Tag Archives: about

What depressed robots can teach us about mental health | Zachary Mainen

Depression seems a uniquely human way of suffering, but surprising new ways of thinking about it are coming from the field of artificial intelligence. Worldwide, over 350 million people have depression, and rates are climbing. The success of today’s generation of AI owes much to studies of the brain. Might AI return the favour and shed light on mental illness?

The central idea of computational neuroscience is that similar issues face any intelligent agent – human or artificial – and therefore call for similar sorts of solutions. Intelligence of any form is thought to depend on building a model of the world – a map of how things work that allows its owner to make predictions, plan and take actions to achieve its goals.

Setting the right degree of flexibility in learning is a critical problem for an intelligent system. A person’s model of the world is built up slowly over years of experience. Yet sometimes everything changes from one day to the next – if you move to a foreign country, for instance. This calls for much more flexibility than usual. In AI, a global parameter that controls how flexible a model is – how fast it changes – is called the “learning rate”.

Failure to adapt to adversity may be one of the main reasons why humans get depressed. For example, someone who becomes disabled due to a severe injury suddenly needs to learn to view themselves in a new way. A person who does so may thrive, while a person who fails to may become depressed.

The idea of a depressed AI seems odd, but machines could face similar problems. Imagine a robot with a hardware malfunction. Perhaps it needs to learn a new way of grasping information. If its learning rate is not high enough, it may lack the flexibility to change its algorithms. If severely damaged, it might even need to adopt new goals. If it fails to adapt it could give up and stop trying.

A “depressed” AI could be easily fixed by a supervisor boosting its learning rate. But imagine an AI sent light years away to another solar system. It would need to set its own learning rate, and this could go wrong.

One might think that the solution would be to keep flexibility high. But there is a cost to too much flexibility. If learning rate is too great, one is always forgetting what was previously learned and never accumulating knowledge. If goals are too flexible, an AI is rudderless, distracted by every new encounter.

The human brain’s equivalent of an AI’s key global variables is thought by computational psychiatrists to be several “neuromodulators”, including the dopamine and serotonin systems. There are only a handful of these highly privileged groups of cells and they broadcast their special chemical messages to almost the entire brain.

A line of studies from my laboratory and others suggest that the brain’s way of setting the learning rate involves the serotonin system. In the lab, if we teach a mouse a task with certain rules and then abruptly change them, serotonin neurons respond strongly. They seem to be broadcasting a signal of surprise: “Oops! Time to change the model.” Then, when serotonin is released in downstream brain areas, it can be seen in the laboratory to promote plasticity or rewiring, particularly to rework the circuitry of an outdated model.

Antidepressants are typically selective serotonin reuptake inhibitors (SSRIs), which boost the availability of serotonin in the brain. Antidepressants are naively depicted as “happiness pills”, but this research suggests that they actually work mainly by promoting brain plasticity. If true, getting out of depression starts with flexibility.

If these ideas are on the right track, susceptibility to depression is one of the costs of the ability to adapt to an ever-changing environment. Today’s AIs are learning machines, but highly specialised ones with no autonomy. As we take steps toward more flexible “general AI”, we can expect to learn more about how this can go wrong, with more lessons for understanding not only depression but also conditions such as schizophrenia.

For a human, to be depressed is not merely to have a problem with learning, but to experience profound suffering. That is why, above all else, it is a condition that deserves our attention. For a machine, what looks like depression may involve no suffering whatsoever. But that does not mean that we cannot learn from machines how human brains might go wrong.

Zachary Mainen is a neuroscientist whose research focuses on the brain mechanisms of decision-making

What depressed robots can teach us about mental health | Zachary Mainen

Depression seems a uniquely human way of suffering, but surprising new ways of thinking about it are coming from the field of artificial intelligence. Worldwide, over 350 million people have depression, and rates are climbing. The success of today’s generation of AI owes much to studies of the brain. Might AI return the favour and shed light on mental illness?

The central idea of computational neuroscience is that similar issues face any intelligent agent – human or artificial – and therefore call for similar sorts of solutions. Intelligence of any form is thought to depend on building a model of the world – a map of how things work that allows its owner to make predictions, plan and take actions to achieve its goals.

Setting the right degree of flexibility in learning is a critical problem for an intelligent system. A person’s model of the world is built up slowly over years of experience. Yet sometimes everything changes from one day to the next – if you move to a foreign country, for instance. This calls for much more flexibility than usual. In AI, a global parameter that controls how flexible a model is – how fast it changes – is called the “learning rate”.

Failure to adapt to adversity may be one of the main reasons why humans get depressed. For example, someone who becomes disabled due to a severe injury suddenly needs to learn to view themselves in a new way. A person who does so may thrive, while a person who fails to may become depressed.

The idea of a depressed AI seems odd, but machines could face similar problems. Imagine a robot with a hardware malfunction. Perhaps it needs to learn a new way of grasping information. If its learning rate is not high enough, it may lack the flexibility to change its algorithms. If severely damaged, it might even need to adopt new goals. If it fails to adapt it could give up and stop trying.

A “depressed” AI could be easily fixed by a supervisor boosting its learning rate. But imagine an AI sent light years away to another solar system. It would need to set its own learning rate, and this could go wrong.

One might think that the solution would be to keep flexibility high. But there is a cost to too much flexibility. If learning rate is too great, one is always forgetting what was previously learned and never accumulating knowledge. If goals are too flexible, an AI is rudderless, distracted by every new encounter.

