mean that it affects only 0.1% of the 0.001% that optionally have it. That is his ‘limelight’; can someone please kick this idiot out of the Labour party (preferably out of UK politics altogether)?

And in the second part, no political party has any business being in the pharmaceutical industry, there is a reason why industrials should never have any political power (well, we lost that one ages ago, but still). His voice giving us: ‘party will create company to make cheap versions of drugs‘, whilst the metrics give us that it will be a population less than a 100 that have this version of Cystic Fibrosis that is what he is fighting for? He cannot even properly represent his constituency and now he is starting patent wars as well as a war with the World Trade Organisation on abolishing or severely changing The Agreement on Trade-Related Aspects of Intellectual Property Rights (TRIPS)? Not only does it not make sense, the impact could be devastating for the UK. This is a person screaming ‘election’ and then spinning silent when it was offered.

It is my personal view that UK labour is better off getting the clown Ronald McDonald to do the Labour party bidding, and it will do a better job than Jeremy Corbyn ever could. His promises are no longer empty, they are now right-out dangerous.

Pharmaceuticals

There is a larger pharmaceutical issue and it has been going on for well over a decade, the issue that patents are reapplied well over 30 years after date, often in a slightly changed form, only barely passing the innovation line is the largest concern for generic medication, yet there are dozens of examples and Orkambi is nowhere near the top 10 in this. Lyrica (Pfizer), Rituxan (roche), Cialis (Eli Lilly), Xolair (Roche/Novartis), Restatis (Allergan) are 5 of the top 10 expiring patents with a value of a little over $16 billion in total, and those owners would like a little longer exclusivity, because the expiration will hit their bottom line in a real hard way. In that list Orkambi does not even stack up to any decent degree and we have larger issues gaining patents with a generic option and Corbyn’s need to make war with TRIPS, whilst the NHS has larger issues, especially as it was Labour who botched the NHS IT project losing £11 billion and small change to the degree of several millions is not one who should be casting voices on ending patents.

The sentiment is not wrong, but the chosen field is a little beyond stupid, making us wonder whether the man is personally dealing with mental health issues. We all have had that moment where we wanted to stand in front of Dwayne Johnson calling him Tinkerbell, not really wise, but we all have those inflated moments of self, to do what Jeremy Corbyn does worse hiding behind one 9 year old with: “Luis is denied the medicine he needs because its American manufacturer refuses to sell the drug to the NHS for an affordable price“, so this is not some Cystic Fibrosis case, this is a very specific case and the medication required many millions to create and pass FDA approval. A medication for CF patients with a rare mutation. With two specific mutations in a disease that knows more than 1,700 mutations that had been found in the CFTR gene. Orkambi works for patients with the F508del mutation in both copies the CFTR gene, the most common mutation in people with cystic fibrosis worldwide. So even if it is the most common, there are 1700 mutations meaning that his war on one medication to a specific subset that comes down to a lot less than 100 patients in the UK. So this idiot (read: Jeremy Corbyn) goes to war, promising to abolish TRIPS and leaving the WTO, all for a subset of people, too small to fill a village? Now consider that the UK has Pharmaceutical interests as well, the top two players in the UK are GlaxoSmithKline and AstraZeneca representing almost £132 billion pounds, because if he does what he does, then those two will vacate as well, this is how stupid Jeremy Corbyn is, but he is hoping that you will not notice this as he is in feigned tears for one nine year old child. I only mentioned the top two, the field is larger than that, but Jeremy Corbyn is willing to throw it all in the air.

