Are anti-cancer patents intrinsically immoral?

I run the risk of getting into hot water over a few of the observations below, but I think that some thought regarding the intersection of public spending, patents, “intellectual” property, and the unnecessarily high costs of life-saving treatments might be worth it.

The following considerations were triggered by a recent Dutch article, published in the well-respected NRC newspaper, describing how the well-known scientist/politician Ronald Plasterk became a millionaire, upon selling a cancer-treatment patent he obtained.^[1] At the basis of some of the arguments over patents described in the NRC article is an interesting Nature Scientific Reports publication detailing a possible source of exclusively tumour-specific molecules.^[2] Such molecules are of course of great clinical interest as they might function as tumour-specific antigens, potentially unleashing the power of our own immune systems against malignant growths, with minimal chances of auto-immune complications. How important activating the immune system can be in fighting off cancer is illustrated by the so-called chimeric antigen receptor (CAR)-T cell therapy,^[3] and the use of antibodies against immune checkpoint proteins such as PD-1/PD-L1 and CTLA-4 to allow much more effective cancer immunotherapy.^[4] In the publication about tumour-specific molecules,^[2] the focus is on the peptides that result from frameshifts in open reading frames which could occur more often in the notoriously sloppy cancer cells. A surprisingly large number of such new, cancer cell exclusive, open reading frames can indeed be found in publicly available large data sets. This means that using the encoded peptides as antigens might help patients combat their tumours in a subtle instance of effective personalized medicine. Thus far the science.

It might surprise the reader that the article in question was accompanied by a competing interest declaration about a patent regarding a: “…method of preparing subject-specific immunogenic compositions based on a neo open-reading-frame peptide database.” The patent in question has in the meantime been sold for quite a lot of money to German biotech company CureVac. This could mean that such potentially life-saving treatment might in the future have limited accessibility, because of extra expenses involved. Call me old-fashioned but how can such a regrettable outcome be justified? Consider: (i) As I mentioned, the analysis was done using large, publicly available, data sets. (ii) All of this important, high level, bio-informatic analysis was performed by Plasterk's co-author, a civil servant employed by an academic hospital, that is, the tax-payer. Of note, this (probably old school) researcher was not involved in the patent at all. (iii) There is no great “conceptual idea/inventive step” (which is often used as an excuse for the extra financial rewards linked to patenting) to speak of. All of the underlying knowledge and the possible application are so mainstream that undergraduate biology or medicine students can (and will have, I am sure) already come up with it. (iv) The vast majority of researchers are still steeped in the “ethics of science”, which means that they know scientific progress depends on open discussion and exchange of ideas. It also means most scientists are much more interested in such progress and the common good than in any financial gain. Alas, such attitudes, so beneficial to science and medicine, are precisely what makes them such easy prey for those who use their scientific literacy in less altruistic ways. Regarding patents, I hope to have made it clear why I consider this specific instance “patently absurd”. However, I must admit that it reflects a wider concern of mine: overall, we should do more to “get the market out of medicine”. So, what could be done? Some of these suggestions might not be popular, but here goes. Government employees should not get patents, unless with specific dispensation. Going further, third parties working with academics should also not get patents regarding such work unless they get consent from, and compensate society via, the appropriate authorities. Most importantly: medical patents should be severely limited in number, scope, and duration of applicability. But until these and other legal and societal frameworks have changed fundamentally, we only have this important warning: “Please remember that proprietary pricing is paid in patients’ lives!”