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SUNDAY, NOVEMBER 08, 2009 12:15 AM IST

In the recent debates on patents, pharmaceutical prices and access to essential medicines, the critical role of scientists and resources of the public sector and academic institutions involved in medical research have often been overlooked. As one of the scientists behind the development of the medicine ‘imatinib’ (marketed as Glivec by Novartis), which has allowed the effective control of a devastating form of cancer, I have witnessed the vital role that academic researchers and public institutions play in bringing new medicines to the market.

Many scientists, if not most of those I have collaborated with in these settings, are engaged in research primarily motivated by the pursuit of knowledge as a means to help patients. For many of these scientists it is, therefore, of great concern that the results of their efforts can’t reach patients and save lives because of pricing strategies and patent policies such as “patent evergreening” (minor changes to existing molecules designed to extend patent monopolies) used by partners further down the drug development process.

Chronic Myeloid Leukaemia (CML) is a disorder of blood cells that transforms through an “accelerated phase” to an invariably fatal leukaemia. Imatinib has radically improved the success of treatment for this disorder and patients treated with the medication can retain a high quality of life. The development of this drug is a journey in scientific discovery that highlights the collaborative and open process of innovation, where both the private and public sectors play an indispensable role. The marketing approval of imatinib was the result of research conducted over decades, marked by international collaboration of scientists from different academic institutions and the private sector.

The basic research that led to the identification of enzyme inhibitors for CML dates back to 1960 with the identification of the Philadelphia chromosome in patients with CML by researchers at the University of Pennsylvania, Peter Nowell and David Hungerford. In 1973, Janet Rowley at the University of Chicago determined that the abnormal chromosome was due to a translocation of genetic material. In the 1980s, several labs, including my own, played an important role in showing how the Philadelphia chromosome produced a cancer causing protein (Bcr-Abl). This research also clearly suggested that the selective blockade of the Bcr-Abl enzyme could provide a means to control and prevent the progression of CML.

In the late 1980s, I began collaborating with industry scientists at Ciba-Geigy (now Novartis Pharmaceuticals) who were developing inhibitors for the class of enzymes to which Bcr-Abl belongs. Both the scientific community and the pharma industry were highly sceptical of the utility and selectivity of these enzyme inhibitors, and interest was limited. Despite this, I suggested that the CML enzyme (Bcr-Abl) would be an ideal target for therapy.

In 1993, I moved to Oregon Health Sciences University in Portland and had a single goal of finding a company that had the best inhibitor for Bcr-Abl and to bring it into clinical trials. My work in Oregon on a therapy for CML was primarily funded by public sources, particularly the National Cancer Institute. My persistence with scientists at Ciba-Geigy (now Novartis) helped to keep the development of imatinib on their agenda despite uncertainty from product managers. As imatinib progressed through early and late clinical trials and demonstrated outstanding results, scientific and media interest in our discovery increased. The approval of imatinib by the FDA in May 2001 for use in CML was the culmination of a 10-year project for me, something I had dreamed of since medical school.

However, the price at which imatinib has been offered for sale by Novartis around the world has caused me considerable discomfort. Pharmaceutical companies that have invested in the development of medicines should achieve a return on their investments. But this does not mean the abuse of these exclusive rights by excessive prices and seeking patents over minor changes to extend monopoly prices. This goes against the spirit of the patent system and is not justified given the vital investments made by the public sector over decades that make the discovery of these medicines possible.

Public institutions around the world have continuously played a critical role in the research that leads to vital new medicines reaching the market. Without access medical research becomes a luxury good. Most of my colleagues would be very uncomfortable if we felt that this would be the result of our decades ofeffort.

Brian Druker, chair of Leukemia Research and professor of medicine at the Oregon Health and Science University Cancer Institute, is recognized as the key researcher behind the discovery of STI571 or imatinib (marketed as Glivec by Novartis). Comment at theirview@livemint.com

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FELIX Said:


This very interesting article ends with an attack on the company's price policy. However the author does not indicate what parameters or evidences were taken into account to judge the price as excessive. Regarding medicines in general, whatever their prices are, many people feel that they are too high.