Can you please explain to me how the government budget will be met when two companies representing a taxable £100,000,000,000 leave the UK? This is the kind of short-sighted, BS carrying ventures that Jeremy Corbyn is handing its constituents. His claim is ‘In England about 5,000 young patients could benefit, but the NHS said it could not afford to pay the bill‘, if there are worldwide 70,000 Cystic Fibrosis (CF) patients the UK cannot have that many, the claim of “US drugs company Vertex priced Orkambi at over £100,000 per patient per year” might be true and for 100 patients that is still serious money, but we need to recognise that we cannot hand every working person a Ferrari, we do not have the money, and it is that extreme. We are in a position where until a patent ends, the maker gets to set the price, or not sell the product. In light of the numbers I see, I want Jeremy Corbyn to give us an exact list of these 5,000 patients and what medication they need. I reckon that the picture shifts a lot faster at that point. And we agree that larger changes are required, yet making a direct case to the WTO that patents cannot be extended above the 35 years is a lot better than abolishing the WTO. Yet Jeremy Corbyn has no options to do that, so he comes with a delusional plan to start a company that ‘create company to make cheap versions of drugs‘, whilst there are plenty of companies doing that, the case remains that patents hand exclusivity until they expire, this year 26 drugs are facing patent expiration and yet, Orkambi is not among them, but 26 patents will become generic, before 2022 42 patents will expire and that is good for a lot of people, yet this system is already in place, we do not need some delusional politician to add his need to become a rich pharmaceutical cat as well.

To be honest, I have never had such a low regard of UK Labour ever before, the fact that I have twice the regard towards LibDems than towards Labour at present is something I never thought possible in the age of Ed Miliband, whomever thought that Corbyn would be a worthy successor deserved the title ‘Joker of the Year‘, as I personally see it, it is actually that bad at present.

So whomever is happy that this optional mental health case is running the UK labour party is in desperate need of some medication (generic NHS funded options will be available).

 

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February 17, 2016 · 20:56

Behind the smiling numbers

An interesting story got to see the internet light by Nicholas Watt (at http://www.theguardian.com/society/2016/feb/16/income-tax-must-rise-3p-to-stop-nhs-staggering-from-year-to-year). The title ‘Income tax must rise 3p to stop NHS ‘staggering from year to year’‘, which implies initially that the NHS needs £1.95m, which might be OK. Yet the truth is far from that, the text gives us that Lord Kerslake stated “Income tax will have to increase by at least 3p in the pound…. “, which is another story entirely (and first evidence that members of the House of Lords are gifted with a decent sense of humour).

His lordship is quite correct when he states: “big questions needed to be asked to ensure that spending kept up with medical advances, an ageing population and the need to invest in hospitals“, yet these are mere facts that should have been asked almost a decade ago, there was a clear and near immediate danger to the health of the NHS. The logic we see after that becomes an issue (read: worry, concern, and both are debatable) “Health spending needs to rise at least in line with GDP. Arguably, we may need to go faster if we want to match European funding. You might argue there is a discount there because we have a more efficient system. But it’s got to be at least GDP-linked otherwise I don’t think we’ll get there“. So let’s take a look. First the Dutch version (at http://www.rijksbegroting.nl/2015/voorbereiding/begroting,kst199401_25.html) gives us two issues should we be willing to ignore language barrier. The BZK gets €71.3b, which is divided in €7.5b called budget financed expenditure and €63.8b from premium financed expenditures. So for argument sake, let’s take the total and divide that on a population of 17 million, this now implies that there is almost €4200 per person (remember that this is a terribly rough estimate).

Now for Belgium we get the VBO with €23.85b. Now we all know that Belgium is a much smaller nation (not that much smaller than the Netherlands in size) and with 11.5 million calling the Belgium nation their homestead we now see that they end up with €2075 per person (Rounded upwards). Perhaps his Lordship could give a slightly more detailed explanation for the remark “Health spending needs to rise at least in line with GDP. Arguably, we may need to go faster if we want to match European funding“. Considering that the Netherlands and Belgium are next to one another and their budgets per person are apart by a mere 49.404%.

This gets me to the core of the proclaimed matter, can anyone explain why we are linking healthcare to GDP? Perhaps, and this is merely a lose speculation, some people in the House of Lords had the time to read a paper by Santiago Lago Peñas (added at the end) called ‘On the relationship between GDP and Health Care expenditure; A new perspective‘, now that might be a good thing, there is nothing wrong with Spain taking the lead in matters (especially if it is a good idea). Santiago Lago Peñas as well as David Cantarero Prieto and Carla Blázquez Fernández have written an interesting paper.

