Sam Uretsky

Where Cancer Patients Rank

The Breast Cancer Awareness Stamp is a semi-postal -- now do the math.

Semi-postals are a feel-good device. You buy a stamp for 43¢. The Postal Service takes its 41¢ for postage, plus some percentage for reasonable costs, and gives the rest to the specified charity. In the case of Breast Cancer Awareness, 70% of the net amount raised is given to the National Institutes of Health and 30% is given to the Medical Research Program at the Department of Defense. According to the New England Journal of Medicine, the NIH budget is about $28.6 billion for fiscal year 2007, a 0.1% decrease from 2006,or a 3.8% decrease after adjustment for inflation -- the first true budgeted reduction in NIH support since 1970. The less we spend on biomedical research, the more money we have for blowing people up.

Of course if you write a check to any cancer-related charity, you can deduct the money from your taxes, so that the government shares your contribution.

Not that the administration isn't well aware of breast cancer. It is. To prove that, you don't have to look any further than Betty Joblove et al. v. Barr Laboratories et. al. in the matter of the price of tamoxifen. Tamoxifen, sold by Zeneca Laboratories (which has since merged with Astra to form AstraZeneca) under the brand name Nolvadex, is an estrogen inhibitor. In 1977 the drug was approved for treatment of breast cancer that had spread to other organs, and in October 1998 the approval was expanded to include preventive therapy for women at high risk of developing breast cancer. The drug is of limited benefit for those women whose breast cancer isn't sensitive to the estrogens, but in a key study, prophylactic use of tamoxifen reduced the rate of breast cancer in high-risk women by 44%. Tamoxifen hasn't been a super seller with sales in the billions, but in 2006 it accounted for $62 million. As a percentage of the company's $6 billion after tax profits for 2006, it's no big deal. But for a woman with no insurance, even the $65.99 a month at Walgreen's can be a major expense, and it would be nice if there were a low-cost generic form available. There almost was.

In 1992, Barr, a maker of generic drugs, challenged Zeneca's patent on the drug, and was upheld in court. In the normal course of things, Barr would have produced a generic version of tamoxifen at a price 30% to 80% below that of branded Nolvadex. Instead, Barr and AstraZeneca entered into an agreement, in which Barr was paid $21 million and its intended supplier of raw materials received $45 million over a 10-year period. Barr did bring out a generic version of tamoxifen, but at a price only 5% below the brand name version. Prescription Access Litigation (PAL), a coalition of about 125 public advocacy groups, charged that this was restraint of trade. They were prepared to fight the case all the way up to the Supreme Court. They almost did.

And while (by a vote of 5 to 4) you can't expect very much of this Supreme Court, the Solicitor General filed a brief which begins "This brief is submitted in response to the Court's order inviting the Solicitor General to express the views of the United States. The United States submits that the petition for a writ of certiorari should be denied. Although the petition presents an important and difficult question, and the court of appeals adopted an incorrect standard, this case does not appear to be a good vehicle for resolving the question presented."

Those may be the views of the Solicitor General, maybe of the Department of Justice, maybe of the whole Bush administration, but are they really the opinions of the United States? Is it really the view of the US that a back room deal that maintains high prices for a drug that protects women from breast cancer should be left alone?

The president of Barr has made some good arguments, from a business viewpoint: Zeneca was prepared to appeal the decision regarding the patent, and subsequent challenges to the patent have favored AstraZeneca, so Barr played it safe. When you have a job that pays $3.7 million a year, you have to make decisions like that.

But when you're in a position to refer to yourself as "The United States" isn't it more appropriate to take a stand in favor of women at high risk of breast cancer, or those who have had a bout of cancer? Wouldn't it be nice, just once, to speak out for the poor, the elderly, the sick? Instead, the Bush administration went to the Roberts Court and asked that the corporations be left alone, and the women at high risk of cancer be overcharged because it's not convenient to discuss this case.

Maybe John Ashcroft was right to put a drape over the bare breasted statue of Justice -- Breast Cancer Awareness is just too inconvenient for this administration to bother with.

Sam Uretsky is a writer and pharmacist living on Long Island, N.Y.

From The Progressive Populist, August 1, 2007

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