Many crimes are laid at the metaphorical door of ‘Big Pharma.’ Big Pharma – often seen as a large, powerful, mysterious conglomerate of disreputable characters – has been accused of everything from conspiring to conceal cures for cancer to creating diseases to drive demand for medications.

With accusations like this flying around, the debate reads as extreme – and in any extreme argument, it can be difficult to know what to believe. There are large profits to be made in the business of medicine and we know that businesses protect their products, and yet the idea that companies make plans to keep people sick seems far-fetched.

How worried about Big Pharma should we be?

Australia’s PBS – our Pharmaceutical Benefits Scheme – keeps medications affordable. Governed by the National Health Act of 1953, the scheme subsidises medicines for any Australian resident with a current Medicare card, or anyone who comes under a reciprocal health care agreement.

Not all medications are on the PBS schedule, but those that are provide a much cheaper option. Practically speaking, if you have a Medicare card in your wallet, you can tell your doctor you need a cheaper option when buying your medication. The doctor can then prescribe you a drug covered by the PBS.

In the United States, the system is different, and pharmaceutical companies can have a notable impact on the healthcare system. Prices are unregulated, and pharmaceutical companies can do things like buy the rights to drugs with expired patents and hike up the price. For example, the case of Albendazole which is a drug used to treat parasites (like threadworm): this drug cost around $6 a day in 2010 and now costs around $120 a day, making treatment difficult for doctors.

For Australians, the threat of pharmaceutical companies – Big Pharma – is less clear. However, in these past months, healthcare professionals have been worried about the affordability of medications in Australia, largely due to trade deals called the Trans-Pacific Partnership Agreement (TPP) signed this week.

So why are health professionals concerned?

La Trobe’s Dr Deborah Gleeson has written extensively on concerns around the TPP. In a co-authored editorial on the Medical Journal of Australia titled What doctors should know about the Trans-Pacific Partnership Agreement, she argued that this agreement ‘represents a new breed.’ The piece outlines main areas of concerns for doctors, stating:

‘One of the key concerns for doctors is access to medicines. Intellectual property rules proposed for the TPPA, if adopted, are likely to prolong monopolies over new medicines and delay the availability of cheaper generics.’

Also of concern, Dr Gleeson told the ABC, was the possibility that ‘pharmaceutical companies would be able to sue governments directly over their pharmaceutical policies.’

The TPP at a glance

You’re probably wondering why you don’t know more about these negotiations. Don’t worry – it’s not just you. There was a lot of secrecy around the proceedings. Here’s the quick guide:

• The talks began in 2010 and very little information about them was released to the public
• WikiLeaks released most of the publicly available information about the talks
• These negotiations were forecast to have a wide range of impacts: from tighter copyright laws to allowing foreign companies to sue signatory governments if they do anything that causes profit loss
• Disagreements over drug patents between the US and Australia delayed the talks, as the US wanted to extend monopolies on biologic medicines
• The TPP was signed on October 6 2015, and the Australian government has claimed we will benefit from them extensively, with Trade Minister Andrew Robb telling news channels the deal encourages growth and jobs

How will the outcome impact us?

Australian health advocates have welcomed the news that Andrew Robb didn’t cave to extended monopolies on some medicines, but are cautious to celebrate until official documentation becomes public.

In her role as spokesperson for the Public Health Association of Australia, Dr Gleeson said: ‘Extending monopolies on expensive treatments for cancer and immune conditions would have meant tens to hundreds of millions in extra expenditure for our Pharmaceutical Benefits Scheme each year.’

However the big concerns are to other countries. Dr Gleeson: ‘While Minister Robb may have avoided delaying access to medicines for Australians, we are acutely aware that the TPP’s intellectual property chapter is disastrous for access to medicines in developing countries such as Vietnam and Peru.’

We spoke to Dr Gleeson this week and asked her to further clarify the decisions made at the TPP. She said:

Australia has agreed to a clause allowing foreign corporations to sue for compensation in international tribunals over government policies that affect the value of their investments. Leaked text suggests investments are defined very broadly and include intellectual property rights such as patents. Unless the Pharmaceutical Benefits Scheme is explicitly exempted, we could see future cases brought by pharmaceutical companies attempting to prolong monopolies or prevent price controls.

At this time, the impacts of these talks is still unclear. The PBS is an important element of our healthcare system as it stands, and should it be threatened, it will change the way Australians receive healthcare.

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