First let’s take a look at part of the abstract, which states “Econometric results show that the long-run multiplier is close to unity, that health expenditure is more sensitive to per capita income cyclical movements than to trend movements, and that those countries with a higher share of private health expenditure fit faster and following a different pattern“. Now, I am not going to take a deep dive into this one (it is after all an abstract), but it gave me a few ideas on where to dig.

Next are a few quotes: “Attention is paid to several usually neglected dimensions of this link. With this aim, four different specifications are presented, with the logarithm of per capital total health care expenditure as the dependent variable in all cases” this doesn’t seem to be more than just a quote, but it will have impact down the track.

It is part 2 called previous evidence that is a first issue. When we accept the initial statement “the debate on this link has moved on whether the income elasticity of health expenditure is greater or less than 1 (Bac and Le Pen, 2002). An income elasticity less than 1 classified health expenditure and income inelastic, therefore, as a “necessary” good. On the other hand, if the elasticity is higher than 1, health will be classified as a “luxury” good“, which will do for now. You see, my issue is when we see the part that follows:

  • The seminal paper by Newhouse (1977)
  • An earlier study by Kleiman (1974) for a different set of countries
  • Leu (1986) using cross-sectional data for 19 OECD countries in 1974
  • Parkin et al. (1987) using similar methods and data from 1980
  • Brown (1987) using a sample of 20 OECD countries

Here we have the first issue. You see, this is not regarding the methodology, it is about the data, methods of data collection, usage of weights (if done), these numbers regarded in contrast towards those temporary populations in reflection to the whole. Health expenditure is one part, but based against which healthy part. Now consider the initial reflection I had on the Netherlands and Belgium. They have very different norms in respect to mental health care. Now consider the statements ‘19 OECD countries in 1974‘ and ‘20 OECD countries in 1987‘ I will again make a clear speculative declaration that the mental health norms are not equal, especially when considering economic differences, which gives my first thought, how useful is the paper on a whole (I am not attacking it) and how applicable this would be (read: could be) in reflection towards the whole.

You only need to scan for ‘psychology, psychiatry and mental health’ to see that the paper does not take this into consideration. As we know that the EEC nations have had their own approach to mental health in the past, is not a statement that they did anything wrong, but if this is the first element that does not align, what else will not align (there are a few). One that shines directly behind the ‘previous evidence‘. You see in my head the question comes to mind when I see “The econometric analysis relies on annual data for 31 OECD countries from 1970 to 2009 gathered from the OECD Health Data Set 2011“, so is this aggregated data or raw data. if it is aggregated data the foundation might not align giving an unbalanced and invalid view (in my personal opinion), if it is raw data, what ground line data (the full population) is added so that the individual record compares towards the national whole, if that is missing how can any calculation be truly reflective of what was, especially taking into account the data is reflective over different time zones with very different social pressures. In that case I wonder if I can get a similar result by calculating Z-scores and run a Crosstabs in IBM Statistics #JustSaying!

Now we get back to the article which comes with the image of a smiling Lord Kerslake. Does this paper validate or invalidate the idea? No it does not, but it leads to questions, serious ones.

The quote “John Appleby, the chief economist at the King’s Fund, has estimated that NHS spending is due to fall from 7.3% of GDP to 6.6% in 2020-21. If health spending were to keep pace with economic growth, Appleby estimates an extra £16bn would have to be found every year by 2020-21 to take the NHS budget to £158bn. This works out at 3p on all rates of income tax, according to the IFS” is next!

The term ‘NHS spending is due to fall‘ reads like an event Baron Munchausen could have come up with (the character from Raspe’s book in 1785, not the syndrome). Of course the prediction is 5 years away, which makes it speculative. Now we know that John Appleby is more than the Chief economist for The King’s fund. He is also a Visiting Professor at the Department of Economics at City University and he has a whole range of publications to his name, so why am I opposed?

