Цена и ценность в российском поле лекарственной онкопомощи, случай инновационного препарата от РМЖ
This article discusses the cultural, institutional and political foundations of the price of a key line of drug treatment for HER2+ breast cancer in Russia. The social biography of trustuzumab, targeted innovative drug for the treatment of metastatic breast cancer with tumor overexpression of HER2, is used as an empirical example – widely famous and well described. On the Russian pharmacological market today trustuzumab is offered under the “Herceptin” brand name, being supported by Swiss “Roche” and as a local biosimilar “Gertikad”, being produced by the flagman of Russian pharmaceuticals “Biocad”.
Money prices originate from structures, institutions, politics and interrelationships as well as from cultural frames and cognitive mindscapes. They convey social meanings significant for people who produce, sell and buy. Prices for innovative anti-cancer drugs are suspected to be detached of production costs. Furthermore, they are suspected to be unfair. Whereas most patients hope and believe that anticancer drugs cure cancer, empirics demonstrate that in practice “gains in survival time associated with innovative anticancer drugs are typically measured in months, not years”. Whether this reality meets the hopes – a great question.
Methodologically, the article combines the results of ethnography of the Russian field of anti-cancer care with elements of netnography and desk research. Being at the epicenter of controversial social and political processes, anti-cancer care field in Russia is extremely closed. Especially, when the question comes to the ultra-high prices for anti-cancer drugs. That is why, along with the data of in-depth interviews with marketing specialists of pharmaceutical companies and oncologists, the study relies on in press and on-line interviews with representatives of government departments, pharmaceutical companies, scientists, leading oncologists of the country and the results of clinical testing of the studied drug published in medical journals and cancer market analytics published in the medical press.
The study reconstructs the value chain behind money prices of anti-cancer drugs in Russia, depicts the ambivalence faced by key institutional actors in the organizational field and shows how the inconsistency of institutional interests and lack of cooperation contribute to the financial toxicity of current methods of anti-cancer war in Russia. Diverse empirical data from ethnography of Russian anti-cancer healthcare give grounds to assume that behind the façade of normalization through the manipulative argument that absolute value of human life makes it priceless, unhealthy prices for innovative anticancer drugs are just a symptom of pathologies of “promises and hope economy” that has occurred around oncological panic. So, to make promising anti-cancer drugs more affordable one should revise structure, institutions, politics, interrelationships, cultural and cognitive mindscapes that justify current attitudes and approaches to cancer, the value chain of promising anti-cancer drugs and its derivative – money prices.