Posted On 8/16/2007 5:47:57 PM
Re: olga Said:


How is the price, cash, for 60 tabs of gleevac 400mg at a wopping 8,300 dollars a month grab you? The constitution of the united states of america states we have a right to "Life, liberty and the pursuit of happiness". We have the right to LIFE! I am a health professional and am disgusted and appalled at this price. I have health insurance and I work two jobs to make sure I can have it....not everyone has the emotional strength or physical strength- something has to give we have to optimize our country's health and do something about it; I don't care if it means banning hot dogs, getting rid of high fructose corn syrup, rationing food etc! The excess in this country is getting out of hand... regards

Posted On 8/31/2008 3:29:33 AM
Pat Said:


I would like to add information regarding steps that have enhanced access to Glivec in the developing world and the positive impact for patients. Novartis initiated an innovative global access model –the Glivec International Patient Assistance Program (GIPAP) --that provides patients with Glivec at no cost, plus wrap-around services geared towards overcoming challenges for treatment compliance. Initiated in 2002 in India, GIPAP provides patients one-on-one counseling from the time of diagnosis. GIPAP provides patients with a personal advocate who supports the patient and his/her family throughout the duration of the treatment. Further, GIPAP has been the catalyst for the formation of patient support groups which are providing long lasting social change in their communities. The patient group in the Philippines, Touched by Max, periodically organizes blood drives in collaboration with university students. As a result, patients in need of blood transfusions are able to access them free of charge. In Malaysia, the local patient group, MaxFamily, has had an impact on pain management during bone marrow aspirations. The Friends of Max in India organizes the largest gathering of CML and GIST patients worldwide, with their next meeting expecting 1,000 patients and their families. All groups have been successful in shifting cultural stigma of cancer, enhancing the relationship between physicians and patients, providing education, information, emotional support, and empowering patients to have a voice in their treatment. GIPAP related patient groups are providing similar kinds of impact in communities in Mexico, Argentina, Chile, Uruguay, Indonesia, The Sudan and other countries. Public-private partnerships -- such as GIPAP -- are essential to access, and I would hope that successful models such as GIPAP can be replicated to other drugs and benefit even more cancer patients. Pat Garcia-Gonzalez Executive Director, The Max Foundation Edmonds, WA; USA

Posted On 8/17/2007 1:45:24 AM
Re: sidharta Said:


In Indonesia now the patients enrolled in GIPAP have been waiting for weeks for the medicines, and instead offered to buy the drug at exorbitant costs. The reason : tax "too high" for Glivec, although it's tax free for GIPAP.

Posted On 9/9/2009 7:40:20 PM
Thomas Said:


Just how did Novartis "abuse" the Gleevec patent? On what grounds/method can the author say that the price is "excessive"? As the author states, drug development is a collaboration between academic researches (w/ both public and industry funds) and industry (who contribute the vast majority of funds, if not all, and resources to ultimately bring the drug to market). The high risk and cost of drug development is understandably a cause for hesitation on the part of industry management, hence it is not uncommon for researches on either side to serve as advocates for a drug. Exactly what is the "acceptable" price of Gleevec, or for any drug? I challenge anyone to come up with an answer that is acceptable by all and/or won't hinder future drug development. Those who do not understand the complex nature and history of drug development will always find drug prices to be "too high".

Posted On 8/17/2007 3:05:09 AM
Re: Jane Said:


Just to put things in perspective. Gleevec(as it is called in South Africa costs R22 000.00. That is about 3 months salary for the average South African. I am not talking about poverty stricken...I am talking average. I simply cannot believe that Novartis have not already made their development costs plus a healthy profit already. It is tough when your choice is bankrupt your family or die. I am lucky to have a medical plan that is paying (so far) but what about the others who don't?

Posted On 9/12/2007 9:50:49 PM
Maria Said:


I am very familiar with Novartis' generous patient assistance program, as well as the wonderful work of the Max Foundation (see comments above), so I am confused over Dr. Druker's comments. I have a lot of respect for Dr. Druker, but I don't understand why he is taking such a blatant stab at his previous collaborators.

