Why are drug prices so high? Investigating the outdated US patent system | Priti Krishtel

翻译人员: Jiasi Hao 校对人员: Lipeng Chen

For my husband, it was love at first sight.

对我丈夫而言， 他是一见钟情。

(Laughter)

（笑声）

Here's what happened.

当时发生了这么件事。

Years ago, Rudy,

几年前，鲁迪，

who I had strictly put in the friend zone at the time,

当时一直被我严格定义为 朋友关系的这个人，

came over to my house and met my dad,

来到我家，遇见了我父亲，

a pharmaceutical scientist who had just retired

一位将一种新药推向市场后

after bringing a drug to market.

刚退休的药物研发科学家。

My dad said,

我父亲说：

"Ah, you probably wouldn't have heard of it.

“啊，你可能从没听过这种病。

It's for IPF,

这药是针对 IPF 的，

idiopathic pulmonary fibrosis."

特发性肺纤维化 （Idiopathic Pulmonary Fibrosis）。”

Rudy paused for a long time, and then he said,

鲁迪沉默不语了一阵， 之后说道，

"That's the disease that took my father's life 15 years ago."

“这是在 15 年前 夺走我父亲生命的疾病。”

鲁迪说那是他 陷入爱情的瞬间——

Rudy says that this is the moment he fell in love.

（笑声）

(Laughter)

With my father.

爱上我父亲的瞬间。

(Laughter)

（笑声）

Even though it was too late for my dad to save his,

尽管我父亲的发明 没来得及拯救他父亲的生命，

he felt that destiny had delivered us this full-circle moment.

但他觉得命运已经给了 我们一个完整的瞬间。

In my family, we have a special love for my father's inventions.

在我家，我们对父亲的发明 都情有独钟。

And in particular, we have a reverence for his patents.

尤其对他申请到的专利们， 有着崇高的敬意。

We have framed patents on the wall in our house.

我们家有面墙上 挂着都是裱好的专利证书。

And there's a recognition in our family that everything I've been able to do --

而且在我家，我们有一个共识： 至今我能做到的一切——

college, law school, health justice work --

大学、法学院 和健康公平相关的工作——

all of it is because America enabled my father

所有的这些 都是因为美国使我父亲得以

to fulfill his potential as an inventor.

充分发挥作为一个发明家的潜力。

(Applause)

（掌声）

Last year, I met the director of the US Patent Office

去年，我第一次见到了

美国专利局局长，

for the first time,

and I sent my family a selfie from that office in Virginia.

从弗吉尼亚的那个办公室里， 我给家人发了一张自拍。

(Laughter)

（笑声）

我收到了好多表情符号的回复，

I got so many emojis back,

you would have thought I had met Beyoncé.

会让你误以为我遇到了碧昂斯。

(Laughter)

（笑声）

然而真相是，

But truth be told,

I was actually there to talk about a problem --

我之所以会在那里 实际上是为了探讨一个问题——

how our outdated patent system is fueling the high cost of medicines

我们过时的专利制度 是如何以生命为代价

and costing lives.

助长了高昂的药物成本。

Today, over two billion people live without access to medicines.

如今，超过 20 亿人 没有渠道获得所需药物。

And against this global crisis,

在这场全球危机中，

drug prices are skyrocketing,

包括相对富裕的国家在内，

including in wealthier countries.

药品价格飙升。

Thirty-four million Americans have lost a family member or a friend

在过去 5 年， 3400 万美国人因此失去了

in the last five years,

家人和朋友，

不是因为无药可救，

not because the treatment didn't exist,

but because they couldn't afford it.

而是因为他们负担不起。

Rising drug costs are pushing families into homelessness,

上升的药物成本正把 无数家庭逼向无家可归，

seniors into bankruptcy

老人们几近破产，

and parents to crowdfunding treatment for their critically ill children.

还有家长们为 身患重病的孩子们众筹治疗。

There are many reasons for this crisis,

造成这场危机的因素有很多，

但其中一个因素， 是我们过时的专利制度，

but one is the outdated patent system

that America tries to export to the rest of the world.

