Remembering when PENICILLIN was as expensive as Avastin is today

In 1943, penicillin-at-cost (at least so claimed Big Pharma and no one ever asked for or got firm proof as to their accuracy) was sold to the US government for $20 per 100,000 units .

The most meaningful way to describe the effect on a family's budget in 1943, if they had had the chance to actually buy the stuff, is to ask how it would have taken them at work to earn that $20.

In 1943, the median male wage earner took about a week to earn $20, the median female about two weeks.

In today's terms, that meant it would cost about $1000 for that dose of penicillin.

Admittedly, that single dose back then in 1943 saved many a life -cured ! - and they didn't need to have another dose again.

By contrast , today's Avastin is a fairly costly cancer drug that can extend life in some terminal patients , but only for an additional four months on average , and at a potential cost of $100,000 a year and up.

To work, it has to be taken constantly every 2 weeks until the patient either dies of the cancer or of old age.

But there are some bacterial diseases ,then and now, that were invariably fatal unless given enormous seeming doses of penicillin  - often the penicillin must being given every few hours, for periods of several months.

Still the cures of even supposedly fatal cases of extraordinarily persistent and antibiotic resistant endocarditis can happen - but it has taken up to a kilo of pure penicillin to do so.

That is equal to 17,000 doses of Penicillin G, each of of 100,000 units in strength !

That is $340,000 in 1943 dollars at 1943 prices and would have  taken 340 years for the average male worker back then to pay for it !

But in the 1943 era, the actual maximum amount of penicillin ever give to an endocarditis patient was a still quite hefty 15 million units  - costing a median 1943 worker 3 solid years of labour to buy.

Three years work for the median worker today in 2013 is at least $100,000 - IE, the average cost for Avastin patients and or their insurers, private and government.

So in 1943, the miracle drug Penicillin G was as expensive for some patients as Avastin and other miracle cancer drugs are today.

But what is the real current at-cost/ bulk price of 100,000 units of Penicillin G today,  in 2013  dollars ?

That would be 2 cents : and would take today's worker not one or two weeks of 40 hour each to pay for it, but rather only about 2 seconds to earn !

Clearly Penicillin G has gone from being the most expensive lifesaver in 1943 to being by far the cheapest lifesaver in 2013 - a lifesaver cheaper than water, a lifesaver too cheap to meter.

The Official History version of why it happens credits those wonderful people at Big Pharma.

If you find that at all credible, you really shouldn't be reading this blog.....

I'm today's go-to expert on yesterday's battle over 'penicillin for all' --- by default

While I consider myself the world's leading expert on the wartime battle over the principle of penicillin for all, I also recognize I am also probably the only person in the world who gives a tinker's damn over that 75 year old battle.

A pity that.

Because there are still lessons for today in that old battle, particularly with regards to drugs now costing cancer patients $300,000 a year per person.

Tired, Poor or Huddled

Roche's Avastin-for-all versus Henry Dawson's Penicillin-for-all , what's the difference ?

Avastin is not in short supply and Roche sells it to all, regardless of race gender et al.

Penicillin G : ditto,ditto .

But Avastin costs $100,000 a year and only extends life an average of 4 months.

In bulk, Penicillin G is only about $1 for a two week long life-saving treatment.

Penicillin is not Avastin, but it could have been...

My book - The smallest Manhattan Project  - is about us , all 10 billion of us , here today or years dead, whose lives have been improved by the advent of inexpensive penicillin.

In a sense, this book is a rarity : one written from the patient's eye view of how that drug came to be ; a welcome change after decades of endless books exclusively devoted to how penicillin looked to the people who discovered and developed it.

Penicillin is frequently called the Miracle Drug but few consider that its biggest medical miracle was really in fact its cost, or rather 'lack of cost'.

Because the diseases that penicillin treats are contagious,  patients too poor to afford a cure remains a reservoir of the most virulent strains, waiting to infect the rest of us.

There actually were methods of preventing much of these diseases before the development of penicillin : they included the ready availability of good jobs, good food, cleaner and bigger homes, greater social respect.

Baring that, only the worldwide availability of a drug that would cure those diseases once they started up, at a price that almost all could readily afford , could reduce these diseases from being endemic or epidemic to just names in a dusty medical textbook.

