tag:theconversation.com,2011:/africa/topics/roche-17049/articlesRoche – The Conversation2017-06-22T15:04:41Ztag:theconversation.com,2011:article/797682017-06-22T15:04:41Z2017-06-22T15:04:41ZWhy competition is key to cutting the cost of cancer drugs in South Africa<figure><img src="https://images.theconversation.com/files/175155/original/file-20170622-11971-1xbml5b.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Shutterstock</span> </figcaption></figure><p>South Africa’s Competition Commission has launched an <a href="http://www.gov.za/speeches/media-statement-commissioner-investigation-manufacturers-cancer-drugs-13-jun-2017-0000">investigation</a> into excessive pricing by three major pharmaceutical companies that have the sole rights to distribute cancer drugs in the country. </p>
<p>The commission’s job is to protect ordinary South Africans from abuse by dominant players. It has <a href="http://www.compcom.co.za/">powers</a> to investigate and evaluate restrictive business practices, abuse of dominant positions and mergers. </p>
<p>Its investigation into the drug companies is vital as cancer treatment is <a href="http://www.cansa.org.za/competition-commission-investigating-pharmaceutical-companies-for-cancer-medicine-prices/">unaffordable for most South Africans</a>. Many medical schemes – which offer medical cover to 16% of the population or 7 million people – refuse to pay for the medication because of the cost. </p>
<p>In South Africa all drug prices are approved and signed off by the medicines pricing committee in the National Department of Health. But our hope is that the commission’s investigation could still drive competition among suppliers, and in turn more affordable prices for cancer treatment. This should result in better access to affordable drugs, particularly for poor people.</p>
<h2>The drugs in question</h2>
<p>Three companies are being probed: Swiss-based <a href="http://www.roche.co.za/home/about-roche/companyprofile.html">Roche</a>, US-based Pfizer and South African company Aspen Pharmacare.</p>
<p>The cancer drugs in the spotlight are used mainly to treat lung and breast cancer but they can also be used in the treatment for other types of cancers.</p>
<p>One of the drugs is trastuzumab which is supplied by Roche and <a href="http://www.who.int/bulletin/volumes/94/10/15-163998/en/">recommended</a> by the World Health Organisation to treat breast cancer and can be used in combination with other drugs for some types of stomach cancer. Roche’s branded versions of the medication is Herceptin. This is the only trastuzumab product currently available in South Africa.</p>
<p>Pfizer provides the only crizotinib product to South Africa for the treatment of lung cancer. Its product, Xalkori, is not yet registered in South Africa, and is only accessed through a special application process under the Medicines Act which enables clinicians to prescribe and use medicines not yet registered by the MCC to treat patients.</p>
<p>Aspen is being investigated for three of the oncology drugs it supplies: Chlorambucil (Leukeran), Melphalan (Alkeran) and Busulfan (Myleran). All are generic drugs but Aspen is the only pharmaceutical company in the country that’s registered with the Medicines Control Council to sell the drugs in South Africa.</p>
<p>Competition authorities in a number of European countries, including the European Union, are also <a href="http://europa.eu/rapid/press-release_MEX-17-1326_en.htm">investigating Aspen</a> for alleged excessive pricing on these and other products. </p>
<h2>Why are they so expensive?</h2>
<p>The cost of a drug is related to its development. Before a cancer drug reaches the market there is a complex clinical research process and an expensive administrative process that requires millions of dollars of investment. This includes regulatory studies and three phases of clinical trials. </p>
<p>In the pharmaceutical industry, the initial patent holder is usually the pharmaceutical company that researched and developed a drug . </p>
<p>Although the patent life from the date that it is filed is 20 years, the average time to bring a cancer drug from the start of clinical testing to regulatory approval is between eight and 12 years. </p>
<p>This means that the actual patent life of a drug from the time of initial marketing can be limited – often less than 10 years. In addition, only 16% to 19% of cancer drugs that enter clinical trials successfully make it to market.</p>
<p>There’s an added challenge in cancer treatments. Even with the arrival of “new and improved” versions of a previously approved drug, the older (and by now generic) drug tends to be viewed as substandard treatment. This perpetuates the situation. And in the last 59 years the health sector has increased its knowledge of cancer and treatment immensely. But it’s not yet at a curative phase. Faced with the seriousness of the diagnosis, patients, family and physicians are often willing to pay the high price of treatment even for marginal improvements in someone’s health.</p>
