Concordia and Liothyronine. Monopolies both large and small within the Health Service

The UK's Competition and Markets Authority (CMA) has found that the drug company, Concordia, has overcharged the NHS for its thyroid drug, Liothyronine. The CMA said that in 2016 the NHS spent £34 million on its drug, liothyronine, whilst in 2006 it was just £600,000. The amount the NHS paid per pack rose from about £4.46 in 2007 to £258.19 by July 2017, a staggering increase of almost 6,000%.

So what is the problem? Has demand for the drug risen? Are there lots more people suffering hypothyroidism? No, all kinds of sickness is rising, but not by 6000% in 10 years! Has there been a supply problem then, some difficulty making the drug, an increase in the cost of making it? No, the CMA said the price rise took place despite production costs being "broadly stable".

               "We allege that Concordia used its market dominance in the supply of liothyronine tablets to do exactly that."

So this is yet another example of pharmaceutical industry profiteering. Nor is it an isolated incident of a drug company milking national governments, national health services, and patients. I blogged in October 2015 about the drug Daraprim and Turing Pharmaceuticals, which gained control over the drug and increased the price from $13.50 to $750, a rise of over 5,000%!

The strategy appears to be for smaller drug companies to gain control over a specific drug, and once in a monopoly position to exploit it for all it is worth.

The price change happened after the drug was de-branded in 2007, that is, the patent expired. Drugs are expensive under patent; but the government can cap the profits drug companies are allowed to make. Afterwards, drug prices usually fall. But not if the pharmaceutical industry takes action, and gives an individual company a monopoly in marketing the drug. This is what happened in this case, and the earlier one concerning Daraprim. Concordia was, until earlier this year, the only supplier of the drug, selling in in more than 100 countries. The CMA report commented:

               "Pharmaceutical companies which abuse their position and overcharge for drugs are forcing the NHS - and the UK taxpayer - to pay over the odds for important medical treatments."

And for some patients, in a country where conventional medicine is also a virtual monopoly, this has indeed become an important drug. The mainstream media produced several patients who have found the drug useful, and have been affected by the price hype. Owing to the cost, the NHS stopped doctors prescribing it, and these patients suffered as a result.

It is, of course, a good human interest news story, and most of the mainstream media reported it. What they did not report, or even suggest, was that this story demonstrates clearly that drug companies are essentially private business enterprises, interested mainly in maximising their profit. Producing drugs is not, for them, a philanthropic patient-centred exercise. Indeed, by hyping the price to this extent it is clear that the last people the company were thinking about were the patients!

Nor did the media ask what appears to be a natural question. How is it that within the pharmaceutical world one small drug company is allowed a monopoly over the manufacture and distribution of a drug? How is it that when an established drug comes off patent, and are 'debranded', its price can rocket? Apparently this is the CMA has challenged a number of drugs companies about. It is not an isolated example.

The company, Concordia, has stated that it did "not believe that competition law has been infringed", and that the pricing of  liothyronine had been conducted "openly and transparently with the Department of Health in the UK over a period of 10 years". However, earlier in 2017, Concordia was accused of pushing up the price of another NHS drug, hydrocortisone, by striking a deal not to compete with another firm. Their innocence, and the innocence of the pharmaceutical industry generally, seems to be highly questionable.

Moreover, the liothyronine case is not the only one being investigated by the CMA. The drug giants Pfizer and Flynn Pharma have been intestigated for excessive and unfair prices being set for the anti-epilepsy treatment, phenytoin sodium capsules, and it has imposed fines of about £45 million on a number of other pharmaceutical companies in relation to the anti-depressant drug, paroxetine.

All this raises another unasked question. If this is so, how is it that a government department, and the NHS, has not picked up on the profiteering? Has there been collusion, at a time when the NHS is getting deeper into crisis and bankrupcy? As I have argued at length elsewhere, the pharmaceutical industry is important to government because it is an important part of the British economy.

Yet as always the main unasked question is whether this drug is safe. Although the media produced patients who felt they had benefitted from it, the Drugs.com website outlines the side effects of the drug, some of them serious. It warns that any patient should get "emergency help immediately" if any of the following known side effects of the drug occurs:

               * Arm, back or jaw pain
               * changes in appetite
               * changes in menstrual periods
               * chest pain or discomfort
               * chest tightness or heaviness
               * cold clammy skin
               * confusion
               * decreased urine output
               * diarrhoea
               * dilated neck veins
               * dizziness
               * extreme fatigue
               * fainting
               * fast, slow, pounding, or irregular heartbeat or pulse
               * fever
               * hand tremors
               * headache
               * increased bowel movements
               * irregular breathing
               * irritability
               * leg cramps
               * lightheadedness
               * menstrual changes
               * nausea
               * nervousness
               * sensitivity to heat
               * shortness of breath
               * sweating
               * swelling of face, fingers, feet, or lower legs
               * troubled breathing
               * trouble sleeping
               * vomiting
               * weak pulse
               * weight gain
               * weight loss
               * wheezing

Monopoly is a major problem in the provision of health care services. A monopoly over the sale of a single drug can lead to cost of pharmaceutical drugs becoming exhorbitant. The monopoly of a single type of medicine within a national health service can lead to patients having to suffer the consequence of harmful and dangerous drugs, with patients believing that they are the only way to treat their illness.

