The fight over cancer drugs in India exposes a fundamental tension in the way we fund pharmaceutical R&D. Patents allow pharmaceutical firms to charge high prices for drugs for a limited period of time to recoup their investment in R&D. This results in more of the drugs that we need, but makes them less accessible to those who need them. The tension becomes greater in the global context because the income disparities between developed and developing country patients are so vast.

This tension in the patent system has been exposed before. A decade ago, courtroom battles and protests over access to patented HIV/AIDS medications in South Africa dominated international headlines. Those fights subsided when multinational companies donated their drugs, charged rock-bottom prices for them in poor countries, or allowed local companies to make generic versions. Yet the emerging fight over cancer medicines threatens to be bigger, as it involves the emerging markets and disease groups on which the multinational drug industry has banked its future.

The international community shows no appetite to agree on new ways to fund pharmaceutical R&D. Talks on alternatives like prize funds and R&D treaties at the World Health Organization have gone nowhere. The United States, Europe, and other developed countries have too much invested in the intellectual property (IP) system. According to the U.S. Patent & Trademark Office, IP in the U.S. is worth more than $5 trillion and is responsible for the employment of as many 18 million U.S. workers. On the other hand, countries like India are not about to agree to tightening standards on the flexibilities that the current IP system gives them on patentability and compulsory licensing.

The solutions to fights pitting cancer patients against patents in India are more likely to reside in making the current system of funding pharmaceutical R&D work better.

First, multinational drugs firms can, and should, reduce the cost of R&D, which would enable these firms to better function in the increasingly price-sensitive global marketplace for drugs. Last month, Andrew Witty, the CEO of GlaxoSmithKline, called the often-cited $1 billion price tag for developing a new drug an "industry myth," based on unacceptably high research failure rates. Government programs can help. The U.S. Food and Drug Administration's Critical Path Initiative is working with the drug industry to improve R&D productivity and could do more with greater funding.

Second, multinational firms must realize that there are low-income segments of the global marketplace that these firms cannot serve, but whose health needs must be met for international support of the pharmaceutical, trade, and IP system to persist. These companies must again be willing to license their patents to emerging country generic manufacturers better able to meet the low-cost, high-volume treatment needs of their poor. Novartis has protested that it was providing free Gleevec to nearly 16,000 patients in India, but more than 300,000 patients had been receiving the drug through local generic producers.

The international patent system has spurred tremendous pharmaceutical innovation. The inventors of Gleevec were awarded both the Lasker Award and the Japan Prize for their contributions to medicine and science. But the patent system must meet the legitimate needs of its constituents to function. If not, accommodations must be made, or last week's fight in the Indian Supreme Court will be simply one of many to come.

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