这个美国尝试 出口到世界各个角落的制度。

The original intention behind the patent system

这一专利制度的本意

was to motivate people to invent

是通过给予一个限时垄断的机会

by rewarding them with a time-limited monopoly.

来激励人们发明创造。

But today, that intention has been distorted beyond recognition.

但如今，那个本意 已被扭曲得面目全非。

Corporations have teams of lawyers and lobbyists

企业们有整个律师和说客团队，

whose sole job is to extend patent protection as long as possible.

他们唯一的工作就是 尽可能延长专利保护时限。

And they've kept the patent office busy.

他们让专利局忙得团团转。

It took 155 years for the US Patent Office

美国专利局花了 155 年的时间

to issue its first five million patents.

来发行其首个 500 万美元的专利。

It took just 27 years for it to issue the next five million.

它又花了 27 年的时间 来发行下一个 500 万美元的专利。

We haven't gotten drastically more inventive.

我们还尚未变得更具发明力，

Corporations have gotten drastically better at gaming the system.

但那些企业们却已开始 玩弄这个体系。

Drug patents have exploded --

药品专利激增——

between 2006 and 2016, they doubled.

在 2006 至 2016 年间， 专利数量翻倍。

But consider this:

但思考一下：

The vast majority of medicines associated with new drug patents

绝大部分获得新药专利的药物

are not new.

并不新。

Nearly eight out of 10 are for existing ones,

几乎 10 中有 8 的药品 是现有药物，

like insulin or aspirin.

例如胰岛素和阿斯匹林。

My organization, a team of lawyers and scientists,

我的组织， 一个由律师和科学家构成的团队，

recently conducted an investigation into the 12 best-selling drugs in America.

近期针对美国最畅销的 12 种药物 展开了一个调查。

We found that, on average,

我们发现，

每一种药物 平均有 125 项专利存档。

there are 125 patents filed on each medicine.

Often for things we've known how to do for decades,

几十年来， 我们一直知道如何做的事情，

like putting two pills into one.

例如把两个药片混合成一个。

The higher a patent wall a company builds,

一个企业的专利墙筑造得越高，

the longer they hold on to their monopoly.

其垄断地位便可维持得更久。

And with no one to compete with,

何况没有竞争对手，

they can set prices at whim.

他们可以拍着脑袋随便定价。

And because these are medicines

外加产品是药品，

and not designer watches,

而非名牌手表，

we have no choice but to pay.

我们别无选择，只能掏钱。

The patent wall is a strategy to block competition.

专利墙是阻碍竞争对手 进入市场的一个策略。

不是美国专利制度创始人

Not for the 14 years maximum

that America's founders originally envisioned,

当初设想的最多 14 年，

or the 20 years allowed by law today,

也不是现在法律允许的 20 年，

but for 40 years or more.

而是 40 年，甚至更多。

Meanwhile, prices on these drugs have continued to increase --

同时，那些药物的价格 还在继续增长——

68 percent since 2012.

自 2012 ， 68% 的增速。

That's seven times the rate of inflation.

这是货币通货膨胀率的 7 倍速。

And people are struggling or even dying,

人们在挣扎，甚至奄奄一息，

because they can't afford the meds.

因为他们买不起药。

Now I want to be really clear about something.

现在，我想要澄清一下。

This isn't about making the pharmaceutical industry the bad guy.

这并不是意味着 把制药行业看作是坏人。

What I'm talking about today

我现在所说的是

is whether the system we created to promote progress

我们为进步而创立的制度

is actually working as intended.

是否真的在起这样的作用。

Sure, the pharmaceutical companies are gaming the system,

当然，制药企业在玩弄这个制度，

但他们玩弄，是因为他们可以，

but they're gaming it because they can.

是因为我们未能让这个制度

Because we have failed to adapt this system

to meet today's realities.

适应当代的现实环境。

The government is handing out

政府现在正在发放

one of the most prized rewards in business --

最具价值的一个商业奖励——

创造一个 能免于竞争的产品的机会——

the opportunity to create a product that is protected from competition --

and asking for less and less in return on our behalf.

并且对我们要求的回报越来越少。

Imagine awarding 100 Pulitzer Prizes to one author for the same book.

