Last month, Jayne Sullivan staged a sit-in at the new Senedd building in Cardiff to demand that Health Minister Brian Gibbins instruct Primary Care Trusts to fund treatment with the medicine Herceptin for breast cancer. This was only one of a number of protests in Wales and England The media make reference to Herceptin being expensive but do not question or probe into why it is so expensive. Herceptin costs £21,800 per patient per year.

This is just one example of a medicine and its cost to the health service and more important the people who would benefit from it. The pharmaceutical industry point to the research and development costs of developing these medicines and innovation as justification for the cost, but what is the truth?

A Superprofitable Industry

The pharmaceutical industry is a multinational industry of great power, influence and profit. The worldwide sale of prescription drugs in 2002 cost health services $400billion. $200billion of these sales were in the USA. There the working class trade off taking medicines against heating and food. In Britain the NHS spends £7billion a year on medicines. In countries without a National Health Service the frailest and most vulnerable parts of society string out prescriptions taking less of the medicine than is prescribed or worse, people risk sharing prescription medicines without knowing any of the contraindications they might have for that particular medicine. Perversely in the USA those without health insurance pay more for medicines as they miss out on discounts negotiated by insurance companies for bulk buying.

The term for the top ten drug companies in this global enterprise is "Big Pharma". These companies are American, British, Swiss and French. In 2002 the combined profit of Big Pharma in the Fortune list of the top 500 companies internationally was more than the profits of the other 490 businesses put together. So why is this industry so profitable? Heavily prescribed drugs are routinely jacked up in price. People are taking a lot more medicines and these are more likely to be expensive new drugs instead of older cheaper ones that do the same thing. The fact is that the research and development part of the drug company's budget is small compared to marketing and certainly much smaller than profit! Prices have little relationship to the costs of making the drugs and could be enormously cut without coming close to threatening research and development. The truth is that most of the research and development of new medicines is done in academic institutions and public monies play a significant role in their development. About a third of medicines marketed by Big Pharma are licensed from academic institutions. The industry is not particularly innovative either, most drugs are variations of the same medicine produced in direct competition with medicines already out and that do the same thing. This duplication is enormously wasteful and outrageous given the rarer illnesses that need scientific attention but don't get it because they will not be profitable.

Patent racket

The patents of medicines are the life blood of this industry as these award the drug company exclusivity of profiting from the sale of that medicine. When the rights to the medicine expire a generic drug (copy) can enter the market at a significantly cheaper price. Big Pharma therefore employ armies of lawyers to ensure they maintain the patent for as long as possible. In 1980 a patent length was 8 years in 2000 this had grown to 14 years. A drug company that has exclusivity to a medicine that sells over $1 billion a year (they call this a blockbuster) for 14 years has secured the companies place amongst the top pharmaceutical companies and with this comes enormous power influencing governments on a global scale. Big Pharma will do almost anything to protect exclusive marketing rights including condemning people in the third world to a premature death from AIDS. Ninety five percent of people with the HIV virus (32 million people) live in the third world. Antiretroviral treatment dramatically reduces mortality from HIV/AIDS in developed countries and has gone a long way in transforming a fatal condition into a chronic one that people now live with. Big Pharma have made billions from the sales of antiretroviral medicines and the costs of these medicines put them out of the reach of the vast majority in the third world.

Let's be clear. There is no link between price and public health need this is about profit and power not health! Marketing- the Biggest Budget Item The biggest item on a drug company's budget is "marketing" this can be two and a half times that spent on research and development. This covers education, advertising and promotion. Translated, this means influencing those that write the prescription or influencing those who influence the prescription writer. Doctors and nurses are given free gifts everything from pens, computer accessories and paper weights to sponsorship to attend world conferences and study days that are not funded by the strapped for cash NHS. A recent study showed that even those doctors who stated they were not influenced by the marketing employed by the drug company did in fact alter their prescription habits accordingly. Lets face it, if marketing didn't work (by that I mean increase profit) they wouldn't invest so much in it. The quest for profit pushes every other consideration aside including public safety. Recently medicines have been withdrawn due to health risks. One of Big Pharma's members has recently had to pay hundreds of millions dollars in compensation due to their negligence in producing a medicine taken by 20 million people worldwide (by my own father in this case) that caused around an estimated 28,000 heart attacks or deaths since 1999. A sensible response should be to invest more in research, development and safety but in fact it is feared that they will respond by being even less innovative in developing new medicines that may be risky. They will not take 'risks' that damage profits.

Deal with this global industry!

So what is the answer to this global industry that puts profit before health and safety, that does not respond to public health need and which condemns the third world and the poor to premature death? The nationalization of the drug companies would provide the NHS and public health with the funding required to dramatically improve the health of the world, re-investing in research and development of medicines produced according to health need not profit. We also have to think about the causes of ill health and disease. Ill-health is strongly associated with poverty; there exists a marked gradient in the incidence of most health conditions in the poorer sections of society and this is due to income, the environment in which people live and a lack of education. Of course under capitalism these problems will never be solved as it is profits not people that matter. All past governments under capitalism have been useless in running society and health care, no matter who is in power the gap between the health of the wealthy and the health of the poor is growing. That is why we need the socialist transformation of society that would allow society to tackle the very causes of ill-health, poverty, housing and the environments in which we live. We need to give everyone the equal opportunity to live life to the full, to be productive and cared for by the society in which we live.

Claire Job (Nurse, Socialist Party Swansea).