Big Pharma / CANCER

Joana Ramos spotlights a crisis that barely figures
in international discussions of essential drugs.

In 1995 I was diagnosed with non-Hodgkin’s lymphoma. Living in the US with health insurance, I got rapid care. I also learned the incidence of this form of blood cancer has risen some 70 per cent in the past 20 years, for reasons unknown.

Treatments did not work. Despite cycles of chemotherapy, the disease progressed painfully, affecting my ability to walk and use my hands. Fortunately in late 1998 I was able to have a blood stem cell transplant from a sibling donor, an option for only 25 per cent of patients. Today I live with long-term effects of both the disease and its treatment, blessed to be alive.

Being ill in the 1990s and trilingual, I soon met others worldwide who were facing similar concerns, especially in Latin America. Via internet discussion lists they voiced their plight.

In the Majority World cancer continues to be a death sentence. While part of the problem is inadequate health services, the largest single barrier is economic. Cancer drugs are priced so high that hospitals cannot stock them, nor can patients buy them.

In these nations cancers are usually detected only at advanced stages, and late diagnosis adds to the high mortality rate. Without access to pain-relieving drugs, most patients then die agonizing deaths.

Cancer statistics are chilling. By best estimates there are:

• 20 million people now living with cancer
• 10 million new cases yearly, 250,000 of which are children
• 6 million yearly deaths

By 2020, 70 per cent of new cancer cases will occur in the developing world, resulting in 15 million deaths annually.¹

In the industrialized world 70 per cent of children with cancer now survive at least five years or are cured. In the rest of the world 90 per cent die – most without treatment.

Globalization is adding new concerns for cancer control. More and more cancer patients in the Majority World are being used in clinical trials as drug companies try to cut costs. And tough anti-smoking campaigns in the West have prompted Big Tobacco to pump up marketing efforts in developing countries as sales decline elsewhere.

Recent wrangling in the World Trade Organization highlights the problem of Majority World access to cheap, generic drugs. Pressed by the pharmaceutical giants that are its most profitable industry, the US tried to limit severely the range of diseases for which generic medicines could be produced locally. Cancer was not included on the list, as if it were a trite concern. Though the disease list was eventually dropped, the affordability issue is far from resolved.

A case in point is cancer drug pricing in Peru where the disease is the leading cause of adult deaths and the second among children aged 5-14.² The minority of Peruvians who receive care in the country’s public-health system find limited services and even more limited access to medicines.

Olga Salaverry of the Asociación de Psicología Aplicada a la Sociedad (ASPAS), a group of psychologists who volunteer services to patients and families, posted this on one web mailing list: ‘Yesterday a woman came seeking help for her mother who has leukaemia. No hospital would accept her, as she has neither insurance nor resources to pay for care. No-one helps the patients who are terminally ill; they send them home to die…’

Peruvians seeking cancer help via the internet are amazed to learn that not only can cancer be treated, but that many basic drugs can be purchased outside the country for a fraction of their price in Peru.

The Ministry of Health (MINSA) publishes prices paid for medicines in Peru. A few examples:

• A 50mg vial of Pharmacia-Upjohn’s doxorubicin (Adrimaycin), used for many cancers, sold for $13,000, while the International Dispensary Association (IDA) sells it for $20 per vial.

• A 1mg vial of Eli Lily’s vincristine (Oncovin) for leukaemias and lymphomas, was sold for $2,671.52. IDA sells it for $1.58.³

High drug prices are not just statistics: they affect real people. Messages such as these from Peruvians on internet discussion lists, appear frequently:

‘We need ARA-C (cytarabine) urgently; there is none available in the hospital.’
Husband of leukaemia patient

‘We owe the hospital 7,000 soles ($2,300) for the chemotherapy drugs, so I take any job I can as I am without papers.’
Father of patient, writing from the US

‘This patient has contracted Hepatitis C from blood transfusions; we cannot treat that nor his cancer.’
Physician of young adult patient

New Peruvian groups like ASPAS and Plenitud de Vivir (parents of children with cancer) are seeking solutions to the problem of drug access which they confront on a daily basis.

In a crisis drug donations can help, but they’re not a long-term answer. The key barrier is that pharmaceutical corporations attempt to impose exorbitant global drug prices while ironically proclaiming their good corporate citizenship – as if access to medicines were solely the province of governments. The World Health Organization’s recently released World Cancer Report should help place cancer on public health agendas, but it must be accompanied by meaningful action on prices.

James Auste, a cancer survivor and the founder of the Manila-based Cancer Warriors Foundation, sums it up: ‘Every three hours another kid dies of cancer in the Philippines. Not because she is too weak to fight the disease. Not because her parents do not care. Not because our doctors do not know anything. But because her family is too poor to buy the medicines.’

Joana Ramos is an oncology social worker and patient advocate living in Seattle. Trained as a medical interpreter, she volunteers as a consultant to cancer groups in several countries including Brazil, Peru and the Philippines.

1 Data from UICC, WHO, IARC and ICCCPO.
2 http://www.minsa.gob.pe/estadisticas/tablas.asp
3 Minsa figures from ‘Los Precios de Adqusicion de Medicamentos en la Entidades de Salud-Año 2002’, www.minsa.gob.pe/infodigemid/degeco/precio/Precios.htm International Dispensary Association prices from http://erc.msh.org