Posted On 8/17/2007 11:12:43 AM
Re: Pedro Said:


Maria,I don't know how "familiar" you are with the "generous" program since I created that program along with Novartis. I guess that either you are misinformed or terribly naive about it. Dr. Druker is not taking any stab at all, he is telling the truth as GIPAP is a big marketing scam perpetrated along with the unfortunate participation of the officers of The Max Foundation... big corruption there. BTW, I am Max's father and I am very sad by the way that his name is daily trashed by this. If you work for "The Max Foundation" your word is useless, if you volunteer for them, clearly you have been misinformed; if you are a relative of a patient, you have been lucky; in whatever capacity, your should dig in just a little bit and you will see how much dirt is there.

Posted On 9/11/2009 3:40:12 AM
Bruce Said:


I am really happy to hear Dr Druker's comments - the scientific community should speak up more about their concerns over access to the fruits of their labour. Finding the "right price" for medicines is certainly a tricky goal. However, I think what Dr Druker is broaching is the unreasonable attempts - through "evergreening" for example - to extend the monopoly privilege granted by a patent beyond its remit. What is at stake is control of the "right price". If the patent system works as it is designed to, then influence over pricing should pass from the private interest to the public interest (in this case because generic producers can enter the market and lower prices) as the patent term expires. No amount of the creditable acts of goodwill from some pharma companies can make up for the fact that it is not their right to have their patent terms extended unfairly and without genuine new innovation. Patients all over the world are able to access life-saving medicines more cheaply once the monopoly control has ended. It is not surprising that Novartis would want to protect its monopoly for as long as it can, but this only demonstrates how scary monopolies can be. Unwarranted private control in the health business is one of the most expensive mistakes our lawmakers let happen: it costs lives.

Posted On 8/20/2007 4:42:27 PM
Martin Said:


In 1988 I had a sibling related bone marrow transplant. In those early years STI-571 had not yet been discovered and the only alternatives were the BMT or a blind study trial basis of Alpha-Interferon I opted for the BMT and am here today for nineteen years post The BMT itself almost killed me as well as suffer considerably I had to undergo total body radiation and massive doses of chemotherapy and be confined to a laminus air flow chamber for months and suffer from Graft Vs Host disease (GVHD) It took me two years to get myself back to a normal way of life If Glivec were around at the time I certainly would have taken this course of treatment Years passed and STI-571 made it's way in the treatment of CML and excited me because I knew that there would be little or no suffering while using this new "Miracle" drug for the many other CML suffers. I met this man to protect his privacy let's call him Mr Z We spoke often and he mentioned that he had been on Glivec ever since it's inception and was doing relatively well with little or no side effects I was able to contact a representitive of Novartis and mentioned that I would be interested in purchasing shares of the company At this time they were making limited amounts of STI-571 and I wanted to see this drug flourish. I mentioned that I would be buying a lot of the company shares, and purchased their American Registary Shares I also mentioned that since I would like to support the company I would also have others purchase shares in quantity I went onto the Internet and emailed many of my family members friends neighbors and many other people that I have known throughout the years Most everyone that I had contacted did purchase these shares and not necessarily to achieve a profit but rather to support Novartis I made friends with many that are currently using Glivec and I am now disappointed at this price gauging I have supported them now they must support those that need Glivec because it is their lifeline

Posted On 9/12/2007 6:11:11 AM
Parichart Said:


Totally agreed with Dr. Druker. I believe there's a certain time where the pharmarceutical should make some profit out of their investment, however, once they reached it, it's time to reconsider the price level and think more about people's lives.

Posted On 9/12/2007 7:20:20 AM
hl Said:


Gleevec costs $2000-$5000 a month in the US, depending on dosage.

Posted On 9/12/2007 10:39:50 AM
Re: olga Said:


No the price of Gleevac 400mg one tab two times a day is $8,300 dollars...with a senior 10% discount maybe 7000. This is not covered under medicare and most insurance companies....this is a sick and outrageous price. Average price of any drug should not exceed more than 1000 dollars a month if a patient has to pay cash.

