Martin Shkreli: Disease or Symptom?

By Sarala Kal

Hillary Clinton said “he was like the worst bad date you can imagine,” and many others call him the villain of the pharmaceutical industry. Thirty-two-year-old Martin Shkreli is a Brooklyn native, whose placement in a high school program for gifted youth serendipitously landed him an internship on Wall Street at the ripe age of 17. Few would expect the child of two immigrant parents, who worked as janitors, to have a career that escalated at such a rapid pace. Shkreli’s intellect and intuition led him to co-founding the hedge fund MSMB Capital Management, co-founding and working as the CEO of the biotechnology company Retrophon, and also co-founding and working as the CEO of Turing Pharmaceuticals. However, what’s gained immense attention from the public is not Shkreli’s professional pedigree, but rather his manipulation of the system. Unphased by negative attention, he has repeatedly been seen trolling the world on Twitter, buying overpriced albums, and raising the price of a drug on the W.H.O. list of Essential Medicines by more than 5000%. It is simple to pinpoint his actions and name him the villain in the ongoing battle of increasing drug prices and the affordability of healthcare. But is he really the root of the problem? Or is he a mere symptom of the disease?

In August of 2015, Daraprim was acquired by Turing Pharmaceuticals. The 62-year old drug, known generically as pyrimethamine, is the standard of care for treating the life-threatening parasitic infection, toxoplasmosis. Toxoplasmosis, for babies born to women who become infected during pregnancy, can be fatal. Additionally, it ravages the compromised immune systems of patients with HIV, and has been identified by the Centers for Disease Control and Prevention as one of the five neglected parasitic diseases for which public health action is necessary. What was once priced at $13.50, after the acquisition by Turing Pharmaceuticals, was raised to $750 overnight. CEO Martin Shkreli justified this price hike by saying that the drug was so rarely used that the impact on the health system would be miniscule, and that Turing would use the money to develop better treatments with fewer side effects. They promised to offer reductions of up to 50% to hospitals, introduce smaller bottles of 30 tablets, lower overall costs and offer free sample packages. Their promises, however, were broken almost immediately. Premiums for patients increased five-fold, some Medicare and Medicaid patients were not even given the option of receiving the drug, and doctors were forced to seek out alternative treatments. The high price of the drug has also given many companies the incentive to work as quickly as possible to produce a generic equivalent. After a tremendous amount of backlash, Shkreli continued to respond to media attention with a smug look and snarky comments, reiterating his point that the only thing that mattered to him was his company’s profit.

The Daraprim case has as much to do with the Food and Drug Administration as with Shkreli. The F.D.A. certification process for generic drugs is grueling enough that whoever owns Daraprim has a virtual monopoly in America. According to an F.D.A. official, Congress has not really vested any authority to the F.D.A. over pricing. One of the strangest things about the anti-Shkreli argument is that it asks us to be shocked that a medical executive is motivated by profit. Shkreli proves a crucial point about money and medicine through his actions. By showing what is legal, he has helped us to think about what we might want to change, and what we might need to learn to live with. Shkreli has opened our eyes to what we need to be focusing on to help change this country and try to make medicine affordable for everyone. Why is Shkreli able to do what he did? This is the real disease, while Shkreli himself is only the symptom.

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