The Philip DeFranco Show - MS 4.2 Why A Deadly Virus Spreading Rapidly In Prisons Has America Looking To Netflix For The Answer

Starting point is 00:00:00 Hello, hello, hello. Welcome to your morning news show. My name is Philip DeFranco, and today we're gonna be talking about something that you might not be aware of, but you probably should be. Today we're gonna be talking about the high number of prisoners in the United States with hepatitis C, and even outside of prison,

Starting point is 00:00:12 hep C is a much bigger problem in America than you might think. So much so that the CDC has said that in recent years, hep C has killed more Americans than any other infectious disease. In fact, in 2013, hep C killed even more people than HIV, tuberculosis, and 58 other infectious diseases combined.

Starting point is 00:00:28 And the more recent numbers do not look great either. Right now, the Department of Health and Human Services says that there are more than three million people in the US living with chronic Hep C. And HHS also estimates there are 17,000 new Hepatitis C cases each year in the United States. But part of the reason that the numbers are so high has to do with America's incarcerated population

Starting point is 00:00:46 because the infection rate among prisoners is staggeringly high. Some studies have said that one in every seven inmates in prisons has Hep C and it's even been estimated that one in three Americans with the disease pass through a correctional facility in any given year. But here's why those numbers are important even if you've never been to prison.

Starting point is 00:01:00 Approximately 640,000 inmates are released from prison every year which means there could be 90,000 Hep C infected people entering the general population annually. Now here's the thing, there are drugs on the market that can actually cure Hep C in most cases, and I'm not saying treat Hep C, I mean actually cure it. And I know, that sounds like really, really good news, but of course, there's a catch. Because the big fact with this situation is, most prisoners are not actually getting these drugs, and when I say most, I don't mean just like a little under half. A survey from 2018 found that roughly 97% of inmates with Hepatitis C are not getting these drugs. And while that may sound infuriating, the reasons why are complicated. So today, to find out why prisoners are not getting these drugs and what people are doing about it,

Starting point is 00:01:39 we had Alyssa Schenicke from the team jump into it. Now, before we dig deeper into why inmates aren't getting treatment, let's talk about what Hepatitis C is and why it seems to affect so many prisoners. The Department of Health and Human Services defines Hep C as, quote, a viral infection that affects the liver and ranges in severity

Starting point is 00:01:55 from a mild illness lasting a few weeks to a serious lifelong illness that attacks the liver. Hepatitis C is divided into two categories, acute and chronic. Acute Hepatitis C is a short two categories, acute and chronic. Acute hepatitis C is a short-term illness that occurs in the first six months after someone is exposed to the virus, and close to 80% of people with acute infections don't actually exhibit any symptoms. But for those who do have symptoms at this stage, they can include fever, fatigue, decreased appetite, nausea,

Starting point is 00:02:21 vomiting, abdominal pain, joint pain, and jaundice, which is yellowing of the skin and the whites of the eyes. In the majority of cases, though, that acute infection leads to chronic infection. And chronic hep C can cause liver cancer or cirrhosis, which is scarring of the liver. So untreated, hep C can be deadly. But why is it such a big problem among inmates in particular? Well, that answer has to do with how the virus is shared. Hep C typically spreads when blood from an infected person enters the body of another person. And in prison,

Starting point is 00:02:49 that happens through tattooing and drug use. Basically times when people share a needle or another instrument that has blood on it. Hep C also spreads quickly in prison because it's a virus that's really hard to kill once it's on a surface. According to the CDC, bleaching, boiling, heating with a flame, or using common cleaning fluids like alcohol or peroxide doesn't clean Hep C from needles, and the virus can live for up to three weeks outside the body. But like we said earlier, there is a cure. In 2014, an American biopharmaceutical company called Gilead Sciences introduced a drug named Civaldi, and Civaldi combined with another antiviral drug cured close to 90% of patients. And that percentage was a huge deal because before Civaldi, combined with another antiviral drug, cured close to 90% of patients.