The human brain’s equivalent of an AI’s key global variables is thought by computational psychiatrists to be several “neuromodulators”, including the dopamine and serotonin systems. There are only a handful of these highly privileged groups of cells and they broadcast their special chemical messages to almost the entire brain.

A line of studies from my laboratory and others suggest that the brain’s way of setting the learning rate involves the serotonin system. In the lab, if we teach a mouse a task with certain rules and then abruptly change them, serotonin neurons respond strongly. They seem to be broadcasting a signal of surprise: “Oops! Time to change the model.” Then, when serotonin is released in downstream brain areas, it can be seen in the laboratory to promote plasticity or rewiring, particularly to rework the circuitry of an outdated model.

Antidepressants are typically selective serotonin reuptake inhibitors (SSRIs), which boost the availability of serotonin in the brain. Antidepressants are naively depicted as “happiness pills”, but this research suggests that they actually work mainly by promoting brain plasticity. If true, getting out of depression starts with flexibility.

If these ideas are on the right track, susceptibility to depression is one of the costs of the ability to adapt to an ever-changing environment. Today’s AIs are learning machines, but highly specialised ones with no autonomy. As we take steps toward more flexible “general AI”, we can expect to learn more about how this can go wrong, with more lessons for understanding not only depression but also conditions such as schizophrenia.

For a human, to be depressed is not merely to have a problem with learning, but to experience profound suffering. That is why, above all else, it is a condition that deserves our attention. For a machine, what looks like depression may involve no suffering whatsoever. But that does not mean that we cannot learn from machines how human brains might go wrong.

Zachary Mainen is a neuroscientist whose research focuses on the brain mechanisms of decision-making

What depressed robots can teach us about mental health | Zachary Mainen

Depression seems a uniquely human way of suffering, but surprising new ways of thinking about it are coming from the field of artificial intelligence. Worldwide, over 350 million people have depression, and rates are climbing. The success of today’s generation of AI owes much to studies of the brain. Might AI return the favour and shed light on mental illness?

The central idea of computational neuroscience is that similar issues face any intelligent agent – human or artificial – and therefore call for similar sorts of solutions. Intelligence of any form is thought to depend on building a model of the world – a map of how things work that allows its owner to make predictions, plan and take actions to achieve its goals.

Setting the right degree of flexibility in learning is a critical problem for an intelligent system. A person’s model of the world is built up slowly over years of experience. Yet sometimes everything changes from one day to the next – if you move to a foreign country, for instance. This calls for much more flexibility than usual. In AI, a global parameter that controls how flexible a model is – how fast it changes – is called the “learning rate”.

Failure to adapt to adversity may be one of the main reasons why humans get depressed. For example, someone who becomes disabled due to a severe injury suddenly needs to learn to view themselves in a new way. A person who does so may thrive, while a person who fails to may become depressed.

The idea of a depressed AI seems odd, but machines could face similar problems. Imagine a robot with a hardware malfunction. Perhaps it needs to learn a new way of grasping information. If its learning rate is not high enough, it may lack the flexibility to change its algorithms. If severely damaged, it might even need to adopt new goals. If it fails to adapt it could give up and stop trying.

A “depressed” AI could be easily fixed by a supervisor boosting its learning rate. But imagine an AI sent light years away to another solar system. It would need to set its own learning rate, and this could go wrong.

One might think that the solution would be to keep flexibility high. But there is a cost to too much flexibility. If learning rate is too great, one is always forgetting what was previously learned and never accumulating knowledge. If goals are too flexible, an AI is rudderless, distracted by every new encounter.

The human brain’s equivalent of an AI’s key global variables is thought by computational psychiatrists to be several “neuromodulators”, including the dopamine and serotonin systems. There are only a handful of these highly privileged groups of cells and they broadcast their special chemical messages to almost the entire brain.

A line of studies from my laboratory and others suggest that the brain’s way of setting the learning rate involves the serotonin system. In the lab, if we teach a mouse a task with certain rules and then abruptly change them, serotonin neurons respond strongly. They seem to be broadcasting a signal of surprise: “Oops! Time to change the model.” Then, when serotonin is released in downstream brain areas, it can be seen in the laboratory to promote plasticity or rewiring, particularly to rework the circuitry of an outdated model.

Antidepressants are typically selective serotonin reuptake inhibitors (SSRIs), which boost the availability of serotonin in the brain. Antidepressants are naively depicted as “happiness pills”, but this research suggests that they actually work mainly by promoting brain plasticity. If true, getting out of depression starts with flexibility.

If these ideas are on the right track, susceptibility to depression is one of the costs of the ability to adapt to an ever-changing environment. Today’s AIs are learning machines, but highly specialised ones with no autonomy. As we take steps toward more flexible “general AI”, we can expect to learn more about how this can go wrong, with more lessons for understanding not only depression but also conditions such as schizophrenia.

For a human, to be depressed is not merely to have a problem with learning, but to experience profound suffering. That is why, above all else, it is a condition that deserves our attention. For a machine, what looks like depression may involve no suffering whatsoever. But that does not mean that we cannot learn from machines how human brains might go wrong.

Zachary Mainen is a neuroscientist whose research focuses on the brain mechanisms of decision-making

Why do new medicines cost so much, and what can we do about it?

Why does it matter what medicines cost?