Well, part of this starts with his own article ‘Social care: a future we don’t yet know‘ (at http://www.kingsfund.org.uk/blog/2015/11/social-care-future), the two quotes that get the foreground are “In our submission to the Spending Review we called for social care to be protected from further cuts and for the money previously agreed for the postponed Care Act funding reforms to be retained and invested in social care. But non-protected departments have been asked by HM Treasury to model cuts of 25 and 40 per cent – so further cuts seem inevitable“, as well as “What would happen if the spending cuts applied to social care over the past five years continue over the next five? Spending on social care for people of all ages as a share of GDP has already begun to fall. It was roughly 1.2 per cent in 2009 but if cuts continue at the same rate it will have halved by the end of this parliament to barely more than a half of one per cent of GDP“. Now there is nothing wrong with any of the texts, John Appleby is not where he is because he is silly, he is very (read: extremely) clued in. I am stating that the environment has changed, it has changed drastically from 2011 onwards and in addition; the changes the UK faces over the next three years will take some of these prediction to town in not so nice a manner.

You will now ask why, which is the question you should ask!

We get part of this from the London School of Economics and Political science (at http://cep.lse.ac.uk/pubs/download/special/cepsp26.pdf), the initial answer is given on page 13. Where we see “To summarise, treatments for the “common mental disorders” of depression and anxiety can be self-financing within the NHS. By spending more, we save even more. This is different from much of NHS expenditure. At the same time we relieve one of the main sources of suffering in our community“, in addition page 15 gives us “According to the 2007 survey, which covered a random sample of households, only 24% of people with depression and anxiety disorders were in any form of treatment“. This now gives us the first part in all this. The overall costs are not in league of the budgets because there is a missing foundations of equality on what falls ‘within’ the NHS. There is no option for the NHS other than to evolve into something ‘more’ complete. The UK is about to get 20,000 refugees from war torn Syria (over several years), the initial approved £1b seems to be nothing more than a drop of water on a hot plate, the ‘why’ will be clear shortly.

The UK has seen a massive rise in mental health issues in the last year alone. Depression and anxiety mainly due to economic events (cost of living) is now a serious concern, especially as the pressures of the economy are likely to continue a few more years. Consider my article two days ago (at https://lawlordtobe.com/2016/02/15/is-there-a-doctor-on-this-budget/) called ‘Is there a doctor on this budget?‘ where we saw the link to ‘Health Care for Undocumented Migrants: European Approaches‘. The graph shown on page 3 is the charm. If we consider the cube, we see that on the X-axis we see subcategories of undocumented migrants, yet the same expenditure would apply to refugees (or the population for that matter). Now consider the Y-axis which is about the type of services and the Z-axis are the funding arrangements. Now this can be treated like a glass with liquid. If we increase the base (X or Y) the funding arrangements go down, it is the simplest of physics, a bigger glass requires more fluid to fill, so we have a population with more health care needs, mental health care in this case and the types of services is not just against depression or anxiety, it will require the coverage of war trauma and shell shock. This will impact refugees of all ages. So the glass gets bigger and bigger and more and more funding will be required to keep funding arrangements on an equal level, this is merely the application of logic.

This is why I opposed John Appleby’s approach, it shows little application of a changing population, merely a greying one (which is a form of change), but it does not hold water against the massive change the UK has faced since 2013 and will face until 2019. This is why I am not in agreement with the statements of John Appleby. Now we get back to Lord Kerslake. You see, the paper I mentioned is an example. It might not even be the foundation of Lord Kerslake’s approach. Yet a multitude of papers clearly show that there seems to be no real no equality in the setting of healthcare (read: cost of health care). It seems to be wearing a different hat in nearly every European nation, it would already be a great leap forward if they all had the same colour, which does not seem to be the case either.

Now we get the quote that wakes us all up “Appleby estimates that NHS spending would have to increase by 30% or £43bn a year to take NHS total spending to the EU-15 average by 2020-21. The IFS estimates that this would involve an 8p increase on all rates of income tax“, which is one side of the option. How about the other side? When we see that AstraZeneca has been able to avoid corporation tax on a massive scale, which dwarves when we compare it to the mergers Pfizer and Allergan have achieved. Is it perhaps possible that his lordship looks at another solution like closing that tax abyss? Might I suggest an idea where any corporation involved in tax avoidance gets its medication ‘grey’ listed? Which means that any drug that could be begotten in a generic form from a place like India will be selected as a first solution? It could even result in India starting businesses in the UK (with the economic benefits that those places will give). It would also send a clear signal that if corporations would like to avoid taxation, which in legal correct way is just fine, but at that point other distributors of pharmaceuticals will be found. I reckon that between that announcement and the offer of reduced medications (read: less costs for the NHS) from pharmaceutical firms would be forthcoming within 24 hours of making the announcement.

