07/14/14

Is There No Balm in Gilead?

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balm of Gilead in an olive wood scoop. marilyna / 123RF Stock Photo

I’ve always felt there was great irony in the fact that my favorite concert memory turned out to be a way of enabling David Crosby’s drug habit. When David Crosby and Kenny Rankin came to the Syria Mosque in Pittsburgh, I made sure I had tickets. Kenny Rankin sang his cover of the Beatles song: Blackbird. David Crosby came on stage with just his acoustic guitar and went through many of his hits with CSN&Y (Crosby Stills, Nash and Young for those born after the Boomer generation). It was great. Then I read in a magazine about David Crosby’s cocaine problem. In the article, Crosby described how he arranged quick solo acoustic concert tours when he was running low on drug money.

In a Rolling Stone interview, David Crosby reflected on his unlikely survival: “‘I don’t know why I’m alive and Jimi isn’t and Janis isn’t and Mama Cass isn’t and all my other friends,’ says Crosby. ‘I have no idea why me, but I got lucky.’” Well he hasn’t been as lucky with his health. He had hepatitis C and needed a liver transplant in 1994. Phil Collins paid for his transplant.

Typical treatment for hepatitis C is 6 to 12 months of a drug cocktail consisting of interferon and ribavirin plus a protease inhibitor. Interferon treatment has both physical and psychiatric side effects. Physical side effects can include flu-like symptoms (41 to 70%), nausea (29 to 46%), anorexia (21 to 32%), and diarrhea (22%). Psychiatric side effects can include: depression (22 to 36%), irritability (24 to 35%), and insomnia 37 to 40%).  Suffice it to say that treatment is not very pleasant.

When I heard the announcement about Gilead Science’s new drug Sovaldi being approved in December of 2013, I was pleased and encouraged. Sovaldi sounded like a real medical break through. It blocks a specific protein needed by the hepatitis C virus to replicate. When Sovaldi is used in conjunction with existing hepatitis C medications such as ribavirin and peginterferon-alfa, a study showed that 12 weeks after the end of the 12 to 24 week treatment regimen, 91% of untreated hepatitis C patients tested negative for hepatitis C!

This is simply amazing. Many of the people I’ve known that began interferon treatment stopped at some point because of the side effects. They simply can’t go on with their daily lives because of the medications. If Sovaldi can cut the treatment time in half and provide a 90% “cure” rate, more people will get and complete treatment.

So it seemed Gilead Science was attempting to live up to its name. Gilead Science’s name and logo intentionally uses the Biblical reference to the balm of Gilead. Gilead was a mountainous region east of the Jordan River that was famous for it healing ointment. The chorus of a classic spiritual, “There is a Balm in Gilead,” goes:

There is a balm in Gilead,

To make the wounded whole;

There is a balm in Gilead

To heal the sin-sick soul.

The existing cost for standard hepatitis C treatment (combination interferon and ribavirin therapy) before Sovaldi was steep, between $10,000 and $12,000. Maybe Sovaldi was going to be the “Hep C balm from Gilead”—or not. I was outraged to see that Gilead was charging $1,000-a-pill for Sovaldi.   A full course of Sovaldi costs $84,000. The full treatment for Hepatitis C will cost over $90,000! And get this—Sovaldi costs about $130 to manufacture.

Other industrialized countries are paying roughly half of the $84,000 cost for Sovaldi. Third world countries like Egypt and India get a 99% discount. According to Dr. Steve Miller on Forbes.com, “Hepatitis C patients in the U.S. are mostly uninsured, underinsured and/or incarcerated. Medicaid, the VA and our prison system bear the brunt of the cost impact, and by extension so do all of us as taxpayers.” So it would seem that in the U.S. there is a balm from Gilead—but you’re going to pay through the nose for it.

Is there no balm [for hepatitis C] in Gilead?

Is there no physician there?

Why then has the health of the daughter of my people

not been restored? (Jeremiah 8:22)

Yes, there is a Hep C balm in Gilead; and yes, there are physicians there to oversee the treatment. But the health of the daughter of your people will not be restored if she doesn’t have good health insurance, or someone like Phil Collins able and willing to make up your financial shortfall.

By the way, first quarter total sales in 2014 for Gilead’s Hep C balm was $2.27 BILLION. It was the fastest drug launch on record.  The Senate Finance Committee is inquiring about the drug. They have requested information for documents related to research and development costs of Sovaldi. Karen Ignagni, chief executive of the trade group America’s Health Insurance Plans, noted that treating all hepatitis C patients would cost $268 billion, which is $5 billion more than was spent on all prescription drugs in 2012. “This pricing, which Gilead attempts to justify as the cost of medical advancement, will have a tsunami effect across or entire health-care system.”

Is it profiteering to have such a high mark up on drugs like Sovaldi? 

Also read, “I Guess I’m a Little Bit Socialist.”