If you are lucky enough to live in a country with comprehensive state-funded healthcare, such as the UK, you probably have no idea how much medicines really cost. But it can be a lot. Some drugs that have been around for ages are very cheap – aspirin, for instance, costs pence. It’s been out of patent and made by numerous companies competing to undercut each other’s price for decades. But new medicines, protected by 20-year patents, can cost hundreds of pounds a packet and sometimes thousands. The new breast cancer drug Kadcyla weighed in at a starting price of £90,000 per patient per year in the UK in 2015, though the manufacturer has now agreed a hefty discount for the NHS.

It is an increasing pressure on all health systems around the world. In 2017, NHS England put its annual drugs bill at £16bn, £9bn of which is GPs prescribing, and said it was rising at 7% a year – faster than the overall NHS budget.

Data chart

Isn’t that really just a problem for poor countries?

No. The new drugs that cure the liver disease hepatitis C were launched at a price that elicited squeals of pain from the UK, western Europe and the United States, as well as India and Romania, which both have high numbers of infections. In the US, the drug sofosbuvir (brand name Sovaldi), launched at a cost of $ 1,000 a pill. In the UK, the manufacturer Gilead was asking £35,000 for a 12-week course, with some patients needing 24 weeks. It was soon clear that no country was going to be able to treat everybody who needed them, even though hepatitis C is a killer in the long term and the drugs are – unusually – a cure.

In the UK, the National Institute for Health and Care Excellence (Nice), which decides whether drugs are value for money, said yes to hepatitis C drugs, provided Gilead gave a discount. The drugs would save years of expensive NHS treatment, including liver transplants. But the government balked at the cost of treating everybody – an estimated 160,000 people are infected. Normally the deal is that the NHS must introduce any drug Nice approves, but in this case it chose to phase it in, treating the sickest first and making others wait, which was unprecedented.

In the US, the cost was out of the question for many people without good health insurance cover. The prices of new cancer drugs have also been prohibitive.

The Doha Declaration

Didn’t drug prices crop up in the US election?

Yes. The cost of drugs became a hot political potato. Hillary Clinton promised to bring down high prices, and Donald Trump also gave the subject a mention. The row wasn’t triggered by hepatitis C, though, or even cancer, but by a scandal concerning the hiked prices of old drugs that caused a huge public outcry in summer 2015 and made Martin Shkreli, then chief executive of Turing Pharmaceuticals (he has had to resign since), the “most hated man in America”. That’s quite an accolade.

Old drugs are out of patent, which means any company can make them, and usually the price drops very low because of the competition. But Shkreli was an entrepreneur who saw no reason why selling drugs should be any different from selling cars: corner the market and hike the price. He did it a few times, but the one that caused all the trouble was a very cheap drug called pyrimethamine, trade name Daraprim. Daraprim had been out of patent for a very long time, having been approved by the US Food and Drug Administration in 1953. It is an anti-parasitic drug given to people with toxoplasmosis infection, particularly where they have weak immune systems because of Aids or pregnancy and cannot easily fight it off. Shkreli bought the drug from another company in August 2015 and hiked the price by 5,000%. It went up overnight from $ 13.50 per pill to $ 750.

So medical drugs are not like Chryslers or Porsches in the public mind, then?

It would seem not. The anger was clear evidence that people think medicines are a special case and that people have a moral right to affordable treatment. There is quite a tension between that view and the pursuit by pharmaceutical companies of profit for shareholders in the free market.

So how much does it cost to make a medicine?

Ah – that’s the $ 64bn question. Well, no, it doesn’t cost $ 64bn to create a drug, but there is a great deal of heated debate about the real cost. The biggest issue is what you factor in. The big pharma companies say you have to calculate not only the (usually cheap) cost of the raw ingredients and manufacturing, but also the cost of research and development of the drug – and also the R&D costs of all the drugs that fail to get to market. Clinical trials to test new drugs for safety and find out how well they work cost millions of dollars, and many drugs look good in the lab or in animals but don’t work in humans – or there are serious side effects. Research pharma companies need to set those costs for failures against the profits from the drugs that work – it’s the only way they can afford to keep looking for new medicines, they say.

The Tufts Center for the Study of Drug Development in Boston, Massachusetts, which produces estimates for the cost of making a medicine every few years, accepts that argument. Drug development is a long process, taking as long as 10 years, it says. It’s expensive. The centre’s latest figure for the cost of developing a prescription drug that gets marketing approval, published in the Journal of Health Economics in March 2016, is a colossal $ 2.558bn. The analysis, Tufts says, was based at least in part on information from 10 pharma companies on 106 randomly selected drugs that were first tested in human subjects anywhere in the world from 1995 to 2007.

Drugs figures

Does anybody contest that figure of $ 2.6bn per drug?

Yes. There are now a lot of campaigners calling for greater access to medicines in both rich and low-income countries. They are not impressed with the argument that pharma should cost in its failures. And furthermore, they say that often the best drugs were invented in university labs, paid for from public funds, so that should also be taken into account. In these cases, they say, the pharma companies buy up promising potential drugs and do the large-scale testing and development.

But if pharma companies insist they have to charge high prices because of their high costs, what can be done?

That’s been much debated in recent years. The first big access-to-medicines movement was sparked by Aids in Africa. The inequity of thousands dying for lack of drugs while people with HIV in San Francisco were alive and well on medication became a huge issue. Campaigners succeeded in enlisting the Indian generic company Cipla to make super-cheap versions of the HIV triple-drug combinations in 2001 that cost $ 100 a person a year instead of $ 10,000.

Why didn’t the rules on patents stop that?

