Sawbones: A Marital Tour of Misguided Medicine - Sawbones: Patents vs. Life-Saving Drugs

Episode Date: July 18, 2023

John Green recently made a video asking Johnson & Johnson not to extend their patent on a tuberculosis drug, which would keep it exclusive and expensive. Dr. Sydnee and Justin talk about how drug patents work, the recent (good) update about bedaquiline specifically, and the next steps that pharmaceutical companies and the government need to make to keep life-saving drugs affordable. We’re back to classic Sawbones, keeping tabs on Big Pharma again.Music: "Medicines" by The Taxpayers https://taxpayers.bandcamp.com/

Saw bones is a show about medical history, and nothing the hosts say should be taken as medical advice or opinion. It's for fun. Can't you just have fun for an hour and not try to diagnose your mystery boil? We think you've earned it. Just sit back, relax, and enjoy a moment of distraction from that weird growth. You're worth it. that weird growth. You're worth it. Alright, time is about to books. One, a marital tour of misguided medicine. I'm your co-host, Justin McAroy. Yeah, I'm Sydney McAroy. Sid, I've been in a remarkably good mood today.

When you're somebody who, you know, never in a quiet nose where their head's going to be at because of chemicals and everything in the world. It's so nice and I'm hoping. It's nice for those around you too. It's a little like. Do people like that too? The people in the house, like that just different people that live here.

Listen. I get bored easily. I love unpredictability. Yeah. So it works for us. It works. I never know what I'm gonna wake it up to. I work for us.

This one's good. This is, I'm in a good vibe and I am hoping that you are going to keep me on this, this, this, this radiation vibe I'm grooving on, but just keep in the, keep the good vibes coming. Well, what do you got this week, Sid? I don't know if I'm pretty excited about it. Well, okay, this isn't bad vibes because, you know,

it's funny as I was researching this topic and putting this episode together, the narrative got better you know, it's funny. As I was researching this topic and putting this episode together, the narrative got better. Like, it's like better news. Oh, good. I wouldn't say like, everything's fixed, don't worry. But like, they heard, they heard you were looking into it. And they're like, quicks and he's coming.

You know, it's funny. And I think I can admit this to you, dear listeners. Like, you've been with us so long. I think you know, I think you know my heart and you understand this. So as I was putting this story together and I think you know my heart and you understand this. As I was putting this story together and I'm thinking, this is important thing. I want to do an episode on it.

I want to talk about it too. I want to also research some of the backstory of this and get that info out there because it's really important for us to be focused on and energized about and talking about. As I was researching it, this actually happened in our notes that happened to me in the moment, but like yesterday now, as we're recording, it sort of came to a resolution. And that's great, I mean, excellent. But also, I had a moment of like, no, not yet.

I need to be able to take credit. No, no, it wasn't that. It was just like, no, I want to talk about it too. No, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, it wasn't that. It was just like, no, I want to talk about it too. No, no, no, no. It got fixed too quick. I didn't get to help. I wanted to help too. Well, if I know anything about the medical system, the underlying issues are probably still

absolutely. They are. The underlying issues are still there. And it's, as with most activist causes, sustained like pressure on organizations to do the right thing is really important. Even if it seems they're starting to do the right thing, you can't take your eye off them. Because, you know, and we're talking about Big Pharma here. And Big Pharma is really tricky. And they have lots of lawyers. This is no shade on your lawyers. I'm just saying they have lots of you. They have lots of lobbyists. They have lots of people who are who are very good at protecting the interests of big farmer. That's what they're paid to do. That's their job. They're very talented and skilled and

intelligent and they will outwile us if we're not paying attention. So anyway, I wanna talk about beta-quilling and drug patents. Many of you may be familiar with this because of either John Green or Hank Green. Because I think John first started talking about it. I believe on Twitter. See, I feel like that now that- I'm missing the narrative. I know, I miss narratives now.

Everybody get off Twitter, come on. I don't know where we go. Okay, do it in my space. I guess. Live journal. I guess. I don't know where we go. Okay, do it in my space. Live journal. I guess. I don't know. But I feel like I was late to this because I don't really look at Twitter much anymore. But anyway, I think John called attention to it first and then, of course, Hank too.

Many of you are probably fans of the Green Brothers as you should be as we are. But what John was talking about is that there is a medication, beta-quilling that is used for tuberculosis, a specific kind of tuberculosis. We often use the abbreviation MDR TB. TB is the common way to refer to tuberculosis. I think most people know that. TB. When I say TB, I mean tuberculosis.

