W5 investigates the high cost of Celgene's Thalidomide
http://watch.ctv.ca/news/w5/pills-patients–profits/#clip281624

Canada’s news program, W5 (which I assume is shorthand for who, what, when, where and why) , did a program called, “Pills Patients & Profits.”  You can see the entire segment on their web site.  Click on the link or image above to watch part 3, which focuses on the cost of thalidomide (Celgene’s Thalomid), which is an important treatment for multiple myeloma.

It’s very informative, so please do watch all four parts.

I started to get some neuropathy just a few months into my first treatment, which was Thalomid. I knew it was a possibility, but I’m hopelessly optimistic, and assumed it wouldn’t happen to me. I quit taking thalidomide within 8 months, because I didn’t want the neuropathy to progress beyond a point that I thought would severely impact my quality of life.

What I ended up with is numbness in my feet and sometimes pain. It started out as a pretty intense burning feeling just three months after I started treatment in 2003.  My feet felt as though they were on fire!  From there, it progressed to numbness.  It sort of feels like my feet aren’t my own. Shoes are no longer comfy.

After treatment with Revlimid and then Velcade, my neuropathy progressed some more.  It changed a little, too.  I now have some significant pain at times. I have to work with my feet up.  I can’t sit at a desk, or anywhere, really, for very long. If I’m seated with my legs down for more than a half hour, I end up with pain up to my knees. I have to get my legs elevated or even lie down to get some relief.

When I first began to feel the effects of peripheral neuropathy (PN), I even had some trouble walking.  I’m used to it now, so I no longer have to keep my eyes on my feet when I walk.  It took a while for me to adjust.

A few days ago I was attempting a an exercise that involved hopping. It was really weird, because I didn’t really know where my feet were.  I had to ask someone else if my feet even left the ground!  That evening, while I was walking the dog, I tried something I hadn’t done in ages.  I tried skipping, just for the heck of it. I couldn’t do it!  Is that something I forgot how to do, or is the PN messing with me?

I decided to look for some information on the web, and found some facts on Livestrong.com:

What are the symptoms of neuropathy?

Peripheral neuropathy can affect the nerves which allow you to tell the position of your hands or feet, the nerves that allow you to sense hot or cold, or the nerves that carry pain sensation. The types and severity of neuropathy symptoms vary greatly. It is difficult to determine the degree of peripheral nerve injury only by the symptoms produced. Peripheral neuropathy symptoms are almost always greatest at night.

Common signs and symptoms include:

  • Numbness or tingling, especially of the hands or feet
  • Pain or cramping, especially of the hands , feet or calf muscles
  • Sensitivity to touch or temperature
  • Loss of reflexes
  • Muscle wasting in the hands and feet
  • Weakness, especially in the feet or hands
  • Clumsiness
  • Loss of balance, particularly in the dark
  • Dizziness, especially when getting up from a bed or a chair
  • Sexual dysfunction

Are some survivors at greater risk for neuropathy?

Neuropathy may occur from cancer or the treatment received. The following types of cancer may bring a higher risk:

  • Lung
  • Breast
  • Ovarian
  • Myeloma
  • Lymphoma and Hodgkin’s disease
  • Testicular

Here’s a link to the entire article: http://www.livestrong.org/site/c.khLXK1PxHmF/b.2660677/

I even found that they have a group for discussion of neuropathy secondary to drugs:

http://www.livestrong.com/groups/group/livestrong-neuropathy-secondary-to-drugs/

Probably most of us who’ve had treatment for our myeloma have been prescribed one of the drugs manufactured by Celgene.   Celgene makes Revlimid® (lenalidomide) and Thalomid® (thalidomide).

That really annoying guy on TV, Jim Cramer (Mad Money, CNBC), says it’s on his list of stuff to buy.   According to the CNBC site:

So when do you buy CELG? Cramer said that investors could wait until the annual American Society of Hematology (ASH) meeting on Dec. 5, where Celgene is expected to present “some terrific Revlimid data.”

“I wouldn’t pull the trigger on this trade until the week before the conference,” Cramer said.

http://www.cnbc.com/id/33603726

I’ll be waiting to see what happens during the ASH conference.