Yet, this was not about the costing, it was about the increase and setting against the GDP. The fact that health spending and economic spending are on par reads more like an option for deferred payments to big pharma and medical supplier than anything else. In case of doctors it would mean that their incomes would go through the roof (which might be a deserved reality), but it is one that the coffers under the care of George Osborne cannot afford.

There is wisdom in his lordship stating that “a royal commission should be established to build a national consensus on NHS funding“, which sounds a lot more ‘reliable’ (read: acceptable) than the Labour party giving way by letting a banker (Sir Derek Wanless) set the NHS spending levels. It is of course desirable to go with the people and keep the directly funded NHS free at the point of use, yet that comes with a price tag that is no longer realistic in this day and age of deficit, in addition harder times are coming for a while longer, making the price tag we already have a non-linear shifting one. Yet I feel adamant to speak that mental health must be fully accepted as part of the NHS (for all people, anywhere in the UK), which slides the scales of budget by a lot. A reality many papers (as I expect it to be) did not take into account. Raising income taxation as implied could equally be an issue as that could potentially drive depression and suicide statistics overnight (the latter would lower rents but that seems just too harsh a solution).

What is a given is that Lord Kerslake is the catalyst that is making us ask several serious questions.

I am however not entirely convinced that his lordship took the best path in getting these issues out into the open.

On the relationship between GDP and Health Care expenditure; A new perspective

 

 

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February 6, 2016 · 12:36

Penis Aqua Rosa Congressista

The Dutch used to have interesting names for classifying people. There was ‘Penis jujubes’ (originally: Droplul), which amounts to Liquorice Penis, which captions the non-Dutch titles dick, asshole and idiot. The other one was ‘Penis Aqua Rosa’ (originally: Lulletje Rozewater), which gets us Rosewater Dick, which is an expression for a man that has no backbone, a man that is weak and submissive. The latter one seems to apply to the US Congress in a few ways.

You see, the  article ‘Drug company boss Martin Shkreli refuses to testify to Congress‘ gives us part of it all (at http://www.theguardian.com/business/2016/feb/04/martin-shkreli-refuses-to-testify-congress-drug-daraprim), an issue that might be seen in the wrong light, if you only go by the one side of the story. You see, this is situation that Congress and their US laws created for themselves. Even if we get the ’emotional’ statement: “One member begged him to examine his conscience“, we all seem to ignore, that this is something Congress achieved all by themselves. You see the quote “Earlier, Shkreli and Turing’s chief commercial officer, Nancy Retzlaff, were criticized for hiking the price of Daraprim despite the fact it is the only government-approved treatment for the rare infection toxoplasmosis, which can be fatal for some Aids and cancer patients and endangers babies in-utero” is at the core of this.

Instead of setting up the law that fairness was at the centre of it all, politicians set the speculation that every pharmaceutical company and their fields would be ‘distributed’, that there was no overlap (for the larger extent), as such pharmaceutical had a clear field for maximised profits. How long did you think it was going to take before someone weaselled themselves into that crowd, with the simple goal of maximising his Return-on-Investment? The United States of America has always been about capitalism and living the dream. Martin Shkreli is doing just that, now we get what some might call ‘sissy noises‘ from the Halls of Congress!

Let’s be Frank (or Punch and Judy; whatever works for you), what Martin Shkreli does is utterly unacceptable, yet, it is Congress that did not legislatively clip the wings of unbridled greed. They sat around as President Bill Clinton called for the end of the Glass–Steagall Legislation. As the majority remained silent additional doors to greed got opened. In all this, the lack of visionaries in Congress, even after 2008 lacked action when it came to protecting the citizens of the United States of America. So when I see the response from a member of congress “member begged him to examine his conscience“, I will kindly tell that congressperson to cry me a river and I’ll do so whilst playing worlds tiniest violin.

