Cancer Patients: dying a thousand deaths

In spite of the advance of medical sciences in many fields , cancer is an area where in spite of a lot of progress , things haven't changed much on the ground. The patient still usually has to go through a prolonged treatment and at the end of which there is nothing called a cure in most instances. What you get is a stage of remission usually and even when you are in remission you are always looking over your shoulder to check for recurrences and in the many cases I have known , sooner or later cancer seems to catch up with you and more often than not , the prognosis progressively deteriorates.

Added to that is the burden of cost. Cancer treatment has always tended to bes expensive for several reasons – the treatment is prolonged for one , the treatment is also not available every where – typically the cheapest treatment available would be in the handful of regional cancer centers run by the government and the travel itself is fraught with costs and logistical expenses.
In spite of the fact that cancer strikes all sections of society and only perhaps lung cancer is associated with a clearly defined high risk behavior , which means that not much preventive measures can be really taken, the disease suffers from neglect. Conditions like HIV and AIDS which have got vocal activist groups taking up the cause of treatment care are able to garner funds from both the government and international philanthropic donors but cancer patients are not so lucky.

Apart from the fact that the very diagnosis of this disease spells worries for a cancer patient’s family, what hits even harder is the exorbitant amount of money charged by the pharma companies for the drugs that are crucial for a cancer patient’s survival at an advanced stage. Till recently the fact that Indian pharmaceutical companies reverse engineered many of the drugs and made them available at comparatively cheaper prices made them some what accessible.

This climate is slowly changing. The newer and more effective drugs which a patient would reach for tom try and prolong life or alleviate symptoms are also the most expensive and the changing patent laws in India more or less make them inaccessible. To cite an example , the multi national Novartis had filed a case in the Madras High Court, challenging the clause of the Indian Patent (Amendment) Act, which does not grant patents to medicines that are new forms of an existing drug or are “ever-greened” rather than being innovations. The patents office in Chennai refused to give patents to Novartis’ leukemia drug Gleevec on the grounds that it was “ever greened”, in February 2006.

Till the litigation in the Chennai patent office, many well known Indian forms were manufacturing the generic product end selling it for a fraction of the multi national's own product. However with Gleevec now having gone into litigation and the patent laws changing their color in conformity with trade laws , many firms have quietly stopped producing the drug. They do not want to invest in a contentious product without the law having been settled. This means that leukemia patients , who could have befitted from the generic versions of Gleevec, now have to purchase the hugely expensive product from Novartis or go without it..... or take the potentially explosive route of purchasing he drug by selling off home and hearth and eventually becoming bankrupt- a scenario by no means uncommon in India and in situations far less prohibitive than cancer.

Even the modified and much harsher patent laws of today which protect the interests of the producer than the consumer provide for the government to suspend the laws of patent and produce drugs generically if in the instance of a public health emergency. But in spite of the fact that cancer is one of the three top causes of death in the country , the government has so far looked the other way and not acknowledged it to be so. Although HIV and AIDS has received the attention it deserves and more there are other pressing public health needs which have not received their due attention. And mean while cancer patients and their families suffer a thousand miseries in their life time facing the burden of expenses and disease that they do.

Killing me Softly.....

Major multi national drug companies are killing us softly and surely even as debates about TRIPS, intellectual property rights , the Mashlekar committee report and other such concerns sail over our head. These and other hens will come home to roost when their implications hit us in real life. Let me share an instance:

A few weeks ago, I got an e mail from some one practising medicine in China. He had come to know of me through a mutual friend. This doctor in china had a patient who was suffering from chronic myeloid leukaemia and needed a drug called Imatinib. The drug was a product of the Swiss drug giant (Glivec) and at the price at which it was available in China, it was going to cost his patient a whopping Rs. One Lakh per month for an indefinite period, given the nature of cancer treatment. But the doctor had heard that in India, generic versions of the drug were available which were available at much lower prices and could I please check about the actual cost and availability.

I did some background research on the net as I had not been acquainted with the drug before though it would be in the news soon enough. My surfing revealed that Indian firms like Ranbaxy, CIPLA and others were indeed manufacturing it although the prices could not be discerned. So to get specific information, I went along to the near by chemist and found that generic versions were indeed available and the prices wee negotiable. But at Rs. 70 per capsule of Imatinib 100mg, though not exactly cheap, the price gap between the Novartis product and the Indian variants was yawning. Glivec is priced at Rs 1, 20,000 per month by Novartis when generic versions manufactured by Indian companies are available for Rs 8,000.

Although the drugs were eventually procured and found their way to my friend’s patient in China, one wonders how long such life saving drugs will be even relatively accessible to the common man. For it is in respect of this drug Glivec, that Novartis has filed a suit alleging violation of the patent laws and the TRIPS agreement in the Chennai High Court. As a life saving drug, it is important that the product be available at prices that one can consider affordable.

The campaign against cheaper access to drugs, initially highlighted by the high cost of anti retro virals has now spread to look at other drugs with global religious leaders having joined worldwide demands that the company withdraw the case in India. These include Nobel Prize winner, Desmond Tutu, Bishop Yvon Ambroise of the Commission for Justice and Peace of the Catholic Bishop’s Conference of India, Prawate Khidharn, General Secretary of the Christian Conference of Asia, Bishop Mark Hanson, presiding bishop of the Evangelical Lutheran Church in America. Charitable associations see Novartis’ challenge as one against the right of worldwide poor patients for affordable drugs.

Drug companies have long argued that huge funding is required to research and carry out clinical trials for new drugs and they need to recover the costs by pricing them high in the initial years when they hold exclusive patents. If that alone were the case , the reasoning might still hold good for the phenomena of ever greening of molecules that large companies indulge in and which will prevent the manufacture of generic versions ever. Ever greening allows companies to make slight changes in off patent molecules and patent those again arguing it has improved efficiency and is in that sense a never ending cycle.

Even as drug companies see their only loyalty to the share holder and there is and will be a perennial clash between private profit and public interest , the only way out seems to be to break the gird lock of private funding in the research of new drugs and encourage, publicise and encourage initiatives like the Neglected Diseases Foundation whose vision it is to improve the quality of life & the health of people suffering from neglected diseases by developing new drugs or new formulations of existing drugs for patients suffering from these diseases. The foundation has broken new ground by launching ASAQ, a none patented, once a day, fixed dose anti malarial, the first new anti malarial drug in decades. Even as drug companies for the most part treat the sick as vulnerable milking cows, initiatives like the Neglected Diseases Foundation deserve all the publicity; encouragement and funding that they need to expand their portfolio.