For 72 hours, Shkreli’s response was well encapsulated in his tweet that said the media can have his middle finger. And then on Tuesday night, he did what no one expected: He stopped antagonizing his antagonists. He even locked his Twitter account, making it private. Shkreli gave one final interview to NBC News, in which he appeared to have conceded slightly in a passive-voice apology, saying, “I think that it makes sense to lower the price in response to the anger that was felt by people.” He did not specify the extent of that lowering, only that it might make sense to have “an affordable price.” He did manage to get headlines this morning to say that he had reconsidered, implying that he has a heart, or is at least responsive to public outrage. That remains to be seen, though it would be a small victory.
Shkreli already considered the price increase to $750 to be “not excessive at all.” Daraprim treats toxoplasmosis, which kills people with weakened immune systems, as in AIDS and during chemotherapy. The parasite Toxoplasmosis gondii lives inside of one third of all people, in little cysts that go unnoticed because they are quarantined in our brains and livers by our immune systems. When those defenses deteriorate, though, the parasite is unleashed and attacks the brain and eyes of its host, resulting in blindness, seizures, and loss of cognitive faculties. One study found that toxoplasmosis encephalitis affected 25 percent of AIDS patients, of which it killed 84 percent.
“I can see how it looks greedy," Shkreli told CBS's Don Dahler on Tuesday morning, after multiple infectious-disease specialists protested that the 5,500 percent price increase would make treatment unavailable to many people in dire need. “But,” he continued, “it actually has a lot of altruistic properties.”
“Altruistic?” Dahler raised both eyebrows.
“This is a disease where there hasn't been one pharmaceutical company focused on it for 70 years,” Shkreli continued, the corners of his mouth angled upward. “We're now a company that is dedicated to the treatment and cure of toxoplasmosis. And with these new profits we can spend all of that upside on these patients who sorely need a new drug, in my opinion.”
Of course, pyrimethamine (Daraprim) is usually an effective treatment for toxoplasmosis. The “we need to subsidize research” explanation is the important part of his argument, and this entire story. That’s the standard defense pharmaceutical companies use to justify high prices. And it almost makes sense.
Medical research is extremely expensive. Except that most of the key innovation is still coming from academic medical centers, funded by taxpayers. Pharmaceutical companies then take that innovation and turn it into a marketable product. That costs money, but not billions of dollars. How anything could justify a drug costing hundreds or thousands of dollars—in the case of the hepatitis C medication Sovaldi, which costs $84,000 for a 12-week course of treatment—while still clearing a 30-percent industry-wide profit margin is difficult to conceive. It might be easier to conceive if budgets were transparent. But, as Gregg Gonsalves, co-director of the Global Health Justice Partnership at Yale Law School emphasized to me, no major pharmaceutical company has ever been willing to disclose how much it actually spends on research and development.