Intended for healthcare professionals

Rapid response to:


Healing an ailing pharmaceutical system: prescription for reform for United States and Canada

BMJ 2018; 361 doi: (Published 17 May 2018) Cite this as: BMJ 2018;361:k1039

Rapid Response:

Euthanizing a terminally ill system that does not want to die!

Gaffney and Lexchin must be commended for their brilliant piece, on behalf of the US and Canadian Pharmaceutical Policy Reform Working Group, and, for daring to call a spade a spade. Indeed, the “pharmaceutical system is broken” and “Only a fundamental reform can ensure universal access to safer, more innovative, and more affordable drugs.” (1)

The evidence has been accumulating for too long. (2,3) Why has the price of insulin products nearly tripled from 2002 to 2013? (4) Could it be a coincidence that only three firms control more than 90% of the world’s production? Cartelization, the combination of apparently independent producers to increase collective profits by restrictive practices, has always been the common rule. James Randall, Archer Daniels Midland‘s (agro-industry) president and lysine cartel leader, disclosed: "The competitor is our friend and the customer is our enemy.”

However, cartelization is only the tip of the iceberg, and many modes of collusion are perfectly legal. Moreover, the industry is most skilled at developing new ways to protect its vested interests. For example, Allergan Plc sold its patents for blockbuster drugs (cyclosporine ophthalmic emulsion for chronic dry eye, Restasis) to an Indian tribe to delay the market entry of generic drugs. (5)

Gaffney and Lexchin’s agenda for reforming the pharmaceutical system is most comprehensive. However, the pharmaceutical system is only one of the by-products of a bigger system. Symptomatic treatment cannot be adequate for a most serious disease such as the plague of corruption.

1 Gaffney A, Lexchin J; US; Canadian Pharmaceutical Policy Reform Working Group. Healing an ailing pharmaceutical system: prescription for reform for United States and Canada. BMJ. 2018 May 17;361:k1039.

2 Braillon A. Drug industry is now biggest defrauder of US government. BMJ. 2012;344:d8219.

3 Braillon A, Bewley S, Herxheimer A et al. Marketing versus evidence-based medicine. Lancet 2012;380:340.

4 Acessed May 19, 2018

5 Ablavsky G, Larrimore Ouellette L. Selling patents to Indian tribes to delay the market entry of generic drugs. JAMA Intern Med 2018;178:179-180.

Competing interests: No competing interests

19 May 2018
alain braillon
senior consultant
university hospital