By Dennis Hemus

Many Multiple Myeloma patients have been damaged by the high cost of drug treatment and worse some do not receive treatment at all because of cost. The following is a brief summary of how I came to intimately know the drug Thalidomide and the journey it has taken me on.
I was diagnosed early in 2001 at the age of 54 and underwent an Autologous Stem Cell Transplant that summer. The result was fantastic. Life with my family was back to normal and my recovery was so complete I could play hockey, backpack and do physical work as I did pre MM. I was the happiest guy in town.
The cancer slowly gained another foot hold and in January of 2005 I had a second SCT but that one did not work and I was in trouble! My Calgary Oncologist suggested that I try Thalidomde. (In Canada procedures like SCT’s are covered so there is no serious treatment cost to the patients but when it comes to drugs that can be a different matter.)
I clearly remember asking my Oncologist, Dr. Stewart, “What does this drug cost” and he sort of grimaced and said, “it is kind of expensive……… it will cost you around $3000 a month”. I just about fell off my chair and asked him to confirm that this was the same basic thalidomide that caused horrific birth defects back in the 60′s. How in the world could an old drug like that cost thousands of dollars? As it turned out, my Doctor was wrong as the drug cost more that $4,000 per month. Fortunately for me, while I was being treated in the Province of Alberta I am a resident of British Columbia and The British Columbia Cancer Agency was the last Provincial body in Canada to cover the cost of the drug, so my Thalomid was funded. (Due to the escalating cost of the drug the Agency no longer covers Thalomid for new MM patients but does pay for those on the shrinking list that have been grandfathered in)
The price of this drug simply did not make sense to me. I could clearly remember that the gas I pumped in high school, back in 1966, cost 40 cents per gallon and I wondered what did Thalidomide cost then……maybe at most just a few dollars for a prescription.  I contacted the Pharmacy of the B.C. Cancer Agency looking for historical pricing which they could not provide past June of 2000 but what I learned was absolutely stunning and left me with the instant opinion that something was very wrong with this picture. Hence, I committed to do what I could to expose and help correct the situation. I will leave you to form your own conclusions but these are the historical facts.
Note: All prices are in USD and a bottle contains thirty 50 mg. capsules. June 2000: $98.40. January 2002: $210:00. May 2003: $363.00. November 2003: $592.50. April 2005: $898.50. Note: The Cancer Agency does not add a dispensing fee or up charges so the prices quoted above is what the Agency or patients of the Agency paid Celgene for the Drug. Prices increased over 800% in less than five years.
I quickly learned that thalidomide was available in other countries at fractional prices. For example, the drug is currently (January, 2008) available at Serral Laboratories in Mexico for a cost of $90 for 50, 100 mg capsules so a typical 200 mg. dose would costs $3.60 / day and just last week an acquaintance (not an MM sufferer) had a prescription for Thalidomide filled in India and that drug cost her $5.60 for a 200 mg. dose. (Courier and Bank charges included) Compare the 2005 Celgene price for that same dose and you will see it cost $119.30 / day. I wondered if Canadians alone were being charged excessively high prices but learned that people in the United States were also facing the same outlandish costs.
It struck me that the best way to expose the matter was to contact the media. I assumed when the public and elected representatives found out what was going on the proverbial poop would hit the fan. Early in 2005 The Vancouver Sun, The Globe and Mail and my town’s local paper all did excellent articles focusing on the extreme cost of this long Orphaned drug. Global Television sent a crew to my home in Windermere, B.C. and a story aired on Global National evening news. Later CBC regional radio interviewed Health Canada looking for answers. I’m sure the facts presented by the media caused people to shake their heads but nothing changed.
My letters and extensive support materials sent to the former and current Minister of Health expressing concerns about the outrageous pricing received little consideration. Direct questions were not answered and crafted “say nothing” replies were all I got back from Ottawa. The whole effort left me frustrated and a bit cynical but recent events suggest there may be hope for a little justice. This is what we know.
Celgene has been bringing Thalidomide (Thalomid) into Canada under the Special Access Program since 1995. Currently, Health Canada does not have the authority to require the company to make a new drug submission and file a Notice of Compliance. HC has repeatedly encouraged Celgene to do so they have not co-operated. Why not? The answer is clear. If the drug followed the usual channels a new drug submission and NOC would have been filed and without patent protection, a generic form of the drug could be made and competition would bring the price down.
If a drug is patented it comes under the jurisdiction of the Patented Medicine Prices Review Board whether it comes into Canada under SAP or if the Company files a Notice of Compliance, the PMPRB has jurisdiction. Celgene maintained that the PMPRB did not have jurisdiction over SAP drugs but the board ruled on January 21, 2008 that it does have jurisdiction and that has important implications.
Celgene received a patent for the drug on April 4th, 2006.
It seems clear to me that Celgene believes it can charge what ever it wants for the drug and did not want the price reviewed by the Patented Medicine Prices Review Board because that board may determine that the price is too high, according to the board’s Excessive Price Guidelines, and require the company to bring the price down. Also, that board can require a company that has over charged for a drug to refund money to the Crown (government) and that money may in turn, be returned to the Provinces, medical plans and maybe even to individuals. It is curious that the price had been hiked to the current peak level in 2005. Celgene would know of the PMPRB and maybe they thought the board would only look at the drug price post patent date. (April 4, 2006)
In my opinion Celgene has clearly over charged and they deserve to have their finger slapped in a big way. (If readers wish to read the current judgement and related laws I will be pleased to offer directions to online sources.
Companies like Celgene often try to justify profits by claiming that they plow most of their gains back into Research and Development but you know that does not wash. The former CEO Mr. Jackson rode off into the sunset with tens of millions of dollars gained from Celgene stock options.
Celgene discriminates against Cancer patents. They have charged one price for thalidomide when it was used for AIDS but a much higher price when the drug is used for Cancer. The company has been blatant about its discriminatory practices as the follow quotations demonstrate. “When we launched it, it was going to be an AIDS-wasting drug,” says Celgene’s chief executive, John Jackson. “We couldn’t charge more or there would have been demonstrations outside the company.” (When Celgene Corp. got its first drug approved, it priced a 50-milligram capsule at $6) “After new information suggested the drug helped treat MM, Mr. Jackson said he felt justified in increasing the price because the drug had gained value-it appears to help cancer patients in addition to those with AIDS”.  In Canada, and in most places around the world, discrimination is not condoned or accepted.
Please understand, I am very thankful for the drug and one of the many that are living proof  that thalidomide is an effective short term treatment for Myeloma but that does not change the facts of the matter and that is: Celgene has been taking advantage of us by over charging.
Revlimid, the analog drug of thalidomide, is priced much higher compared to Thalomid and again the company charges excessive prices because they can. They seem to see MM patients as a captive market and act without conscience. The truth is MM patients are a captive market and we essentially just have the big bomb drugs, Velcade and Thalidomide/Revlimid for treatment of our disease. Each drug company wants to stay price competitive with the other but usually we associate competition with bargains or at least fair pricing. In this case we have the companies competing to see if they are pricing their drug as high as the other and they talk of market share in their investment literature as if they were selling buttons instead of life extending drugs. What happened to making something that helps people and making a reasonable profit? Keep in mind Celgene simply found a new application for the old drug Thalidomide and while they did have huge expenses to test and gain approvals for the drug this does not justify charging what they do.
People in the United States are being exploited too. I do not exactly understand what gives Celgene the market protection that they enjoy but it seems to boil down to the STEPS program. It took me almost three years to fully understand the whys and the wherefores of the situation in Canada and I expect that the same careful positioning for profit also exists South of the Canadian border. Celgene seems to enjoy unique market protection in New Zealand, Australia and other countries and I do not know exactly why.
So what to do? In Canada it seems clear that we should pressure our elected representative to influence the Supreme Court of Canada to hear the appeal case between the Patented Medicine Pricing Review Board and Celgene. Nine months have passed since it was ruled that the PMPRB had jurisdiction. Celgene appealed that decision and that court case has not even been scheduled. In the mean time Celgene continues to rack up huge profits. I truly hope that President Obama will keep his word and investigate big drug companies. It seems clear to me that Celgene and the case of Thalidomide is a very clear example of how big drug companies take advantage of captive, dependent people. This is the worst form of gouging. To date the Canadian Government has done next to nothing concerning this issue. It is my hope that the new Minister of Health will do something.

