Big Pharma - How much power do drug companies have? | DW Documentary

[Music] the pharmaceutical companies hiking the prices of drugs martin scarely is the former ceo of turing pharmaceutical

who's responsible for hiking the price of at least one drug by five thousand percent are you gonna change the price no martin martin shkreli is a phenomenon he

illustrates that the system is broken and that the drug ecosystem is completely money-driven [Music] richer and more powerful than ever underpinned by its influence networks

the pharmaceutical industry stands unchallenged in its ability to dictate government health policies the industry's power is comparable to that of a state

the pharmaceutical industry is so rich and so powerful its lobbying affects congress greatly and also the fda

while the industry benefits hugely from publicly funded research it manages to steer healthcare expenditure towards its most expensive medications

no good idea goes forward without a pharmaceutical company partner and yet the current pricing is absolutely indefensible in my opinion

the pharmaceutical industry's main concern is now profit their concern is shareholders not patients it's a very cruel

business model because if you can't pay for it you don't get it the battle against the covet 19 pandemic has further wet the pharma company's appetite

has the pharmaceutical industry's thirst for profit become a threat to our public health systems

[Music] daraprim is on the world health

organization's model list of essential medicines an invaluable weapon in the fight against malaria and a serious infection caused by hiv

a young u.s financier martin shkreli manager of a hedge fund investing in health products bought the rights to the drug in the united states

he then bumped up the price of dara prim from 13 and 50 cents to 750 a 5 000 increase

[Music] martin shkreli refused to budge on the price of his medication please welcome to the stage martin shkreli founder facing the financial

press he tried to defend the indefensible thanks for coming thank you up here if you could rewind the clock a few months i wonder if you would do anything

differently i probably would have raised the price higher is probably what i would have done um why

i think health care prices are inelastic i could have raised it higher and made more profits for our shareholders um which is my primary duty and again

no one wants to say it no one's proud of it but uh you know this is a capitalist society capitalist system and capitalist rules and my investors expect me to

maximize profits not to minimize them or go half or go 70 but to go to 100 an immoral increase maybe but perfectly legal as part of an investigation into the

scandal of unchecked drug prices martin shkreli was summoned to appear before a u.s congressional committee

u.s congressional committee what do you say to that signal pregnant woman who might have aids no income

she needs dereprim in order to survive what what do you say to her when she has to make that choice what do you say to her on the advice of council i invoke my fifth amendment privilege against

self-incrimination and respectfully decline to answer your question somebody's paying it's the taxpayers that end up paying for some of them i know you're smiling but i'm very

serious sir i ask now that the committee excuse the witness from the table without without objection so ordered we'll pause for a

moment as mr shkreli is escorted out [Music] martin shkreli was soon dubbed the most hated man in america

[Music] some time later he was arrested by the fbi and convicted by a federal court on securities fraud

he was sentenced to seven years in federal prison beyond his individual case shkreli became the embodiment of the excesses of

the pharmaceutical industry and the embodiment of its cynicism the price of daraprim has never returned to its original level

some useful fools attract attention by their behavior which while cynical is actually very useful in giving a clear picture of what these people and their abuses of the system represent the

derivative [Music] over the past 10 years the landscape of

the drug industry has dramatically changed a handful of pharmaceutical companies manufactures the vast majority of drugs

one of the world's top five is swiss company novartis having acquired a host of smaller companies it boasts an annual turnover of 45 billion dollars and now

holds some promising patents and treatments for cancer and other rare diseases the two american giants pfizer and johnson and johnson have also bought dozens of rival firms to expand their

markets [Music] another top five company is rosh a swiss drug manufacturer which has acquired 25

competing therapies and the french giant sanofi has an annual turnover of more than 40 billion dollars it too has bought a dozen pharmaceutical laboratories in europe

and north america with each having 100 000 employees these multinationals make up the global market commonly known as big pharma

to maintain their monopoly on certain diseases large laboratories are accused of playing down or hiding from the health authorities some of the results of their clinical trials

[Music] the upshot is that some of the drugs released on the market trigger serious side effects in the patients they are supposed to be treating

like mediator a drug produced by sergei laboratories from france and withdrawn from the market 30 years after launch amid a major scandal

or depokine an epilepsy treatment one of the world's most widely distributed drugs in the last 50 years made by the french giant sanofi the drug

while effective is at the center of a huge health scandal in europe its use has been proved to be extremely dangerous for the unborn child in pregnant women

