Each year, the Access to Medicine Foundation publishes a hierarchical list of pharmaceutical companies ranked on their efforts to “improve access to medicine in developing countries.”  See: http://www.accesstomedicineindex.org/ranking. Without wanting to diminish the good intention of this group, the index, from my cynical perspective, may denote little more than the level of “honor” amongst thieves.

Gilead — the Poster Child:

 While seemingly noble on the surface, one does not need to dig deeply to discover the degree to which these companies are vastly more concerned with quarterly returns to shareholders than altruistic actions that benefit global health. Take Gilead Science, for instance, and the company’s perceived, initial reluctance to discount Sovaldi – a breakthrough drug in the treatment of Hepatitis C. The undiscounted cost for a course of treatment is approximately $85,000. According to a June article in Forbes, “Sovaldi costs about $130 to manufacture, reinforcing how outrageous its pricing is.”

Yet, it was only after being cast as the poster-child for egregious profiteering that Gilead reassessed its stance on the cost and availability of Sovaldi. The organizations that spoke out about Gilead’s pricing were formidable, as evidenced by an article appearing in the April 11, 2014 edition of Bloomberg News stating: “The WHO yesterday called for ‘‘a concerted effort’’ by various stakeholders to lower the cost of the drug.”

Implicit in the WHO comments was a threat that generic versions could be produced independently of Gilead: “In addition to tiered pricing, voluntary and compulsory licensing, where generic-drug makers are given permission to produce more affordable versions of a medicine, can also help achieve affordability, the WHO said.”

Bowing to Pressure:

In response to increasing public pressure and the potential loss of control of their golden goose, Gilead slashed the costs of Sovaldi to selective countries, such as Egypt and India, where there are large populations of infected individuals that lack the resources to pay for the drug. Yet, they did little to address the drug’s unaffordability to the myriad of indigent patients in economically developed countries.

It’s worth noting that Gilead acquired the ability to manufacture Sovaldi through the purchase of Pharmasset at the cost of $11 billion. Amazingly, “Gilead is on pace to recoup the full cost of its $11 billion investment in just over one year. That is unprecedented,” according to the Forbes article.

Deanna Beasley, writing for Reuters, quoted Brendan Buck, a spokesperson for America’ Health Insurance Plans, as stating: “The blank check mindset we’ve seen from Gilead is a threat to our entire health care system, and we hope they will pursue more sustainable pricing in the future.” Gilead ranks fifth from the top (out of twenty) on the Access to Medicine list.

18/20 Companies Guility

It is unfair to single-out Gilead as the greedy one amongst pharmaceutical and biotech firms. As a recent New York Times article pointed out, “Eighteen of the 20 companies in the index have settled or been convicted of unethical marketing, unfair competition or bribery in the last two years.”

Again, I applaud the foundation’s efforts. Whether its list  is a noble attempt to improve transparency within the pharmaceutical industry and catalyst for greater altruism or simply lipstick on the pig, I will leave up to you…my reader.