Martin Shkreli thinks he made a mistake: He didn't hike the price of his drug enough.
And that willingness to say something so awful, so off-putting, is just one reason why he's so darn useful to have around.
The controversial pharmaceutical CEO spoke at the Forbes Healthcare Summit on Thursday, and I had a balcony seat to watch Shkreli defend his decision to raise the price of Daraprim by more than 5,000 percent (and his subsequent choice to renege on promised price cuts). Shkreli's justification: His responsibility is to shareholders, not patients.
"I'm going to maximize profits," Shkreli said. "That's what people [in health care] are afraid to say."
One woman asked Shkreli how he would redo the past three months, if given the chance. After all, he was pilloried worldwide, scrutinized by regulators, and used as a political punching bag.
But Shkreli was unrepentant. "I would have raised prices higher," he said. "That's my duty."
Even at a Forbes summit — a room packed with libertarians, industry executives, and Wall Street traders — there was more shock than awe.
"He either doesn't care what people think, or he's a sociopath," one prominent pharmaceutical expert told me after Shkreli exited the stage.
Shkreli styles himself as a truth teller, saying the hard things that no one else is brave enough to reveal about health care. And in some ways, he's right! Major insurers, drugmakers, and hospital systems collect billions of dollars in annual earnings … but cloak many profit-driven decisions by defending them as beneficial for patients. By being brutally honest about his motives, Shkreli is a rare exception. His comments may be odious, but they're not baseless.
That doesn't make them morally right, though. One reason we need Martin Shkreli is to protect against other Martin Shkrelis, who find ways to exploit the system and turn patients into profit centers. The cost of Daraprim — a drug that AIDS patients and others use to fight certain infections — went from $13.50 per pill to $750 per pill after Shkreli bought the rights to produce the drug.
And make no mistake: The cost of drugs is a growing problem in health care. New data released by CMS this week found that prescription drug spending shot up more than 12 percent last year, significantly outpacing the 5 percent overall rise in health spending.
That's not all on Shkreli and others like him. (Peter Bach, a Memorial Sloan Kettering oncologist who spoke about 30 minutes before Shkreli took the stage, made the point that there's very little downward pressure on pharmaceutical companies' prices.) In fact, Shkreli is a rather small part of the problem—only 10,000 patients or so use Daraprim per year. There are bigger organizations than Turing Pharmaceuticals engaging in objectionable behavior but not taking the same body blows.
But in some ways, Shkreli's very visible, unrepentant actions are playing the same role when debating drug costs that a mass shooting plays when talking about gun violence. Are most Americans directly affected? No. Is it a visible symptom of a larger problem? Yes. And does it mobilize would-be reformers? Definitely.
Just look at how Shkreli's actions are leading to actual, incremental change. Last month's budget deal contained an important provision to curb generic drug price growth, which was directly targeted at Shkreli-like behavior. Presidential candidates like Bernie Sanders and Hillary Clinton are talking about the need for drug price reform — and in an unusual development, Republicans such as Marco Rubio are speaking up too.
Shkreli on Thursday vowed that despite all the criticism, he's not going away. (The negative attention "hasn't hurt [my company] one bit," he said on Thursday.) Let's hope that's true — and specifically, that Shkreli won't be silenced.
There are real questions about whether American health care has a profit problem. As long as Shkreli is around, provocatively stirring the pot, we'll have to face some uncomfortable truths — and hopefully get some necessary answers.