Congress is in an emotional state, suddenly crying for those who cannot afford it, yet what clear provisions in legislation has it given to the coffers of the United States? You see when we consider November 23rd (at http://www.forbes.com/sites/antoinegara/2015/11/23/pfizer-and-allergan-merger-ranks-as-biggest-ever-pharmaceutical-deal) and we see “On Monday, Pfizer PFE +0.10% and Allergan unveiled an all-stock merger that will allow the combined company, Pfizer PLC, to move its headquarters to Ireland and focus on corporate cost cuts“, which is set at $160 billion, you better believe that this impacts the taxability of that corporation by a lot. As far as I can tell from the surface, the total of pharmaceutical mergers LAST YEAR ALONE is well over 600 billion, so half a trillion dollars, all now going via Ireland. How much noise is congress making there? Or do these ‘respectful’ members of congress have a few too many friends in ‘those’ circles? Better to loudly focus on the one man out as Pfizer, Allergan and a few others. Can we all agree that the difference of 600 billion, being taxed at 25%, or being taxed at 17% is worth moving house over? You see, I love Sydney, but when someone tells me that moving will get me $48 billion, I will start singing ‘My heart is in Ireland‘ and I will enthusiastically pack my bags. You see, I can always get a second apartment in Buenos Aires and life of my self-made cash cow, getting me $50K a day and still allow me to double my fortune before I retire, making me live of $200K a day until I die. That is the track that Congress left open. This can be seen (at http://www.forbes.com/sites/antoinegara/2015/11/23/pfizer-and-allergan-merger-ranks-as-biggest-ever-pharmaceutical-deal), the quote there “move its headquarters to Ireland and focus on corporate cost cuts“, can be seen as ‘tax cuts’ and now guess what a chunk of those cost cuttings will go? You probably guessed it, the gents (ladies too) of the board of directors of Pfizer.

So, when I state to the person in Congress ‘go cry me a river’, I am being pretty serious. For the mere reason after all those hard words that the media published on how this was going to get stopped, on how some African American in a non-circular room (according to whitehouse.gov) decided to call for ‘Closing Corporate Tax Loopholes’ in July 26th 2014. I am guessing that this was unsuccessful as Pfizer basically walked out with well over half a trillion. The move started in November 2015 and the press has been absent of any failure to stop Pfizer from moving away from the American non-tax havens, towards the shores of paddy’s Irish Whiskey and the real tax havens.

Let’s be clear, that this does not excuse Martin Shkreli from the acts he is doing, or would it stop me from legislatively going after Martin Shkreli if I could. The mere reality is that it will be close to impossible to do because the US Congress had enabled much of what Martin Shkreli did, which is not what they intended to do, yet it is what is the non-emotional result, so in that matter ‘examine his conscience‘ applies to a much larger extent to Congress and its need to clean up the mess that allows corporate American to get around taxation. A mess congress might not be willing to fix for the simple speculation that when not re-elected those members of Congress need to rely on large corporations for their next pay check.

I am not the only one on this horse, as far as I can tell ‘the New Yorker’ and a few others are starting to realise that no matter how objectionable the acts of Martin Shkreli are, there is now a focal point change. This focal point is about how Congress itself is part of the problem, not part of anyone’s solution (at http://www.newyorker.com/culture/cultural-comment/everyone-hates-martin-shkreli-everyone-is-missing-the-point), how there is an unlabelled coffer with funds to buy items of survival for people who cannot afford it. The New Yorker states it as “mysterious corporate bargaining, and occasional charitable acts“, this includes (as I personally see it) Pfizer and their transplanted plus 600 billion, moving to Ireland.

So even when we consider the acts of Martin Shkreli to be vile and evil, how is the inaction of Congress not worse? How is it that we cannot condone the acts of a failed administration, whilst the acts of a person who was in it for the money from day one to be such a surprise?

A man that graduated from Bernard M. Baruch College of the City University of New York, who became a hedge funds manager, ‘evolved’ as an entrepreneur and who is living the American dream.

How are any of the unfolding elements a surprise to anyone?

