Black Hats and White Horses - Series Part I

Pharma Bro – The Accidental Antihero

Here we delve into the extremes of human potential: the noble and the nefarious, good versus evil, heroes and villains. Those who bring truth and light to the world, the embodiment of selfless bravery in pursuit of justice and greater good. Their challengers; who embody chaos, cruelty, and the pursuit of personal gain at the expense of others. The eternal conflict between heroes and villains not only captivates our imagination but also reflects our own inner struggles, highlighting the complex nature of humanity and the choices that define each of us. But what happens when the lines are blurred? When someone turns out, perhaps even by accident, to be both the dark and the light. Morality does not always embody the mutual exclusivity of black or white. Sometimes heroes wear the black hat of villainy and sometimes the villain rides in on a white horse

Once upon a time… a few years back…

The headlines roared: “Pharma Bro Raises the Price of Life Saving Drug 5000%” And we chanted in unison; “Pharma Bro, that repulsive, villainous creature!”

You would be correct in that initial assessment. Martin Shkreli, AKA “Pharma Bro” is indeed repulsive and what he did was truly villainous. But what if we took a step back and looked at the story from another angle. Perhaps we might see Pharma Bro as more of an unwitting harbinger than an actual kingpin villain. From the right vantage point we may even see him as something of a court jester distracting from a dark truth that lays hidden behind him in the shadows.

5000%. It’s a tough pill to swallow for sure.

Here are the facts:

On August 10, 2015, Turing Pharmaceuticals (Martin Shkreli’s company) acquired Daraprim, a medication approved by the FDA in 1953, from Impax Laboratories  for $55 million. The drug's most prominent use as of late 2015 was as an anti-malarial and anti-parasitic, used to treat patients with both AIDS-related and AIDS-unrelated toxoplasmosis. Shortly after acquiring the rights to Daraprim, Turing Pharmaceuticals raised the price from $13.50 per tablet to $750.00 per tablet. 

Unbelievable. How could he do such a thing?! How many patients suffered because they could not afford this outrageous price?! I thought the same thing. I polished my pitchfork and followed the story like a bloodhound to a scent but was curiously surprised when finally the story came to a pleasing, yet somewhat vexing end. In 2018 Martin Shkreli was sentenced to seven years in prison. Yes. Excellent. All is as it should be in our fairytale world where the bad guys get what’s coming to them. Except for the curious detail of why he went to prison. Turns out it wasn’t for egregiously raising the price of that life-saving drug. It had nothing to do with his actions as they related to Daraprim at all. 

The thing about Shkreli is that, well, he really is an asshole. After purchasing the rights to Daraprim and raising the price 5000% this guy actually went on national television to announce that he is not sorry and he won’t lower the price. I am cry laughing literally. It is so absurd. So utterly and unabashedly villainous. In truth, he might have gotten away with it had he not been so starved for attention – live streaming himself playing video games, making awkward provocative statements to seemingly no one alone in his little room and picking fights with random anonymous teenagers on the interweb. It was all too bizarre to ignore. His desire for attention so strong that he desperately seized the moniker of “villain” and wore it like a mob-wife wears a mink coat.

He said it and no one listened. He had already been labeled the bad guy, and so we heard him, but we didn’t listen. We were too busy seething at his audacity to hear the truth which is that everything Martin Shkreli did with Daraprim was 100% legal.

On August 4, 2017, a trial jury found Shkreli guilty on two counts of securities fraud and one count of conspiracy to commit securities fraud, and not guilty on five other counts which included wire fraud.

But wait. None of those sound like drug price manipulation or price gauging.
Correct.

“Over a five-year period, Shkreli is alleged to have perpetrated a series of frauds on investors in his hedge funds and Retrophin’s shareholders in order to cover up his poor trading decisions,” said Andrew J. Ceresney, Director of the SEC’s Division of Enforcement.

Hmm. Still doesn’t sound like drug price gouging and doesn’t mention Daraprim.
Because it’s not. The fact is that there is no limit to how much a pharmaceutical company in the U.S. can raise the price of a drug.

Unlike other nations, the U.S. allows manufacturers of drugs and biologics to set whatever price they choose. For drugs with market exclusivity and without therapeutic alternatives, the scarcity of competition and the pervasiveness of insurance mean that lowering U.S. prices significantly requires government intervention and we all know that ain’t gonna happen! Big pharma is the second largest lobbying group in the country with a 2023 spend of $378 million.

U.S. drug prices for name brand drugs average almost 3.5 times prices in OECD countries overall and averaged almost twice prices in Canada, United Kingdom, Germany, or France. Examples of high-priced U.S. drugs that lack meaningful price competition include many biologics, oncology treatments (including immunotherapies), and “orphan drugs” which receive longer periods of exclusivity in exchange for targeting narrow patient populations.

Having the federal government lower drug prices directly—whether by negotiating with terrorists, ahem I mean, manufacturers or unilaterally setting prices—would save money for millions of Americans but will likely never happen. Because the U.S. allows uncapped pricing, U.S. drug companies generate an estimated three-quarters of worldwide drug company profits in the United States.  

Three-quarters of worldwide drug company profits come from us. US. Right out of the sweet little pockets of our mothers*, fathers*, brothers and sisters, elderly grandparents, our friends, literally all of us. 

And Martin Shkreli told us so. We just hated him so much we couldn’t hear the truth he was actually telling us, silently pointing to a larger villainy at play—not the individuals exploiting the law, but the framework that permits such exploitation

As this narrative concludes, let’s sit back and take a hard think. About villains. About heroes. About how maybe sometimes a person can be both and truthfully, usually are.

* I want to note here that when I say “mother” – it doesn’t necessarily mean a biological woman who physically bore you. Mothers can take all forms. Sometimes we have other family members who offer a “motherly” role. Sometimes it can be friends that act as mothers. Mother figures can be men, women, non-binary folks – literally anyone. This goes for “fathers” too. Family means your circle, whatever that looks like for you is absolutely perfect.