Patents normally apply for about 20 years but have to be registered in each country where the drug is sold. That stops other companies making rival copies that might compete to push the prices down. But India had different intellectual property rules at the time, which meant the HIV drugs patents did not apply there. So India’s generics companies became the pharmacy for the developing world. But the rules have since changed and attempts to make cheap copies of new drugs such as the hepatitis C medicines in India have been subject to long battles in court.

Herception

At least health services can save money by using cheap copies once drug patents run out.

Yes. The good news for hard-pressed health services everywhere is that it is now possible to make cheap copies of “biologics” as well. These are much harder to copy, because they contain living cells or blood or proteins, not just simple chemicals. Many cancer drugs are biologics and for some time many doctors had doubts that the so-called biosimilars would work as well as the originals. But now it is clear they do. And the Royal Marsden cancer hospital in London says one year’s use of the first cancer biosimilar, a version of rituximab to treat lymphomas, has saved the NHS £80m. They estimate the health service could save £200m to £300m a year – maybe more – by embracing the biosimilars coming along, which include a version of the breast cancer drug trastuzumab, better known as Herceptin.

But campaigners say patients with cancers and other life-threatening diseases who don’t have loads of money cannot just wait for the patents to run out.

Is it just radical campaigning groups that are trying to get the prices of the patented medicines down?

No. Médecins Sans Frontières, winner of a Nobel prize, has played a big part through its access campaign, which started in 1999, proclaiming “medicines shouldn’t be a luxury”, but the issue has also more recently been taken up in the United Nations. It’s about the cost of drugs that the entire world needs, including new antibiotics the pharma companies have stopped trying to invent because they can’t make a profit on them.

The World Health Organization is strong on access to medicines for all and also has a list of essential medicines that all countries are advised they should stock. A UN high-level panel on access to medicines spent the best part of a year deliberating over the issues, with members from pharma companies as well as civil society and academics. It said the current setup has failed to come up with the drugs we need, whether antibiotics for all of us or cures for Zika and Ebola in low-income countries where there isn’t a market because people have no money (and because some terrifying diseases are rare). It tried to balance the conflicting demands of trade and the right to health in its final report in September 2016, in which it backed “delinkage” of the costs of R&D from the eventual price of the drug. That’s possible if you can have some sort of deal funded by governments or philanthropists that rewards companies for getting a much-needed drug like an antibiotic into the hands of doctors, so they would not make their money from sales.

What next?

The UN report has given everybody food for thought and is still being discussed. “The world must take bold new approaches,” it said, but that won’t happen quickly. The majority of big pharma, with the possible exception of GSK, whose then chief executive Sir Andrew Witty was on the panel, was unenthusiastic about the report. That might be mainly because it supported governments’ right to invoke a get-out from the World Trade Organization’s Trips agreement to bypass drug patents and make cheap versions in the interests of public health (the 2001 Doha declaration). But as happened with Aids, each new crisis over access to medicines – whether concerning a common liver disease or a rare cancer, and particularly over the antibiotics that are under threat and vital to all our lives – is likely to put pressure on companies to find ways to bring the costs of medicines down.

FURTHER READING:

WHO: Medicines pricing and financing

WHO: Innovation, access and use

UN secretary general’s high-level panel on access to medicines, final report

Access to Medicines Foundation annual index on how leading pharma companies make their drugs available in poorer countries

Lancet Global Health blog

Newsweek: How prescription drugs get their prices

Forbes: The Cost Of Developing Drugs Is Insane. That Paper That Says Otherwise Is Insanely Bad

Why do new medicines cost so much, and what can we do about it?

Why does it matter what medicines cost?

If you are lucky enough to live in a country with comprehensive state-funded healthcare, such as the UK, you probably have no idea how much medicines really cost. But it can be a lot. Some drugs that have been around for ages are very cheap – aspirin, for instance, costs pence. It’s been out of patent and made by numerous companies competing to undercut each other’s price for decades. But new medicines, protected by 20-year patents, can cost hundreds of pounds a packet and sometimes thousands. The new breast cancer drug Kadcyla weighed in at a starting price of £90,000 per patient per year in the UK in 2015, though the manufacturer has now agreed a hefty discount for the NHS.

It is an increasing pressure on all health systems around the world. In 2017, NHS England put its annual drugs bill at £16bn, £9bn of which is GPs prescribing, and said it was rising at 7% a year – faster than the overall NHS budget.

Data chart

Isn’t that really just a problem for poor countries?

No. The new drugs that cure the liver disease hepatitis C were launched at a price that elicited squeals of pain from the UK, western Europe and the United States, as well as India and Romania, which both have high numbers of infections. In the US, the drug sofosbuvir (brand name Sovaldi), launched at a cost of $ 1,000 a pill. In the UK, the manufacturer Gilead was asking £35,000 for a 12-week course, with some patients needing 24 weeks. It was soon clear that no country was going to be able to treat everybody who needed them, even though hepatitis C is a killer in the long term and the drugs are – unusually – a cure.

In the UK, the National Institute for Health and Care Excellence (Nice), which decides whether drugs are value for money, said yes to hepatitis C drugs, provided Gilead gave a discount. The drugs would save years of expensive NHS treatment, including liver transplants. But the government balked at the cost of treating everybody – an estimated 160,000 people are infected. Normally the deal is that the NHS must introduce any drug Nice approves, but in this case it chose to phase it in, treating the sickest first and making others wait, which was unprecedented.

In the US, the cost was out of the question for many people without good health insurance cover. The prices of new cancer drugs have also been prohibitive.

The Doha Declaration

Didn’t drug prices crop up in the US election?