Starting point is 00:03:32 And that percentage was a huge deal because, before Civaldi, treatments for Hep C only cleared the virus in about half of patients. Gilead also had a patent for Civaldi when they introduced it into the market, which meant the company was the only maker of this new and more effective drug. And that put Gilead in a position where they could charge close to whatever they wanted. So in 2014, Gilead charged around $84,000 per treatment course. That was nearly $1,000 a pill. We reached out to Gilead for a comment on this piece, but as of filming, they haven't responded to our request. But Gilead has said in the past they came up with that number based on a price-per-cure model, basically claiming that their drugs were still a cheaper option than the long-term treatment someone might need without the drugs. Here's a video Gilead made in 2015 that talked about the cost of treating the long-term symptoms of hep C.

Starting point is 00:04:11 As this often silent disease progresses, so do the related costs. For example, we spend roughly $60,000 each year per patient with end-stage liver disease, and almost twice as much per patient with liver cancer. All totaled, Hep C is responsible for more than $34 billion in annual medical costs. Curing more people with Hep C sooner could mean less liver cancer, fewer liver transplants, and a lower risk of death, and could greatly reduce a lifetime of medical expenses. Gilead's price-per-cure model also factored in that patients would only need to buy a limited supply of their expenses. Gilead's price per cure model also factored in that patients would only need to buy a limited supply of their product. So for Gilead, that meant the more people had access to the drugs, the smaller their consumer pool would be. The company also said they needed

Starting point is 00:04:54 to price their drugs high to fund future research and development. Here's Dr. Michael Sofia, one of the inventors of Civaldi, talking about that idea. We as a society, I think, at least in the United States, value innovation. And in order to get innovation, you have to have people willing to pay to support that innovation. But even though Civaldi's price tag was high, insurers were willing to pay. So Gilead kept the price. Within 12 months, Gilead's second hep C drug, Harvoni, entered the market. This drug could cure people even faster, and as you're probably expecting, it came with an even higher price tag. Harvoni sold for about $94,000. Now, more recently, Gilead has had some competition enter the market, but the competing drugs aren't

Starting point is 00:05:42 as effective, so Gilead's been able to keep their prices high. Right now, Gilead's drugs currently cost around $500 a pill, or $42,000 per treatment course. At this point, you may be able to guess why prisoners aren't getting the Hep C drugs. Even after negotiating with some drug companies for a lower price, state prisons typically can't afford to treat everyone. And that's exactly what's happening in states like New Mexico. New Mexico's prison population currently has the highest prevalence of hepatitis C out of any state in the country. More than four out of every 10 inmates are infected. That's around 3,000 inmates in total. But just 46 prisoners received treatment last year. The state hopes to triple the number of prisoners getting treatment this year, but that will cost close to $2.5 million.

Starting point is 00:06:25 So if you're doing the math, that's $2.5 million for only around 150 inmates, which is close to $17,000 per inmate. If New Mexico wanted to treat every infected prisoner in their state, they would need $50 million. But $50 million is currently more than Newxico's entire annual health care budget for its prisons so for now only a fraction of the state's infected inmates get treatment but even though prisons in some states like new mexico aren't buying hepatitis c treatment for everyone that actually hasn't really hurt business for a drug company like gilead in fact gilead's business model of charging u.s patients a lot but only curing a fraction has actually made the company tons of money over the years. In just 2014 alone, Gilead more than doubled its revenues, from $11 billion to $25 billion, thanks to its hepatitis C drugs. That same year, Americans

Starting point is 00:07:16 spent $6.5 billion on Civaldi. That was the most money spent on any drug in the United States in 2014. After introducing Civaldi and Harvoni, Gilead was actually making so much money that the United States Senate opened an investigation into the company. Here's Senator Ron Wyden explaining what the Senate investigation found. Using Gilead's own documents, the evidence shows that the company pursued a calculated scheme for pricing and marketing its hepatitis C drug based on one goal, maximizing revenue regardless of the human consequences. So basically, the Senate said Gilead didn't have to charge so much, but they just wanted to make the most money possible.