MDR means multi-drug resistant. So it's TB that's really hard to treat. That's the important part. It's the same, by the way. I think it's always important. I always try to tell patients this. If I think something is MRSA or MRSA. MRSA.

That's just a really resistant strain of staff. So it's a staff infection. You may have heard of staff infections. They're really common. This is still just staff. It's just a really resistant form of staff, meaning that we have to use different antibiotics to fix it. It makes sense to me.

Same idea, but generally same bug. There's differences, but generally same bug. So same idea. So this medication is really critical because with MDRTB, you don't have a lot of options to treat it. And you need something that's a pill because a lot of the parts of the world that are really affected by TB, it can be hard.

Like that delivery of healthcare can be more difficult because we're talking about resource limited settings or rural settings where it can be hard to get like injections or IV meds out to people. You need stuff that travels easily. And the reason that John Green drew attention to it and that we are talking about it now is that this medication was about to come off patent this year. That's a big deal for medicines. This is something that is like a lot of us in healthcare will sort of track occasionally when there's a medicine that a lot of our patients want or one that we Know works well and are trying to give to people

When it's when it's first introduced the drug company that makes it will patent it, right? Right because they want to make money off of it And then you know the argument that they will always make which is to some degree true We spend a lot of money and time making it. And so now we need a return on our investment. So they patent it to protect it, so other companies can't make it. Other companies can't make the same thing, and you can't make generics of it for cheap. So then basically they get a monopoly on it.

They get to set the price, and whatever they said is what you have to pay. An insurance company's may choose to cover it or not. For most of these drugs, when they're first introduced, the idea that you could afford the amount of pocket is not realistic for the vast majority of Americans. And I know, by the way, this system can work differently in different parts of the world. I'm speaking primarily about the way the pharmaceutical industry operates in the United States of America. There are still these issues because pharmaceutical companies are multinational, you know,

giants, for the most part. The company that made this med Johnson and Johnson is also Janssen. It just depends on where you are. But anyway, so a lot of there are issues with the pharmaceutical industry and probably the entire world. To exactly like Mickey Mouse. Mickey Mouse What well Mickey Mouse is supposed to end in public domain and Disney keeps fighting to keep Mickey Mouse out of the public domain Because they want to hold on to him 24 Mickey Mouse theoretically in Earth's public domain But it's just steamboat willy Mickey Mouse, so no gloves no color But if you want to draw black and white Mickey Mouse They can't stop you anymore. Let me ask you something. Yes.

So is the real, like the version of Mickey Mouse that we know today, what number like trademark are we on? What do you mean? Well, you said that it's just a steamboat Willie one. Yes. It's not the number, it's not re trademark. It's an element of his appearance. So the gloves weren't instinctive but willy.

They weren't until the big year after. So, so, 2025, then you could do that version of Mickey Mouse. And he wasn't in color until 1935. So, that's when you can do that. Okay, no, this is a really good analogy for what I'm gonna explain to you about drug patents. So, so keep that in that. Okay. No, this is a really good analogy for what I'm going to explain to you about drug patents. So keep that in mind. The only Mickey Mouse you can use next year will be the Steamboat Willie Mickey Mouse.

We're going to get to that. That's a good analogy for this. So the drug, this drug beta quilling was introduced in, well, first it was like mentioned, it was investigated all the way back in 2004. In this country, in the United States, it was investigated all the way back in like 2004. In this country, in the United States, it was introduced in 2012. And it is a, you know, it's this blockbuster drug at the time. Like when it was introduced, it was a big deal because it treated this really resistance train of TB. It was a pill. In case you're curious, it is a a viral quinolone antibiotic if you want to know what

class of drugs it is. And basically the way that it works in TB is it blocks the synthesis of something called ATP, which is like energy for the tuberculosis bacteria and it kills. Your losing, your losing. It doesn't matter. Pull up, pull up, smile your losing. It kills TB that other drugs can't.

And it was, when it came out, it was the first drug, new drug, the first new drug, I should say, for TB that had been introduced in over 40 years. So it was a huge deal when it came to the market. And a lot of people who were working to fight TB and try to eradicate TB in different parts of the world, were really thankful that this drug was introduced. And the people who are rooting for TB

and trying to get it spread everywhere, they were very frustrated. Ah, not again. We're just making some end-way. We're trying to give everybody TB. I mean, I guess it's just TB at this point. It was on the other side. Tiberculosis itself was upset.