Posted On 8/31/2008 3:35:00 AM
Nancy Said:


I am a 63 year CML patient. The cost of my Gleevec is $3,000 per month. My insurance covers most of it. In two years I will have to move to Medicare and it will cost me approximately $4,000 per year for this drug. It is my understanding that to qualify for assistance you must have no insurance at all. This drug will very likely allow me to live a full life span . . . my father lived to the age of 101. What insurance will fund my Gleevec for 720,000 should I live for only 20 years more and assume the price does not increase? If the answer is "what the market will bear" and you are dealing with a fata disease such as this, I guess the sky is the limit.

Posted On 9/12/2007 6:14:42 PM
Richard Said:


There have been several books and magazine articles over the past few years about the reality vs. the claims of pharmaceutical companies about their pricing policies for drugs. The tweaking of patent products to increase their patent monopoly is relatively new and I believe laws should restrain this practice so that only truely new products can be given patent protection, and that for a limited time. One study I've seen quoted a number of places compares the amount of money pharmaceutical companies spend on marketing drugs to the amount spent on research on truly new drugs and have consistently found that research money is substantially LESS than marketing money. Unfortunately, advertising and marketing budgets have been steadily increasing. I''d like to see comparable proof that research money has been increasing at anything close to the advertising and marketing. Note that those doing research on Imatinib had to look long and hard to find a drug company that would undertake the drug research, and that there was also considerable pressure needed to get the company to bring the product to market (because CML is a relatively rare cancer). In addition, the company got additional government incentives to market it through a government "Orphan Drug" incentive program. Unfortunately drug companies, like many companies, are more interested in the "sure thing" than in taking real risk, and then want to squeeze the consumer dry on whatever drugs turn out to be effective, even if many consumers are unable to afford the drug as a result. If drug companies truly want to function in a free trade market place, they should take their risks on new drugs as a priority to maintain their standing for producing superior products. The way things are now, this policy is honored more in the rhetoric of the advertiser than in the reality of the company policy. Richard

Posted On 9/13/2007 3:04:53 AM
Doug Said:


Aside from the corporate share of R&D costs, the company bears practically the entire burden of legal liability if patients are injured by the drug under their patent. Doctors and hospitals have malpractice coverage, but face it: the drug companies have the deeper pockets. National Cancer Institute would not bear any degree of liability for injury from outcome of a scientific development that they initiated. Personally, I would like to see Novartis reduce the cost of Gleevec - particularly since they also own the patent on Tasigna which is the 2nd generation version. (Don't confuse this with the "evergreening patents" that the article mentioned. Tasigna has demonstrated 50 times more efficacy against the disease, and has a much smaller incidence of side effects). While I would welcome lower prices on these products, I also believe that Novartis has demonstrated adequate committment to pro bono ethic by the price relief programs they offer to uninsured.

Posted On 8/29/2008 5:20:32 AM
Helen Said:


are there any way to get help for gleevec? Mine went up $269.25.was $4000, a month. now it is much higer.

Posted On 9/4/2008 7:12:24 PM
Ralph Said:


I am a CML patient and have been on 600mg Gleevec since 12/2002. In the past 5+ years, my insurance company has paid Novartis over $300,000. Novartis has also instituted 2 price INCREASES, hardly a 'patient friendly' action. So, while every company has a right to make a profit, this is without a doubt price gouging. I agree that govt price controls would eliminate the profit motive for developing new, innovative designer drugs like Gleevec. That doesn't excuse the pharmas from their heartless profiteering. Thank God for my health benefits. God help me if I ever lose them.

Posted On 9/25/2008 2:27:22 AM
Avijit Said:


I am from India and here glivoc costs around Rs. 100,000 per dosage. this is disgustingly vulgar pricing and totally unmindful of the health of people living in developing countries. Speaking from the perspective of someone living in third world, most of the people of India cannot afford this drug and even those who can usually don't opt for it because it puts a great burden on them finanacially. Nowdays there is litigation going on over here on the patent issue of glivoc between novartis and other Indian generic manufacturers who make the same drug and sell it at a much lower price. It is one thing for a drug company to recover its costs of research and to earn profits and its another to price a drug at such an amount that majority of people are deprived of it. Then what is the use of developing newer drugs if they are out of the reach of the affected people who needs them the most. I completely agree with the author and will suggest that the drug companies should think about the needs of the people while fixing the drug prices.

Posted On 2/12/2009 4:23:01 PM