想象为同一本书的一位作者 颁发 100 项普利策奖。

(Murmurs)

（低语）

It doesn't have to be this way.

这并非是唯一的出路。

We can create a modern patent system

我们可以建立一个现代专利制度

to meet the needs of a 21st-century society.

来满足 21 世纪的社会需求。

And to do that,

为了做这件事，

we need to reimagine the patent system to serve the public,

我们需要重新设想专利系统 服务公众使命，

not just corporations.

而非仅仅让企业获利。

So how do we do it?

所以，我们应该怎么做？

Five reforms.

五个改革。

First, we need to stop handing out so many patents.

首先，我们需要 减少专利发放数量。

回顾肯尼迪政府，

Back under the Kennedy administration,

in an effort to curb rising drug costs,

为制约药品价格飞涨，

a congressman from Tennessee proposed an idea.

田纳西州的一名国会议员 提出了一个想法。

He said,

他说，

"If you want to tweak a drug,

“如果你想要微调药品成分，

and you want to get another patent on it,

从而给药品再另上一个专利，

the modified version has to be significantly better, therapeutically,

改良版本的药品在病人身上

必须呈现显著增强的治疗效果。

for patients."

Because of intense lobbying,

当时因为激烈的游说，

这个想法从未能被通过。

this idea never saw the light of day.

But a reimagined patent system

但是对专利制度的重构

能够让曾经那个简单却优雅的提议 重见天日并发展演变。

would resurrect and evolve this simple, yet elegant proposition.

That to get a patent,

为了获得一个专利，

you have to invent something substantially better

你必须发明 和现有解决方案相比

than what's already out there.

实质上更好的一些东西。

This shouldn't be controversial.

这不应该成为一项争议。

As a society,

作为一个社会，

we reserve the big rewards for the big ideas.

我们为大胆的想法 保留丰厚的奖励。

We don't give Michelin stars to chefs who just tweak a recipe --

我们不会给只是微调食谱的厨师们 颁发米其林星级——

而是给那些改变我们 对食物的思考的厨师们。

we give them to chefs who change how we think about food.

And yet, we hand out patents worth billions of dollars

然而我们 却因一个微乎其微的改变，

for minor changes.

发放价值数十亿美元的专利。

It's time to raise the bar.

是时候提高门槛了。

Second,

第二，

我们需要改变专利局的财政激励。

we need to change the financial incentives of the Patent Office.

Right now, the revenue of the Patent Office

现在，专利局的收益

is directly linked to the number of patents that it grants.

是与授予的专利数量直接相关的。

That's like private prisons getting paid more to hold more people --

就好比私营监狱 收更多钱，来关押更多人——

it naturally leads to more incarceration,

自然而然导致更多监禁，

not less.

而非更少。

The same is true for patents.

对于专利而言，同样。

Third, we need more public participation.

第三，我们需要更多的公众参与。

现在的专利制度就像一个黑匣子。

Right now, the patent system is like a black box.

It's a two-way conversation between the patent office and industry.

这是专利局和行业之间的 一个双向沟通。

You and I aren't invited to that party.

你我从未被邀请参与。

But imagine if instead,

但设想，

如果专利局变身为 一个市民学习和创造力的活跃中心，

the Patent Office became a dynamic center for citizen learning and ingenuity,

staffed not just by technical experts and bureaucrats,

其雇员不局限于技术专家与官员，

but also by great public-health storytellers

也将把对科学充满热情的，

with a passion for science.

很棒的公共卫生故事讲述者纳入其中。

Regular citizens could get accessible information

常规市民因此能接触到

about complex technologies

复杂的技术——

例如人工智能，或基因编辑——

like artificial intelligence or gene editing,

enabling us to participate in the policy conversations

从而让我们能够加入到

that directly impact our health and lives.

直接影响我们健康和生活的 政策对话中。

Fourth,

第四，

我们需要有上诉的权利。

we need to get the right to go to court.

Right now in America, after a patent is granted,

当前在美国，专利被授予后，

the public has no legal standing.

公众没有法律地位。

Only those with a commercial interest, usually other drug companies,

只有那些有着商业利益的， 通常为另一个药企，

have that right.

