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 Investigating the outdated US patent system | Priti Krishtel

譯者: Lilian Chiu 審譯者: NAN-KUN WU

For my husband, it was love at first sight.

對我丈夫而言，是一見鍾情。

(Laughter)

（笑聲）

Here's what happened.

事發經過如下。

Years ago, Rudy,

數年前，魯迪，

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

他當時被我明確歸在 一般朋友圈中，

came over to my house and met my dad,

他來我家見我爸爸，

a pharmaceutical scientist who had just retired

我爸爸是藥物科學家，

讓一種藥物上市場之後， 他便在不久前退休了。

after bringing a drug to market.

My dad said,

我爸爸說：

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

「啊，你可能沒有聽過它。

It's for IPF,

是治療 IPF 的藥物，

idiopathic pulmonary fibrosis."

也就是特發性肺纖維化病。」

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

魯迪沉默了好一會兒，接著他說：

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

「十五年前，這種疾病 奪走了我爸爸的性命。」

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

魯迪說，他就是在這一刻戀愛了。

(Laughter)

（笑聲）

With my father.

對象是我爸爸。

(Laughter)

（笑聲）

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

雖然已經太遲， 我爸爸無法拯救他的爸爸，

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

但他覺得，命運帶給 我們這個圓滿的時刻。

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

在我家，我們特別 愛我爸爸的發明。

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

我們特別崇敬他的專利。

We have framed patents on the wall in our house.

我們家裡牆上掛著錶框的專利。

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

在我們家中，大家都很清楚， 我所能做的一切——

college, law school, health justice work --

大學、法學院、 健康平等的工作——

all of it is because America enabled my father

這全部都是因為美國讓我爸爸

to fulfill his potential as an inventor.

能發揮他身為發明家的潛力。

(Applause)

（掌聲）

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

去年，我第一次會見

美國專利商標局的局長，

for the first time,

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

我從他們的維吉尼亞州辦公室 發了一張自拍照給我家人。

(Laughter)

（笑聲）

I got so many emojis back,

我得到好多表情符號回覆，

you would have thought I had met Beyoncé.

多到你會以為我見到碧昂絲了。

(Laughter)

（笑聲）

But truth be told,

但，說真的，

I was actually there to talk about a problem --

我是去那裡談一個問題——

how our outdated patent system is fueling the high cost of medicines

我們過時的專利制度 怎麼會促成藥物的高成本，

and costing lives.

並造成死亡。

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

現今，有二十億人 在生活中無法取得藥物。

And against this global crisis,

對這項全球危機更不利的是，

drug prices are skyrocketing,

藥物價格猛漲，

including in wealthier countries.

包括在比較富裕的國家也一樣。

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

有三千四百萬美國人曾經在過去

五年間失去一位家人或朋友，

in the last five years,

not because the treatment didn't exist,

原因不是因為沒有治療方法，

but because they couldn't afford it.

而是因為負擔不起。

Rising drug costs are pushing families into homelessness,

越來越高的藥物成本， 讓家庭變成無家可歸，

seniors into bankruptcy

讓年長的人破產，

and parents to crowdfunding treatment for their critically ill children.

讓父母必須要做群眾募款才能 讓他們生重病的孩子接受治療。

There are many reasons for this crisis,

這項危機會發生， 背後有許多原因，

but one is the outdated patent system

但其中一個原因就是美國試圖出口到

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

世界上其他地方的過時專利制度。

The original intention behind the patent system

最初創造專利制度的意圖

was to motivate people to invent

是要鼓勵大家發明，

by rewarding them with a time-limited monopoly.

獎勵方式是給他們 有期限的獨佔權。

But today, that intention has been distorted beyond recognition.

但現今，這個意圖已經 被扭曲到無法認出來了。

Corporations have teams of lawyers and lobbyists

企業有律師和說客的團隊，

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

他們的唯一工作就是要盡可能 將專利保護時間延長。

And they've kept the patent office busy.

且他們一直讓專利商標局很忙碌。

It took 155 years for the US Patent Office

美國專利商標局核發 其最初五百萬個專利，

to issue its first five million patents.

就花了一百五十五年的時間。

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

接下來的五百萬個， 只花了二十七年核發。

We haven't gotten drastically more inventive.

並不是我們的發明才能突飛猛進。

Corporations have gotten drastically better at gaming the system.

是企業利用制度的能力突飛猛進。

Drug patents have exploded --

藥物專利爆增——

between 2006 and 2016, they doubled.

從 2006 年到 2016 年， 數量變成兩倍。

But consider this:

但，想想這一點：

The vast majority of medicines associated with new drug patents

和新藥物專利相關的

大部分醫藥都不是新的。

are not new.

Nearly eight out of 10 are for existing ones,

十個專利當中將近有八個 是既有藥品的專利，

like insulin or aspirin.