<p>Drug companies also have to go through a lengthy process before they can start selling a drug. Once a drug is approved by a regulatory authority it needs to be registered with a country’s medical control council before it can be prescribed by oncologists. This registration process can take a long time. </p>
<h2>What needs to be done</h2>
<p>The biggest problem with the price of cancer drugs is that there is no competition among truly effective cancer drugs to lower their cost. Healthy competition between different drugs would drive lower prices and keep prices reasonable for the consumer.</p>
<p>One way that competition has been achieved for other pharmaceutical drugs has been through the generic route. Once the patent expires, manufacturers of generic versions can produce more cost-effective versions. This is happening for some cancer drugs. But there are two limitations: one is that it takes a long time to develop cancer treatments. And generic versions of cancer drugs are much higher than those used to treat non-malignant (non-cancerous) diseases. </p>
<p>So what can be done? There are three options:</p>
<ul>
<li><p>encourage oncologists to prescribe drug treatment that isn’t as expensive,where possible. </p></li>
<li><p>reduce prices by introducing a form of generic price control, where predetermined pricing limits are prescribed, and </p></li>
<li><p>promoting a non-profit generics model, where certain designated generics would be made available at cost, as opposed to be sold at a profit.</p></li>
</ul>
<p>The competition case in South Africa is also an important part of the campaign to make sure that cancer drugs are more affordable. As incidence of cancer <a href="http://www.cansa.org.za/category/recent-posts/cope-with-cancer/about-cancer/statistics/">continue to rise</a>, massive resources are being poured into cutting-edge research and biotechnology to successfully treat this dread disease. But these benefits aren’t being felt by the vast majority of people in the world.</p><img src="https://counter.theconversation.com/content/79768/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Natalie Schellack does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>The high cost of cancer drugs in South Africa has come under the spotlight with an investigation by the Competition Commission in the country.Natalie Schellack, Associate Professor and Course Leader: Post Graduate Programmes in Clinical Pharmacy in the Department of Pharmacy, Sefako Makgatho Health Sciences UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/382872015-09-29T20:08:36Z2015-09-29T20:08:36ZControversies in medicine: the rise and fall of the challenge to Tamiflu<figure><img src="https://images.theconversation.com/files/96412/original/image-20150928-21366-d740kn.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">As part of pandemic preparation, in the early 2000s many countries amassed large stockpiles of the influenza neuraminidase inhibitor Tamiflu.</span> <span class="attribution"><a class="source" href="https://www.flickr.com/photos/hisgett/3641376785/">Tony Hisgett/Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span></figcaption></figure><p>One of the biggest recent controversies in medicine involves the effectiveness – or otherwise – of the antiviral drug Tamiflu. Governments around the world have stockpiled the drug for use in severe influenza pandemics, but many have raised doubts about its effectiveness.</p>
<p>Influenza causes annual “seasonal” epidemics in temperate countries and circulates year-round in the tropics. Pandemics occur when there’s a relatively new flu virus containing components of bird or swine flu viruses, against which the human population has little protection. </p>
<p>Global pandemic preparedness efforts were spurred in the early 2000s by the emergence of SARS, and highly pathogenic H5N1 influenza in birds, which was associated with rare but often fatal infection in humans. The problem is that the severity of pandemics can vary markedly; from the Spanish flu of 1918-19, which is estimated to have killed 20-50 million people worldwide, to the much milder 2009 swine flu, which <a href="http://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1001558">resulted in between</a> 150,000 and 250,000 deaths (a similar number to the annual mortality of seasonal epidemics). </p>
<h2>Reviewing evidence</h2>
