The best of luck to all who try this
Just to try to capture neoliberalism - well, just good sense in fact - in a nutshell. Markets often work and when they do use markets. Markets sometimes don’t work and when they don’t don’t use them. A neoliberal is just any person who thinks markets work more often than you do.
With that in mind:
Yet for some patients with rare diseases, commercial interests are dictating who gets to access life-saving treatment and who doesn’t. Pharmaceutical companies have long been driven by global demand and the potential for the highest profits. In the past two decades, the market has exploded: pharma revenues worldwide have exceeded $1tn. For patients with common conditions, this investment in healthcare can only be good news. But the narrow focus of this strategy means that, in the UK, the one in 17 of us who will at some point be affected by a rare condition risk being forgotten.
OK - the claim is commercial pharma works just great for many things but doesn’t for all. So, where it doesn’t use some other system. We can’t see any objection to that.
However, it’s not, perhaps, quite as simple as is being portrayed.
Great Ormond Street hospital (Gosh) recently announced that it was taking the unprecedented step of attempting to obtain the licence itself for a rare gene therapy on a non-profit basis, after the pharmaceutical company that planned to bring it to market dropped out. If successful, it will be the first time that an NHS trust has the authorisation to market a drug for this kind of treatment. The move could act as a proof of concept for bringing drugs to UK patients that pharmaceutical companies aren’t willing to risk their profits on.
Ah, well, no. The development costs of a new treatment are high. It’s possible to have the most lovely arguments about how high, estimates range from “only” $500 million up to $2 billion. The vast majority of that cost being the testing regime and the seeking of authorisation and licence to be able to market. The new and interesting chemical is a small fraction of that cost.
The rare disease problem is that the disease is rare. Whether we use profit making companies, charities, government or whatever else to perform the task we do still want whatever it is that is done to be value additive. If we’re to spend $500 million (or $2 billion) we still want a profit on that expenditure - profit in the real sense, that the value gained from having done it is greater than the alternative uses of the same scarce economic resources. Whther that profit then becomes a profit to the capitalists or just the general value addition to society as a whole is an entirely secondary question. We still want the value from having spent $500 million to be greater than the $500 million spent. Changing who spends and how the $500 million, changing who gains that value added, doesn’t change that base calculation.
This particular rare gene therapy is for bubble baby - the absence of an immune system. The incidence is somewhere between 5 and 15 children a year in the UK. Spend $500 million to save 15 children? Well, maybe. 70 years of life from a one off treatment at $40,000 per QUALY gives us $2.8 million a treatment and $42 million a year in societal benefit. If the treatment can be marketed elsewhere as well then that cost per life saved falls precipitately.
But again, note that that calculation is the same whether it’s Great Ormond St or vile capitalist b’stard spending the $500 million. The problem isn’t the capitalists and their lust for profit. It’s the rarity of the disease being treated and the costs of gaining authorisation for the use of the treatment.
There is an easy way out of this of course. Lower the cost of gaining that authorisation. Cull the bureaucracy and so solve the problem - but doesn’t culling the bureaucracy solve so many problems, eh?