How Big Pharma secures drug monopolies
Patently insane: How Big Pharma gouges drug prices
Tahir Amin: So the patent system has been a great driver of medical inventions. We've seen some terrific discoveries and inventions in the medical space. But as we've evolved in the system, I think we're starting to see-- as a lawyer who's practiced in this area, we're starting to see a lot of strategies that are played by pharmaceutical companies in order to maintain their monopolistic hold or their exclusivity hold over a particular product. And what they do is they ratchet up a number of patents around a particular product in order to prevent competition from getting in.
And we all know that once you have competition, prices drive down. There's a number of studies that show prices can drop more than 50% if you get competition in the marketplace sooner. So the idea that companies want to do is to basically prevent that competition from coming in earlier. And then the other argument of that is: are they then really inventing new things? Because what they do is they hold on to the marketplace as long as they can on the existing product.
They extend the franchise out by using patents, sometimes with the potential of holding the market for 40 years unless litigated. And we all know that litigation doesn't solve all the problems. And we've seen that in a number of the top-selling drugs in the United States. We've done studies as an organization where we have seen price hikes between 2012 and 2016 on the top 12 selling drugs in the United States have 68%.
And we've seen in parallel to that the number of patents that have been stacked up on those products, even after the product has been approved, even after the initial patent has expired, which is a 20 year term. And so they're just pushing it out further and further and further so that they can delay the competition getting in. And that all leads to market power and it all leads to the ability to increase prices at will.
If you look at a pharmaceutical company, the scientists who work there, the people who work on the development of drugs, their primary purpose is to help people, I believe. I genuinely believe that. I believe the conversations I've had with people from that sector. They believe that if they bring a new product to market and it saves someone's life or it can actually make somebody healthy, they really do believe that.
Unfortunately, there's a business side to it, as well. And so what you have is for every scientist, you have probably two lawyers who are watching over them saying, "OK, how can we extract a patent out of this and to make sure that nobody else gets in there?" And so what we have is then you have-- in particularly the pharmaceutical market, there's an argument that it's become overly financialized in terms of its investors who drive what companies do, rather than maybe the initially intended purpose was to deliver health products and to help make people not have to become ill and stay alive.
And I think some of that has got lost in the process as pharmaceutical companies now really start to look at their bottom line and their shareholders and what the investors want rather than what their original purpose was (to help people become healthier). And I think that the bargain of that has tilted more towards the financial-ization of things rather than thinking about health first.
I-MAK comprises lawyers and scientists who have come from the private practice background. We've all worked in industry. I myself have been a solicitor in the United Kingdom, working for the commercial side of intellectual property for over 10 years. And we've taken that knowledge to apply it in a public interest way, whereby we look at, particularly in the pharmaceutical industry, how do pharmaceutical corporations strategize their patent filings in order to get the maximum protection?
So what we do is, we look at a product, it could even be still in development, and we'll do what we call the due diligence and the analysis of all their patent filings. So for example, if it's a product that revolves around a small chemical compound, we'll identify what that chemical structure is, and then what we'll do is we'll do patent searches. There are various databases that you can use. We put in keywords, we will use compound searches, and then we'll find out what it is that the company has filed for. And then we track how many other patents that the company is adding on in the lifetime of the product.
And that way, we build up a sense of what is their entire portfolio around that particular product. And that then gives us a sense of what their strategy is, what potentially is the new version of the product that they may be lining up. So what they do is typically, products these days in the pharmaceutical market, they're on the market for five years and then they'll switch it out to the next version of the product. And these patents usually tell you what's coming down the line. And we use that essentially then to make decisions.
And often at the behest of organizations, such as Doctors Without Borders, who want to get access to these products, but they say "the patents are a barrier, the prices are too high." And then we'll investigate the science behind them as we're doing these analysis. And what we realize is many times, the science behind it is not new. And then at that point, we decide whether we want to challenge those patents in order to remove the barriers so that competition can get in earlier.
And by doing that, then we get generic competition in earlier if we're successful, and prices drop significantly. And we've achieved in various ways. For example, in India, we've been very successful with the HIV drug Kaletra, which is a product owned by Abbott Laboratories and now Abbvie. And we were able to challenge the key patents on their drug such that Abbott eventually withdrew all its patent applications, and Indian generic companies could continue to supply this particular product at a much lower price not only to Indian patients, but also many patients around the world, and particularly in Africa.