<p>Governments tend to prepare for the worst because there’s no way of knowing the impact a flu pandemic will have on the population. And, as pandemics are rare, the evidence base for public health responses has to be largely taken from studies of seasonal influenza.</p>
<p>As part of pandemic preparation, in the early 2000s many countries amassed large stockpiles of the influenza neuraminidase inhibitor Tamiflu. A 2000 clinical trial had <a href="http://jama.jamanetwork.com/article.aspx?articleid=192425">indicated modest benefits</a> from this drug, but its ability to <a href="http://jama.jamanetwork.com/article.aspx?articleid=193547">reduce disease severity and limit onward spread</a> had potential for much greater benefits in reducing death and disease at the population level.</p>
<p>In 2006 the <a href="http://www.cochrane.org/about-us">Cochrane Neuraminidase Inhibitors Review Team</a> published a review on behalf of the Cochrane Collaboration, an independent network of researchers who review evidence for medical interventions to help improve health-care decision-making. <a href="http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD001265.pub2/abstract;jsessionid=DAAC348A24E621BF48DEDF728C522519.f01t02">Its overall conclusion</a> was that the drug shouldn’t be used for treating seasonal flu, but was suitable for use as part of a suite of public health measures in pandemics.</p>
<p>But in the aftermath of the – fortunately – mild 2009 pandemic, the social and economic costs of the global public health response to this event were widely questioned. In particular, given the large amounts of money spent on Tamiflu, claims of <a href="http://www.bbc.com/news/10235558">conflict of interest</a> and <a href="http://ahrcanum.com/2009/07/01/tamiflu-linked-to-origins-of-ah1n1-swine-flu-pandemic/">conspiracy theories</a>, some <a href="http://www.dailymail.co.uk/news/article-1176743/Donald-Rumsfelds-controversial-links-drug-company-Tamiflu.html">more credible than others</a>, abounded. </p>
<p>Then, in the process of updating their 2006 Cochrane review, and in response to <a href="http://www.bmj.com/content/339/bmj.b5106.long">questions raised</a> through the Cochrane review’s feedback mechanism regarding prevention of complications and drug safety, the reviewing team requested access to Roche Tamiflu trials data in 2009. They were refused. In the years that followed, Roche came under particular scrutiny with claims that <a href="http://www.bmj.com/content/345/bmj.e7303">critical clinical trial information</a> had been withheld from publication. </p>
<p>In 2012, the <a href="http://www.bmj.com/tamiflu">BMJ launched a website</a> devoted to a public campaign, lobbying the company to release full clinical reports on all relevant studies conducted in support of the drug’s licence. The campaign was successful when, in 2013, Roche provided all the requested documentation. </p>
<h2>The question mark</h2>
<p>For the first time, full clinical study reports, which include tables of all study outcomes rather than those selected for publication, were made available. In addition, submissions to and correspondence with drug regulatory authorities were included. These reports, often many hundreds of pages long, formed the basis of a new meta-analysis conducted by the <a href="http://bmjopen.bmj.com/content/4/9/e005253.full">Cochrane Neuraminidase Inhibitors Review Team</a>. </p>
<p>With the new information to hand, the authors concluded the <a href="http://bmjopen.bmj.com/content/4/9/e005253.full">risk of bias</a> in several published studies was higher than had been previously assessed. This was due to missing or incomplete information, or deficiencies in study design. </p>
<p>Roche provided data on 83 studies, and regulatory authorities provided information on more than 200 trials. But only 46 studies (20 of Tamiflu and 26 of Relenza) were included in <a href="http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD008965.pub4/abstract;jsessionid=76F622C5B03F0FF262E8B76396219022.f03t01">the final analysis</a> as eligible and unbiased. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/96413/original/image-20150928-21366-19hmcgm.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/96413/original/image-20150928-21366-19hmcgm.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=420&fit=crop&dpr=1 600w, https://images.theconversation.com/files/96413/original/image-20150928-21366-19hmcgm.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=420&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/96413/original/image-20150928-21366-19hmcgm.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=420&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/96413/original/image-20150928-21366-19hmcgm.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=528&fit=crop&dpr=1 754w, https://images.theconversation.com/files/96413/original/image-20150928-21366-19hmcgm.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=528&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/96413/original/image-20150928-21366-19hmcgm.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=528&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">A 2014 review found giving the drug to family members of an infected person prevented infections in about 15% of people.</span>