That is why I can say, with absolute assurance, that even those of us who have never had a single treatment of beta-lactam (penicillin family) antibiotics are in better health today because the grandparent of them all, Penicillin G , is water cheap - literally a lifesaver "too cheap to meter" .

But it almost didn't happen , we almost lost "inexpensive penicillin".

We almost got an expensively patented synthetic drug more akin to Avastin and all those other $100,000 a year plus medications.

"The smallest Manhattan Project" is the story of a doctor ( himself slowly dying of another unrelated disease) who sacrificed his own health to see penicillin from the patient's point of view.

His name should be honoured for all time.

This, despite the fact that he did not discover penicillin and then neglect it (Fleming) nor did he start its re-discovery and eventual development, albeit while pursuing a pathway that nearly killed off that development (Florey).

Dr Martin Henry Dawson, for that was his name, merely said penicillin should be made available - now! - for every single patient whose life could be saved by it , even during the height of a Total War .

Nay, he went much, much further.

Dawson in fact said all should have access to life-saving penicillin, particularly in the middle of a Total War.

That was because that war was supposedly being fought against one opponent in particular, solely because that opponent's core philosophy said that 'some lives are more worthy than others'.

How could we continue to conduct that war with any moral vigour when our own medical establishment was 'me-tooing' Hitler's doctors ?

Now the mantra 'Penicillin for all who needed it regardless of their income level or skin colour' in the mid-1940s meant its mass production, given the vast amount of infectious disease endemic in those years.

And mass production has its myriad ways of driving production costs down, down , down --- as happily happened in the case of Penicillin G in almost textbook manner.

'Penicillin for all' quickly became 'inexpensive penicillin for all' and once that happened, penicillin began to work almost like the way a good public health vaccine program should work : the treatment of the many ultimately offering 'herd protection' to all the rest of us, free of charge.

Insulin is another drug frequently called a miracle drug.

But the sad fact is that it is far more common today than it was beforeinsulin was discovered, for a variety of reasons.

By contrast, the names of all those bacterial household scourges that so terrified our mothers and grandmothers are not even known to most of us under the age of 50, and most doctors practising today have never seen a case of them.

And that is just the sort of modern day miracle that Dawson's mantra of 'penicillin for all' can produce.

For the complex truth is that our choice of medical ethics has economic consequences and these in turn feedback and have medical consequences.

The case of what the mantra of 'penicillin for all' ultimately led to should be taught in every health economics and health ethics oriented university department for just those very reasons....

Lifesaving 'too cheap to meter:' the legacy of the smallest Manhattan Project

Remember that solemn pledge from the biggest Manhattan Project ?

After killing a few hundred thousand civilians overseas, they promised to make up for it by offering us endless, abundant, safe electricity at prices 'too cheap to meter'.

They were joking, right ?!

By contrast, consider the legacy of the smallest Manhattan Project.

It has offered us decades of lifesaving at prices 'too cheap to meter'.

That is an amazing feat considering it was performed against the combined resistance from the biggest of the wartime Allied  governments and from many politically powerful firms in wartime's Big Pharma.

Penicillin, more than 85 years after its initial discovery, still can stop cold the toughest bacterial infections going, and do so at prices dirt cheap, offering us true life saving at prices too cheap to meter.

Contrast that to today's to cancer drugs,  averaging at costs between $100,000 to $350,000 a year, that can only promise to extent the average life by about four months.

This is because natural penicillin was born in the public domain, born the original genetic drug , and Man failed totally to synthesize it and expensively patent it.

Penicillin is often called the miracle drug and perhaps its biggest miracle was economic, not medical : it could be given the opportunity to save hundreds of millions worldwide because it wasn't priced like Avastin but rather was almost as cheap as water.

(A real miracle - and I repeat, it almost didn't happen, we almost lost inexpensive penicillin.)

That was because our busy wartime Allied bureaucrats and busy wartime drug executives spent zillions in scarce tax dollars to try to synthesize and patent penicillin rather than getting down to doing Job One with readily available natural penicillin.

Their Job One and Two and Three should have been saving lives in a worldwide war crisis.

Henry Dawson's 'Penicillin-for-all' did not just mean making it available to all at a steep price, like Avastin : it meant making it available to all patients, at a price even the poorest can afford...