And so we were to keep that market at a much accessible way for people living with HIV/AIDS. And that, for us, has been one of the greatest successes. But more recently we've done it for the new Hepatitis C drugs. For example, just this year, we got a decision in the drug by Gilead called sofosbuvir. We were able to win a case in China. And China has 10 million people living with hepatitis C. And the fact that we won these two cases in China now has the potential for other actors to come in and supply the Chinese market, which could save conservatively, if you were just to treat 15% of the people living with hepatitis C in China, that would save $13 billion. So overall, our impact of our work has the potential of saving $1 billion to the various countries that then need to be able to get access to these drugs.
- Scores of people — including many beloved musicians and celebrities — are dying from perfectly legal pharmacutical drugs. And many big companies are profiting.
- After cornering the market, these giant corporations inflate the prices to gouge the consumer.
- Lowering drug prices could be obtained by starting first in the patent office.
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The COVID-19 pandemic is making health disparities in the United States crystal clear. It is a clarion call for health care systems to double their efforts in vulnerable communities.
- The COVID-19 pandemic has exacerbated America's health disparities, widening the divide between the haves and have nots.
- Studies show disparities in wealth, race, and online access have disproportionately harmed underserved U.S. communities during the pandemic.
- To begin curing this social aliment, health systems like Northwell Health are establishing relationships of trust in these communities so that the post-COVID world looks different than the pre-COVID one.
COVID-19 deepens U.S. health disparities<p>Communities on the pernicious side of America's health disparities have their unique histories, environments, and social structures. They are spread across the United States, but they all have one thing in common.</p><p>"There is one common divide in American communities, and that is poverty," said <a href="https://www.northwell.edu/about/leadership/debbie-salas-lopez" target="_blank">Debbie Salas-Lopez, MD, MPH</a>, senior vice president of community and population health at Northwell Health. "That is the undercurrent that manifests poor health, poor health outcomes, or poor health prognoses for future wellbeing."</p><p>Social determinants have far-reaching effects on health, and poor communities have unfavorable social determinants. To pick one of many examples, <a href="https://www.npr.org/2020/09/27/913612554/a-crisis-within-a-crisis-food-insecurity-and-covid-19" target="_blank" rel="noopener noreferrer">food insecurity</a> reduces access to quality food, leading to poor health and communal endemics of chronic medical conditions. The U.S. Centers for Disease Control and Prevention has identified some of these conditions, such as obesity and Type 2 diabetes, as increasing the risk of developing a severe case of coronavirus.</p><p>The pandemic didn't create poverty or food insecurity, but it exacerbated both, and the results have been catastrophic. A study published this summer in the <em><a href="https://link.springer.com/article/10.1007/s11606-020-05971-3" target="_blank">Journal of General Internal Medicine</a></em> suggested that "social factors such as income inequality may explain why some parts of the USA are hit harder by the COVID-19 pandemic than others."</p><p>That's not to say better-off families in the U.S. weren't harmed. A <a href="https://voxeu.org/article/poverty-inequality-and-covid-19-us" target="_blank" rel="noopener noreferrer">paper from the Centre for Economic Policy Research</a> noted that families in counties with a higher median income experienced adjustment costs associated with the pandemic—for example, lowering income-earning interactions to align with social distancing policies. However, the paper found that the costs of social distancing were much greater for poorer families, who cannot easily alter their living circumstances, which often include more individuals living in one home and a reliance on mass transit to reach work and grocery stores. They are also disproportionately represented in essential jobs, such as retail, transportation, and health care, where maintaining physical distance can be all but impossible.</p><p>The paper also cited a positive correlation between higher income inequality and higher rates of coronavirus infection. "Our interpretation is that poorer people are less able to protect themselves, which leads them to different choices—they face a steeper trade-off between their health and their economic welfare in the context of the threats posed by COVID-19," the authors wrote.</p><p>"There are so many pandemics that this pandemic has exacerbated," Dr. Salas-Lopez noted.</p><p>One example is the health-wealth gap. The mental stressors of maintaining a low socioeconomic status, especially in the face of extreme affluence, can have a physically degrading impact on health. <a href="https://www.scientificamerican.com/index.cfm/_api/render/file/?method=inline&fileID=123ECD96-EF81-46F6-983D2AE9A45FA354" target="_blank" rel="noopener noreferrer">Writing on this gap</a>, Robert Sapolsky, professor of biology and neurology at Stanford University, notes that socioeconomic stressors can increase blood pressure, reduce insulin response, increase chronic inflammation, and impair the prefrontal cortex and other brain functions through anxiety, depression, and cognitive load. </p><p>"Thus, from the macro level of entire body systems to the micro level of individual chromosomes, poverty finds a way to produce wear and tear," Sapolsky writes. "It is outrageous that if children are born into the wrong family, they will be predisposed toward poor health by the time they start to learn the alphabet."</p>Research on the economic and mental health fallout of COVID-19 is showing two things: That unemployment is hitting <a href="https://www.pewsocialtrends.org/2020/09/24/economic-fallout-from-covid-19-continues-to-hit-lower-income-americans-the-hardest/" target="_blank" rel="noopener noreferrer">low-income and young Americans</a> most during the pandemic, potentially widening the health-wealth gap further; and that the pandemic not only exacerbates mental health stressors, but is doing so at clinically relevant levels. As <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7413844/" target="_blank" rel="noopener noreferrer">the authors of one review</a> wrote, the pandemic's effects on mental health is itself an international public health priority.