<span class="attribution"><a class="source" href="https://www.flickr.com/photos/k790i/3852576091/">Anil Jadhav/Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
</figcaption>
</figure>
<p>Still, the <a href="http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD008965.pub4/abstract;jsessionid=76F622C5B03F0FF262E8B76396219022.f03t01">findings of this 2014 review</a> were remarkably similar to the group’s previous reports. The review showed Tamiflu hastened flu recovery by about 17 hours in adults and 29 hours in kids. Anticipated side effects of nausea and vomiting were reported in less than 5% of treated people. And giving the drug to family members of an infected person prevented infections in about 15%.</p>
<p>The meta-analysis also looked at the risk of hospitalisations and secondary infections following flu. It concluded that antivirals were ineffective for reducing these adverse outcomes. But because the trials under consideration were mostly in generally healthy people with seasonal influenza infections, the <a href="http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD008965.pub4/abstract;jsessionid=76F622C5B03F0FF262E8B76396219022.f03t01">number of hospitalisations</a> was very small, affecting only 71 of 4,400 study participants. And while the main review finding was of a 1% absolute reduction in self-reported pneumonia, this figure represented a 56% relative risk reduction in the Tamiflu-treated group.</p>
<p><a href="http://community.cochrane.org/features/tamiflu-relenza-how-effective-are-they?">Based on this evidence</a>, BMJ and Cochrane Collaboration questioned the usefulness of neuraminidase inhibitors in pandemics and called for governments to review their guidance for the drug’s use.</p>
<h2>A different view</h2>
<p>Meanwhile, another independent group, the <a href="http://www.mugas.net">Multiparty Group for Advice on Science</a>, brought together four leading academics in the field of influenza to review and oversee re-analysis of Tamiflu trials data. To support this work, they obtained an unrestricted grant from Roche. Their aim was to resolve uncertainties regarding appropriate public health use of this drug. </p>
<p>The group negotiated with Roche to gain access to not just summary reports of treatment group outcomes (as previously analysed), but individually listed patient data from nine adult Tamiflu trials involving 4,328 participants. These provided much greater statistical power to assess differences. The trials, selected on the basis they assessed the currently recommended treatment dose, would have been included among those provided to the Cochrane reviewers.</p>
<p>This <a href="http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2814%2962449-1/abstract">new analysis found</a>, similarly to the Cochrane review, that the drugs hastened recovery from influenza infection by about a day, with the side effects of nausea and vomiting in a minority of patients. It said that in people with confirmed flu, Tamiflu <a href="http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2814%2962449-1/abstract">reduced the risk of secondary respiratory infections</a> requiring antibiotics by 44%. Hospitalisations in the Tamiflu group were down by 63%. </p>
<p>These findings were more in keeping with observational studies of “real world” Tamiflu use among patients hospitalised with a clinical or laboratory diagnosis of influenza during the 2009 pandemic. While this broader clinical definition of flu is less specific than in a randomised trial, it does represent the basis on which doctors make treatment decisions in everyday practice. </p>
<h2>Other research</h2>
<p>A <a href="http://www.ncbi.nlm.nih.gov/pubmed/23204175">meta-analysis of published data from 90 such studies</a> published in 2012 demonstrated a 60% reduction in the odds of intensive care unit admission and death among hospitalised influenza patients who received prompt antiviral therapy. This study was also funded by an unrestricted grant from Roche. </p>
<p>And <a href="http://www.thelancet.com/journals/lanres/article/PIIS2213-2600%2814%2970041-4/abstract">a follow-up 2014 analysis</a> of individual patient data from nearly 30,000 participants who took part in studies identified through the 2012 meta-analysis found a 50% reduction in the odds of death among those treated within 48 hours of symptom onset, compared with no treatment. It was also funded by Roche.</p>
