A food pyramid is a better analogy than a scavenger

Video killed the radio star. Has NICE killed Pharma R&D? #MSBlog #MSResearch

Anonymous; Monday, February 03, 2014 5:23:00 pm: “Prof. G a better analogy for big pharma joining the fray are hyaenas coming to feast on the carcass. Once they have finished there will nothing left for the vultures.”

“Excuse me; you have the wrong analogy. Before Pharma, and
now Big Pharma, got involved with MS it was an orphan disease. It is now a $15
billion per year market and growing. A better analogy would be a food chain or
pyramid; as one level grows fat it feeds the next level, which as it grows and becomes fat and juicy it attracts predators from the level above. As the
pyramid grows it produces dung, or fertilizer, which feeds the bottom of the chain
and the pyramid gets bigger. The scavenger analogy is negative and implies that
it will self-destruct once the bones are devoured or picked clean. We need the MS pyramid to grow, and grow, and grow, the unmet need in MS is massive.”

“The cynics reading this blog need to try and take a macroeconomic
look of Pharma and ask who owns Pharma? Most Big Pharma companies are listed
public companies that are owned by shareholders. Some the biggest institutional
shareholders are pension and insurance funds; these are the economic pillars of
modern society.  Therefore it is in everyone’s
interest that Pharma do well and make profits and reinvest them in R&D and
innovation. The latter is what will get us new drugs and improve the quality of
life of the people living on the planet with MS and other diseases. Built into
the Pharma model is a patent expiry date. Why? An innovation or discovery is
not a license to print money forever. When a patent expires generic or
biosimilars are made and the price of drugs plummet, or at least are reduced
substantially. This is the bargain that we as a society have struck with Pharma;
we pay a lot now for cheap drugs in the future. The looming patent expiry date
is an important incentive for Pharma to innovate. Without new patents they
would die.”

“I also agree that Pharma are their own worst enemy and they
as an industry have done some pretty awful things in the last few years. They
are, however, cleaning up their act and some of the fines imposed on them, have
been so humongous, that they have little option but to stay clean. At the same
time several countries are putting in place mechanisms for driving down drug prices
so that the regional profits Pharma make are being squeezed. This is a
particular issue in the UK and mainland Europe. This has resulted in Pharma
hiking their prices in places where there are few price controls, for example
the USA. This has led to a widening price differential between the prices US
citizens pay for drugs and what we pay in Europe. For example, glatiramer acetate
is ~7x more expensive in the USA compared to the UK, fingolimod is over 3x more
expensive, etc. What does this mean? It means the USA is subsidising drug
prices and drug development for the rest of the world. Can this go on?
Possibly, but I suspect not for long. Big Pharma have been buying time by closing
down their R&D facilities in Europe and moving them to the USA. I was asked a rhetorical question by one Pharma executive, who shall remain unnamed, why should Pharma invest in
markets where we can’t make a profit? The politicians in the USA don’t mind this
price differential as long as Pharma are investing in the US, i.e. creating
jobs and making corporate profits. Capitalist USA is about money going around; the
more you circulate money, the larger the economy, the more you make in taxes.”

think that the gradual exodus of Pharma R&D from the UK, and Europe, to the USA and developing markets is a
massive problem. It creates a structural hole in our economy; virtually all of
Pharma’s jobs are highly skilled jobs. We need these jobs for our University
graduates. In the same way that “video killed the radio star” NICE is killing Pharma
R&D.  Is it too late to stop the
exodus? I suspect it is.”

About the author

Prof G

Professor of Neurology, Barts & The London. MS & Preventive Neurology thinker, blogger, runner, vegetable gardener, husband, father, cook and wine & food lover.


  • Prof G has been a big winner from the current system. His COI list is huge – every company involved in MS research. This equates to big money – in addition to an NHS salary and an academic salary. It leaves a bad taste in my mouth. Why should anyone do nicely out of a disease when there are no treatments for progressive MS or treatment to repair the damage. Mouse will say they are coming, but they've been coming since the 1970s. I'm sure there are doctors and researchers out there who are doing work on diseases for the love of mankind ie no interest in topping up their salaries with "honorarium" from drugs companies who are only interested in profit (not the patient). When you take money from these companies you become part of the problem. Some of the biggest breakthroughs in medicine eg small pox virus, radiation treatment etc came from dedicated scientists without the inducement of money from pharma companies. My pet hate is the injectibles, particularly copaxone. No one knows how it works, it is mildly effective at best and costs £8-9k a year. This drug summarises all what is wrong with MS research / pharma.

    • Some of the big breakthroughs…….came years ago when there was a small knowledge base and no globalisation and is a very different world from today.

      What are your recent breakthroughs….I am sure we can find some

      Gone are the days where you could invent a drug be a two legged guinea pig and bobs your uncle now the process costs millions, Did you know that to speak to the European regulators cost £30,000. to perform some simple regulatory test in rats for a month costs about £150,000 but that up to a few more months and that is half a million gone.

      Can you think of a few good examples where some Doc/Reseacher has developed a licensed treatment (not some phase II trial) independent of pharma in the modern era?

      This is a very serious question which I would like an answer too.
      In MS I can't think of any, Can you?

    • Well you can work with drug companies in the hope that the pace of new drugs for MS is moved forward or you can sit atop your lofty moral mountain in the hope that others will do it instead. Personally, I think Prof G has it right. He may sup with Pharma but he uses a very long spoon. Who would pay for large-scale clinical trials if not Pharma? It's way beyond the means of charities.
      As for Copaxone, many of our comments/posts would seem to fit with your views.

  • Prof G, you don't seem to understand the point of NICE. The FDA has rejected alemtuzumab- but pharma will continue to invest there. NICE equivalents exist all over Europe, yet pharma still has presence all over Europe. I suggest you get your facts right before speaking.

    • It is got to do with NHS costs and profits, which has everything to do with NICE. Why would we invest in the UK if we can't get a fair price for our products. For example, the cost per quality that NICE are prepared to pay for DMTs for MS are not indexed linked. In other words NICE is simply bullying Pharma to provide cheaper and cheaper drugs. If NICE was about cost effectiveness then they would link their cost-effective models to inflation.

      It is a sad state of affairs, but Prof G has got this one right.

    • Prof G- if you don't believe in NICE then I don't think you believe in the NHS. Why do you stay in this country?

    • Re: "Prof G- if you don't believe in NICE then I don't think you believe in the NHS."

      Who said I don't believe in NICE. They are a pretty effective organisation that is doing a great job for the NHS. The issue I was raising is a political one; it was about the decision to create NICE in the first place. It is too late to change that we now have to live with the consequences.

      NICE also have several functions; a very important one is setting quality standards. This is will help drive improvements in care across the country; for example it provides benchmarks to judge our services against and to use the results to justify investment in MS services.

  • http://www.forbes.com/sites/johnlamattina/2013/04/02/myths-in-the-pricing-of-new-drugs/
    I think re-posting this article is warranted. Is it wrong to charge $54k for dimethyl fumarate and $10 for acetaminophen? Does the benefit of treating MS with tecfidera and delaying disability have a greater economic impact than alleviating a transient headache with tylenol? I would say yes. Should pharma price drugs differently according to the countries' GDP? Look at HIV drug pricing.Certainly the cost in third world countries (where the majority of HIV exists) compared to the U.S. is drastically different. Under pressure from human rights groups big pharma has allowed other companies to distribute ant-retrovirals at reduced cost. Does this suggest life is worth more or less depending on your economic predisposition?

By Prof G



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