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letter (edited): With the heavy encouragement of pharmaceutical companies, the blame for such shortfalls often falls on the National Institute for Health and Care Excellence (Nice), the public body that advises the NHS on whether medicines represent value for money. But high medicine prices, including that of Enhertu (average course of treatment: £117,857), are not some natural or necessarily occurring thing. While pharmaceutical companies are famously opaque when it comes to the real cost of producing drugs, it has been repeatedly shown that the NHS has been overcharged for similar cancer treatments. Most obviously, Trastuzumab, which is a key component of Enhertu, was previously sold in the UK at a price 10 times its actual cost of production. The non-availability of key drugs is the result of business decisions made by corporations whose primary interest is in keeping prices high to maximise profit. When people’s lives are at stake, this is inexcusable. Even more so when you consider that the monoclonal antibody technology on which Enhertu is partly based was developed with huge amounts of public funding from the UK’s Medical Research Council. In cases where medicines are priced out of reach of the NHS, the government should be prepared to override patents – supporting the manufacture of medicines domestically. Where the public has contributed to drug development, the case for strict conditions on pricing is even stronger. Tim Bierley Global Justice Now