As an American doctor, I think you deserve to hear the truth about our healthcare system

I will never forget the time I had to amputate a patient's leg because had to choose between insulin, food and housing

Eugene Gu
New York
Monday 20 May 2019 22:11
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Secretary of Health Alex Azar was previously president of Eli Lilly while the price of insulin tripled
Secretary of Health Alex Azar was previously president of Eli Lilly while the price of insulin tripled

Every year, American taxpayers spend more than $39bn through the National Institutes of Health to fund medical research to discover new lifesaving treatments and drugs. American patients risk their health and sometimes even jeopardize their lives to test whether these new drugs are safe and effective during clinical trials.

When the time comes to reap the benefits, however, Americans pay much higher prices for the same drugs that patients within universal healthcare systems overseas can obtain at much lower cost. This is in spite of the fact that Americans sacrifice so much more to help bring these drugs to market.

Much of it is because big pharmaceutical companies exploit both the private American health care system and our patent laws to perpetuate an injustice on the American people.

Take for example the California-based pharmaceutical company Gilead Sciences, which markets the drug Truvada, a formulation of two antiretroviral medications tenofovir and emtricitabine that inhibit the HIV virus' ability to hijack our cells and replicate. Truvada is so effective at pre-exposure prophylaxis (PrEP) to prevent HIV infection that it is included in the World Health Organization’s List of Essential Medicines as an absolutely critical part of any basic healthcare system.

While the generic version of Truvada is available in many countries outside the United States for around $840 annually per patient, Gilead uses its patent on the drug to charge Americans close to around $24,000 annually per patient. That’s for the exact fixed dose combination of tenofovir and emtricitabine that costs around $60 annually per patient to produce.

Unfortunately the healthcare consequences of this are severe. According to the CDC, around one million patients are at high risk of contracting HIV in the US — but only 160,000 patients are taking Truvada because of its high cost. With correct daily use, Truvada is 99 per cent effective, yet over 40,000 people are infected with HIV in America every year. If generic Truvada were available and all 40,000 patients were on it before being infected, the number of people would be closer to around 400. Endemic spread of HIV in the US could then be drastically reduced — or even eliminated.

What's infuriating is that American taxpayers funded much of the research and development for Truvada. So much, in fact, that according to the Yale Global Health Justice Partnership it's the CDC that actually owns the patent for the drug. So Gilead has basically been making $3bn a year selling a drug that actually belongs to Americans themselves.

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And that’s not all. Gilead recently partnered with Secretary of Health and Human Services Alex Azar and President Donald Trump to roll out a public relations scheme to fool the public. During this, Gilead declared that it would be donating enough Truvada to treat 200,000 patients each year until 2030. While it sounds great on the surface, that basically means it will donate around $12m a year while making billions in profits and getting a tax break.

I am not surprised that Alex Azar would promote such a deal in favor of big pharmaceutical companies at the expense of vulnerable patients. After all, before Azar joined the Trump administration he was the vice president of Eli Lilly, where Novo Nordisk and Sanofi — two other big pharmaceutical companies — more than tripled the price of insulin.

Just like Truvada, insulin is on the WHO List of Essential Medicines, yet there is no effective generic available in the United States. Due to a loophole in patent law called “evergreening", big pharmaceutial companies like Eli Lilly, Novo Nordisk, and Sanofi make incremental improvements to the same basic insulin that Charles Best and Frederick Banting discovered in 1921. While Best and Banting sold their patent for $1 in the hopes that they could help save as many lives as possible, pharmaceutical companies have since increased the price of insulin so high through evergreening that many patients resort to rationing their insulin just to survive.

I will never forget the first time I had to amputate a patient's leg because of poorly controlled diabetes. It was my intern year as a surgical resident and the man came into the clinic with a foul-smelling open wound on the heel of his foot that probed down to the bone and extended up his ankle. After we prepped and draped him in the operating room and marked out our incision, I couldn't believe that I was cutting through all his arteries, bones, nerves, and muscle and removing his leg just to save his life because he had had to choose between food, shelter, and his insulin. We're the richest, most technologically advanced nation in the world and we can't provide the most basic care for our own people.

It is time for us Americans to realize that our lack of a universal healthcare system makes us vulnerable to pharmaceutical companies who, to my mind, take our taxpayer-funded research, use our bodies for clinical trials, and sell us back the drugs we helped develop at exorbitant prices just because we don't have the combined purchasing and negotiating power that people in other countries with universal healthcare systems enjoy. From insulin to Truvada to almost every single essential medication on the WHO list, we often literally pay with an arm or a leg — or even with our lives.

Eugene Gu is a surgeon and scientist whose medical research concentrates on developing a cure for babies with congenital heart and kidney disorders

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