And so it came to pass – King Charles suffered such side effects from chemotherapy, that he was apparently forced to cancel engagements with three ambassadors and scheduled events in Birmingham; think of the thousands of disappointed subjects. The debilitating side effects of the chemotherapy drug laid even a king, low.

All credit to companies whose chemotherapy drugs have, in many cases, cured cancer; and in others, prolonged lives by months and years. However, the dark side of these drugs are the side effects suffered by the majority of users – indicating a serious defect in these drugs. Unfortunately, cancer victims have no option but to accept such defects in the hope of a cure or precious extra time with loved ones. Because chemotherapy drugs of all such companies have similar side effects, with no evidence of attempts to eliminate them, the public would consider such behaviour by the companies as an abuse of market power.

Let’s consider market power in the sale of basic items such as clothing and vehicles. The public know that these products are works in progress – their manufacturers treading the continuous improvement track. Jeans – a staple in wardrobes of poor and rich alike – have improved their stitching at stress points, eliminating the use of rivets. Their use on certain jeans today, are merely decorative. Vehicles have the lower fuel Eco mode and accident prevention alerts – demonstrative of continuous improvement. Clothing and/or vehicles with defects are withdrawn immediately, protecting market share; bottom line; and avoiding adverse publicity. This is the iron law of markets: all things being equal, consumers will purchase defect-free products.

Sadly, there is no comparable market force requiring, in the main, US-based chemotherapy drug companies, to manufacture drugs without debilitating side effects. This is because the US Federal Drug Administration (FDA) have enabled these companies to create the Eliot Ness of markets, where the companies are the market. Furthermore, the FDA permits these companies to operate at the lowest common denominator viz churn out drugs with similar side-effects, referred to in the industry as me-too drugs.

Authors Jeffrey K Aronson and A Richard Green discuss such drugs in their article, Me‐too pharmaceutical products: History, definitions, examples, and relevance to drug shortages and essential medicines lists*:

Several definitions of me‐too drugs have previously been offered, none satisfactory. Goodman’s dismissal of them as “drugs without signal advantage of any sort” was echoed in 1964 by Lasagna, who described them as being “hard to justify putting into man at all, let alone on the market”. Similarly, in 1994 Desmond Laurence and John Carpenter defined me‐too drugs as “Slang for a drug [sic] developed to allow a pharmaceutical company to gain a share of the existing market. Any gain to therapeutics is purely incidental.”

(*PubMed Central, National Library of Medicine)

By permitting companies to market me-too drugs viz drugs with the same defects, the FDA have eliminated market forces for such drugs. And to the public’s entitlement to defect-free drugs, the companies have adopted Rhett Butler’s classic, ‘Frankly my dear, I don’t give a damn.’

While non-chemotherapy drugs also have side effects, none come close to the debilitating side effects of chemotherapy used by millions around the world. The US Dana-Faber Cancer Institute reports that, according to the World Cancer Fund International, there were an estimated 18 million cancer cases worldwide in 2020. The Australian Cancer Council estimates that in 2024, around 169,500 Australian would be diagnosed with cancer.

The solution is hiding in plain sight. The FDA and the TGA (Australian Therapeutic Goods Administration that approve the sale of drugs in Australia), must require these companies to market drugs either without, or with minimal, side-effects. The companies’ quality assurance programs commit them to continuous improvement. Consequently, the FDA and the TGA would be within their rights to require companies to demonstrate that – as part of their continuous improvement – they are striving to manufacture drugs without side effects.

According to the US Pharmaceutical Technology, the 2023 annual revenues of the top eight companies manufacturing chemotherapy drugs, ranged between about US$45bn to US$85bn. Companies generally spend around US$1bn to bring a drug to market. The enhanced power of AI should enable companies to eliminate, or substantially reduce, the debilitating side effects of their drugs, lowering the cost of marketing a drug – which would result in a lower impact on their bottom lines.

The members of the US Pharmaceutical Research and Manufacturers of America (PhRMA), include companies that manufacture chemotherapy drugs. Their home page states: ‘We’re working to drive patient-centred progress in innovation, affordability, and access to life-saving prescription medicines.’ Because innovation should include manufacturing drugs without debilitating side effects, the PhRMA should be required to remind their members of this fact.

Donald Trump’s focus on doing what is best for the American public, must include those on chemotherapy. Health tzar Robert F Kennedy Jr must instruct the FDA to give chemotherapy drug companies, say, a maximum of two years, within which to eliminate the debilitating side effects of their drugs. Aside from helping millions of cancer victims around the world, the instruction would create market forces that are presently non-existent in the chemotherapy drug market.