Yeah, sure. If it has like a, if it's sentient and has a, it probably has a few boosters. There's people that watch like NCIS, you know what I mean? I don't see why there's not people that cheer for tuberculosis. I don't think this, I don't think you can draw a girl. Benshopero has fans.

Why can't tuberculosis have fans? There you go. That's where I would put TB right alongside Ben Shapiro. So anyway, and I know like in that story, okay, so TB largely affects parts of the world where there's resource limited people are living in povish settings. So you could start to see like Johnson and Johnson in this scenario is like, and there hadn't been a new drug introduced in 40 years, they took a risk, right?

Like you could make that argument, like deciding that these are the people we want to focus on. This is the issue we want to address, and this is the drug we want to develop, knowing the patient populations aren't going to have like a ton of cash to pay for it. Like, you know, it's not like they made a new vanity drug, right? So like a lot, and that's, and the reason I'm saying this is that this is always the argument on the side of the pharmaceutical industry. We took a big risk. We made a med that you really need it. And it was first like it took them like eight years of development beyond all of the early stuff that led to the development of this drug. So like it is, I guess that is kind of a risk. Now on the flip side, TB is a big deal.

As of 2021, there's the last stats that I found, 1.6 million people around the world died from tuberculosis. And it specifically affects some populations more than others. So like 187,000 of those people also have HIV. TB is the 13th leading cause of death worldwide. And it was the leading cause of it, like, of death infectious disease wise.

It was the number one infectious disease killer worldwide until something took its place. COVID COVID. I imagine that in the coming years, TB will again reclaim that first position. So it takes more lives than HIV, AIDS, which I think we probably hear more and talk more about overall, at least in this country than we do tuberculosis. And even has not that much. Right, exactly. Not enough at least.

So it is a giant problem in 2021, 10.6 million people had, you know, got sick with tuberculosis. And it is curable, by the way. So when we talk about how many people die of it, TV is curable. We can fix it. There also is a vaccine. Now in this country, we don't get it, but it is something that you get depending on where you live. So it's preventable and it's curable and it's still killing this many people.

That's a question of will and resources, right? Exactly. Exactly. It is a public health crisis that persists that we are not doing enough about as a global community. So there are entities addressing it aggressively. We should be doing more. So this medicine coming off patent is going to be a huge big thing, right? Exactly, because the regimen for multi-direg resistance TB that was out there prior to beta-quilling being introduced required like 20 months or more of treatment, a combo of medicines, daily injections, and they had much higher adverse events related to those medications. So the previous regimen was difficult, dangerous, hard to deliver, not effective, but like,

you know, not efficient, not applicable to most people. Beta Quilling changed the game, but it was expensive. It was expensive as soon as it was introduced, you know? Because it's a new med. And as John's would tell you, you don't wanna make their nut? They wouldn't do that. Well, but they, I think it's really important,

like pharmaceutical companies are pretty good about not saying that. That. They, like that is true. I mean, it's capitalism. They're for companies, for companies. This isn't a charitable organization. Like, they're not, no, but they don't say that.

What they say is, listen, we put so much money and time into this. Time that we could have done other things. We did this. So all that money, we have to recoup that for the next big innovation. We're really hurting them. Like, right, like, like, if the old way we can continue to innovate is if we make money to, you know, encourage us

to do so. This is capitalism. But here's what I would tell you about, and I want you to think about this as we talk about the patent battle that is maybe coming to an end right now. How much of beta-quilling did J&J pay for? Because when we talk about who to help. No, like the, in the whole cost of making it, making it something that was approved and came to market.

How much did they put in? Because there are studies out there you can find. I found a 2020 study specifically asking who paid for this drug, whose money was spent in the development of this drug, whose money was spent in the development of this drug, meaning who should get to profit off of it, or how much should it cost? That's the bigger question, not who gets the profits, but depending on who paid for it, is it fair for them to charge as much as they do, for the markup on these drugs to be as completely wild as they often are? And by the way, those prices climb as they get closer to going off patent.

Where? Yeah. Where? It's so weird. So here's what you need to know about beta-quilling. Public contributions, meaning clinical trials that were funded by tax dollars or grants. Okay. Money that came from the taxpayers, okay?