[Music] i often compare my condition to the effects of a violent electric shock like a short circuit in an electric box

everything disconnects i lose consciousness suffer convulsions then come round a few minutes or a few hours later the fear of never waking up is a

constant so for me medication is vital no question about it without medication i wouldn't be here today

[Music] i knew i had to consult my doctor first i asked my family physician is this suitable for pregnant women i was told it was fine

my gynecologist and neurologist told me the same thing [Music] nathan was born with a urogenital abnormality

time went on and nathan passed the age when he should have started talking and sitting up he didn't either and her husband became increasingly worried they filmed their son nathan to

document his delayed development as evidenced to doctors an abnormally calm child he did not smile lacked muscle tone and exhibited signs of language delay and relationship

disorders and i was told he wasn't a late developer it was a disorder natal suffers from severe neurological sequela

marine marta embarked on an extensive investigation into the side effects of the drug depokine eventually becoming a whistleblower and filing a complaint against sanofi in a

bid to have the company's responsibility recognized she's created an advocacy group with thousands of victims [Music] in france and switzerland several

individual lawsuits and a class action are currently underway against sanofi the firm is under investigation for aggravated deceit and accidental injuries

[Music] it was also a way for me to make amends the guilt was overwhelming when you take a medication every day twice a day in my case and poison your

baby it's still difficult for me now so for me the process of making amends and exposing sanofi's deceit was

essential [Music] the victim's grievance is that they were not forewarned about the risks of taking the drug during pregnancy [Music]

according to the health authorities since the drug was first marketed in 1967 tens of thousands of children in europe have suffered birth defects and mental impairment

what you have here is a pharmaceutical laboratory that doesn't play the information game and fails to communicate all the information it has to the health authorities

it may not have been 100 sure but we know that the lab wrote in 2003 that it had been aware of the issues since 1970

the laboratory's reply is yes but the risk seemed slight sanofi is one of the main big pharma companies the biggest in france in terms

of research and development of new drugs with branches in a hundred countries worldwide their slogan is empowering life

after weeks of negotiations their management agreed to an interview under one condition sanofi refused to discuss the ongoing

legal proceedings in the cases of marine marta and victims associations in europe how long have those in charge at sanofi been aware of depakine's serious side effects

to answer your question first depakine is used in the treatment of epilepsy that's the therapy for which we were licensed to sell the product remember

epilepsy is a serious condition has been rigorous in monitoring and supplying information to the health authorities medical profession and patients the health authorities say your

application lacked detail and your warnings were poorly explained i don't think we are vague we report all the information we have in our possession the inspector general of social affairs

carried out a thorough examination of the depakon case it concluded in 2016 that it was scientifically impossible given the data available at the time

to conclude a direct correlation between valproid and neurodevelopment prior to 2004.

despite everything how do you explain your failure to convince the health authorities to act faster in informing medical professionals and above all patients who might be pregnant it is the responsibility of our company

to ensure at all times that the information we gather about the use of this product pharmacovigilance scientific developments be constantly transmitted to the health

authorities that's our duty and we do that regularly systematically and transparently while the evidence was piling up on the link between the drug depokine and

serious disorders affecting children it took another 11 years for patients to be alerted in 2015 sanofi finally came to an agreement with the ansm the official

body that licenses drugs in france the patient package insert supplied with depoken was amended to clearly indicate the significant risk of deformity and

developmental problems almost 50 years after the drug was first launched despite all of the warnings the warning in the patient package insert was finally included in 2015 in

extremely precise terms would you mind reading the first hard-hitting paragraph no no you'd rather i did it yes go ahead sanofi's patient package insert is now

very clear in all languages depakine can seriously harm an unborn baby when taken during pregnancy exposed children are at high risk of

serious intellectual and motor development disorders in up to 30 to 40 percent of cases and or deformities in around 10 percent of cases

their argument is the state licensed me to sell this product so don't blame me but wait in the volkswagen dieselgate scandal the government deemed the cars roadworthy but it is volkswagen's

responsibility to pay for the lies and the defects in their cars not the governments absurd manufacturers are responsible for their products

the authorities were remiss but the main responsibility lies with the manufacturer only after a two-year battle was marine marta able to ensure a warning would be

affixed on the depokeen label like those found on alcoholic drinks

[Music] all pharmaceutical companies are looking for what they call a blockbuster a drug

that treats widespread diseases and can be marketed worldwide to preserve exclusive rights big pharma companies have developed some powerful strategies