Yes. The cost of drugs became a hot political potato. Hillary Clinton promised to bring down high prices, and Donald Trump also gave the subject a mention. The row wasn’t triggered by hepatitis C, though, or even cancer, but by a scandal concerning the hiked prices of old drugs that caused a huge public outcry in summer 2015 and made Martin Shkreli, then chief executive of Turing Pharmaceuticals (he has had to resign since), the “most hated man in America”. That’s quite an accolade.

Old drugs are out of patent, which means any company can make them, and usually the price drops very low because of the competition. But Shkreli was an entrepreneur who saw no reason why selling drugs should be any different from selling cars: corner the market and hike the price. He did it a few times, but the one that caused all the trouble was a very cheap drug called pyrimethamine, trade name Daraprim. Daraprim had been out of patent for a very long time, having been approved by the US Food and Drug Administration in 1953. It is an anti-parasitic drug given to people with toxoplasmosis infection, particularly where they have weak immune systems because of Aids or pregnancy and cannot easily fight it off. Shkreli bought the drug from another company in August 2015 and hiked the price by 5,000%. It went up overnight from $ 13.50 per pill to $ 750.

So medical drugs are not like Chryslers or Porsches in the public mind, then?

It would seem not. The anger was clear evidence that people think medicines are a special case and that people have a moral right to affordable treatment. There is quite a tension between that view and the pursuit by pharmaceutical companies of profit for shareholders in the free market.

So how much does it cost to make a medicine?

Ah – that’s the $ 64bn question. Well, no, it doesn’t cost $ 64bn to create a drug, but there is a great deal of heated debate about the real cost. The biggest issue is what you factor in. The big pharma companies say you have to calculate not only the (usually cheap) cost of the raw ingredients and manufacturing, but also the cost of research and development of the drug – and also the R&D costs of all the drugs that fail to get to market. Clinical trials to test new drugs for safety and find out how well they work cost millions of dollars, and many drugs look good in the lab or in animals but don’t work in humans – or there are serious side effects. Research pharma companies need to set those costs for failures against the profits from the drugs that work – it’s the only way they can afford to keep looking for new medicines, they say.

The Tufts Center for the Study of Drug Development in Boston, Massachusetts, which produces estimates for the cost of making a medicine every few years, accepts that argument. Drug development is a long process, taking as long as 10 years, it says. It’s expensive. The centre’s latest figure for the cost of developing a prescription drug that gets marketing approval, published in the Journal of Health Economics in March 2016, is a colossal $ 2.558bn. The analysis, Tufts says, was based at least in part on information from 10 pharma companies on 106 randomly selected drugs that were first tested in human subjects anywhere in the world from 1995 to 2007.

Drugs figures

Does anybody contest that figure of $ 2.6bn per drug?

Yes. There are now a lot of campaigners calling for greater access to medicines in both rich and low-income countries. They are not impressed with the argument that pharma should cost in its failures. And furthermore, they say that often the best drugs were invented in university labs, paid for from public funds, so that should also be taken into account. In these cases, they say, the pharma companies buy up promising potential drugs and do the large-scale testing and development.

But if pharma companies insist they have to charge high prices because of their high costs, what can be done?

That’s been much debated in recent years. The first big access-to-medicines movement was sparked by Aids in Africa. The inequity of thousands dying for lack of drugs while people with HIV in San Francisco were alive and well on medication became a huge issue. Campaigners succeeded in enlisting the Indian generic company Cipla to make super-cheap versions of the HIV triple-drug combinations in 2001 that cost $ 100 a person a year instead of $ 10,000.

Why didn’t the rules on patents stop that?

Patents normally apply for about 20 years but have to be registered in each country where the drug is sold. That stops other companies making rival copies that might compete to push the prices down. But India had different intellectual property rules at the time, which meant the HIV drugs patents did not apply there. So India’s generics companies became the pharmacy for the developing world. But the rules have since changed and attempts to make cheap copies of new drugs such as the hepatitis C medicines in India have been subject to long battles in court.

Herception

At least health services can save money by using cheap copies once drug patents run out.

Yes. The good news for hard-pressed health services everywhere is that it is now possible to make cheap copies of “biologics” as well. These are much harder to copy, because they contain living cells or blood or proteins, not just simple chemicals. Many cancer drugs are biologics and for some time many doctors had doubts that the so-called biosimilars would work as well as the originals. But now it is clear they do. And the Royal Marsden cancer hospital in London says one year’s use of the first cancer biosimilar, a version of rituximab to treat lymphomas, has saved the NHS £80m. They estimate the health service could save £200m to £300m a year – maybe more – by embracing the biosimilars coming along, which include a version of the breast cancer drug trastuzumab, better known as Herceptin.

But campaigners say patients with cancers and other life-threatening diseases who don’t have loads of money cannot just wait for the patents to run out.

Is it just radical campaigning groups that are trying to get the prices of the patented medicines down?

No. Médecins Sans Frontières, winner of a Nobel prize, has played a big part through its access campaign, which started in 1999, proclaiming “medicines shouldn’t be a luxury”, but the issue has also more recently been taken up in the United Nations. It’s about the cost of drugs that the entire world needs, including new antibiotics the pharma companies have stopped trying to invent because they can’t make a profit on them.

