New cancer drugs can work wonders, BUT WHO CAN AFFORD THEM?
NGOs are lobbying with health minister Anbumani Ramadoss to reduce prices ……….Pronoti Datta | TNN
Mumbai: Clara DSouza is admirably stoic as she discusses her agonising problem. A breast cancer patient, the 56-year-old craft teacher at Kurlas Holy Cross School has been prescribed the drug Herceptin as she has a 20 to 30 per cent chance of a relapse. In India the drug, which has been described as the last and most effective line of defence against breast cancer, costs Rs 1,09,200 a vial. Patients typically need six vials. DSouza, who has already spent more than two-and-a-half lakh on her her treatment, dearly wants the drug but wonders how her middle-class family will raise the money for it. If you take it, youre tension free, she says. My husband and children are deciding.
DSouzas anxieties are shared by thousands of cancer patients who cant afford life-saving medicines that are phenomenally expensive. India is one of the worlds largest manufacturers of affordable, generic drugs. But a new generation of medicines that entered the market after a patent law came into effect in 2005 (on Indias membership to the World Trade Organisation, WTO) is prohibitively expensive. Unlike older cancer drugs that destroy cells without being able to distinguish between good and bad ones, a number of the new drugs are targeted therapies. This means that they treat cancers specific to individuals. DSouza, for instance, has tested positive for a hormone receptor that Herceptin is designed to treat.
The NGO Cancer Patients Aid Association (CPAA) has been lobbying to get the government to take action to bring down drug prices. What we want the government of India to do is to look into the pricing of drugs to ensure that women who need these drugs get them at affordable prices, says CPAAs executive director Shubha Maudgal. She cites the case of a former colleague, Jenny Quadros, who died in 2007 of breast cancer. CPAA had already spent Rs 5 lakh on her treatment. When her doctor said that the drug Avastin might help, CPAA found itself in a moral dilemma. As just one cycle of Avastin costs Rs 25,553 and there was no guarantee of cure, Maudgal says the NGO wondered whether it could afford to shell out more money. Jenny died before a decision could be made.
In April, the NGO wrote an open letter to union health minister Anbumani Ramadoss requesting him to look into the matter. From November 15 to 17, CPAA will host Reach to Recovery, a conclave of NGOs dedicated to the rehabilitation of cancer victims from across the country. At the end of the event, CPAA will approach Ramadoss again.
The chief target of agitating NGOs is the 2005 patent law. Before the law, India allowed foreign drug companies in the country to patent the process of making a drug but not the molecule. As a result, local companies could legally copy the molecule to make far cheaper generic versions.
The law now allows companies to patent the molecule. But, thankfully say NGOs, a number of safeguards make it tough for drug makers to get patents. The safeguards have been a boon to local drug manufacturers who use them to oppose the patenting of foreign drugs so that they can make cheaper versions. One of the safeguards is that evergreening or making minor variations to an existing drug, does not make it eligible for a patent. The drug must be a new invention. Also, patents are country specific. This safeguard enabled CPAA to stop Novartiss bid for an Indian patent for leukaemia drug Glivec, even though it has patents for the drug in several countries.
Cancer support groups say the government has to step in to make drugs cheaper on humanitarian grounds. Leena Menghaney, a campaigner with Medecins Sans Frontieres which deals with HIV-related issues, supports compulsory licensing by the government. If the government were to allow several companies to manufacture the same drug, she points out, prices would be reduced as a result of competition. The government, however, has reserved such a measure for times of national emergency.
At the Tata Memorial hospital, up to 40 per cent of the needy cancer patients admitted are treated free of cost. The hospitals former head of oncology Dr Purvish Parekh says that the social work department of the hospital raises about Rs 50 crore by way of donations each year. But, as he points out, In a country as vast as India, all this can seem like a drop in the ocean. Till either the government or drug companies take action, patients like Clara DSouza find themselves on the horns of a painful dilemma: life at the cost of financial ruin or the uncertain imminence of death.
PILL TALK
PILL TALK
GLIVEC: Made by Novartis. Costs Rs 1.25 lakh for a months dose. Has to be taken for life. Generic versions cost Rs 14,000 a month
HERCEPTIN : Made by Genetech. Costs Rs 1,09,200 a vial. Six vials needed
AVASTIN: Made by Genetech and Roche. Costs Rs 25,553 per 100mg vial. For colon, lung and breast cancer
TARCEVA: Made by Roche. Costs Rs 36,490 for ten 100mg pills. For lung and pancreatic cancer
FIGHTING THE GOOD FIGHT: A counselling session at the CPAA office