  

Health Monopoly means patients suffer, and even die

Where there is effective competition, in any sphere of life, customers or consumers are usually given choice. They can see what is available to them, and decide which product most meets their needs and requirements.

• For instance, if we were to visit a car showroom today to purchase a car, and were told that they could not sell us one with windows, or a roof, we would take ourselves to another showroom. 
• If the salesman told us that all their cars could only be started by a turning handle, operated from the front of the car, we might want to look at other options.
• If we were shown a car that could only travel at 30mph, or that only achieved 5 miles per gallon of petrol, we might decide to look for more effective and economical vehicles.

Indeed, such a showroom, such a car manufacturer, would soon find themselves out of business, as most of their prospective customers would want something that worked a little better.

These might sound like strange and excessive scenarios, perhaps as there are many car manufacturers, each seeking to respond to consumer requirements.

Yet, in the provision of health services, there is no such competition. Visit your doctor, or your local hospital, and you will be offered conventional medical treatment, most of which is based on pharmaceutical drugs and vaccines. If you want some other form of medical therapy you will not only be in the wrong place, no-one at the surgery, or the hospital, will bother to tell you about alternatives.

If conventional medicine was offering something that was safe and effective this might not represent a problem. We would be ill, receive the treatment, and get better. But this is seldom the deal offered to us by our doctors.

Arthritis. 

NHS Choices tells us that "osteoarthritis cannot be cured, but treatment can ease your symptoms and prevent them from affecting your everyday life”. The main conventional treatment for 'easing the symptoms' of arthritis are painkilling drugs. Yet these painkilling drugs are dangerous. And doctors know they are dangerous! But will they direct you to an alternative medical therapy, like homeopathy, which can cure arthritis safely and effective?

They will not. One has to suppose they prefer their patients to suffer - even when they admit that they have no cure.

Fibromyalgia (Chronic Fatigue)

This condition can be a very painful, but once again, NHS Choices confirms that: “there is no (conventional) cure for fibromyalgia, but treatment can ease some of your symptoms and improve quality of life”. So patients might be sent to specialists, such as rheumatologies, neurologists or psychologists, who will use painkillers and other drugs, but not to alternative practitioners who can actually treat the disease successfully.

Again, the NHS admits that conventional medicine has nothing to offer, but they refuse to refer patients on for more effective or safer treatment.

And there are many other diseases that conventional medicine has no safe or effective treatment. Indeed, in writing my new ebook, "Why Homeopathy?", which compares conventional medicine with homeopathy in the treatment of a variety of illnesses, I have been surprised at the number of times the conventional medical establishment freely and openly admits it has no effective treatment.

So a car with no windows, with no starter motor, and offering only a dreadful motoring experience is not either strange or excessive. It is what routinely happens which sick people visit conventional medical practitioners. There are many other diseases that conventional medicine admits it cannot treat, yet refuses to refer patients on to those who can.

Moreover, conventional medical practitioners also know, and admit, that their drugs cause side effects, and that these side effects can themselves be serious illness and diseases, including liver, kidney and heart disease, diabetes, confusion (dementia) and much else.

The analogy here might be that the car salesman cannot guarantee that travellers will not be poisoned by exhaust fumes, or crash randomly into obsticles at any time!

Death
Nor is the prospect of death an obstacle to the conventional medical establishment. The monopoly they hold within the NHS is to precious to put at risk by suggesting that there may be other treatments that might help patients.

I remember some years ago listening to news story about the man in Dundee who contracted Rabies from a bat. He was treated in hospital, presumably using conventional medical treatment. It was reported that 'there was no cure' for this condition, but they were making him as comfortable as possible.

I wrote to the Department of Health asking whether anyone within the health service in Dundee had bothered to see whether there was any traditional therapy for the condition, and in particular, whether they had contacted a homeopath in the area. I pointed out that Homeopathy treats 'like with like' using substances in high dilution/potency, and that the remedy 'Lyssinum' was made from the saliva of a rabid dog. I said that if asked, any homeopath could have tried this remedy, or indeed several others used by homeopaths for the treatment of this disease, to try to save this man's life.

The response I received was that was a matter of patient confidentiality, and the could not give me the information I required. The man’s death was announced a few days later.

Homeopathy is regularly used to treat rabies in eastern Europe, and elsewhere. The only assumption that can be drawn from this situation is that when people have illnesses that conventional medicine cannot cure, no effort is made by conventional medical practitioners to check whether alternative  medical therapies  might help – even when, as in this case, death was the outcome.

There are many other medical conditions (dementia, Ebola, et al) that lead to death, for which there is no conventional treatment. Whilst the conventional medical establishment will often conduct vastly expensive research into new drug or vaccine development, a simple referral to a homeopath, or indeed research into alternative treatments, is never suggested.

The NHS, and indeed many national health services throughout the world, are monopoly suppliers of conventional drug/vaccine medicine. Regretfully, they are more interested in protecting their monopoly than offering patients a real choice of medical therapy - even when they have nothing safe, or effective to offer us.