Starting point is 00:08:03 But it's worth noting here that Gilead isn't currently making these astronomical profits everywhere. Because in other countries, a hep C cure can actually cost less than $100 a person. So let's talk about one of those countries. It's one of Egypt's worst public health scandals. Patients flocking to health clinics like this one in Cairo, all sick with a chronic and often deadly disease which attacks the liver.

Starting point is 00:08:27 In 2013, Egypt had the highest rate of hepatitis C in the world, and the government was actually largely responsible for why so many were infected. 50 years ago, the Egyptian government wanted to combat schistosomiasis. It's a parasite that spreads to humans from freshwater snails.

Starting point is 00:08:42 So the government held these mass treatment campaigns where dozens of people would be given shots. But at these centers, the same needles were used repeatedly. At the time, it wasn't known that hepatitis C was transmitted through infected blood. But obviously, the shared needles helped to spread the virus. And by the late 2000s, one in every 10 Egyptians had the virus. After the Egyptian government realized they were largely responsible for spreading hepatitis C, they created a plan to treat it. But their first plan wasn't that effective. So once Gilead started selling Civaldi, the Egyptian government wanted those drugs.

Starting point is 00:09:12 Egypt and Gilead then began negotiating a price. At the same time, Egypt was also considering Gilead's application to patent its hep C drugs. The patent would have allowed Gilead to dominate the hep C drug market in the country. But the Egyptian government rejected that patent application. And that's really important because it meant that cheaper generic versions of Civaldi and Harvoni would eventually be sold in Egypt. But Gilead still wanted in on the massive Egyptian market before generics would start hitting the shelves. So Gilead and Egypt made a deal. Gilead would give Egypt their name brand drugs for cheap, as long as the country promised to keep Egyptians from selling the drugs in the black market to people from countries like the U.S. And obviously, Gilead didn't want to take a hit on money-making countries

Starting point is 00:09:53 like the United States. But Egypt eventually agreed to that plan. And under the deal, Gilead agreed to sell Civaldi for $250 a bottle and Harvoni for $300 a bottle. With those prices, the government could cure Egyptians for around $1,000 a patient. Now, since that deal has been made, generic manufacturers have entered the market, and Gilead's prices have gotten even lower. Currently, thanks to generics, curing Hep C in Egypt costs around $80 a patient. That's 0.2% of what they currently cost in the United States. Other countries like Brazil, Ukraine, Argentina, China, and India have also rejected Gilead's patents and now offer lower-priced generic versions of hep C drugs.

Starting point is 00:10:33 So that brings us to the question. Why doesn't the U.S. just deny Gilead its patents and open the door for cheaper generic drugs? Well, there have been efforts to do that. In 2017, a non-profit called the Initiative for Medicines, Access, and Knowledge, or IMAC for short, filed challenges to Gilead's patents. IMAC argued the basic components of Gilead's hep C drugs aren't actually unique enough to merit patent protection. But the United States Patent and Trademark Office has disagreed, and they've upheld Gilead's patents. But that doesn't mean generic drugs are off the table completely. Because in January of this year, Gilead actually authorized a new subsidiary to sell a generic version of Harvoni. The generics are currently being sold at $24,000 per treatment

Starting point is 00:11:15 course. But obviously, that's still really expensive. And that price actually isn't even a discount for New Mexico's prison system. Remember, we said earlier the state currently spends around $17,000 per inmate on treatment. So if Gilead's new generic versions aren't cheap enough, what options do states have to get drugs to their inmates? Well, two states are considering a new payment model for hep C treatments. Louisiana and Washington are hoping to make a deal with Gilead or its competitors, which would allow them to pay a flat fee for unlimited access to drugs. It's a system that's been labeled the Netflix model, since it works similar to the subscription service. The hope is that the system would allow more inmates to have access to hep C treatment, while helping states maintain a predictable budget. The Netflix model is actually a system