比如胰島素或阿斯匹靈。

My organization, a team of lawyers and scientists,

我的組織是一個由律師 和科學家組成的團隊，

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

我們最近調查了

在美國賣得最好的十二種藥物。

We found that, on average,

我們發現，平均而言，

there are 125 patents filed on each medicine.

每一種醫藥有 一百二十五項專利申請。

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

這些專利的內容通常都是 我們數十年前就知道的，

like putting two pills into one.

比如把兩種藥丸結合成一種。

The higher a patent wall a company builds,

公司建造的專利牆越高，

the longer they hold on to their monopoly.

他們就能壟斷越久。

And with no one to compete with,

沒有競爭者，

they can set prices at whim.

他們就可以隨興訂價。

And because these are medicines

因為這些是醫藥，

and not designer watches,

不是設計師手錶，

we have no choice but to pay.

我們沒有選擇，只能付錢。

The patent wall is a strategy to block competition.

專利牆是一種阻擋競爭的策略。

Not for the 14 years maximum

專利的時間並不是美國創始者

that America's founders originally envisioned,

原本預想的最多十四年，

or the 20 years allowed by law today,

也不是現今法律所允許的二十年，

but for 40 years or more.

而是四十年以上。

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

同時，這些藥物的 價格持續增加——

68 percent since 2012.

從 2012 年起增加了 68%。

That's seven times the rate of inflation.

是通貨膨脹率的七倍。

And people are struggling or even dying,

人們因為無法負擔醫藥

because they can't afford the meds.

而十分掙扎，甚至因此而死。

Now I want to be really clear about something.

我想要把一件事說清楚。

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

我並不是要把藥業說成是壞人。

What I'm talking about today

今天我要談的是，

is whether the system we created to promote progress

我們創造這個制度 本來的目的是要促進進步，

is actually working as intended.

但有沒有真的如預期進行？

Sure, the pharmaceutical companies are gaming the system,

的確，藥廠在利用制度，

but they're gaming it because they can.

但它們會這麼做， 是因為它們可以這麼做。

Because we have failed to adapt this system

因為我們並沒有讓這個制度

to meet today's realities.

符合現實狀況。

The government is handing out

政府交出了

one of the most prized rewards in business --

對企業最有價值的獎勵之一，

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

即創造出無競爭之產品的機會，

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

且政府代表我們所要求的 回饋也越來越少。

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

想像一下，把一百個普利茲獎

都頒給同一本書的一名作者。

(Murmurs)

（低語聲）

It doesn't have to be this way.

不必要這樣的。

We can create a modern patent system

我們可以創造一個 現代的專利制度，

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

來滿足二十一世紀社會的需求。

And to do that,

若要做到這一點， 我們就需要重塑專利制度，

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

讓它能服務大眾， 而不只是服務企業。

not just corporations.

So how do we do it?

我們要怎麼做？

Five reforms.

五項改革。

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

第一，我們必須要 停止核發這麼多專利。

Back under the Kennedy administration,

在甘迺迪執政的時候，

in an effort to curb rising drug costs,

針對遏止藥物價格上升 所做的努力方面，

a congressman from Tennessee proposed an idea.

有位田納西州的議員 提出了一個想法。

He said,

他說：

"If you want to tweak a drug,

「若你想修改一種藥物， 且想因此再拿到一個專利，

and you want to get another patent on it,

the modified version has to be significantly better, therapeutically,

修改的版本就必須要對病人

有顯著更好的療效。」

for patients."

Because of intense lobbying,

因為強力遊說的緣故，

this idea never saw the light of day.

這個想法從來沒有見到天日。

But a reimagined patent system

但，若能重塑一個專利制度，

would resurrect and evolve this simple, yet elegant proposition.

就能讓這個簡單但高雅的提案 有機會復活、進化。

That to get a patent,

若要取得專利，

you have to invent something substantially better

你的發明必須要比

than what's already out there.

現有的東西明顯更好。

This shouldn't be controversial.

這點不該有爭議。

As a society,

身為一個社會，

we reserve the big rewards for the big ideas.

我們會保留大獎賞給宏大的想法。

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

我們不會把米其林星等給予 只把食譜稍做修改的大廚；

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

而會給予那些讓我們改變 對食物想法的大廚。

And yet, we hand out patents worth billions of dollars

但，我們卻把價值 數十億美金的專利

for minor changes.

發給一些小改變。

It's time to raise the bar.

該是把標準提高的時候了。

Second,

第二，

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

我們必須改變專利 商標局的金錢獎勵。

Right now, the revenue of the Patent Office

目前，專利商標局的利潤

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

與它核准的專利數目 有直接的關係。

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

就像是私人監獄，

關越多人賺越多錢——

it naturally leads to more incarceration,

很自然就會導致更大量的監禁，

not less.