[Music] this is the story of a revolutionary treatment for amd age-related macular degeneration a severely disabling eye

disease that can lead to blindness millions of patients are affected worldwide it's also the story of the competition

between two equally effective drugs one costing 40 times more than the other until 2005 there was no effective treatment and many patients lost their

sight today [Music] then came a new drug that significantly slows the progression of the disease

a liquid injected directly into the eye [Music] the therapy had been developed in the united states and was said to

revolutionize treatment of the disease several major ophthalmologists launched clinical trials on thousands of patients they were unable to treat

it's the leading cause of permanent blindness in people over the age of 65 in fact perhaps for any disease worldwide there is a role uh for pharmaceutical

companies particularly in research and development of new medications they they invest many years and and a lot of dollars that being said

um you know they are for-profit companies and and their objective is to is to find um what they call the blockbuster drug that they can sell a lot of to a large population which is

why there is a lot of r d or research and development going into macular degeneration because it is such a common disorder

[Applause] this first treatment was developed by the american laboratory genentech it was called avastin

newly licensed by the fda in america the drug was officially used to treat colon cancer then by accident an american professor discovered that its properties

significantly delay the development of amd and improve eyesight progresses slowly and it causes legal blindness phil rosenfeld began

uh experimenting with intravenous avastin for the treatment of neovascular amd there was really

no studies done by the pharmaceutical company to do that it was really some a doctor and a pharmacist who worked together to come up with what might be the

optimal dosing of avastin in the eye the treatment worked flawlessly [Music] professor rosenfeld presented his

results at the annual ophthalmology conference the results were like nothing we'd ever seen before every retina specialist that i know who was at that meeting our jaws were on the floor because of the first

time we had seen an improvement in visual acuity whereas every treatment that came before it had a decline in vision over one year period we'd never seen that before

and because avastin was priced to be given uh for cancer was inexpensive so for the first six to twelve months everyone all over the

world was using avastin to treat these patients until lucentis came out meanwhile ophthalmology researchers at the very same american genentech

pharmaceutical laboratory that manufactured avastin for cancer were developing a new treatment specifically for amd lucentus

introducing lucentis a breakthrough in neovascular amd lucentis redefines efficacy all the studies showed that the two treatments

were identical except the new lucentis treatment was much much more expensive for avastin that would make avastin about fifty dollars an injection

and then when lucentis comes out a single dose in the eye is two thousand dollars meanwhile in france pharmacists in hospitals were becoming interested in

treating the eye condition with the avastin used for cancer [Music] avastin is dosed in bottles

for injection into the eye pharmacists had to repackage it in syringes at a lower dose you take a file a small bottle

containing 16 milliliters then use it to fill a number of syringes maybe a batch of 50 for ophthalmological injections [Music]

it entails repackaging the contents of a bottle into an injectable form [Music] the really important thing is to ensure the preparation is completely sterile

before delivering it for administration by the ophthalmologist the syringe must be absolutely sterile [Music] this meant we could make syringes for

around 50 euros each you have to include staff costs and testing costs plus the premises and equipment have to be paid for so the cost for us was 20 times less

than it was for lucentis which cost around a thousand euros a syringe [Music] in europe while expensive the cost of

the new lucentis eye treatment was still only half what it was in the united states where prices are not controlled the drug was marketed by swiss

laboratory novartis avastin is sold by the other big swiss laboratory rosh which bought out the american company genentech