You and I, Joe, Joe worker. So through public contributions, it was between $109 and $252 million. These are US dollars. Tax credits were 22 to 36 million. Tax deductions were 8 to 27 million. Administration of a donation program was 5 million. There were PRV revenues. It were 300 to 400 million. administration of a donation program was five million there were PRV revenues that were three hundred four hundred million total public investment in this drug was between four fifty five

to seven hundred and forty seven million dollars is our job the uh... j and j put in ninety to two forty million so depending on i mean because all of this all of this, it's hard to get the, nobody wants you to know the exact numbers. So either way, the public contributed at the low end 1.6 times as much money as the private company on the high end 5.1 times, as much money. We pay for these drugs, everybody.

It's our drugs. I'm not saying that the company doesn't also, I'm saying that the primary funder for medical innovation is us. We, like, we the people are paying for these medications. And then when we the people see them approved by the FDA, and then we can get them and we're sick and we're like, hey, I paid for that. Give it to me. They say, it's going to be thousands of dollars and your insurance company won't cover it.

Sorry. And this isn't just leveled at J&J. All the, and every company that we, we lauded for making a COVID vaccine and we were so cheering on our favorite. Big pharma. Remember, they all do this. So this isn't one company. Classic solvans.

Classic solvans is back. We're fighting again. We had a brief honeymoon with the drug companies when they were making COVID vaccines. And now we're back on their butts. So, and I mean, I think that the question is, how much money do you need to make off of a life-saving drug before you consider it worth your while to save lives? Yeah.

And I think this is hard because there are scientists, we've said this with the COVID vaccine. There's scientists behind all this who I know don't feel this way, who I know aren't making this, who aren't sitting there in their labs for days and weeks and months and years, perfecting these molecules, thinking, I'm gonna make so much money. That's not what they're thinking. Well, it's not what they're thinking. No, I know, that's what I'm saying.

And this is what sucks is if you break it down to any individual human in the chain, and you ask them about the morality of this, then they would probably say, oh, yeah, we should try to help people. This is the problem living in the capitalist system. They are not just encouraged, but required to try to squeeze as many nickels out of everybody as they can.

People get freaked out about AI, drives me crazy. You know, we've already been living under the tyrannical rain of an algorithm for years now. It's a bunch of humans serving this algorithm that will give them the most money. Like we've been doing it, right? So no one is to blame other than, I mean, I'm sure there are people to blame.

But the system is built for this. Like this is what it's supposed to do. I'm gonna start calling you Neo if you keep talking like this. Really? Like from the Matrix? That's cool. Yeah, I could get down with that. No, but I mean, what you're saying. I know Kung Fu. What you're saying is right. I don't. Also, recognizing that that a pharmaceutical company is not a single human. It's in a mahogam of a bunch of different people

who don't necessarily feel this way. Extrably, this out to out of housing developments. Right. We have homeless people. You're building building. You're building houses. Why can't you make them like a, so you make enough money to pay your people? And then also you put people who don't own homes in them. Well, because that's not the system. The system is we get as much money forward as as we humanly can and otherwise we're failing the system. And, well, and we have a lot of intellectual frameworks that have been constructed around that to tell us that it's the right thing to do. But I think, but like John Green called on this, and this helped turn the tide on this issue, there are lots of people who work for these companies who are good people who don't agree with this.

And if you ask them, the problem is that the corporation gets to be a thing of its own in this society. The corporation can have wants and needs and desires and demands. And it is much more powerful than us, the individual. Because it's a moral smoke screen that allows people to operate with moral impunity because they're serving this capitalist system. It's and things have moved far away from like, I always think about Jonas Salk with the polio vaccine. He didn't patent it because he said, could you patent the sun? We've moved

a long way. Those people are still there. Now there's people, there are Jonas Salks there. Yeah, but there's also people in the government who was like, can we patent this on? Actually, that's a great idea, Jonas. Thank you so much. I know. Anyway, so where does that leave us with beta-quilling and the patent? Why? It was filed initially in 2003, generally patents last 20 years, generally.

It's 2023, it's time for it to end, so what's the beef? I'm gonna tell you after we go to the billing department. Let's go. Let's go. Let's go. Let's go. Let's go. Let's go.

Let's go. Let's go. Let's go. Let's go. Let's go. Let's go. Let's go. Let's go. Let's go.

Let's go. Let's go. Let's go. Let's go. Let's go. Let's go. Let's go. Hi, I'm Ketchum. And I'm Sox. And I'm Ball Bearings. And I'm Pigeons. And I'm Water Towers. And I'm Cardboard? Surprise! We're actually humans.

