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Published on March 6, 2008

Ethicists and economists fear Thailand will be taking a major step back for social welfare if the Samak Sundaravej government goes ahead with plans to deny affordable cancer drugs to needy patients.

For several weeks, economic arguments have been put forward claiming that the country would face serious trade sanctions if the compulsory licences to import generic cancer drugs, granted by the previous government, are not rescinded.

"The Thai private sector is afraid of losing tariff privileges if the US decides to impose trade retaliation," said Thai Chamber of Commerce chairman Pramon Sutivong, adding that 20 per cent of Thai exports to the US, worth about US$4 billion (Bt131.5 billion), are under the United States' low-tariff generalised system of preferences programme.

The government committee looking into compulsory licensing said Thailand would save up to Bt8 billion using these drugs to treat an expected 62,000 cancer patients over the next five years.

Compulsory licensing allows the government to bypass the patent of three breast and lung cancer drugs - Docetaxel, produced by SanofiAventis; Erlotinib, manufactured by Roche; and Letrozole, made by Novartis.

Using these numbers alone, the government's choice seems clear as the potential economic losses seem greater than the money saved by purchasing generic drugs, said leading philosophy scholar Suwanna Satha-Anand from Chulalongkorn University. But when deciding life-saving issues, there are other factors that deserve consideration, she said.

"In fact this is a classic [philosophical] debate," Suwanna said. "In the utilitarian world, the minority has to sacrifice. But human life and dignity are unquantifiable elements that command a greater level of respect than being measured by a baht lost or gained here or there.

"In our real life, there are also spaces for special relationship. For example, we won't give up our parents' lives even if doing so would benefit millions of other lives on earth."  

Thammasat University economist Sarinee Achavanuntakul agreed that the government cannot measure the value of human life by numbers.

"Drugs are no ordinary commodities; they are life-saving necessities. This is precisely the reason the WTO established the compulsory licensing clause for pharmaceuticals - so that needy patients could gain access to potentially life-saving drugs, that they otherwise could never afford," Sarinee said.

The World Health Organisation said in a report last month that Thailand's compulsory licences are a valuable tool that allow access to critical drug treatments in the public health system.

Imatinib costs Bt900 per tablet, while the price of the generic version is between Bt50 and Bt70. Docetaxel costs Bt26,500 per 89 milligram injection, but the generic version costs Bt4,000. Erlotinib costs between Bt2,800 and Bt3,000 per tablet, but the generic version is priced between Bt275 and Bt735. Letrozole costs Bt230 per tablet, while the generic pill is priced between Bt7 and Bt10.

"These important drugs are the results of decades of research and development invested by pharmaceutical companies. It is unfair to put forward the price comparison between the original drugs and their nearly costless copy versions," said Teera Chakajnarodom, general manager of the Pharmaceutical Research and Manufacturers' Association of Thailand.

"The cost of each original tablet reflects the amount of money and research that went into inventing it, so that companies and scientists have incentive to create new drugs for complicated diseases," he said. 

Such logic, Sarinee said, assumes patients would pay the higher price.

"These patients can't afford the drugs at all at these rates, so they do not constitute a market," Sarinee said. "Therefore the companies are not really losing any money by offering it to them at reduced rates, as the only cost is manufacturing, which is minimal."

While not ignoring the research and development claims, Suwanna said the pharmaceutical industry has been the beneficiary of medical knowledge and wisdom passed down and disseminated free of charge. 

"In the capitalism-dominated world, people talk about intellectual property without seeing the complex roots of those ideas," Suwanna said. "The value of nature and culture are not reflected in the costs."

Many oncologists are hopeful that the current policies will be allowed to stand.

"Ethically and professionally, every patient deserves the best treatment, and I'm happy if we can offer that without concerns over their ability to pay," Dr Suppakorn Rojananin, head of Siriraj Hospital's surgical department, said.