[Music] especially rosh don't like it when products they sell to treat a specific condition are used

then concocted a strategy to prevent doctors from using avastin to treat eye conditions and convince them to inject lucentis were you visited by representatives of

novartis or roche at that time about that treatment absolutely yes they came to say they didn't understand why we were using avastin a cancer

treatment to treat ophthalmological conditions i had a meeting with the general manager of novartis who came to the hospital to ask me why i insisted on making these avastin

syringes when lucentis was a licensed treatment [Music] so i explained my thinking which was how best to serve the public and patients

allied to economic and health considerations the conversation was mostly about the potential danger to patients did you think novartis was putting pressure on you

if it was pressure it carried no threats [Music] since all international studies demonstrated the equal effectiveness of the two treatments hospital pharmacists

naturally favored the least expensive option [Music] the two laboratories rush and novartis launched a long legal procedure against

the french state the maneuver was doomed to fail avastin was eventually authorized for use in france but it was too late

the problem now for the health system is that it has a setup that is so complex for ophthalmologists to manage that basically everyone has given up

[Music] thus almost all patients treated for amd were given an injection of the more expensive products including the one

made by novartis [Music] in italy in 2014 rush and novartis were fined some 180

million euros for illicit price fixing of the two drugs in late 2020 france fined rush and novartis 444 million euros

there were people in the alpha helmet community who really liked using lucentis it's a great drug i have the utmost respect for the role that the pharmaceutical industry plays in our

field no good idea goes forward without a pharmaceutical company partner and yet the pricing

to me particularly when you've got a fifty dollar disruptor that's equally effective the current pricing is absolutely indefensible in my opinion it's

estimated that the us saves three billion dollars a year by using a vast instead of lucentis

according to the regulations the french medicines agency cannot force rosh to manufacture avastin syringes for the treatment of amd despite two months of negotiations the

multinational rush refused to be interviewed its legal department told us we do not wish to speak or be filmed on this subject but are more than willing to

answer any questions you may have in writing question why does the laboratory refuse to manufacture avastin syringes for the treatment of amd

answer rush develops drugs only for medical needs not covered by existing drugs where there are no therapeutic alternatives [Music]

[Applause] rush then says no and the public authorities are powerless to force their hand

lobbying has paid off the cheaper alternative is rarely used the big winner is novartis which coincidentally owns a third of

rash [Music]

in the united states the price of drugs is completely unregulated as soon as the fda approves the drug the pharmaceutical companies are free to impose their prices

elected officials democrats and republicans alike persist in trying to force manufacturers to lower the cost of new treatments in vain

one recent medication has changed the health economy an overpriced treatment that has launched a new scramble for profit between the biggest pharmaceutical companies

[Music] this is a major american discovery a new treatment against hepatitis c it helps cure the often deadly chronic

liver disease by eradicating the virus sovaldi made by gilead the world's 10th largest pharmaceutical company was launched on the u.s market in 2014

the price of the three-month treatment 84 000.

that's a thousand dollars a tablet [Music] so valde is the first of the drugs that actually cures

hepatitis c in three months the virus is gone that is manufactured by what is now a very big drug company called gilead

sciences but gilead had nothing to do with the research uh that that discovered cevaldi gilead sciences bought

thermoset and they bought it because that way they could get their hands on zivaldi they are concentrating more on diseases

that don't affect that many people better life and death diseases so they can charge whatever they want so they charged eighty four thousand

dollars the sales of gilead sciences uh came to 32.5 billion dollars

of which 55 percent this is according to the annual reports was pure profit the american drug then hit the european market at half the price

the price of treatment for a course of sovaldi was 42 000 euros the still exorbitant cost aroused a

great deal of outrage among patients the ngo med sound du monde launched an awareness campaign in france 230 000 patients were affected

at 42 000 euros a pop in terms of health insurance the hepatitis c treatment was one of the most expensive around here we can thank gilead for marketing

sivaldi because they showed the wider public that today drugs are not sold for the price they should be sold at it reflects the necessity for gilead to recover the huge costs involved having

spent 10 billion they had to fix a high price i heard that hepatitis c could be treated the treatment now available was

expensive but it cured the disease in 12 weeks patients who had for the most part until then being condemned by hepatitis c

gilead was in a position of relative strength having a unique treatment that offered a cure that were rather

robust and tense then got underway the price today has come down by more than half under pressure the american pharmaceutical lab lowered the price of

the three-month sovaldi treatment in france from 42 000 to 24 000 euros a u.s

senate commission revealed the company's confidential marketing strategy [Music] we had access to thousands of pages of internal gilead documents so we could

see that in gilead meetings marketing ideas were aired in particular ideas for pricing but no mention was ever made of the actual outlay for r d manufacture

and marketing in this internal presentation the gilead sales team recommends an introductory price of between eighty thousand and eighty five thousand dollars dismissing

concerns about any potential scandal in the press the sole concern was how to maximize profits achieve strong financial margins

cover costs then move on public health considerations were never an issue [Music] is now director of unitade a body

operating within the world health organization charged with negotiating significant price reductions with large pharma companies to treat patients in the southern hemisphere

