SECOND OPINION | The secret world of drug prices, and more of this week's health news

The World Health Organization calls for more transparency on drug prices, Martin Shkreli gets his own musical and surgeons protest new headwear rules, in this week's Second Opinion.

Also, a fashion fight in the operating room, and a musical about Martin Shkreli

In the satirical musical about "Pharma Bro" Martin Shkreli, the pharmaceutical CEO is portrayed by magician, juggler and professional clown Patrick Swailes Caldwell. (Pharma Bro)

Hello and happy Saturday! Here's Second Opinion, our roundup of the week's interesting and eclectic news in health and medical science.

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Ending the secrecy behind high drug prices

Secrecy is one of the biggest barriers to tackling unaffordable drugs, World Health Organization officials said. This week the WHO invited more than 200 government and industry representatives to Amsterdam for a fair-pricing forum to come up with a global strategy to fight high prices.

"More transparency is absolutely vital," said Dr. Marie-Paule Kieny, an assistant director-general with the WHO. "At present we have little transparency on what inputs actually make up the decision to price the medicine. Nor do we have evidence of the true cost of R&D and of who actually pays for it."

Kieny called on countries to start sharing their drug price secrets to give them more leverage in negotiations with the world's pharmaceutical giants. Right now, health officials in one country don't know how much other countries are paying, because companies negotiate with each government separately and then swear officials to secrecy.  

Fair prices do not necessarily mean low prices, Kieny said, because if prices are too low companies will stop making the drug and simply leave the market, making the accessibility problem worse.

The WHO forum established a clear goal for world drug prices: "A reasonable return on investment in exchange for an affordable price, one that does not bankrupt health systems and other payers." That goal is aimed at sustaining the pharmaceutical sector and still allowing universal access to medicine.

Maker of 'world's most expensive drug' raided 

Alexion Pharmaceuticals, producer of what has been dubbed the world's most expensive drug, was in the news this week after Brazilian police raided the company's Sao Paulo office.

Canadians might recognize Alexion as the company that tried to sue Ottawa after a federal agency accused it of charging too much for Soliris, the only drug available to treat a rare blood disease. Soliris can cost more than half a million dollars per patient per year.

Brazilian authorities are investigating whether Alexion covered the legal costs for patients trying to force the Brazilian government to pay for Soliris. In Brazil, patients can sometimes get access to expensive drugs through the courts.

Alexion told us by email that it provides support to patient groups in Brazil in the form of unrestricted grants. The company also said it is co-operating with the Brazilian authorities on the investigation.

Meanwhile, here in Canada, there's still no decision in the original fight between Alexion and Canada's drug regulator, the Patented Medicine Prices Review Board. Closing arguments were heard in mid-April and now both sides are awaiting the decision.

PharmaBro: An American Douchical debuts off-Broadway

What's a "douchical"? It's a musical about a pharmaceutical "douchebag," according to playwrights Lauren Gundrum and Joel Esher, who have created a fictional story about the exploits of notorious pharmaceutical CEO Martin Shkreli.

In 2015, his company jacked up the price of an old drug by 5,000 per cent. Then Shkreli bragged about it, triggering a social media fury. Shkreli resigned from Turing Pharmaceuticals and then infuriated music fans by boasting about buying the only copy of a rare Wu Tang Clan recording for $2 million, an escapade that inspired PharmaBro: An American Douchical.

Esher has only talked to Shkreli once, when Shkreli was live streaming from his bedroom, inviting random people to call and chat. "So I called him and asked him how he would feel if someone wrote a musical about his life and he said he wouldn't care," Esher told us. "So I said, 'OK' and hung up."

Martin Shkreli, former CEO of Turing Pharmaceuticals, is sworn in to testify at a hearing on Capitol Hill in Washington last year. (Joshua Roberts/Reuters)

"We found the perfect person to play him," Gundrum said, describing lead actor Patrick Swailes Caldwell as a magician, juggler and professional clown. Esher said Shkreli knows about the show, but won't be tweeting about it now that he's been suspended from Twitter for harassing a female journalist.

The show opens in New York City on Saturday for a six-week off-Broadway run. Gundrum and Esher are hoping it will attract the attention of a producer and become the first "douchical" on Broadway.

About that pill ... what ever happened?

Just days after the drug price controversy first exploded back in 2015, Shkreli promised to lower the price of Daraprim, a drug used to treat toxoplasmosis, a parasitic disease. But Shkreli reneged on his promise. The drug went from $13.50 per pill to over $750 per pill, and stayed there. And this week there were reports that Turing Pharmaceuticals is considering selling the rights to the now-valuable drug for $100 million.

Daraprim is not sold in Canada because it never received Health Canada approval.

Hairy debate in the operating room

Surgeons are expected to cover their hair when they're operating on patients, to reduce the risk of surgical site infections. But how they do that has become a prickly issue, ever since the traditional surgical skull caps were banned in the U.S because they leave sideburns and ear hair exposed.

The American College of Surgeons protested the new rule, declaring the skull cap to be the symbol of the surgical profession.

"You'll see individuals in hospitals who have a cloth skull cap on and a semi-transparent bouffant cap on top of it, I'm not kidding," said Dr. Kevin Gibbons, a neurosurgeon at the Buffalo General Medical Center.

Skull cap or bouffant? It's a style war that's raging in operating rooms as surgeons argue for choice in head covering. (Peter Power/St. Joseph’s Healthcare Hamilton)

Some surgeons have argued they need to wear the tight-fitting skull caps, rather than the loose bouffant style the new rules demand, because they're more comfortable, especially if they're also wearing surgical instruments on their head.

"I'm a neurosurgeon and we have operations that last six or eight hours long," Gibbons told us. "It's not just a style preference. I would call it a personal performance preference."

The debate has become so heated that U.S. regulators have threatened to revoke hospital certifications if surgeons continued to wear their sporty skull caps in the operating theatre.  

No evidence for a ban

So Gibbons and some colleagues decided to fight back with science. They compared infection statistics before and after the skull caps were banned at their Buffalo medical centre, and found no difference in patient infections during surgery. The paper, published this week, concluded there is no evidence for a ban on skull caps.

In Canada, surgeons are still happily wearing whatever they want as long as their hair is covered.

"Some people have personalized caps," said Dr. Anthony Adili, chief of surgery at St. Joseph's Healthcare in Hamilton. "I wear a bouffant. A lot of my surgeons and a lot of the nurses will wear a cap, and the caps sometimes are colourful and might have some writing on it, so I'm sure there's some style component to this," he told us.

But there is one new rule about surgical caps in Canada, Dr. Adili said.

"If they do wear the linen caps, they have to be laundered by the hospital laundry services. They can't wash them at home."