 

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September 22, 2015 · 22:11

In Greed we trust

In greed we trust, all others are expected to die! That is the basic setting which is now ruling the internet and it all started when the CEO of Turing Pharmaceuticals AG bought the rights to generic drug Daraprim and he subsequently raised the price by 5500%. This now creates two parts. They are:

  1. How is this legal?
  2. How to prevent such dangerous situations?

The initial part is not found. You see, when we look at the definition of Financial Exploitation, we get: “Financial exploitation occurs when a person misuses or takes the assets of a vulnerable adult for his/her own personal benefit. This frequently occurs without the explicit knowledge or consent of a senior or disabled adult, depriving him/her of vital financial resources for his/her personal needs” (source:  National Adult Protective Services Association (NAPSA)). Most forms of protection against exploitation is against what people own. One of the most famous cases in Australia is Commercial Bank of Australia v Amadio (1983) 151 CLR 447; [1983] HCA 14. Yet, the law regarding exploitation of something that is not owned is not clear, in certain places we see that in the Generics and Biosimilars Initiative Journal (GaBI Journal). 2012;1(3-4):146-9. The title of the PPRI conference reports gives us this with ‘The potential of generics policies: more room for exploitation’. The tactic is quite sound, if the price of normal medication cannot be lowered, than raising the price of generics is a sound strategy from the view of the greedy. The paper also gives us “Mr Richard Bergstrom, President of the European Federation of Pharmaceutical Industries and Associations stated that ‘once patents expire, prices should fall to a low, but sustainable, level’. In this panel discussion but also throughout the conference there appeared to be a common understanding that generics competition works well”. This was a view stated almost 3 years ago, which is true. However, the solutions that are addressed to a 2% or even 1% market does not seem to have too many alternatives, this is where the solutions like Daraprim and Cycloserine seem to come into play. The older small solutions that have no equal because the need is too small, now a massive option for larger profits.

When we look at Bloomberg on August 6th, we get: “Allergan Plc’s Actavis unit got a subpoena from the U.S. Justice Department seeking information on the marketing and prices of its generic drugs, becoming the biggest company yet to draw scrutiny in the government’s widening antitrust probe of the industry. The June 25 subpoena also sought information about communications with competitors regarding the products, Allergan said Thursday in a filing. While the company didn’t supply further information and didn’t specify the competitors, rivals including Lannett Co., Endo International Plc, Par Pharmaceutical Holdings Inc. and Impax Laboratories Inc. have made similar disclosures in the past several months“, as well as “Some 10 percent of generic drugs doubled in price between July 2013 and June 2014, and half of all generic drugs rose in price, according to an analysis earlier this year of Centres for Medicare and Medicaid data cited by Senator Bernie Sanders, an independent from Vermont who’s running for president, and Representative Elijah Cummings, a Democrat from Maryland”

So as we see these events, why did Martin Shkreli make this move? An entrepreneur of his achievements does not play around. What is his game?

The ‘defence’ we see from the other side is “Shkreli said: “We need to turn a profit on the drug.” He defended the decision by telling Bloomberg News that newer versions of the drug needed to be developed and his was the first company “to really focus on this product” for decades and that such research was extremely expensive“. This goes against the statement he later makes, which was “He also promised that: “If you cannot afford the drug we will give it away for free.” Shkreli also said the drug was currently under priced” (source: http://www.theguardian.com/business/2015/sep/21/entrepreneur-defends-raise-price-daraprim-drug).

Now we have an issue with all this. Is this about the medication, or is this a first step to bleed dry health systems?

