{"id":7736,"date":"2015-09-24T22:05:23","date_gmt":"2015-09-25T02:05:23","guid":{"rendered":"http:\/\/blogs.nejm.org\/hiv-id-observations\/?p=7736"},"modified":"2015-10-02T06:31:36","modified_gmt":"2015-10-02T10:31:36","slug":"decision-to-lower-price-of-pyrimethamine-a-good-one-especially-given-the-defense-of-the-price-hike","status":"publish","type":"post","link":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/decision-to-lower-price-of-pyrimethamine-a-good-one-especially-given-the-defense-of-the-price-hike\/2015\/09\/24\/","title":{"rendered":"Decision to Lower Price of Pyrimethamine a Good One, Especially Given the Weak Defense of the Price Hike"},"content":{"rendered":"

The big ID story the past couple of weeks is that the price of pyrimethamine — a drug that’s been available generically for decades — went from $13.50 to $750 for one pill<\/em> after the exclusive rights to the drug were\u00a0purchased by Turing Pharmaceuticals.<\/p>\n

Now, after a barrage of criticism — all the way from this little blog<\/a> to the Infectious Diseases Society of America<\/a> to the New York Times<\/a><\/em> to the leading Democratic candidate for President<\/a> — the company\u00a0has wisely decided to lower the price.<\/p>\n

Exactly what<\/em>\u00a0the price will be remains to be seen, because there’s a lot of space between $13.50 and $750, but we’ll find out\u00a0soon enough.<\/p>\n

How about defense of the initial decision to raise the price?<\/p>\n

Roll ’em:<\/p>\n

[youtube http:\/\/www.youtube.com\/watch?v=L-U1MMa0SHw&w=560&h=315]<\/p>\n

There are a bunch of claims here that don’t quite ring quite true.<\/p>\n

Namely:<\/p>\n

    \n
  1. We don’t “desperately” need new treatments for toxoplasmosis [0’54”, those are minutes and seconds in the video]. Most people\u00a0who have toxoplasmosis have asymptomatic latent infection and need no treatment. 90% of those that do<\/em> develop active disease generally respond to the treatments we have. Clinically relevant resistance is, fortunately, a rare event. Alternative therapies (notably trimethoprim\/sulfamethoxazole) are also pretty good, and have become standard-of-care in some settings.<\/li>\n
  2. Treatment of toxoplasmosis does not cure it [5’22”] — if a patient’s immune system again becomes weakened, they can suffer a relapse even after they have been treated. This is why chronic suppressive therapy must be continued indefinitely if a patient remains immunocompromised.<\/li>\n
  3. Patients with AIDS\u00a0who need treatment don’t get a “very short treatment administration” [5’30”].\u00a0The HIV Opportunistic Infection Guidelines<\/a> recommend 6 weeks of initial therapy, followed by\u00a0chronic maintenance therapy until there is “an increase in CD4 counts to >200 cells\/\u00b5L after ART that is sustained for more than 6 months.” In other words, patients treated for toxoplasmosis can easily be on treatment for a year, sometimes\u00a0even longer.<\/li>\n<\/ol>\n

    The part around 2’30”, however, is\u00a0undeniably<\/em> true:<\/p>\n

    Profits are a great thing to maintain your corporate existence.<\/p><\/blockquote>\n

    Look,\u00a0there is nothing wrong with companies making profits for discovering,\u00a0developing, and creating good products — this is a capitalist country, after all, and innovation should be rewarded. I write that sentence keenly aware that the\u00a0new iPhones are about to appear in stores this weekend, and yes, my iPhone 4 is looking a little tired.<\/p>\n

    But with the pyrimethamine price increase,\u00a0some sort of threshold of reasonableness was passed.<\/p>\n

    The negative response has been essentially universal, and quite appropriate.<\/p>\n","protected":false},"excerpt":{"rendered":"

    The big ID story the past couple of weeks is that the price of pyrimethamine — a drug that’s been available generically for decades — went from $13.50 to $750 for one pill after the exclusive rights to the drug were\u00a0purchased by Turing Pharmaceuticals. Now, after a barrage of criticism — all the way from […]<\/p>\n","protected":false},"author":6,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[3,4,5,8,9],"tags":[423,1076,936],"class_list":["post-7736","post","type-post","status-publish","format-standard","hentry","category-health-care","category-hiv","category-infectious-diseases","category-patient-care","category-policy","tag-hiv","tag-pyrimethamine","tag-toxoplasmosis"],"post_mailing_queue_ids":[],"_links":{"self":[{"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/posts\/7736","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/users\/6"}],"replies":[{"embeddable":true,"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/comments?post=7736"}],"version-history":[{"count":0,"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/posts\/7736\/revisions"}],"wp:attachment":[{"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/media?parent=7736"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/categories?post=7736"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/tags?post=7736"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}