E-DRUG: Medicines for the needy - Patents and Costs (cont'd)
One other point that deserves mention. One constructive way to cut the
prices on patented drugs is to do some focussed research on their
pharmacodynamics, from the perspective of going the innovating firm one
better in discovering the optimal regimen. The history of this little
corner of pharma research is that most drugs come to market with doses set
too high, or interdose intervals set needlessly close. And then there's
the matter of the gut wall enzymes -- the lead article in the April issue
of CPT demonstrated that taking lovastatin with grapefruit juice increases
the plasma levels of drug and first metabolite by 15 fold, which says that
taking the drug plus about a tenth the usual dose (at a corresponding
reduction in acquisition cost) would result in the usual therapeutic
levels of drug and its active metabolite.
It is possible to obtain patent protection on innovative regimens in the
US, and some other countries, but not all -- I'm one of the coinventors of
that aspect of the transdermal scopolamine patch, the (costly) development
of which rewrote the pharmacology of scopolamine by showing what could be
done with a low, constant rate of drug delivery, avoiding in all but a
very small proportion of patients the unpleasant side-effects that this
drug has been known for a century. I get no royalties from these
patents, but did share in a small fraction of the wealth created by the
innovations at ALZA Corp during the 1970's and 1980's. That allows me
the freedom to donate my time to worthy academic activities, write
long-winded email notes on the evils of bad economics, and make
high-risk investments in innovative start-up firms, etc.
On Tue, 26 May 1998, Peter Mansfield wrote:
> Subject: E-DRUG: Medicines for the needy - Patents and Costs
> John Urquhart wrote:
> > I suggest that you urge your government to abandon funding of health
> > research and use the money to pay for medicines for the needy, on the
> > grounds of first things first. While you're at it, give your salary to
> > the poor, on the same principle.
> I think John has moved from Patents to me. This is a shame because I think
> that there is a time and place for everything including Patents. I prefer
> trying to find the best balance between opposing forces within a mixed
> economy. Consequently I would like to be challenged further with evidence
> in support of Patents.
> John has also extrapolated from what I wrote to create a simplistic
> position and then attribute it to me. However the challenge to practice
> what I preach is worthwhile and deserves a response.
> re medicines for the needy
> As it happens the Australian Pharmaceutical Benefits System PBS (which
> Richard Laing has summarised accurately, see Chris W. Green Re: E-DRUG:
> Costs of developing drugs) already ensures the affordablity of medicines
> for all Australians. Consequently, I am free to advocate more funding for
> My concern about the PBS is that the combination of minimal financial
> barriers with no effective control over misleading promotion has lead to
> overuse of some drugs especially more expensive ones. For example,
> Australia has one of the highest rates of use of antibiotics. The PBS
> budget has grown at up to 17% per year in recent years.
> If anyone cares to see what I have been "urging" on Australian National TV
> recently a transcript is available via the MaLAM Web site "What's new"
> re my salary
> I work half time for MaLAM with out pay. I work half time as a GP to
> support myself, my wife, 3 young daughters, a pet mouse and 3 chickens!
> Dr Peter Mansfield
> Director, MaLAM
> MaLAM encourages pharmaceutical companies to provide more reliable
> information to assist appropriate health care.
> MaLAM Headquarters
> PO Box 172, Daw Pk SA 5041, Australia
> phone/fax +61 8 8374 2245
> [Moderators Comment: I am pleased to read Peter's response to John
> Urquhart's last message. I have had a few message crticizing me for posting
> the message in the first place. So I will be more cautious in the first
> But the issue itself is interesting. Do patent's promote the public health?
> I remember hearing a long time ago Sir Douglas Black, the President of the
> Royal College of Physcians saying that if we stopped research and just used
> the drugs we had correctly the world would be a better place. This may be
> seen as an extreme view but if we think of how many conditions could be
> treated and are not and how many diseases are inappropriately treated I
> think there is a point to the comment. Richard Laing Co-Moderator]
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