Humans making a podcast about those kinds of topics. Because those are real episode topics on the podcast, secretly incredibly fascinating. That's a podcast where we take ordinary seeming things like Ketchum and Sox and Cardboard and bring you the little-known history and science and stories that make those things secretly incredibly fascinating. Secretly incredibly fascinating! The title of the podcast! Hear the back catalog any time and hear new amazing episodes every Monday at MaximumFun.org.

You want to hear a celebrity impression? Where's the beef? That's good. Where's the beef lady? That was a good one. I think I... 80s to the love that. Okay.

So like I said, the patent should be running out this year. Everybody's very excited. Like, I found a lot of articles like written last year that are like, it's a new era. Beta quillings going off patent. We are so freaking excited. I love scientists who write that kind of stuff. I mean, it's a big deal for saving lives. And by the way, patents and exclusivity

are two different things when it comes to pharmaceuticals. And they can run concurrently. You can have exclusive rights to a drug, meaning you can't have generics and you can also patent a drug so nobody else can make it. And I don't know. But the important thing for this is the patent. They're all different rules and I read them

and I wish I was a lawyer to understand them. Anyway, so J&J is fighting it because kind of like what you said with Mickey Mouse, this is a good analogy, okay. Another life-saving. Another life-saving is pharmaceutical. Mickey Mouse. So in 2003, they patented beta-quilling.

Well, in 2007, J and J filed another patent on it for another piece of it. Cause there's lots of different things that go into the drug itself, right? Right. There's like figuring out the active part that does whatever it does to the organism or in your cells or whatever.

But there's like how you package it, there's how it gets into cells, there's the delivery mechanism. There's lots of different pieces to a pharmaceutical. And every one of those can be patented. So, Steamboat Willie can be patented, but then when you add gloves, that can be patented. And then when you make him color, that can be patented. All that is true about medications. And when you patten a new part, a term that they use for

that is ever-greening, Do you restart the patent clock, basically? Have you made it? So now we're 20 years from 2007, which is what Jay and Jay has been saying. Oh, well, actually, we're gonna honor this in four years because that's when the patent expires because of this other thing we did in 2007, which is legal, by the way.

Like, they're not doing anything that isn't legal. This is legal. You can do this. It's worth, it's worth noting also that in Disney's case, they have fought and lobbied to change the law, the law to make it so that Vicky Walsh doesn't go into the public domain. Yeah. Well, and J&J is not doing anything that is illegal, which shouldn't give them, I mean, that doesn't let them off the hook.

What it says is who wrote the laws and whose interests were they serving. But and I should just, by the way, there are TB activists who have been trying to make this happen for a long time, who have been arguing these cases for a long time. Like this isn't, we, all of us in the podcast and video and social media world who pay attention these things and do our best to be science communicators and do our best to tell you about stuff. Like we are, we are standing on the shoulders of giants who have been doing this kind of work for a long time. And there was a huge global campaign in October of 2019, where

medicines, sans frontiers, which is doctors without borders. It sounds bad. Don't you think it's better? It's better. It's better. It's better. It's better. It's better. But they got together with TB activists and they had this huge campaign outside all the J&J offices in the US, in South Africa, in Brazil, in Belgium, in Ukraine, in Spain Spain basically demanding that they lower the price of beta-quilling to no more than a dollar a day for patients with MDR TV. So this has been happening for a while.

Now, now all these activists demanding this doesn't always necessarily mean they change their minds. But that's what that has been building to this. And this happened, by the way, we've talked before about the initial AIDS epidemic, these sorts of things happened, right? Demanding people need these drugs. We can't wait, we don't care about your patent. 20 years is too long.

Do you know how many people will die? Do you know how many people would have died in the next four years if they maintain their patent? How many? Six million. That's so many. So how can you make more than one patent on a single medicine? That was a question I had.

Well, we kind of talked about that. Like, you can patent different pieces of it. There can be novel stabilizers or capsule coatings or like a good example is the delivery mechanism of a butyl. So a lot of you may use an albuterol and halor if you have asthma or COPD or something like that, right? And it helps open your airways, this drug. It's old drug.