Working to close the health gap<img type="lazy-image" data-runner-src="https://assets.rebelmouse.io/eyJhbGciOiJIUzI1NiIsInR5cCI6IkpXVCJ9.eyJpbWFnZSI6Imh0dHBzOi8vYXNzZXRzLnJibC5tcy8yNDc5MDk1MS9vcmlnaW4uanBnIiwiZXhwaXJlc19hdCI6MTYxNTYyMzQzMn0.KSFpXH7yHYrfVPtfgcxZqAHHYzCnC2bFxwSrJqBbH4I/img.jpg?width=980" id="b40e2" class="rm-shortcode" data-rm-shortcode-id="1b9035370ab7b02a0dc00758e494412b" data-rm-shortcode-name="rebelmouse-image" />
Northwell Health coronavirus testing center at Greater Springfield Community Church.
Credit: Northwell Health<p>Novel coronavirus may spread and infect indiscriminately, but pre-existing conditions, environmental stressors, and a lack of access to care and resources increase the risk of infection. These social determinants make the pandemic more dangerous, and erode communities' and families' abilities to heal from health crises that pre-date the pandemic.</p><p>How do we eliminate these divides? Dr. Salas-Lopez says the first step is recognition. "We have to open our eyes to see the suffering around us," she said. "Northwell has not shied away from that."</p><p>"We are steadfast in improving health outcomes for our vulnerable and underrepresented communities that have suffered because of the prevalence of chronic disease, a problem that led to the disproportionately higher death rate among African-Americans and Latinos during the COVID-19 pandemic," said Michael Dowling, Northwell's president and CEO. "We are committed to using every tool at our disposal—as a provider of health care, employer, purchaser and investor—to combat disparities and ensure the <a href="https://www.northwell.edu/education-and-resources/community-engagement/center-for-equity-of-care" target="_blank" rel="noopener noreferrer">equity of care</a> that everyone deserves." </p><p>With the need recognized, Dr. Salas-Lopez calls for health care systems to travel upstream and be proactive in those hard-hit communities. This requires health care systems to play a strong role, but not a unilateral one. They must build <a href="https://www.northwell.edu/news/insights/faith-based-leaders-are-the-key-to-improving-community-health" target="_blank" rel="noopener noreferrer">partnerships with leaders in those communities</a> and utilize those to ensure relationships last beyond the current crisis. </p><p>"We must meet with community leaders and talk to them to get their perspective on what they believe the community needs are and should be for the future. Together, we can co-create a plan to measurably improve [community] health and also to be ready for whatever comes next," she said.</p><p>Northwell has built relationships with local faith-based and community organizations in underserved communities of color. Those partnerships enabled Northwell to test more than 65,000 people across the metro New York region. The health system also offered education on coronavirus and precautions to curb its spread.</p><p>These initiatives began the process of building trust—trust that Northwell has counted on to return to these communities to administer flu vaccines to prepare for what experts fear may be a difficult flu season.</p><p>While Northwell has begun building bridges across the divides of the New York area, much will still need to be done to cure U.S. health care overall. There is hope that the COVID pandemic will awaken us to the deep disparities in the US.</p><p>"COVID has changed our world. We have to seize this opportunity, this pandemic, this crisis to do better," Dr. Salas-Lopez said. "Provide better care. Provide better health. Be better partners. Be better community citizens. And treat each other with respect and dignity.</p><p>"We need to find ways to unify this country because we're all human beings. We're all created equal, and we believe that health is one of those important rights."</p>
Can passenger airships make a triumphantly 'green' comeback?
Large airships were too sensitive to wind gusts and too sluggish to win against aeroplanes. But today, they have a chance to make a spectacular return.