The World Health Organization is strong on access to medicines for all and also has a list of essential medicines that all countries are advised they should stock. A UN high-level panel on access to medicines spent the best part of a year deliberating over the issues, with members from pharma companies as well as civil society and academics. It said the current setup has failed to come up with the drugs we need, whether antibiotics for all of us or cures for Zika and Ebola in low-income countries where there isn’t a market because people have no money (and because some terrifying diseases are rare). It tried to balance the conflicting demands of trade and the right to health in its final report in September 2016, in which it backed “delinkage” of the costs of R&D from the eventual price of the drug. That’s possible if you can have some sort of deal funded by governments or philanthropists that rewards companies for getting a much-needed drug like an antibiotic into the hands of doctors, so they would not make their money from sales.

What next?

The UN report has given everybody food for thought and is still being discussed. “The world must take bold new approaches,” it said, but that won’t happen quickly. The majority of big pharma, with the possible exception of GSK, whose then chief executive Sir Andrew Witty was on the panel, was unenthusiastic about the report. That might be mainly because it supported governments’ right to invoke a get-out from the World Trade Organization’s Trips agreement to bypass drug patents and make cheap versions in the interests of public health (the 2001 Doha declaration). But as happened with Aids, each new crisis over access to medicines – whether concerning a common liver disease or a rare cancer, and particularly over the antibiotics that are under threat and vital to all our lives – is likely to put pressure on companies to find ways to bring the costs of medicines down.

FURTHER READING:

WHO: Medicines pricing and financing

WHO: Innovation, access and use

UN secretary general’s high-level panel on access to medicines, final report

Access to Medicines Foundation annual index on how leading pharma companies make their drugs available in poorer countries

Lancet Global Health blog

Newsweek: How prescription drugs get their prices

Forbes: The Cost Of Developing Drugs Is Insane. That Paper That Says Otherwise Is Insanely Bad

If you’re homelessness minister, maybe you should know something about it | Neil Coyle

The new “homelessness minister” has begun her job badly. Heather Wheeler claims not to know why homelessness has risen for seven consecutive years – that’s every year since she was elected. She has also been gazumped by the Cabinet Office minister, David Lidington, who is also chair of the government’s rough sleeping advisory panel. The panel has finally held its first, belated, meeting.

Wheeler needs to get to grips with the brief she has held since January. The first step in tackling any problem is understanding what has caused it. Admitting she doesn’t understand this basic element of her brief is terrible news for homeless people and bodes badly for her government’s commitment to halve homelessness by 2022. I welcome this target as co-chair of the all-party parliamentary group for ending homelessness and support the minister’s claim she will “move heaven and earth” to tackle the problem, but the first step is a hard, objective look at how it has come about.


The government’s absence of leadership created a vacuum that charities and others have struggled to fill

Since austerity programmes pursued by the government in 2010, councils’ ability to tackle homelessness has been undermined by a dramatic reduction in funds to help build sufficient, genuinely affordable homes. Public health cuts and attacks on community pharmacy budgets have ended some drug and alcohol cessation services. Mental health services have been axed and direct financial support has been pulled from people’s pockets.

The government recently announced, for example, it would have to reassess 220,000 people with mental health problems for personal independence payments after failing to properly take into account the impact of their conditions. The Department for Work and Pensions fought the case through the courts, wasting thousands of pounds of taxpayers’ money, but has finally had to admit its mistake. Given that 40% of homeless people have a mental health condition, the scale of the government’s damage to this group is incalculable.

With falling financial support, a failure to tackle the housing crisis, and a reduction in support to manage mental health conditions, the scene has been set. Universal credit has made matters worse for those people who struggle to manage finances, especially for the month-and-a-half automatic waiting period for a first payment. The personal debts and arrears clocked up in this period are worth about £5m to my local council alone and universal credit was specifically cited as the cause of homelessness by one man I met recently while out with St Mungo’s in Southwark.

The minister’s failure to understand the root of the problem hasn’t prevented its rising visibility. With more than 300,000 families now in temporary accommodation and almost 5,000 people rough sleeping nightly, people are more aware of the issue. The death of a man on parliament’s doorstep shamed the UK and led to greater demands for action. Wheeler needs to catch up.

The government’s absence of leadership created a vacuum that charities and others have struggled to fill. The mayor of London, Sadiq Khan, and Manchester’s mayor, Andy Burnham, are pioneering their own efforts and extending help. The Robes Project in south London now covers 28 churches in two boroughs for the whole of winter, offering a safe, warm space for homeless people, and in some shelters even a hot meal. The appetite for change is growing: witness the thousands of referrals from the general public to the Streetlink app in London to help rough sleepers into shelters.

The minister’s claim not to know why the problem has become so dramatic is a revelation. In any other job, I suspect an employer would be seeking her resignation. But then, Wheeler reports to a government with collective responsibility for causing this growth in homelessness. Ignorance may seem preferable to culpability.

Neil Coyle is Labour MP for Bermondsey and Old Southwark

Corbyn writes to May about man’s £54,000 NHS cancer bill

Jeremy Corbyn has written to Theresa May about Londoner Albert Thompson’s £54,000 bill for cancer treatment, saying the government risks allowing a patient to die because of difficulties proving immigration status.

Thompson, 63, who has lived continuously in the UK for 44 years since arriving from Jamaica as a teenager in 1973, is not receiving the radiotherapy he needs for prostate cancer because the London hospital where he was due to start treatment last November told him he needed to provide proof of residency or pay upfront for his care.

He was unable to supply officials with required documents, so he was told he needed to find £54,000. Thompson, who has asked for his real name not to be used, is increasingly worried about the potential impact on his health of the delay of more than four months. The Labour leader called on ministers to “intervene immediately in his case to ensure that this man gets access to the care that he needs”.

