Pfizer and Enbrel

What is the Point of Business?

This case asks you to evaluate a business decision involving scientific uncertainty, the cost of further research, shareholder value, access to medicine, and corporate responsibility.

Case Summary

What’s the accusation in the Post’s story?

Basically, that Pfizer had evidence that Enbrel could be useful in Alzheimer’s disease, and didn’t do anything with it. This came from an analysis of insurance claim data: a set of about 127,000 patients with an Alzheimer’s diagnosis and a set of 127,000 without. It turns out that more people in the second group had been treated with Enbrel (302 patients) versus the first (110 patients). The Post obtained internal Pfizer documents discussing this and whether it was worth further investigation, and the company had concluded it wasn’t.

Why wouldn’t they?

Several reasons. The biggest, though, is that no one undertakes an Alzheimer’s trial lightly. The clinical success rate for Alzheimer’s trials is arguably zero per cent. There are a couple of therapies approved, but they don’t affect the disease progression at all—they help a few people, a bit, for a little while, and that’s it. That argues for a huge unmet need in the area, but it also argues for caution. Many, many approaches have been tried already, from many angles, and every single one of them has gone down in flames.

Background

Pfizer, one of the world’s largest pharmaceutical companies, co-markets Enbrel (etanercept), a biologic drug developed to treat autoimmune diseases such as rheumatoid arthritis and psoriasis. Originally created by Immunex and later acquired through Amgen, Enbrel became a blockbuster medication, generating billions in revenue annually. Its success, however, has been accompanied by complex ethical questions about access, pricing, and corporate responsibility in the pharmaceutical industry.

The Ethical Dilemma

By 2019, Enbrel had been on the market for two decades, protected by a series of patents that prevented competitors from producing biosimilar versions. In 2019, The New York Times reported that Pfizer researchers had discovered evidence suggesting Enbrel might reduce the risk of Alzheimer’s disease by as much as 64%. Despite the potential societal benefit, Pfizer chose not to pursue further research or publicize the findings, citing inconclusive data and the high cost of clinical trials. Critics argued that withholding such information—especially about a condition with no known cure—raised serious ethical concerns about transparency and moral responsibility.

At the same time, Enbrel’s U.S. list price had climbed to over $5,000 per month. Patients, advocacy groups, and policymakers accused Pfizer and Amgen of exploiting patent extensions (“evergreening”) and aggressive pricing strategies to maximize profits at the expense of patient access. Defenders of the company countered that the high price reflected years of R&D investment, stringent regulatory oversight, and the need to fund future innovation.

Key Ethical Issues

Discussion Question