<p>Given that randomised controlled trials are logistically and ethically challenging to conduct in pandemic events, it’s <a href="http://www.nature.com/news/analysis-of-trial-data-revives-flu-drug-row-1.16820">unlikely there will ever be a consensus</a> on Tamiflu’s effectiveness for use in pandemics. But observational studies conducted during the 2009 pandemic seem to reinforce the initial clinical trials evidence base on which Tamiflu was recommended for stockpiling against pandemic threats. </p>
<p>Indeed, <a href="http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2815%2960074-5/abstract">the drug’s benefits</a> appear to be greatest in severe influenza seasons and pandemics.</p><img src="https://counter.theconversation.com/content/38287/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Jodie McVernon is a member of the Australian Technical Advisory Group on Immunisation and has provided advice to the Australian Government Office of Health Protection on pandemic planning, including on antiviral stockpiling and distribution; she is also a Director of the Influenza Specialist Group. </span></em></p>One of the biggest recent controversies in medicine involves the effectiveness of the antiviral drug Tamiflu. Governments have stockpiled the drug but many have raised doubts about its usefulness.Jodie McVernon, Associate Professor, Population Health, The University of MelbourneLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/419922015-05-19T05:11:52Z2015-05-19T05:11:52ZThe buck stops elsewhere: how corporate power trumps politics<figure><img src="https://images.theconversation.com/files/82047/original/image-20150518-25407-10mta8k.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Someone's pulling the strings.</span> <span class="attribution"><a class="source" href="https://www.flickr.com/photos/rhyick/4750313718/in/photolist-8eLALE-awdmd9-Porsy-brxXk3-8iv4YW-ecmoou-ecfJXD-ecmoFG-ecmoCs-cgc2Zm-bxmXR4-2rps7-efmFtr-fmMQ7F-9UTstW-9UQABr-9UQzjB-9UTsi9-9UTtq1-9UTsao-9UTs1b-9UTsZy-9UQB6Z-9UQArx-9UQzPt-9UTrns-9UTrVw-9UTrKj-9UTrv9-9UTqWh-9UQAQz-9UQznH-9UTqZ1-9UTrcG-9UTsQj-9UQBkt-9UTrD1-9UTsHb-9UTrhY-9UQALV-9UTrrL-9UTs6o-9UQBfg-9UTrQd-964Ex7-4puDhs-Mcpag-Mcp3t-McgX1-McgR5">William Sun</a>, <a class="license" href="http://creativecommons.org/licenses/by-nc-nd/4.0/">CC BY-NC-ND</a></span></figcaption></figure><p>We may be delighted or depressed that the UK general election delivered an unexpected Tory majority, but does it really make a difference? Most of the decisions that affect our lives, our environment, our working conditions and the products and services we have access to are devised, controlled and delivered by business. </p>
<p>It is instructive that of the top 100 economic entities in the world – countries included – <a href="http://www.corporations.org/system/top100.html">more than 50 are multinational corporations</a>. The money the government relies upon to put its policies into practices come from taxes – taxes that multinational corporations can easily avoid by relocation, while onerous regulation is just as easily sidestepped. The banks are a great example. Only recently, <a href="http://blogs.channel4.com/siobhan-kennedy/hsbcs-threat-leave-london-big-deal/1013">HSBC used the threat of leaving the UK</a> in an attempt to influence UK government policy. </p>
<p>Globalisation has brought us to a situation where we have a regulatory vacuum – global regulation is practically non-existent and insufficient to match the growing power and influence of profit-maximising multinational corporations.</p>
<h2>Inside the game</h2>
<p>It is not just globalisation that reduces the influence of national government. Political parties themselves rely to a great extent on business support to fund their campaigns, a fact which, it’s fair to surmise, might limit their motivation to pass legislation which could hurt the business interests which helped to get them elected. <a href="https://theconversation.com/how-the-economics-of-lobbying-make-democracy-about-more-than-votes-40394">Business lobbying is also a worrying trend</a>. One leaked proposal from the European Commission <a href="http://corporateeurope.org/power-lobbies">highlights how business lobbying</a> has resulted in proposals for lighter regulation that reduces the ability of the EU to regulate on issues relating to areas such as chemicals, climate change and social conditions.</p>
<p>There has also been concern that other traditional brakes on corporate power such as pressure groups, NGOs and unions are becoming increasingly toothless. The argument runs that NGOs have been co-opted by business through partnership agreements and unions have been wounded by successive legislation which seeks to <a href="http://www.unrisd.org/80256B3C005BCCF9/%28httpAuxPages%29/1CA8A49E3513DE1C80256B610059BA0D/$file/utting.pdf">limit their power</a>. </p>