71 million people worldwide carry the hepatitis c virus the best duplicate it's extremely the drop in price was considerable and was

established by introducing generic drugs and giving the pharma lab assurances that we would open major markets rather than sell a little at a high

price we offered the chance to sell a lot at a lower price we scored a victory by ensuring treatment was accessible at a reasonable

price [Music] thus treatment for hepatitis c using the generic drug produced by mylan costs

less than eighty dollars available only in developing countries in the northern hemisphere a course of treatment still costs tens of thousands

of euros the price of drugs no longer reflects the real cost of research rather the financial power of a few large companies scrambling for a

disproportionate profit with the appearance of new gene therapies to treat certain cancers or rare diseases prices are still increasing reaching several hundreds of

thousands of euros all the major big pharma companies are in the race for these new treatments they save lives but at what cost

[Music] a new gene therapy to fight cancer is now marketed by swiss company novartis to treat leukemia

its name is kim raya its price is 320 000 euros per patient [Music] the therapy was discovered by a team of

publicly funded university researchers at the university of pennsylvania but flexing its financial muscles novartis became co-owner of the patent

professor of hematology jean-paul vernon is a renowned expert in blood cancers techniques there's a whole technique involved

using gene therapy a gene is introduced which allows t cells to target diseased cells and enable them to be destroyed it's a very interesting system but

there's no justification for charging 350 000 euros if state structures in france went along with it it would doubtless cost 30 or 40

000 but not 350 000 euros obviously it's the farmer industry's job to keep a lookout for something interesting the research is no longer carried out by the pharmaceutical industry

the work is tackled by publicly funded research public the drug companies they don't do their own innovation anymore they do zero

innovation or close to zero the innovation still comes from nih-funded research what we're seeing now is a big

change that i think is terrible and this big change is instead of being

focused almost exclusively on the size of the market on volume it's now focused on price they acquire a drug that's effective

against a serious disease multiple sclerosis cancer serious disease that people will pay almost anything to get

and jack up the price so that it can cost hundreds of thousands of dollars for a year's treatment i mean hundreds and thousands of dollars

it's a very cruel business model because if you can't pay for it you don't get it cancer treatments now cost something

like 300 000 or 400 000 euros while the number of cancer patients in france is around a million eight hundred thousand with four hundred thousand new cancer cases every year

i cannot see how in the future we will be able to treat more than 1.5 million people when the price scale is some 300 000 euros

[Music] there's a whole sales pitch relating to the therapeutic value and life-saving value of these medications which has been skillfully put forward by opinion

leaders to convince governments which basically says that drugs heal they are a unique product the high cost is the price of life it's pure marketing better cures mean

higher prices the problem is that each country defends its multinationals france defends sanofi the usa defends pfizer and the big

american companies switzerland defends novartis and roche it's hard to reach consensus to bring down prices to reasonable levels [Music]

after two months of negotiations the multinational novartis turned down our request for an interview instead they sent a simple press release

we price our new medicines based on the value they deliver to patients health care systems and society we strive to take into account income levels local

affordability barriers and economic realities while maintaining the sustainability of our business novartis tells us as its representatives have explained to political decision

makers that this new single-dose cancer therapy must be compared to a treatment of drugs taken for life in late 2019 the laboratory agreed to a

slight decrease in france where the price of kimraya went down from 320 000 euros to 297 666 euros

the fda now is on the payroll of the pharmaceutical industry they pay user fees to the part of the

fda that evaluates new drugs for approval so this makes this part of the fda dependent on

the companies that they are supposedly regulating the drug companies love it because it makes the

part of the fda that evaluates their drugs extremely friendly since they support it it is a blatant conflict of interest this ought

to be well-funded and there ought to be

no conflicts of interest

[Music]

you