Decision to Lower Price of Pyrimethamine a Good One, Especially Given the Weak Defense of the Price Hike

September 24, 2015

Paul E. Sax, M.D.

Paul E. Sax, M.D., is director of the HIV Program and Division of Infectious Diseases at Brigham and Women's Hospital in Boston.

The big ID story the past couple of weeks is that the price of pyrimethamine -- a drug that's been available generically for decades -- went from $13.50 to $750 for one pill after the exclusive rights to the drug were purchased by Turing Pharmaceuticals.

Now, after a barrage of criticism -- all the way from this little blog to the Infectious Diseases Society of America to the New York Times to the leading Democratic candidate for President -- the company has wisely decided to lower the price.

Exactly what the price will be remains to be seen, because there's a lot of space between $13.50 and $750, but we'll find out soon enough.

How about defense of the initial decision to raise the price?

Roll 'em:

There are a bunch of claims here that don't quite ring quite true.


  1. We don't "desperately" need new treatments for toxoplasmosis [0'54", those are minutes and seconds in the video]. Most people who have toxoplasmosis have asymptomatic latent infection and need no treatment. 90% of those that do develop active disease generally respond to the treatments we have. Clinically relevant resistance is, fortunately, a rare event. Alternative therapies (notably trimethoprim/sulfamethoxazole) are also pretty good, and have become standard-of-care in some settings.
  2. Treatment of toxoplasmosis does not cure it [5'22"] -- if a patient's immune system again becomes weakened, they can suffer a relapse even after they have been treated. This is why chronic suppressive therapy must be continued indefinitely if a patient remains immunocompromised.
  3. Patients with AIDS who need treatment don't get a "very short treatment administration" [5'30"]. The HIV Opportunistic Infection Guidelines recommend 6 weeks of initial therapy, followed by chronic maintenance therapy until there is "an increase in CD4 counts to >200 cells/µL after ART that is sustained for more than 6 months." In other words, patients treated for toxoplasmosis can easily be on treatment for a year, sometimes even longer.

The part around 2'30", however, is undeniably true:

Profits are a great thing to maintain your corporate existence.

Look, there is nothing wrong with companies making profits for discovering, developing, and creating good products -- this is a capitalist country, after all, and innovation should be rewarded. I write that sentence keenly aware that the new iPhones are about to appear in stores this weekend, and yes, my iPhone 4 is looking a little tired.

But with the pyrimethamine price increase, some sort of threshold of reasonableness was passed.

The negative response has been essentially universal, and quite appropriate.

Paul Sax is Clinical Director of Infectious Diseases at Brigham and Women's Hospital. His blog HIV and ID Observations is part of Journal Watch, where he is Editor-in-Chief of Journal Watch AIDS Clinical Care.

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NEJM Journal Watch is a publication of the Massachusetts Medical Society.

Reader Comments:

Comment by: Seer Clearly (Denver, CO) Tue., Oct. 6, 2015 at 6:30 pm UTC
Thanks for your note, but I think you haven't gone far enough. Turing incurred no cost whatsoever in developing pyrimethamine. The only cost incurred was for buying the rights to the drug. Essentially these are false costs that capitalism imposes in rewarding the original rightsholder that do not benefit the buyer in any way: in other words, speculation. And then there is amount Turing proposed to charge, which rewards them as well with further speculation. And as you pointed out their justification of paying for develping new drugs is nonsense. To sum it up, a discussion of costs of any sort should be off the table in this case.

Instead, we should be talking about the ethics our society should agree on and then use our faithful servants in Government to impose. Do we think it's acceptable to found corporate empires on the backs of those suffering chronic, fatal disease? Or on the backs of insurance companies that turn around and charge all of us?

As a doctor, your position is probably like mine: the ethics of this situation are unacceptable. However as a doctor, your duty to your patients and your capabilities to influence the situation put you in a different position where you have the responsibility to drive for real change in the regulatory and legal circumstances that make this travesty possible. That includes condemning the actors here with the firmest language, as well as holding our government responsible as the final enabler of this murderous price increase.

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