Vegans and vegetarians often have nutrient deficiencies and lower BMI, which can increase the risk of fractures.
- The study found that vegans were 43% more likely to suffer fractures than meat eaters.
- Similar results were observed for vegetarians and fish eaters, though to a lesser extent.
- It's possible to be healthy on a vegan diet, though it takes some strategic planning to compensate for the nutrients that a plant-based diet can't easily provide.
Comparison of fracture cases by diet group
Credit: Tong et al.<p>The results showed that vegans were especially vulnerable to hip fractures, suffering 2.3 times more cases than meat-eaters. Vegetarians and pescatarians were also more likely to suffer hip fractures, though to a lesser extent.</p><p>One explanation may be that non-meat eaters consume less calcium and protein. Calcium helps the body build strong bones, particularly before age 30, after which the body begins to lose bone mineral density (though consuming enough calcium through diet or supplement can <a href="https://ods.od.nih.gov/factsheets/Calcium-Consumer/" target="_blank">help offset losses</a>). Lower bone mineral density means higher risk of fracture.</p><p>Protein seems to help the body absorb calcium, <a href="https://www.bonejoint.net/blog/did-you-know-that-certain-foods-block-calcium-absorption/#:~:text=Historically%2C%20nutritionists%20have%20warned%20that,may%20increase%20intestinal%20calcium%20absorption." target="_blank" rel="noopener noreferrer">when consumed in normal levels</a>. The recent study, along with past research, shows that people who don't eat meat tend to have lower levels of both protein and calcium. When the researchers accounted for non-meat eaters who supplemented their diets with calcium and protein, fracture risk decreased, but still remained significant.</p>
Credit: Pixabay<p>Another explanation is body mass index (BMI). Non-meat eaters tend to have a lower BMI, which is associated with higher fracture risk, particularly hip fractures. In the new study, vegans with a low BMI were especially likely to suffer hip fractures. That might be because having more body mass provides a cushioning effect when people fall.</p><p>Still, the study has some limitations. For one, White European women were overrepresented in the sample. The researchers also didn't collect precise data on the type of calcium or protein supplementation, diet quality or causes of fractures.</p><p>Another complicating factor: Producers of vegan products, such as plant-based milk, are increasingly fortifying foods with nutrients like calcium and protein, so modern vegans are potentially at lower risk of deficiency.</p><p>The researchers wrote that their findings "suggest that bone health in vegans requires further research."</p>
Staying healthy on a vegan diet<p>So, does a vegan diet necessarily lead to worse bone health? Not necessarily. But it's safe to say that people who don't consume meat, dairy and eggs should be extra vigilant about consuming enough essential nutrients. That can be harder than it seems.<br></p><p>One major reason is that the body generally has an easier time absorbing nutrients from animal foods than plant-based products. So, while a salad could contain the same amount of calcium as a glass of milk, the body absorbs more calcium when you drink milk. What's more, there are some molecules and <a href="https://www.healthline.com/nutrition/7-nutrients-you-cant-get-from-plants#5.-Docosahexaenoic-acid-(DHA)" target="_blank">nutrients you simply can't get from plants</a>.</p><p>As such, many vegans round out their diets with supplements, including zinc, iron, iodine, long-chain omega-3s, and vitamins D, K-2, and B-12, to name a few. If you're on a vegan diet or considering making the switch, it's probably best to consult a dietician, and to make sure you maintain a <a href="https://www.cdc.gov/healthyweight/assessing/bmi/adult_bmi/english_bmi_calculator/bmi_calculator.html" target="_blank" rel="noopener noreferrer">healthy BMI</a>.</p>
A study by UK archaeologists finds that longbows caused horrific injuries similar to modern gunshot wounds.
- UK archaeologists discover medieval longbows caused injuries similar to modern gunshot wounds.
- The damage was caused by the arrows spinning clockwise.
- No longbows from medieval times survived until our times.
Battle of Agincourt.
The angle of entry into a cranium found during the excavation at a medieval Dominican friary in Exeter, England.
Credit: Oliver Creighton/University of Exeter
Never made a turkey before? Don't worry, science can help.
- This year, many people will be making a Thanksgiving dinner for the first time. It's often harder than it looks.
- Luckily, an online calculator website has one just for thawing turkey, and can explain why you need to wait so long.
- The website has other calculators as well, for needs you didn't know you had.