The delivery mechanism of your little teeny inhaler, the little L-shaped thing that you squirt in your mouth, that changed at one point mainly because we wanted to eliminate chlorofluoracarbons, CFCs that were used in the way that it squirts in your mouth. And when they changed that, they were able to extend patents. It's why a butyrol and hairlars have stayed expensive. Nowadays, they're finally generic, some of them. But for a long time, I remember buying my patients, they're a butyrol and hairlars, because they didn't have insurance, this is prior to the Affordable Care Act.

And like the cheapest, yeah, literally, thank you. The cheapest that I could often get was between 40 and 50 bucks. For literally a life saving inhaler. For a drug that had been around for, who knows how many decades. But anyway, so you can do that. So to give you an idea why beta-quilling isn't the end of this fight. The top 12 brand drugs on the market last year were protected by 848 total patents. It's an average of 71 per drug. That's 38 years without competition on average.

So that 20 years is just like that's the opening offer from the patent office a lot of the times. Humera, which treats kind of arthritis and is a really important drug and you can read there are lots of articles about how Humera, they had 132 patents that were granted. And that was I think less than half of what they attempted to patent. I think they tried to patent over 300 different aspects of Humera and have made billions off this drug, by the way, that is absolutely essential for some people and they just cannot get access to. And they call these patent thickets, by the way.

Patent thickets? Uh-huh. You create a patent thicket around your drug so that you can make as much money off it as possible for as long as possible. There's a patent thicket around your drug so that you can make as much money off it as possible for as long as possible. There's a patent thicket of 96 patents around Revlimed, which is a cancer drug. So that could, if they all hold, that's 40 years with no competition. Same with Lantis, which is a really essential insulin. A lot of my patients need it or use it, and it has 49 patents. So anyway, this is not just a J or use it, and it has 49 patents.

So anyway, this is not just a J&J problem. This is a systemic problem. Now, the Green Brothers brought a lot of awareness to this. A lot of people on social media took notice. There was a lot of pressure on J&J to do, we say do the right thing, but I think this is all like, this is moral relativism, right? In this situation, the right thing is to let the patent expire. I think there's probably a better

right that could have been done, right, but there were past that point. So to do the right thing, and they got, and they, and this is in addition to all the pressure they were already getting from the global community for years now, right? This sustained pressure, this was sort of the tipping point. And Johnson and Johnson announced yesterday, that was Thursday the 13th, that they had granted stop TB partnerships, global drug facilities licenses that enable global drug facility to tender procure and supply generic versions of, oh, the branding for this is searcher row. Searcher row or beta quilling for the majority of low and middle and come countries.

It's too bad instructor, doesn't it? And I am searcher row. I'll be guiding you through the depths for the majority of low and middle income countries, including countries where patents remain in effect. So that all that sounds good. Okay. That sounds good. Hopefully that will play out like they say. Now I always I always think like I mean they can supply generic versions for the majority of low and middle income countries for the majority. So there's wiggle room in here. And I think that that, that of course is concerning. And so in response to that, as John Green pointed out, what we still need to get Johnson and Johnson

to do is commit to this deal with the global drug facility in perpetuity. Like don't go back on it. Yeah. Next year, when you decide to file a new patent because you did something else or whatever, or because you decide to defend, I mean, I don't know how many patents there are, I'm bed acquilling, these are the two I know about. How many could there be? And if you are gonna do it,

will you at least give solbona's a heads up this time so we can get out in front of this thing and not leave the green brothers to get all the credit? Really, guys? Yeah, I don't know. John, for John Green writes the best the only book of that, the year that Fulmer Sharks amount, Hank has everybody loves Hank now

because he's in an incredibly inspiring cancer battle. This is ridiculous. Let us get a hand on the ball. Please, we're all trying our best here. The green brothers are making coffee that funds like villages and stuff. like, please guys, leave a little bit of credit for the rest of us. Please leave some good works undone.

So we are friends with the greens. We like greens. This is a good, this is a good, this is a good, this is a good, said. Make keeping the TV drug generic is a step too far. Hey, good job. You hear me? You've gone too far.

You saved too many lines. You saved too many lines. Don't do any good works. We said the doctor here. We've something for the rest of us. And I'm a podcaster. This is close to I get, guys. You gotta give me something.

A couple other things remember, in addition to the deal being in perpetuity, they need to give us a list of what countries do you mean? What do you mean the majority? Like which ones and who are you leaving off and why? I mean, I think that that's a little sketch. And then publicly announced, acknowledge, and this is the other part, any other patents, that this amounts to a functional abandonment of secondary patents on beta quilling in countries with high TB burden.

