The Economics of Extortion: Could Cannabis Replace the Leukemia Drug Gleevac?

What is the moral difference between threatening a person’s life to extort a million dollars and charging a person a million dollars for a lifesaving drug?

If the answer appears obvious to you, slow down. While a desperate patient taking out a second mortgage on their home to save their life may feel the victim of highway robbery, the applicable public policy considerations are not at all the same. For-profit pharmaceutical companies which develop lifesaving therapies are furthering the important public policy of improving human quality of life, regardless of whether their primary motive is people or profit; armed robbers leech off the productivity of others.

Nevertheless, there must be some price point for important treatment which is just too high. So argue the authors of a new op-ed in Blood, the journal of the American Society for Hematology. The authors focus on Gleevec, a drug brought to market by the pharmaceutical giant Novartis for the treatment of chronic myeloid leukemia (CML) and which by all accounts has made an enormous difference in the lives of the patients who use it. Whereas before Gleevec’s introduction in 2001, patients afflicted with CML had to endure drug regimens with terrible side effects and low chances of increasing their survival rate, the new drug ushered in a new era in which leukemia patients could live relatively normal lives only narrowly shortened by their illness; even Novartis’ fiercest critics must acknowledge the company has created a drug of great worth to many.

It is only when attempting to fix such a drug’s worth with any precision that the murky ethical questions come to the fore.  One school of thought with special affinity for the “free market” maintains the “worth” of such a drug is irrelevant; the only number which matters is the price the market will bear.

Yet the op-ed authors criticize this view, analogizing to “profiteering” retailers who jack up the price of drinking water in the wake of a natural disaster – and in any case the rules of the pharmaceutical market do not follow simple principles.  For proof, look no further than a recent ruling by the Supreme Court of India invalidating an application by Novartis to extend Gleevec’s patent in the subcontinent and clearing the way for a flood of generic Gleevec knockoffs from the world’s top producer of such drugs. While this may be great for the millions of Indians suffering from leukemia, it also has the effect of increasing Novartis’s incentives to raise its Gleevec prices in the US, where the company’s patent is still valid and insured patients already pay up to $30,000 out of pocket year after year.

“In the midst of a market conundrum with no easy fixes, cannabis represents a potential way out.”

In the midst of a market conundrum with no easy fixes, cannabis represents a potential way out.  As far back as the 1970s, the so-called Munson study of rats with various forms of cancer found that test subjects exposed to cannabinoids displayed a significantly lower incidence of leukemia; subsequent experiments on mice have found similar results (see Marijuana: Gateway to Health by Clint Werner). Yet attempts to study the effects of cannabis on treating human leukemia patients have been stymied by obstructionist Federal policy. While it is still unknown whether cannabis could treat CML as effectively as Gleevec, the very possibility demands action.  If future patients could have a choice between a $100,000 “wonder drug” and a truly wonderful drug easily available in their backyard, isn’t that a future worth pursuing?