<p>What it all means is that worrying about which political party is in charge, or the legitimacy of a party with a small minority, is pretty much pointless. The real power over the electorate is wielded by shadowy CEOs, unelected, and relatively unaccountable. For example, while the political parties have been arguing over how to deal with the funding crisis in the NHS, there is relatively little airtime given to the legitimacy of companies who benefit at the expense of taxpayers.</p>
<h2>Legal highs</h2>
<p>BBC Radio 4’s Inside Health programme <a href="http://www.bbc.co.uk/programmes/b055g8zm">has highlighted the case of the pharmaceutical giant Roche</a>. The Swiss group had two drugs – one cheap, one expensive – that medical trials had proven equally effective at treating macular degeneration, a common eye complaint in older people which can lead to blindness. However, Roche has only licensed the expensive drug to treat the condition, a decision that is great for Roche’s bottom line, <a href="http://www.taxpayersalliance.com/_avastin_vs_lucentis_how_the_nhs_pays_over_the_odds_for_drugs">yet costs the UK taxpayer about £84m</a>. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/82056/original/image-20150518-25400-3p7m6y.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/82056/original/image-20150518-25400-3p7m6y.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/82056/original/image-20150518-25400-3p7m6y.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=232&fit=crop&dpr=1 600w, https://images.theconversation.com/files/82056/original/image-20150518-25400-3p7m6y.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=232&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/82056/original/image-20150518-25400-3p7m6y.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=232&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/82056/original/image-20150518-25400-3p7m6y.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=292&fit=crop&dpr=1 754w, https://images.theconversation.com/files/82056/original/image-20150518-25400-3p7m6y.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=292&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/82056/original/image-20150518-25400-3p7m6y.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=292&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Getting to the point. Drugs companies and the NHS.</span>
<span class="attribution"><a class="source" href="https://www.flickr.com/photos/quatar/12977337115/in/photolist-kLLfcD-aPhpgz-nof1zM-b5ZsH6-pGLnN-9nhsni-nErjPi-6EKeq-mYunbu-8FXfRY-noeAD1-8FXfUm-26EvT-75B4e-nEw9uG-nErjti-7iJUSF-9fWF9y-7iTcxT-PnAgx-nUxhuR-rKnSK-a3NzH-27bJt-4c29KQ-8FXjxd-4yaonk-3fpFPS-7iKsN">Nicola Sapiens De Mitri</a>, <a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span>
</figcaption>
</figure>
<p>It was interesting that the focus of the programme was on the doctor’s dilemma; the risk of being penalised for prescribing a cheaper drug, against prescribing a drug that costs thousands more than necessary. The idea that Roche should be under pressure to license the cheaper drug was hardly even considered. </p>
<p>The trouble is that we seem to have become used to the idea that business interests are aligned somehow with our own. It would seem that this assumption was in play when the Conservative party proudly publicised a letter showing the support of 100 business leaders before the election. <a href="http://www.theguardian.com/politics/2015/apr/01/labour-offers-counterpunch-to-daily-telegraph-business-letter">Labour’s response</a> drew attention to the fact that few of the electorate are business leaders and that such a letter says little about the Conservatives’ ability to meet the needs of all society. Nonetheless, few were in doubt that this sign of support from business leaders benefited the Conservatives at the expense of Labour. </p>
<p>It is an odd conclusion too. A closer examination of business behaviour would highlight some very worrying examples of where that alignment has failed, particularly after the last few decades which have seen wave upon wave of business scandals. </p>