So that's the last piece of this that they really need to do because otherwise, they could come in like I said, companies create these patent thickets, or they could just call on a different patent. I mean, the problem is like, if you start making these generics and then they decide like, okay, actually, we only were giving you this deal for a year, and it's over now, and now we're defending our patents again. They've got the weight, they've got the money,

they've got the power, they've got the legal prowess, they've got it, they can do that, they can stop you. And those of us who work in healthcare activism or in these medical nonprofits or these, I mean, there's only so much we can do to fight back. Now, who could fight back? The Green Brothers. Well, obviously the Green Brothers.

Aside from the Green Brothers, the governments. Oh yeah, yeah, yeah, forgot. Why are pharmaceutical companies allowed to, you know, do this to us. So you're saying there's still more work to do? Yes, I'm saying that they're that sustained vigilance, attention, outrage is necessary so that they don't go back on these things so that they don't, and this happens a lot when a corporation comes under like a negative spotlight, is they'll do something quickly to try to kill the noise. And then everybody goes, oh yay, we fixed it.

And then they move on to the next thing, right? Because that's the nature of, especially like with social media. What's the next thing? What's the next thing? That's how we all are sort of trained. So you're saying that the greens left the job have finished?

No, I'm not saying that. Pretty sloppy sloppy guys. Guess it's time for your sub-ignits to take it. No, because John is the one that pointed out that we need to, we need to continue to demand these other things, because it's not enough to just stop there. We need more. And I don't know, I mean, I don't trust. The Green Brothers, me neither, yes. If a company, and this isn't even about trust, because I don't want. I mean, I don't trust. If a green brother is me neither, yes.

If a company, and this isn't even about trust, because I don't want to make this an emotional thing, if a company's goal is to make money, which it is, if you build a business that's for profit, what's your goal? Make money. I mean, that's intrinsically what it is. Like you do whatever else you do, but like your goal is to make money, you know, you don't like sell pants because you are passionate about, you know, else you do, but like your goal is to make money. You know, you don't like sell pants because you are passionate about, you know,

maybe you're passionate about pants, but like you hope to make money off the pants, right? You've really got me with this metaphor, please make a way. When in healthcare, my goal is never to make money. My goal is to take care of people. And so when the two start getting intertwined, people will get hurt inevitably, because the companies are trying to make money. And those of us who need to

get these drugs to the patients are just trying to save lives. Our goals are not the same. And sometimes they run it cross purposes because I don't care if you make money. Give me the frickin' pills so people don't die of a curable disease in the year 2023. And people are not sentenced to die because they happen to be born in a part of the world with less healthcare resources or because they happen to be born impoverished. It's not, that is not the equitable society that we want to live in. And so healthcare cannot be left up to the capitalist free market. Thank you so much for listening to our DSA podcast.

We hope that you have enjoyed it. Let's start, go ahead. Can I say one other thing? We've talked a lot about the Green Brothers too. Again, I would just like to reassert, we are friends with. And you can, you can, you can, you're out on your own on this one, okay?

And I would also like to say, a of you wrote in when Hank announced his diagnosis and asked us to talk about the type of cancer Hank has and all that. Here's what I would tell you, first of all, Hank, of course, is an excellent science communicator. And if you are not already following and listening to the various things Hank puts out in the world, whether YouTube's or TikTok's or whatever, you should be because Hank is doing a far better job than I ever could of educating people about what he's going through and what the implications of that are. I mean, and not just like his personal experience, but like the scientific ins and outs. He is doing a, I don't even have the

words for it. An incredible job. It's incredible. It's it is truly, it is truly, he's made me cry many times watching the strength of going through it and describing it in great detail. And I don't, there is no, there's no need for me to tell that story because he's doing it. You can follow him. So his, his TikTok handle is at the McElroy family. So go follow him right now. Dustin. It's what America needs you to do. Well, you really appreciate it.

And of course, we all are thinking about Hank and wishing him the best. Yeah. By the way, they're genuinely actually good human beings. If you know them in real life, they're as good as they seem. Thanks so much for listening. Uh, thanks to the taxpayers for using their some medicines as the intro and outro of our program.

And thanks to you, the people for listening. We appreciate it so much. That's going to do it for us for this week until next time. And I'm Justin McRoy. I'm Sydney McRoy. And as always, don't drill a hole in your head. Maximumfun.org. Comedy and culture.

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