After acquiring the drug Daraprim in August, Turing Pharmaceuticals AG decided to increase the price of this medication by 5,500%, from $13.50 to $750 per tablet. Amid the outrage and ad hominem attacks that ensued, the media lost an excellent opportunity to inform the public about the science behind the drug, as well as the disease it treats. As a scientist trying to develop alternatives to Daraprim, I feel obligated to give the general public a closer look at the pros and cons of this drug, argue why better medicines are needed and provide a substantive critique of Turing’s rationale for price hike.
Setting the record straight
Contrary to some reports, Daraprim, scientifically known as pyrimethamine, does not treat HIV. It treats toxoplasmosis, an infection caused by the parasite Toxoplasma gondii. It is also used to treat T. gondii’s close cousin, Plasmodium falciparum, which causes malaria.
T. gondii persistently infects over two billion people worldwide. That’s over one-third of the world’s population. Despite its prevalence, the parasite remains quiescent and harmless in healthy individuals, making toxoplasmosis a rare and neglected infectious disease. However, when a pregnant woman acquires this parasite for the first time, the parasite can be transmitted to her foetus, causing damages in the eyes and the brain. The parasite also infects immunocompromised patients such as those with full-blown AIDS, with often fatal consequences. In fact, brain inflammation because of toxoplasmosis is responsible for killing 20% of all patients with AIDS.
Such side effects are due to the drug’s mechanism. Daraprim targets T. gondii parasite’s vitamin B production. Unfortunately, since the same vitamin B production can be found in humans, the drug harms both the parasite and healthy human cells. I often remark how taking Daraprim is akin to receiving chemotherapy in pill form. Therefore, a new, better, less toxic medicine is needed.
Critique of Turing’s (original) plan
Amid public outrage, Turing Pharma announced that they would make Daraprim “more affordable,” though it has not specified a new price for the drug. The pharmaceutical company’s original plan had four main components:
– to increase price of Daraprim by 5,500% and turn a profit on the drug
– to force insurance companies to absorb financial impact of the price hike
– to utilise the profit to fund research and development of better alternatives to Daraprim, and
– to make Daraprim free to patients who could not afford the drug or those without health insurance.
Considering corporations’ profit-driven nature, there was no guarantee that Turing would do what it promised and devote profit from Daraprim to develop better alternatives. Even when given benefit of the doubt, Turing Pharma’s plan to hike Daraprim’s price by 5,500% is not the best model for financing drug development. At first, the plan looks reasonable: it avoids making a profit on patients and ensures that the poor and the uninsured could still access the drug. Nonetheless, this plan has unintended and adverse consequences for health providers. For the brief period that the price hike had gone into effect, it quickly became too expensive and cost-ineffective to stock Daraprim, delaying care to patients in need. Given the fact that Daraprim is classified as a World Health Organisation Essential Medicine, any actions that reduce accessibility of the drug are unacceptable.
While I appreciate Turing’s seemingly altruistic intention in developing medicines better than Daraprim, I do not think such a dramatic price hike is the best course of action to finance development of new drugs. Turing could build on existing research and bring promising therapeutics to fruition. It could also apply for grants from the National Institute of Health and other governmental funding bodies to finance drug development. All in all, if Turing genuinely wanted to improve the lives of those with toxoplasmosis, it would not have done so at the expense of accessibility to Daraprim.
*Bo Shiun Lai  is a Gates Cambridge Scholar pursuing a PhD in Pathology at the University of Cambridge. He helped develop a new paradigm that can deliver antiparasitic agents across multiple membrane barriers and published his findings on the Proceedings of the National Academy of Sciences USA. Picture credit: from Wikimedia Commons . It shows dormant, encysted parasites in the brain. Daraprim is ineffective against dormant parasites.
Bo Shiun Lai
- 2013 PhD Pathology
- Jesus College
Toxoplasma gondii is a parasite that infects over one-third of the world’s population. Damages as a result of T. gondii infections affect the eyes and brains of newborns. Through my undergraduate work, I helped develop a novel paradigm (Lai et al.) that can deliver medicines across multiple membrane barriers and into the parasite. More importantly, this approach can also deliver inhibitors into encysted, dormant parasites, which are impervious to treatment. The process through which parasites respond to external stress by switching from the active form to the dormant (and incurable) form remains unclear. At Cambridge, I will work in Dr. James Ajioka’s toxoplasmosis laboratory. My project will help decipher the molecular pathways involved in such a stress response. Once these pathways are elucidated, medicines can be developed to prevent parasites from becoming dormant (leaving them vulnerable to existing medicines) or kill parasites directly during dormancy.