不是更少。

The same is true for patents.

專利也是一樣的道理。

Third, we need more public participation.

第三，我們需要更多公眾參與。

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

目前，專利制度就像是個黑盒子。

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

它是專利商標局和產業 之間的雙向對話。

You and I aren't invited to that party.

你我並沒有受邀參與。

But imagine if instead,

但，想像如果換個方式，

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

專利商標局變成公民學習

和獨創性的動態中心，

staffed not just by technical experts and bureaucrats,

成員不只是技術專家及官僚，

but also by great public-health storytellers

還有很出色且對科學有熱忱的

with a passion for science.

公共健康說故事者。

Regular citizens could get accessible information

一般公民可以取得

關於複雜技術的資訊，

about complex technologies

like artificial intelligence or gene editing,

比如人工智慧或基因編輯，

enabling us to participate in the policy conversations

讓我們能夠參與會直接影響

that directly impact our health and lives.

我們健康和生活的政策對話。

Fourth,

第四，

we need to get the right to go to court.

我們需要取得上法庭的權利。

Right now in America, after a patent is granted,

目前，在美國， 當專利被核准之後，

the public has no legal standing.

公眾並沒有法律上的立場。

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

牽扯到商業利益才有那個權利，

比如其他製藥公司。

have that right.

But I've witnessed firsthand how lives can be saved

但我曾經親眼目睹，日常公民

when everyday citizens have the right to go to court.

有權利上法庭確實可以拯救人命。

Back in 2006 in India,

2006 年，在印度，

my organization worked with patient advocates

我的組織和病人倡議者合作，

to challenge, legally, unjust HIV drug patents,

在法律上挑戰不公平的 愛滋病藥物專利，

at a time when so many people were dying,

當時，好多人的死因

because medicines were priced out of reach.

是因為醫藥價格超出他們的負擔。

We were able to bring down the prices of medicines

我們做到把醫藥的價格

by up to 87 percent.

壓低高達 87%。

(Applause)

（掌聲）

On just three drugs,

只靠三種藥物，

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

我們就幫健康體制 省下了五億美金。

Now, cases like these can save millions of lives

這類例子可以拯救數百萬人命，

and billions of dollars.

省下數十億美金。

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

想像一下，美國人也有權利 上法庭會是怎樣的狀況。

And lastly, we need stronger oversight.

最後，我們需要更嚴的監督。

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

我們需要一個獨立單位

來扮演公眾的代言人，

regularly monitoring the activities of the Patent Office

經常監督專利商標局的活動，

and reporting to Congress.

向國會報告。

If a unit like this had existed,

如果有這樣的單位存在，

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

舉例來說，就有可能早點 逮到矽谷公司 Theranos，

before it got so many patents for blood testing

避免它靠血液檢測 取得那麼多專利，

and landed an evaluation of nine billion dollars,

估計有九十億美金的價值，

when in reality,

但實際上，完全沒有任何新發明。

there was no invention there at all.

This kind of accountability is going to become increasingly urgent.

這種問責性會越來越急迫。

In the age of 23andMe,

在「23與我」的時代，

important questions are being asked

重要的問題有被提出，

about whether companies can patent and sell

包括公司是否能用 我們的基因資訊和病人資料

our genetic information and our patient data.

來取得專利並用來銷售。

We need to be part of those conversations

在太遲之前，我們 必須要參與這些對話。

before it's too late.

Our information is being used to create the new therapies.

我們的資訊被用來 創造新的治療方法。

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

當有一天，我和我的家人，

或你和你的家人，要面臨診斷時，

or for you and yours,

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

我們會需要透過群眾募資才能 救我們所愛的人一命嗎？

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

我不想要住在這樣的世界裡。

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

我不希望我的兩歲兒子 住在這樣的世界裡。

My dad is growing older now,

我父親年事已高，

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

他還是像以往一樣， 聰明卻很安靜，且很重視道德。

Sometimes people ask us whether things get heated between us:

有時，有人會問我們， 我們之間是否會有火藥味：

the patent-holding scientist

持有專利的科學家，

and his patent-reforming lawyer daughter.

和他的專利改革律師女兒。

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

會這麼問，是深深誤解了 真正重要的關鍵點，

because this is not about scientists versus activists,

因為重點並不是 科學家對上活動家，

or invention versus protection.

或發明對上保護。

This is about people,

重點是人，

our quest to invent and our right to live.

是我們對發明的追求 以及生存的權利。

My dad and I understand that our ingenuity and our dignity

我和我父親都了解，我們的才智

和我們的尊嚴是息息相關的。

go hand in hand.

We are on the same side.

我們站在同一陣線。

It is time to reimagine a patent system

該是重塑一個專利制度

並反映出那份認知的時候了。

that reflects that knowing.

Thank you.

謝謝。

(Applause)

（掌聲）