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$1,000 Pills and the Future of Global Medicine

By Bernadette N. Lim

Hepatitis C, a liver-damaging virus, is best known as a “shadow epidemic” suspected of causing precipitous rise in rates of liver cancer, a disease increasing faster than any other cancer in the United States. The disease affects more than four million Americans and is disproportionately found among society’s marginalized populations, including prison inmates and injection drug users. An estimated 130 to 150 million people are infected worldwide.

Though these statistics and stories are worthy of alarm, costs of treating this epidemic are far from urgent. In April 2014, the World Health Organization approved two new oral drugs that fight hepatitis C, but their costs are far from affordable. Gilead Science’s 12-week course of the hepatitis C drug Solvadi costs $84,000, which translates to $1,000 per pill. Johnson & Johnson’s drug Olysio, often prescribed with Solvadi, costs $66,360 for the 12-week regimen.

Pharmaceutical companies oftentimes justify these high costs by simply pointing to the length of time and amount of money that is invested in the research and development process. According to the Pharmaceutical Research Manufacturers of America, research and development for just one medicine takes 10 to 15 years and more than $1 billion.

In spite of these undoubtedly expensive costs, such an outrageous and unaffordable cost of treatment in the midst of a growing epidemic should not be allowed. While pharmaceutical companies may refer to a large R&D budget as justification for its outrageous drug treatment costs, human suffering of disease is ignored. Many of those at-risk for the disease, including inmates, can barely afford basic resources, let alone a $1,000 hepatitis C pill.

The influence of economics and big data by decision makers has been growing within government policy compared to perspectives from historians, anthropologists, and psychologists. Prominent ideas held by academics claim that complex treatments simply cannot be done in resource-poor settings or among uneducated, marginalized populations of society. The marginal revolution of economics has convinced us that we live in a world strapped by financial and human resources. And yet, as economic arguments and cost-benefit analysis become priorities in global policy, we must evaluate social constructions that lie behind outrageous claims of dollar amounts and profit. We must keep in mind the politics and social climate that create our conceptions of cost and benefit. What defines cost? Who is worthy of benefit? Where does the marginal dollar that can alleviate costs lie? For those in need, high drug treatment prices become more than a dollar sign: They are dollar-value designators of those worthy to live and those unlucky enough to die.

We’ve seen the disastrous effects of prioritizing costs over human realities throughout history. The outrageous modern day costs of hepatitis C drugs recall the struggles of the war against HIV/AIDS. Those most at risk of getting infected with HIV/AIDS in the United States include society’s marginalized populations such as the LGBTQ community, injection drug users, and minorities. In the early stages of the HIV/AIDS epidemic, youth activists were at the forefront in pressing the FDA to approve drugs at a faster pace. Yet even with the release of the first HIV/AIDS drug, zidovudine, many still could not afford the drug’s cost of $10,000 or endure the drug’s vicious side effects in the late 1980s. Only in 1996, through tireless advocacy by AIDS activists, did affordable costs and long-term effective treatment with little side effects emerge with the use highly active antiretroviral therapy treatment.

Today, as exemplified by justifying and tolerating the appalling cost of hepatitis C drugs, we are still questioning whether saving lives is a worthwhile “bang for your buck” endeavor.

If health intervention and action is dependent on merely one discipline or field of study, the fruits of social justice and health equity can never be fully realized. What is “efficient” and “effective” must be clarified and challenged further by health economists and policymakers.

Unless we truly make the individual human experience and quality of life the utmost priority in global medicine, we have yet to achieve health equity for all.

Bernadette N. Lim ’16 is a joint human evolutionary biology and studies of women, gender, and sexuality concentrator living in Dunster House.

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