才有有上诉权利。

But I've witnessed firsthand how lives can be saved

但我亲眼见证过 当每位市民有权利上诉时，

when everyday citizens have the right to go to court.

生命能如何被挽救。

Back in 2006 in India,

在 2006 年，印度，

my organization worked with patient advocates

我的组织 和病患拥护者们携手

在法律上挑战不公平的 艾滋病（HIV）药物专利。

to challenge, legally, unjust HIV drug patents,

at a time when so many people were dying,

因为药品标价不合乎常理，

because medicines were priced out of reach.

曾一度让大量患者垂死挣扎。

We were able to bring down the prices of medicines

我们通过不懈努力最终 使得药品价格

by up to 87 percent.

下降 87% 。

（掌声）

(Applause)

On just three drugs,

只是 3 种药物，

we were able to save health systems half a billion dollars.

我们便能为整个医疗卫生体系 节省 5 亿美元。

Now, cases like these can save millions of lives

诸如此类的案例 能够拯救上百万的生命

and billions of dollars.

和数十亿美元的开销。

Imagine if Americans had the right to go to court, too.

想想一下，倘若美国的普通市民 同样拥有上诉权利会如何。

And lastly, we need stronger oversight.

最后一点， 我们需要更强有力的监管。

We need an independent unit that can serve as a public advocate,

我们需要一个能够 以公共倡导者身份服务的独立部门，

regularly monitoring the activities of the Patent Office

对专利局的活动进行定期监察

and reporting to Congress.

并向国会汇报。

If a unit like this had existed,

如果这样的一个部门曾已存在，

it would have caught, for example, the Silicon Valley company Theranos

它本能早早地揪出 例如一家名为 Theranos 的硅谷公司，

before it got so many patents for blood testing

在这家公司为其血液检测技术 申请如此之多专利，

公司市场估值达 90 亿美元前，

and landed an evaluation of nine billion dollars,

when in reality,

然而事实是

there was no invention there at all.

这其中没有丝毫的发明创造。

This kind of accountability is going to become increasingly urgent.

这样的问责制度将变得 越来越迫切。

In the age of 23andMe,

在我 23 岁的时候，

important questions are being asked

很多人都在问我很多重要的问题：

about whether companies can patent and sell

企业是否可以申请专利

并且贩卖我们的 遗传信息和患者数据。

our genetic information and our patient data.

在一切为时已晚之前，

We need to be part of those conversations

before it's too late.

我们需要加入这场沟通。

Our information is being used to create the new therapies.

为开发新型疗法， 我们的个人信息正在被使用。

当负面诊断结果降临的瞬间， 于我和我的家庭，

And when that moment of diagnosis comes for me and my family,

or for you and yours,

或是你和你的家庭，

are we going to have to crowdfund to save the lives of those we love?

难不成我们别无他法，只能众筹 来医治我们所爱之人的生命吗？

That's not the world I want to live in.

这不是我想要居住的世界。

It's not the world I want for my two-year-old son.

这不是我想要我 2 岁儿子 生活的世界。

My dad is growing older now,

我的父亲正在慢慢变老，

and he is still as quietly brilliant and morally directed as ever.

但他仍旧如往常一样 低调、有才华，而且注重道德。

Sometimes people ask us whether things get heated between us:

有时人们问我们 我俩是否经常因不同身份而针锋相对：

the patent-holding scientist

一个持有专利的科学家父亲，

and his patent-reforming lawyer daughter.

和一个支持专利改革的律师女儿。

It's such a profound misunderstanding of what's at stake,

对于这个问题， 存在着一个很深的误解。

因为这与 科学家 vs. 活动家无关，

because this is not about scientists versus activists,

与发明 vs. 保护无关。

or invention versus protection.

This is about people,

这关乎于人，

our quest to invent and our right to live.

我们对发明的追求和生存的权利。

My dad and I understand that our ingenuity and our dignity

我和我父亲都深知 我们的创造力和尊严

go hand in hand.

是相辅相成的。

We are on the same side.

我们是并肩作战的。

It is time to reimagine a patent system

现在是时候考虑重构一个专利制度

来体现我们的深刻理解了。

that reflects that knowing.

Thank you.

谢谢。

(Applause)

（掌声）