Have you used thalidomide?

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ConsumerInformant has written more from personal experience on this blog. His mother has taken thalidomide.

Please comment on your own experiences.

On Sunday I drove a friend to Rocky Mount, NC to visit some friends. It was 2 hours each way, with a few hours in between. By the time I got home, my feet felt as though they were in flames and someone was beating on the soles with a hammer.  From the knees down felt numb.  This happens to me when I have to sit for too long.  This is a result of treatment with thalidomide and Velcade.  Luckily, the pain and discomfort goes away by the next morning and I’m left with the numbness in just my feet.

What is it that makes the PN so much worse while sitting?

Last night I started to develop a few little itchy spots on my arms and hands and my right eyelid swelled a little. By morning, the spots on my arms and hands were gone, but my entire right eyelid was swollen and red. At this moment, both eyelids are swollen and red, and so are my fingers. There are some itchy raised spots on my arms and legs too, mostly around the joints.

I’ve been taking Thalomid and dexamethasone (in 4 pulses of 4 days on/4 days off – 40 mg each day) for about a month now. Why would side effects manifest themselves at this point? Maybe there’s some cumulative effect with dexamethasone. It’s possible, because up until the third pulse, I hadn’t experienced that meanness other people talked about. Boy, was I in a bad mood! I could relate to what the others were saying.

I called my oncologist’s office this afternoon when it appeared that the itchy swelling wasn’t going away, but getting worse. He wasn’t in, so I called my primary care physician. He thinks it’s a result of the high doses of steroids and said I could take Benedryl to help with the itching and swelling. I must need a lot, because what I’ve taken so far today hasn’t put a dent in it. It would be nice if I could go to my vet and get a shot. :) If it’s not better in the morning, I’ll call my oncologist again.

I’m not sure if I should go ahead and take my evening dose of Thalomid or not. Tomorrow morning I start my last pulse of dex. Dex is supposed to help swelling :)