Starting point is 00:11:57 that Australia has used since 2015, and a recent analysis published by the New England Journal of Medicine has actually estimated it saved the country nearly $5 billion U.S. dollars. In just the past few weeks, Louisiana announced it will partner with a Gilead subsidiary. Under the deal, the state will get five years of unrestricted access to hep C treatment. But details about pricing haven't been released yet since the contract isn't final. Washington is also in the process of accepting and considering bids from drug companies. But Gilead has said they are interested in a Netflix deal there too. So we'll have to wait and see what happens there in terms of pricing.

Starting point is 00:12:29 But actually, on that note, some prisoners are tired of waiting, and they're taking things into their own hands. Since 2015, prisoners in at least 16 states have filed lawsuits after prisons have refused to give them treatment. And in most of these cases, prisoners have been claiming that their lack of medical care is actually unconstitutional. And they've cited a 1976 Supreme Court case that ruled prisoners have to be given adequate health care. The Supreme Court also ruled that ignoring a prisoner's serious medical needs can amount to cruel and unusual punishment, which is a violation

Starting point is 00:12:59 of the Eighth Amendment. And in a lot of these cases, states have been settling and agreeing to treat more inmates. For example, Massachusetts settled by agreeing to give all prisoners in the advanced stages of hepatitis C access to drugs. And a federal judge in Florida ordered the state to provide drugs to all inmates with severe liver damage by the end of 2018. Florida will also give drugs to those with significant damage this year. However, New Mexico hasn't been sued by any inmates. But it's definitely possible we could see a lawsuit any day now. Now, before we wrap up,

Starting point is 00:13:28 it is worth noting that even though Gilead has made a lot of money off of Sovaldi and Harvoni, in recent years, they've started to make less. And that's because the drug cures. And for the biopharmaceutical companies out there, there isn't actually a lot of business incentive to make a drug that cures. Right, if every single person who had Hep C

Starting point is 00:13:42 in the United States bought Sovaldi and Harvoni in 2014, the company still would have made tons of money that year, but Gilead wouldn't have made money in the long term. So from a cold business perspective, the way for Gilead to make the most money over the years would have been to create a drug that treats Hep C's side effects, but doesn't completely cure the virus. Especially if that drug then has to be taken for the duration of that person's life. So that's why you have people and companies saying that the best way for these companies to make money is not to cure disease. So you have this situation where the new drugs have been life-changing for some, but at the same time you have this environment where pharmaceutical companies feel like they need to charge a lot and limit access to drugs that actually cure people to make their profits last a few years. And then that result of that is you have these states that are unable to afford treatments that they should be giving their inmates. And so then you get the majority of prisoners just sitting in their cells getting sicker and sicker and sicker from this disease.

Starting point is 00:14:23 But with all of that said, it brings us to the point of the video where I pass the question off to you. What are your thoughts around this? Who do you blame? How do you think that Netflix model is going to work in Washington and Louisiana? What do you think is the solution to this situation? That's where I'll leave you and of course it brings us to the ending. Remember if you like this video, you like the deep dives that we do, let us know. Hit that like button. Also, if you're new here, you want more of the videos we throw out on this channel, be sure to subscribe, click that bell to turn on notifications. Also, if you want to here, you want more of the videos we throw out on this channel, be sure to subscribe. Click that bell to turn on notifications.

Starting point is 00:14:46 Also, if you want to support the content that we're putting out monetarily, you can subscribe to DeFrancoElite.com with a paid subscription. We otherwise just lose money on these videos, but it is important to get these stories out. But with that said, I love your faces. Thanks for watching, and I'll see you back here later today right here on this channel for a brand new Philip DeFranco show.

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The Philip DeFranco Show - MS 4.2 Why A Deadly Virus Spreading Rapidly In Prisons Has America Looking To Netflix For The Answer

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