為什么天文數字的藥品價格不利于健康和利潤

為什么天文數字的藥品價格不利于健康和利潤

The price of pharmaceuticals around the world can vary dramatically depending on who's paying for the drugs and where those patients happen to live.

世界各地的藥品價格可能會有很大的不同，這取決于誰為藥品買單，以及這些患者恰好住在哪里。

Take the pneumonia vaccine. Doctors Without Borders just struck a deal on it for refugee children in Greece. The aid group will pay $9 per immunization for a drug with a list price of $540. In local Greek pharmacies, the vaccine costs $168. France pays $189 for the inoculation while the far less wealthy nation of Lebanon pays $243 for it, according to the group. In India you can get it for roughly $60.

拿肺炎疫苗來說。無國界醫(yī)生組織剛剛為希臘的難民兒童達成了一項協議。該援助組織將為一種標價為540美元的藥物支付9美元的免疫費用。在希臘當地的藥房，這種疫苗售價168美元。該組織稱，法國為接種疫苗支付189美元，而富裕程度遠不及法國的黎巴嫩為243美元。在印度，大約60美元就可以買到。

The global drug pricing system is "broken," says Fatima Suleman, a professor of pharmaceutical sciences at the University of KwaZulu-Natal in Durban, South Africa. "Affordability used to be an issue primarily for low- and middle-income countries, but it's now a global issue," she says.

南非德班夸祖魯-納塔爾大學的藥學教授法蒂瑪·蘇爾曼說，全球藥品定價體系已經“崩潰”。“負擔能力過去主要是低收入和中等收入國家的問題，但現在這是一個全球性的問題，”她說。

This weekend, Suleman is participating in the Fair Pricing Forum, a conference sponsored by the World Health Organization. The event brings together pharmaceutical executives, government health officials, academics and advocacy groups to look at ways to make global drug prices more affordable — while also benefiting drug manufacturers.

本周末，蘇爾曼將參加由世界衛(wèi)生組織主辦的公平定價論壇。這次活動將制藥高管、政府衛(wèi)生官員、學者和倡導團體聚集在一起，研究如何讓全球藥品價格更容易負擔得起-同時也讓制藥商受益。

We called up Suleman, who specializes in pharmaceutical policy, to ask her how the global health community could help patients get access to medicines they need and allow drug companies to reach much larger markets. This interview has been edited for length and clarity.

我們打電話給專門研究制藥政策的蘇爾曼，詢問她全球衛(wèi)生界如何幫助患者獲得他們需要的藥物，并允許制藥公司進入更大的市場。為了篇幅和清晰度，本次采訪經過了編輯。

Why not just let the free market sort out the price?

為什么不讓自由市場來決定價格呢?

Well, because we are looking at a free market that's failing. Otherwise, why would something like insulin — that's almost a century old — still be priced so high that people are going into poverty not just in the U.S. but in countries like Tanzania and elsewhere to get access to their medicines? If this market was working, something like insulin would now be at an affordable price. But it's not.

嗯，因為我們看到的是一個正在失敗的自由市場。否則，為什么像胰島素這樣的東西--已經有近一個世紀的歷史了--價格仍然如此之高，以至于人們不僅在美國，而且在坦桑尼亞等國家和其他地方為了獲得藥物而陷入貧困?如果這個市場正常運作，像胰島素這樣的東西現在應該是一個負擔得起的價格。但事實并非如此。

There's something in the system of medicine pricing that's broken and it's something that we need to really look at and figure out how we can fix.

在藥品定價體系中有一些東西已經被打破了，我們需要認真研究并找出解決的辦法。

Part of what you are arguing is that changes in global pricing could potentially benefit pharmaceutical companies by giving them increased access to billions of new customers in low- and middle-income countries. Have you seen an example of this?

你所說的部分原因是，全球定價的變化可能會讓制藥公司更多地接觸到中低收入國家的數十億新客戶，從而潛在地使它們受益。你見過這樣的例子嗎?

Absolutely. We saw this with hepatitis C, where at first, the treatment was priced so high in the U.S. and in Europe it was unaffordable in most of the world. [The hepatitis C treatment released by the biopharmaceutical company Gilead in 2014 cost more than $1.000 per pill, and a single course of treatment was approximately $80.000.]

絕對一點兒沒錯。我們在丙型肝炎中看到了這一點，一開始，這種療法在美國和歐洲的價格非常高，在世界上大多數地區(qū)都是負擔不起的。[生物制藥公司吉利德在2014年發(fā)布的丙型肝炎治療藥物每片成本超過1000美元，一個療程約為8萬美元。]

Other manufacturers in certain regions of the world [were allowed] to produce the medicines and supply them to certain areas at a much lower price. [Gilead granted licenses to two companies to produce generic versions of the drug to sell only in low-income countries. These were markets where few customers could afford the original list price.] And we saw the price of the hepatitis C medicines fall dramatically.

世界上某些地區(qū)的其他制造商被允許生產這些藥物，并以低得多的價格供應到某些地區(qū)。吉利德向兩家公司發(fā)放了許可，允許它們生產只在低收入國家銷售的仿制藥。在這些市場上，很少有顧客能付得起原價。我們看到丙肝藥物的價格大幅下降。

How do you address the fact that some medicines, no matter what you do, are going to be incredibly expensive to produce?

你如何應對這樣一個事實:無論你做什么，有些藥物的生產成本都將高得令人難以置信。

We want transparency from the industry. Tell us what your research and development costs are, whether it's an expensive way of production that you can't get away from or whether it's a failed production line or a failed [clinical trial].

我們希望行業(yè)透明。告訴我們你的研發(fā)成本是多少，這是一種你無法擺脫的昂貴的生產方式，或者是一條失敗的生產線或一項失敗的(臨床試驗)。

As long as everybody is aware about that, people will be much more inclined to say OK, I'm ready to pay a little bit extra for this medicine because I know that it will help fund something that's going to help me further down the line.

只要每個人都意識到這一點，人們就會更傾向于說，好吧，我準備為這種藥多花點錢，因為我知道它將有助于資助一些東西，這些東西將有助于我今后的發(fā)展。

But at the moment there's all this murkiness. Part of the concern is the kickbacks, discounts, the perverse incentives in the system that are also unclear. So all we're saying is: Can we get transparency?

但目前所有這些都很模糊。人們擔心的部分原因是回扣、折扣，以及系統中不明確的不當激勵措施。所以我們說的是:我們能獲得透明度嗎?

Any final thoughts on the push for fair pricing globally for drugs?

對推動全球藥品公平定價有什么最后的想法嗎?

We need more dialogue [for example, at the current forum]. At the end of the day, we have patients saying, "I want access to these high-cost medicines. Why am I not getting it?" And I think people need to understand that changing systems is slow. [That] it doesn't happen overnight, but that there is a global attention on this issue and we are hearing their voices and we do want change.

我們需要更多的對話(例如，在目前的論壇上)。在一天結束的時候，我們有病人說，“我想要獲得這些高成本的藥物。為什么我得不到它?”我認為人們需要明白改變系統是緩慢的。這不是一朝一夕的事情，但是全世界都在關注這個問題，我們聽到了他們的聲音，我們確實希望改變。

And that's why these forums take place.

這就是為什么會有這些論壇。