Corbyn said Thompson’s situation was not unique and he was dealing with a similar case in his constituency, which he had also raised with the Home Office. He said the cases were a direct result of new regulations introduced last October requiring hospital departments and community health services to check every patient’s paperwork, including passports and proof of address, and charge upfront for their healthcare if they did not have documentary proof of eligibility.

The case raised the prospect that many undocumented British citizens were being denied free NHS treatment, and that the principle of the universal NHS, free at the point of need, was being eroded, he wrote.

“Every patient, including British citizens, can be asked about their residency status and made to prove they are entitled to free NHS care,” he said. He quoted concerns raised by the shadow spokesperson for health and social care, Philip Hunt, who said in the Lords last year that, as a result of the new regulations, “many people who legitimately live here and have every right to NHS treatment are going to be challenged by the NHS”.

Thompson, who worked as a mechanic before he became ill, has never applied for a British passport because he had no need to, but the Jamaican passport he arrived with was lost many years ago. In the tightened hostile immigration environment, launched by Theresa May in 2013, he has struggled to prove his eligibility for housing support and free healthcare.

A spokesperson for the hospital said Thompson “continues to be treated by his GP as directed by the cancer specialist. His radiotherapy is not urgent. We are very sorry this has caused Mr Thompson distress and uncertainty and are working hard to try to resolve this as quickly as possible.”

Thompson said he had not seen a GP about his prostate cancer treatment since early last year.

Doctors have expressed confusion at the decision to classify the radiotherapy as non-urgent. Joe Rylands, a spokesperson for Docs Not Cops, a group of healthcare professionals campaigning to protect free access to healthcare for all people, said: “I cannot foresee any circumstances whereby a patient has been deemed to need ‘discretionary’ radiotherapy for prostate cancer. Either they need it by team decision, when it is potentially life-saving, or they don’t. To withdraw it on the basis of nationality appears unethical and incompatible with the principles of the NHS.”

A Downing Street spokesperson said the prime minister had received the letter and would respond in due course. A Department of Health and Social Care spokesperson said: “Our guidance makes clear that urgent and immediately necessary care should never be withheld or delayed.”

Corbyn writes to May about man’s £54,000 NHS cancer bill

Jeremy Corbyn has written to Theresa May about Londoner Albert Thompson’s £54,000 bill for cancer treatment, saying the government risks allowing a patient to die because of difficulties proving immigration status.

Thompson, 63, who has lived continuously in the UK for 44 years since arriving from Jamaica as a teenager in 1973, is not receiving the radiotherapy he needs for prostate cancer because the London hospital where he was due to start treatment last November told him he needed to provide proof of residency or pay upfront for his care.

He was unable to supply officials with required documents, so he was told he needed to find £54,000. Thompson, who has asked for his real name not to be used, is increasingly worried about the potential impact on his health of the delay of more than four months. The Labour leader called on ministers to “intervene immediately in his case to ensure that this man gets access to the care that he needs”.

Corbyn said Thompson’s situation was not unique and he was dealing with a similar case in his constituency, which he had also raised with the Home Office. He said the cases were a direct result of new regulations introduced last October requiring hospital departments and community health services to check every patient’s paperwork, including passports and proof of address, and charge upfront for their healthcare if they did not have documentary proof of eligibility.

The case raised the prospect that many undocumented British citizens were being denied free NHS treatment, and that the principle of the universal NHS, free at the point of need, was being eroded, he wrote.

“Every patient, including British citizens, can be asked about their residency status and made to prove they are entitled to free NHS care,” he said. He quoted concerns raised by the shadow spokesperson for health and social care, Philip Hunt, who said in the Lords last year that, as a result of the new regulations, “many people who legitimately live here and have every right to NHS treatment are going to be challenged by the NHS”.

Thompson, who worked as a mechanic before he became ill, has never applied for a British passport because he had no need to, but the Jamaican passport he arrived with was lost many years ago. In the tightened hostile immigration environment, launched by Theresa May in 2013, he has struggled to prove his eligibility for housing support and free healthcare.

A spokesperson for the hospital said Thompson “continues to be treated by his GP as directed by the cancer specialist. His radiotherapy is not urgent. We are very sorry this has caused Mr Thompson distress and uncertainty and are working hard to try to resolve this as quickly as possible.”

Thompson said he had not seen a GP about his prostate cancer treatment since early last year.

Doctors have expressed confusion at the decision to classify the radiotherapy as non-urgent. Joe Rylands, a spokesperson for Docs Not Cops, a group of healthcare professionals campaigning to protect free access to healthcare for all people, said: “I cannot foresee any circumstances whereby a patient has been deemed to need ‘discretionary’ radiotherapy for prostate cancer. Either they need it by team decision, when it is potentially life-saving, or they don’t. To withdraw it on the basis of nationality appears unethical and incompatible with the principles of the NHS.”

A Downing Street spokesperson said the prime minister had received the letter and would respond in due course. A Department of Health and Social Care spokesperson said: “Our guidance makes clear that urgent and immediately necessary care should never be withheld or delayed.”

Corbyn writes to May about man’s £54,000 NHS cancer bill

Jeremy Corbyn has written to Theresa May about Londoner Albert Thompson’s £54,000 bill for cancer treatment, saying the government risks allowing a patient to die because of difficulties proving immigration status.