How to thaw a turkey using science!<p> The Omni Calculator <a href="https://www.omnicalculator.com/" target="_blank" rel="noopener noreferrer">website</a> is home to calculators that can determine many things, including how <a href="https://www.omnicalculator.com/other/sunscreen" target="_blank" rel="noopener noreferrer">long you can be in the sun safely</a>,<a href="https://www.omnicalculator.com/other/sunscreen" target="_blank" rel="noopener noreferrer"> </a>to the odds of your town having a <a href="https://www.omnicalculator.com/other/white-christmas" target="_blank" rel="noopener noreferrer">white Christmas</a>. It now has a dedicated tool for finding how long it will take you to prep your <a href="https://www.omnicalculator.com/food/turkey-thawing" target="_blank" rel="noopener noreferrer">turkey</a> in time for a socially distanced holiday. The <a href="https://www.omnicalculator.com/food/turkey-thawing" target="_blank">Turkey Thawing Calculator </a>was created by Jagiellonian University cognitive science graduate Maria Kluziak with the help of Wojciech Sas, a Ph.D. candidate in molecular magnetism and nanostructures at the Institute of Nuclear Physics in Poland. </p><p>The fundamental problem is that you need to add heat to the frozen bird to unfreeze it without also encouraging the growth of bacteria. To do this, you have to put the turkey somewhere where it will heat up slowly and evenly. There is a trick, though; this can take a long time because of the amount of energy involved. Exactly how long you need to spend on it can be hard to determine if you've never done it before. </p><p>This is where practical, day-to-day science comes in. The processes of heating something are well-studied areas of thermodynamics which we use every day. <br> <br> As Kluziak tells Big Think: </p><p>"If you look closely, you'll notice how we're all surrounded by numbers. Yet most of the time people choose to go with their intuition while making day-to-day decisions. We, as scientists and experts in our own fields, are trying to build a world where people make better, more informed decisions backed by concrete science - Using physics to chill drinks, math to find out how much pizza to get, and even calculating how much groceries are enough to survive a quarantine. It works."</p>
So, how do I thaw a turkey?<img type="lazy-image" data-runner-src="https://assets.rebelmouse.io/eyJhbGciOiJIUzI1NiIsInR5cCI6IkpXVCJ9.eyJpbWFnZSI6Imh0dHBzOi8vYXNzZXRzLnJibC5tcy8yNDgwNjA0Ny9vcmlnaW4ucG5nIiwiZXhwaXJlc19hdCI6MTY0NzI3NTQzN30.hr2xv0tzFU_12bA-wwKwBPv0Tou_ZcdMoF1VDlov-0k/img.png?width=980" id="07afc" class="rm-shortcode" data-rm-shortcode-id="522a8b8370fecb9dcb3bf483adea6fa5" data-rm-shortcode-name="rebelmouse-image" />
Credit: Omni Calculator<p> By slowly exposing the turkey to cool air or water, it heats up to a point where the bird is above freezing but not so warm that bacteria will start multiplying. Two of the safe ways to do this stand above all others; you can thaw it in the refrigerator or the sink.<br> <br> Using a refrigerator can take days; the calculator creators suggest a day for every four pounds of bird. Doing it with cold water in the sink is faster, needing only two hours per pound, but requires that you drain and refill the sink with new, cold water every thirty minutes. The ideal temperature during thawing shouldn't exceed 39°F/4°C.</p><p>"In our thawing model, we use a scientific approach, which is based on the use of heat transfer equations," the scientists write. "Since these types of problems are, in general, very complicated, we use some approximations, which allow us to estimate the thawing time with reasonable accuracy. As a result, you can see how the average temperature of the turkey changes in time." </p><p>You can learn more about the equations and get tips on using the calculator <a href="https://www.omnicalculator.com/food/turkey-thawing" target="_blank" rel="noopener noreferrer">here</a>. You can also learn why you shouldn't use a hairdryer or a tub full of hot water to do the job. <br> <br> One of the best parts of science is that its findings are often universally applicable. If you understand why something works in one case, you can use it everywhere else. Kluziak reminds us why this might be great for cooking:<br> <br> "The rules that govern the process of thawing are roughly the same for every kind of food, what's different are the numbers that determine the more specific things like thawing time. The general ideas remain the same regardless of the food, and I would say they are pure common sense. For example, if you're defrosting food, don't do it at room temperature to avoid bacteria - this is true every time!"<strong></strong></p><p><strong> </strong>Whoever said you'd never use the science you learned in high school at home didn't understand how often we use physics—this calculator remind us that it is everywhere. So fear not, ye first-time turkey chefs! Science can help you have your main course and eat it too. </p>