<p>The consequences of those scandals for society and the environment have been devastating. Thousands lost their jobs and pensions <a href="http://www.nytimes.com/2001/11/29/business/enron-s-collapse-the-overview-enron-collapses-as-suitor-cancels-plans-for-merger.html">when Enron collapsed due to fraudulent accounting</a> in 2001. The huge environmental, social and economic consequences of inadequate regard for health and safety seen in massive oil spills are still being felt today; look at <a href="http://www.theatlantic.com/photo/2014/03/the-exxon-valdez-oil-spill-25-years-ago-today/100703/">Exxon in 1989</a> and <a href="https://theconversation.com/two-years-on-the-legacy-of-the-bp-deepwater-horizon-oil-spill-12754">BP in 2010</a>. Similarly, the global financial crisis of 2008 led to the collapse of financial institutions – or their expensive rescue – and presaged a global recession which has been associated with massive business failures, job losses, and the loss of trillions of dollars by households and businesses globally. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/82070/original/image-20150518-25444-14r2gqj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/82070/original/image-20150518-25444-14r2gqj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/82070/original/image-20150518-25444-14r2gqj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=450&fit=crop&dpr=1 600w, https://images.theconversation.com/files/82070/original/image-20150518-25444-14r2gqj.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=450&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/82070/original/image-20150518-25444-14r2gqj.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=450&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/82070/original/image-20150518-25444-14r2gqj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=566&fit=crop&dpr=1 754w, https://images.theconversation.com/files/82070/original/image-20150518-25444-14r2gqj.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=566&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/82070/original/image-20150518-25444-14r2gqj.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=566&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Fire engulfs the Deepwater Horizon rig in 2010.</span>
<span class="attribution"><a class="source" href="https://www.flickr.com/photos/flseagrant/7782496154/in/photolist-cRHjYb-8ynVB8-btbfEc-8cvak2-8ynVuD-8pQb3m-bN5BLR-8pM1ma-btbgvF-8ajEZM-8kjqMq-7Zja6s-8yqXXE-888JMj-89wnQW-8bpe5b-8ccTJV-85pwUH-83pooq-83DGVw-8djtMZ-8brcLf-8gXXKS-bN6hxK-8g1712-8g171i-8g16ZV-8g171e-8g16Zv-8g16Zx-8ccWZ4-83tid7-8NgjPC-8g7Vyn-8g7Vxx-8g7VzD-8pvK6M-8pvK7Z-8cNoNY-83uFds-888JQ7-8pvK9X-83fxFs-82WmwK-8wJpB5-8wJpEQ-888HMV-8kirf4-8kireR-8kirdv">Florida Sea Grant</a>, <a class="license" href="http://creativecommons.org/licenses/by-nc-nd/4.0/">CC BY-NC-ND</a></span>
</figcaption>
</figure>
<p>This disconnect between business and societal interests is particularly stark in sectors such as pharmaceuticals where we trust businesses with our health. It is of growing concern, for example, that the profit-maximising strategies of drugs companies are leading to an innovation crisis in terms of treatments for important diseases. This is because it is more profitable to make treatments for common but trivial diseases suffered by the wealthy, rather than risk research and development into life-threatening diseases such as cancer, or diseases that <a href="http://www.palgrave.com/page/detail/unhealthy-pharmaceutical-regulation-courtney-davis/?K=9780230008663">primarily affect poor populations</a>. </p>
<p>But healthcare is just one example. Across policy areas, the real decisions that affect our lives are happening in corporate boardrooms. Our democratic system has developed checks and balances as a means to prevent abuses of power by political leaders of the kind experienced in previous centuries. The idea was that a multi-party democracy with a vigilant media, and separation of executive and legislative function, would protect us from a malign dictatorship. However we are fighting the battles of the last century. We need new forms of checks and balances that acknowledge and tackle the new corporate globalised reality. </p>
<p>So don’t be too happy if your chosen party got elected, and don’t be too sad if it didn’t. The difference political parties can make to our lives in practice gets less with every passing year. Political power is waning – we need to wake up to the reality of where the real power lies, and start considering how we can apply the same principles of transparency, legitimacy and democratic accountability to business as we do to government.</p><img src="https://counter.theconversation.com/content/41992/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Denise Baden does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Whether you cheered the election result or were cast into a depression, it doesn’t really matter. The real power lies outside of Westminster, and outside of our control.Denise Baden, Associate Professor in Business Ethics, University of SouthamptonLicensed as Creative Commons – attribution, no derivatives.