Gaëlle Krikorian's book, Des big pharma aux communs: petit vademecum critique de l'économie des produits pharmaceutiques [From big pharma to the commons: a critical vademecum of the economics of pharmaceuticals][1] offers to a French-speaking readership a concise and easy-to-access perspective on the economics of pharmaceuticals.
The author's critical perspective provides food for thought for discussions about social innovations for rare diseases and the implications of these innovations for the pharmaceutical industry. Gaëlle Krikorian, who holds a PhD in sociology, alternates between research, policy advice, and engagement in civil society. She has been a longtime activist in Act Up, then an advisor for the Greens in the European Parliament and policy director of the Access to Essential Medicines Campaign of Doctors Without Borders (MSF).
In this tex, she argues that the economics of pharmaceuticals, as it currently stands, is condemning to an inexorable decline of the number of people who have access to health innovations - not only in low-income but also in high-income countries. She contends that a shift in trajectory is possible, and that to do so, an accurate understanding of the “current dysfunctions, imbalances, and abuses is necessary to propose alternative ways of manufacturing and distributing the products” on which lives depend.
In her book - which is not focused on rare diseases but tackles important issues for the development and distribution of drugs for these conditions - she first discusses the symptoms that affect drug economics. “Market failure” is the main one. The term is often used by policy makers to designate “the absence of cures for clearly identified needs”, especially (but not only) for so-called emerging or neglected diseases, which attract little interest from the pharmaceutical industry because of their lack of profitability. Far from being a marginal weakness, asserts Gaëlle Krikorian, it is a fundamental symptom that needs to be addressed. Public or NGO investment in the development of drugs for these diseases cannot compensate for the lack of R&D needed to ensure access to treatments.
The pharmaceutical industry’s move towards selling less but more high-priced drugs instead of massive quantities of low-priced ones involves occasional shortages of the most common drugs (such as penicillin or morphine), significant price increases in vital products (insulin in the US market, for example), and astronomical prices for innovative treatments for a number of rare diseases.
She then discusses the diagnoses drawn from these manifestations of dysfunction. Without patents to protect inventions, what interest would the pharmaceutical industry have in investing in an activity as costly as research? Questioning the idea, she instead asks why, in view of the mass of public funding invested, “monopolies should be granted to firms”. Innovation, she analyzes, is far from depending on firms' financial investment alone, it “results from a succession of public financing of fundamental research”, to which are added, in particular in France, “tax credit mechanisms” that finance R&D, not to mention the provisions allowing firms to optimize their taxation. She criticizes the “absolute lack of transparency prevailing in the pharmaceutical world”.
Justified by the various parties involved in marketing and pricing by “business secrecy”, it covers in particular the details of pricing negotiations with the public authorities, but also the results of clinical trials, making the introduction of alternative products all the more complex. But this issue of transparency also concerns “the intervention of the private sector in the elaboration of public health policies”, whether in the form of public-private partnerships, the propensity of certain senior civil servants to convert to the pharmaceutical industry, or lobbying.
In the third part of the book, Gaëlle Krikorian contemplates what the alternatives might be. These include the Commons. In a previous post, Commons: A Claim to Redesign the Governance of Knowledge and Technology (March 2022), we referred to Gaëlle Krikorian's work on this issue. For her, there is an urgent need to build alternatives that would restore the priority of public health and the needs of patients. This requires taking into account the public funds invested and giving power back to public authorities, but also relocating the production of medicines, and finally preventing "the right to exclude from use being at the heart of the definition of property". It calls for changes in the law, compulsory licenses, new forms of collaboration and contracting between the different actors involved, including transparency.
[1] Gaëlle Krikorian, Des big pharma aux communs : petit vademecum critique de l'économie des produits pharmaceutiques [From big pharma to the commons: a critical vademecum of the economics of pharmaceuticals], is published by a Canadian publisher from Montréal, Lux Éditeur [European release: October 6, 2022. North American release: November 10, 2022].
Written by: Florence Paterson