Cure Everyone! An Opinion

I suppose I’m an idealist. When I first heard of the cure for genotype-1 hepatitis C, I envisioned folks lining up for medicine that would be given to them, regardless of their financial means, and with Gilead Sciences leading the charge with their liberal patient assistance program for miracle drug Harvoni, in my naivete, I believed this model would expand to cover everyone. In the light of shocking profitability, it seems like Gilead could well afford to subsidize treatment for half the world, without a single corporate executive giving up his helicopter rides. Now, I hear from a reliable and anonymous source, that the pharma is pushing back, insisting that hep C patients revert to their insurances to finance a cure. The problem is, most insurances have designated Harvoni not as a first line drug, as we all know it should be, but as a drug of last resort. Insurances now treat Harvoni as a pharmaceutical transplant. As people wait until they’re sick enough for an opportunity for healing, they’re developing the inevitable complications of untreated HCV – a huge burden on our healthcare system, and an enormous toll on patients.

We’re living in an era in which many extol private enterprise as the cure to all our ills, that we’re all better off without government intervention in the world of capitalism, that we can trust corporations, made persons through the Supreme Court’s decision on Citizens United, to behave as persons with a conscience. I’m writing this to tell you, it just ain’t so.

I believe our NIH and CDC should intervene, providing the cure for all genotype-1 patients. Now, I’m old enough to remember when the polio vaccine came on the scene. Unlike HCV, polio was a bacteria, not a virus, which made the disease a relatively easy target. We lined up at health departments, doctor’s offices, and public schools for this vaccination, which protected us for life. The government made sure that so many people got the vaccination, polio was essentially eradicated. But this was a vaccine – a vaccine without a cure. In the case of hepatitis C, we have the opposite problem: a cure without a vaccine. Its RNA strand mutates at a rate that creates a moving target, nearly impossible to hit. For some reason I can’t figure, pharmaceutical companies view cures differently from vaccines. Why? Ultimately, both vaccination and the cure achieve similar goals: a clinical move toward eradication of HCV.

Recently, Gilead sciences made a deal with the Veterans Administration to purchase Harvoni at half price: $500 per pill – a life raft with a huge hole in it. How long will it take the VA to run out of money for this program? They’ve already run out of the 400 million dollars allotted for hep C treatment and are seeking additional funding. For Gilead to hold hostage more than 180,000 veterans infected with the disease, over pricing issues, is, in my opinion, morally unconscionable.

Were Gilead still paying off R&D, or production costs, their astronomical price for Harvoni might be defendable. However, R&D costs were paid off within months of the drug’s release. Many believe new drugs will force the price of Harvoni down. I have doubts. I can see things going the other way. In fact, I can see Gilead setting the standard for pricing. Besides, how much less would a competitor’s drug need to be to effectively undercut Gilead’s price? Ten percent? Twenty percent? Certainly not enough to heal the homeless, the incarcerated, the working poor, the uninsured, injection drug users and our veterans.

My view: Cure everybody as early in their disease as possible, without regard for a patient’s ability to pay. Getting the cure is not a matter of individual privilege, but a matter of the public health. Perhaps drug companies should be required to give something back for the privilege of earning huge profits resulting from our free market capitalist system.

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