Triage

First, let me honour James Orbinski for bringing the reality, the horror, of the word ‘triage‘ into public consciousness.

Triage is doing medicine with limited resources. I submit that pharmaceutical resource choices are also a form of triage.

Here you will find an article complaining that Canada lags behind on rare disease research. I hold that this is a form of triage, and could be a correct decision. The article references an unfortunate individual whose life-extending treatment costs $200,000.00 a year. The condition is extremely rare, one in 100,000 or so.

I ask you to think: how much vaccine (polio, flu, measles, whatever) or research (artemisinin generated in yeast instead of bacteria, for example) could be funded with $200K per year.

One country, New Zealand, performs triage overall in its drug decisions. There is a government agency to achieve this. I believe this agency will come under attack as New Zealand goes into further trade agreements, such as this one.

The pharmaceutical industry is driven by profit, not humanitarianism. The entire book Information Feudalism, ISBN 1-56584-804-7 is about this. India was forced to disallow generic drug manufacturers by elongating and broadening patent restrictions. Claims of poorer quality were false. On page 67-68 of this book we read this:

Having just returned from medical work in Nepal, I am intrigued by the Association of the British Pharmaceutical Industry’s statement that “the pharmaceutical industry in the UK is highly competitive especially in terms of prices.” Most of the drugs available in Nepal are manufactured in India and their efficacy in clinical practice I have found to be the same as their UI equivalents but the price is about one-tenth to one-twentieth of the UK price. Any argument about research and development costs can hardly apply to such humble drugs as paracetamol.

Here you will find that a specific HIV drug costs about $25K per year. At one point some other drugs were of the order of $1300 per month. India offered to produce that for about five bucks, and were told they’d be trade-sanctioned into the ground if they did so. So they joined GATT, TRIPS, et cetera. African countries agreed to prosecute generic manufacturers of drugs under patent.

Wholesalers regularly squeeze pharmacies as well. This page is not meant to be visible by non-medical practitioners. I found it by google searching.

So, what’s my point? Triage is my point. We should, as human citizens, demand that our governments and health practitioners do the following:

  • bargain for the best treatments, based on cost-effectiveness and patient counts.
  • question the profits of Big Pharma. Is this fair?
  • Question focusing on rare drug research. Is this good triage? or just good money?

In The Economist page, there is hope, where these words appear:

Second, the price of AIDS drugs plunged. In May 2000 a year’s “triple cocktail” therapy cost $10,000 or so. By 2011 the same pills sold for $62 in poor countries. PEPFAR cash buys generic versions of patented drugs, which may be supplied only to poor countries. Last year two drugmakers won most of PEPFAR’s contracts: Aurobindo, an Indian firm, and Matrix, an Indian firm acquired in 2007 by Mylan, an American one. PEPFAR’s bidding system keeps margins slim even by the standards of the generics industry, says Rajiv Malik, the president of Mylan. But volumes are huge.

I note that $62 a year is roughly $5 a month – what the Indian firms said they could produce it for, in the first place.

Again, think about triage: we have a poplulation with ailments. Let’s be efficient with limited resources. And not try to do everything, even if a newspaper article thinks we should.

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