Justin Webb: how much should our nation spend on vital medicines?

"Concentrate not on the cost of the drug but on the benefit, the outcome, for patients"


My son owes his quality of life to a catastrophe that befell an American family in the hot, miserable Mississippi summer of 1866. The Civil War was over and a veteran was trying to set up a cotton plantation. He had fought on the winning side for the antislavery Union – and looked forward to living a normal and profitable life after the slaughter.


But shortly after starting his business, his entire family fell ill with malaria. He and his son survived, but his wife and their unborn child perished. He packed his bags and sent his son to live with his parents and he did what comes naturally to Americans. He started over. He moved north to Indiana and tried a new business, making pharmaceutical products. He had been frustrated by the uselessness of the drugs that had been available as his wife died; he wanted to do better.

And he did. His name was Eli Lilly, and the company he founded, and his son later ran, became the world’s first proper pharmaceutical empire. By the time Mr Lilly died he was a millionaire. Today, Eli Lilly’s annual takings are in the billions; it has brought to the world some of its most famous and successful drugs.

They include Humalog, a synthetic insulin that type-one diabetes patients rely on to stay alive. Without it they would have to use animal insulin, which is less predictable and can pass on infections. Humalog, for my son Sam, is the difference between a miserable, pain-filled half-life, and the full fun life that he lives.

So how should we feel about Eli Lilly? At a conference I attended recently the drugs companies – Lilly and the rest of them – were in angry mood. They say they are sick of being treated like killers, rather than saviours. And their representatives are issuing what amounts to a threat: if you hate us so much that you squeeze our profits over the next few years, we will stop curing your illnesses.

A question: what proportion of our annual wealth do we spend on medicines? The answer surprised me. It is less than one per cent. This is the amount we choose to spend on the cancer drugs, the statins, the diabetes drugs and the advanced antibiotics that are part of modern life.

News reporting of the costs of medicines, particularly advanced and experimental medicines for rare conditions, can perhaps lead taxpayers to conclude that our national drugs bill is already outrageously high and needs reducing. But some people would make the opposite argument: that a real devotion to healthcare in Britain ought to involve a greater devotion to paying for drugs, a willingness to put our national money where our mouths are. Close hospitals, increase efficiency, streamline processes, hold down wages – but open our wallets when it comes to drugs. Concentrate not on the cost of the drug but on the benefit, the outcome, for patients.

But here is our problem. Eli Lilly has not always been true to the memory of their hard-working founder. They are accused by campaign groups of ethical failings and one massive recent criminal case resulted in a record fine. They are not really interested in people, you could suggest. They are interested wholly in profit.  

So if we raise the drugs budget – if we decide that medicines are our priority – do we not risk wasting our money and contributing to the greed of those who control pharmaceutical companies? How can we know that we’re getting real value?

Our news is full, at the moment, of the fuss and bubble of crises in the BBC and elsewhere. But the longer-term issues we must face cannot be measured in statements and resignations and headlines. How much we should pay for drugs is a question as vital as it is intractable. We need to hear both sides and make sensible decisions.

I am looking now at a phial of Humalog. I really do not know what to make of it…


Justin Webb is a presenter on Today – Monday-Friday 6am and Saturday 7am on Radio 4