For this we must show one additional quote. It is “Shkreli’s start-up company, Turing Pharmaceuticals, acquired Daraprim in August. The drug was first developed in the 1940s and is used to treat toxoplasmosis, an infection that is not common but is particularly dangerous and can be fatal“. The question in my mind is how this existing drug is any form of treatment against the complications of AIDS? A drug that is over 60 years old, which is suddenly the foundation towards a cure? What are we not seeing? Well, that part is shown by CNBC (at http://www.cnbc.com/2015/09/21/drug-prices-big-price-increase-for-daraprim-rescinded.html). Here we see that this is the second act. The first one was “Cycloserine was acquired last month by Rodelis Therapeutics, which promptly raised the price to $10,800 for 30 capsules, from $500. But the company agreed to return the drug to its former owner, a non-profit organization affiliated with Purdue University, the organization said on Monday“, after which the price ‘stabilised’ at twice the original price. So is this about a changing approach to the increase of generic medication by 100%-300% in the end? In addition, the other CNBC quote is “However, outrage over a gigantic price increase for another drug spread into the political sphere on Monday, causing biotechnology stocks to fall broadly as investors worried about possible government action to control pharmaceutical prices. The Nasdaq Biotechnology Index fell more than 4 percent“, now this is all starting to make sense. A hedge funds manager playing the market and playing the waves of market exploitation. This is not unheard of, more important, for the most, we could argue that no illegal acts were undertaken. The Guardian stated “It is not uncommon for companies to use inventive interpretations of government regulations and loopholes in the law to corner the market for certain drugs, especially ones that were developed a long time ago and have only a limited market“, which is true, but when we considered the additional event that the Guardian ignored, give us cause for concern. I am not stating that the Guardian is trying to misinform its readers, their conclusion on one case is sound. Yet, when we see the addition that came from CNBC regarding Rodelis Therapeutics, we see another side. Here we see a side of market exploitation and Market manipulation, as far as I can tell at present in a very legal way. That we see from “Mr. Hasler said the new price was needed to stem losses”. Really? So is this about feigned losses, or is this one of many steps where drugs that treat smaller populations to grow 100%-300% in price to assure a market niche that most NHS systems (US, EEC and Commonwealth nations) are unable to fight. In this way on an international level the respected NHS versions will be placed under additional pressure. As I see it, Martin Shkreli has started Turing Pharmaceuticals AG to dig into this very profitable branch. In addition, for something this expensive, how come those rights transferred for only 55 million?

It seems to me that parts in all this remains unstated. Why?

Now in this part I am not having a go at journalists as in the past. For one, this is an evolving story, in the second part there are a few sides to all this. For one, I am speculating in what the game is here (speculating is not now, nor should it ever be regarded as factual). In addition there are sides that have not played yet. One of these sides is the law. As I personally see it, certain entrepreneurs, wealthy or not are now trying to corner the 2% treatment solutions, perhaps even the one percent group. Consider how this affects the UK. Let’s use the UK statistics. When we consider 240 million patients a year. If 2.4 million people require a drug and if that price suddenly goes up from $500 to $1000 (the Cycloserine example). This is only in the UK. Which gives them an additional 1.2 billion and this is only ONE nation, now consider the effect on the EEC as well as the US and the other Commonwealth nations, now the money becomes really handsome. Even at 0.1% it is a massive influx of money and for now all very legal. I have full faith that the law will be adjusted, yet we will see that it will be adjusted too late and some of these fast moving rascals will have made a massive additional amount of money, which is not an illegal act by the way.

This whilst I am still slaving over my issues of Infringement. That and a massive student loan will not propel me whilst some dubious hedge funds individual walks away with billions. A clever mind is half the battle!

So as this event escalates, the UK will have a new problem, because as is, the prospect stated ‘Planned NHS expenditure for 2015/16 is £116.574bn‘ is possible off by no less than 10%, the generic pharma side is only one side. I wonder what happens when these ‘entrepreneurs’ acquire the service contracts of hospitals at large, what happens when the MRI contracts are sold off to third parties? What happens when those prices go up? This is a path that Stadium Group CEO Charlie Peppiatt seems to be walking towards in a very successful way. As one third of the planet goes into ‘one foot in the grave mode’ that population will require a massive amount of support in medical terms (until they move towards their respective casket or urn). There is one side that is an issue for the other players. As I see it Martin Shkreli might be the most visible one but as I see it not the brightest (massively richer than me though), in one bash he has given visibility to a move that many wanted to keep under wraps, because out of sight, out of mind and that would have resulted in profits (loads of it). The visibility forced on the eyes of many might now result in NHS safety valves that could stop the forced squandering of funds. I wonder if my view is correct and more important will proper steps be taken sooner rather than later.

I’ll let you decide.

 

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