Thompson, 63, who has lived continuously in the UK for 44 years since arriving from Jamaica as a teenager in 1973, is not receiving the radiotherapy he needs for prostate cancer because the London hospital where he was due to start treatment last November told him he needed to provide proof of residency or pay upfront for his care.

He was unable to supply officials with required documents, so he was told he needed to find £54,000. Thompson, who has asked for his real name not to be used, is increasingly worried about the potential impact on his health of the delay of more than four months. The Labour leader called on ministers to “intervene immediately in his case to ensure that this man gets access to the care that he needs”.

Corbyn said Thompson’s situation was not unique and he was dealing with a similar case in his constituency, which he had also raised with the Home Office. He said the cases were a direct result of new regulations introduced last October requiring hospital departments and community health services to check every patient’s paperwork, including passports and proof of address, and charge upfront for their healthcare if they did not have documentary proof of eligibility.

The case raised the prospect that many undocumented British citizens were being denied free NHS treatment, and that the principle of the universal NHS, free at the point of need, was being eroded, he wrote.

“Every patient, including British citizens, can be asked about their residency status and made to prove they are entitled to free NHS care,” he said. He quoted concerns raised by the shadow spokesperson for health and social care, Philip Hunt, who said in the Lords last year that, as a result of the new regulations, “many people who legitimately live here and have every right to NHS treatment are going to be challenged by the NHS”.

Thompson, who worked as a mechanic before he became ill, has never applied for a British passport because he had no need to, but the Jamaican passport he arrived with was lost many years ago. In the tightened hostile immigration environment, launched by Theresa May in 2013, he has struggled to prove his eligibility for housing support and free healthcare.

A spokesperson for the hospital said Thompson “continues to be treated by his GP as directed by the cancer specialist. His radiotherapy is not urgent. We are very sorry this has caused Mr Thompson distress and uncertainty and are working hard to try to resolve this as quickly as possible.”

Thompson said he had not seen a GP about his prostate cancer treatment since early last year.

Doctors have expressed confusion at the decision to classify the radiotherapy as non-urgent. Joe Rylands, a spokesperson for Docs Not Cops, a group of healthcare professionals campaigning to protect free access to healthcare for all people, said: “I cannot foresee any circumstances whereby a patient has been deemed to need ‘discretionary’ radiotherapy for prostate cancer. Either they need it by team decision, when it is potentially life-saving, or they don’t. To withdraw it on the basis of nationality appears unethical and incompatible with the principles of the NHS.”

A Downing Street spokesperson said the prime minister had received the letter and would respond in due course. A Department of Health and Social Care spokesperson said: “Our guidance makes clear that urgent and immediately necessary care should never be withheld or delayed.”

Corbyn writes to May about man’s £54,000 NHS cancer bill

Jeremy Corbyn has written to Theresa May about Londoner Albert Thompson’s £54,000 bill for cancer treatment, saying the government risks allowing a patient to die because of difficulties proving immigration status.

Thompson, 63, who has lived continuously in the UK for 44 years since arriving from Jamaica as a teenager in 1973, is not receiving the radiotherapy he needs for prostate cancer because the London hospital where he was due to start treatment last November told him he needed to provide proof of residency or pay upfront for his care.

He was unable to supply officials with required documents, so he was told he needed to find £54,000. Thompson, who has asked for his real name not to be used, is increasingly worried about the potential impact on his health of the delay of more than four months. The Labour leader called on ministers to “intervene immediately in his case to ensure that this man gets access to the care that he needs”.

Corbyn said Thompson’s situation was not unique and he was dealing with a similar case in his constituency, which he had also raised with the Home Office. He said the cases were a direct result of new regulations introduced last October requiring hospital departments and community health services to check every patient’s paperwork, including passports and proof of address, and charge upfront for their healthcare if they did not have documentary proof of eligibility.

The case raised the prospect that many undocumented British citizens were being denied free NHS treatment, and that the principle of the universal NHS, free at the point of need, was being eroded, he wrote.

“Every patient, including British citizens, can be asked about their residency status and made to prove they are entitled to free NHS care,” he said. He quoted concerns raised by the shadow spokesperson for health and social care, Philip Hunt, who said in the Lords last year that, as a result of the new regulations, “many people who legitimately live here and have every right to NHS treatment are going to be challenged by the NHS”.

Thompson, who worked as a mechanic before he became ill, has never applied for a British passport because he had no need to, but the Jamaican passport he arrived with was lost many years ago. In the tightened hostile immigration environment, launched by Theresa May in 2013, he has struggled to prove his eligibility for housing support and free healthcare.

A spokesperson for the hospital said Thompson “continues to be treated by his GP as directed by the cancer specialist. His radiotherapy is not urgent. We are very sorry this has caused Mr Thompson distress and uncertainty and are working hard to try to resolve this as quickly as possible.”

Thompson said he had not seen a GP about his prostate cancer treatment since early last year.

Doctors have expressed confusion at the decision to classify the radiotherapy as non-urgent. Joe Rylands, a spokesperson for Docs Not Cops, a group of healthcare professionals campaigning to protect free access to healthcare for all people, said: “I cannot foresee any circumstances whereby a patient has been deemed to need ‘discretionary’ radiotherapy for prostate cancer. Either they need it by team decision, when it is potentially life-saving, or they don’t. To withdraw it on the basis of nationality appears unethical and incompatible with the principles of the NHS.”

A Downing Street spokesperson said the prime minister had received the letter and would respond in due course. A Department of Health and Social Care spokesperson said: “Our guidance makes clear that urgent and immediately necessary care should never be withheld or delayed.”