The Cancer Calculus

EXPOSURES - EXPOSÉS, 20 Apr 2026

International Consortium of Investigative Journalists - TRANSCEND Media Service

The International Consortium of Investigative Journalists Is Proud to Bring You Our Latest Investigation

13 Apr 2026 – In late December, nine pharmaceutical executives came together at the White House to celebrate deals struck with President Donald Trump to slash prices on some of their flagship drugs. Among the executives — whose combined annual compensation topped $100 million — was Robert M. Davis, CEO and chairman of Merck & Co.

He nodded along and smiled as the president crowed about lowering the cost of prescriptions for Americans. But when it was Davis’ turn to speak, he failed to mention his own company’s biggest moneymaker: the blockbuster cancer drug Keytruda.

Keytruda has been hailed as a game changer in cancer treatment, but much of the world can’t afford it. Now, The Cancer Calculus, a yearlong investigation by the International Consortium of Investigative Journalists, sheds new light on how Merck has fended off competitors to keep the price of Keytruda sky-high, locking out patients and squeezing health care systems worldwide.

Reporting by dozens of ICIJ media partners across five continents paints a picture of deep and dangerous inequity. Some patients are so desperate for Keytruda that they seek cheaper alternatives on the black market. Others turn to the courts, only to face harrowing bureaucratic obstacles as they fight to survive.

In India, families seeking Keytruda struggle with poor health coverage. In Brazil, thousands take legal action. In South Africa, a single dose of Keytruda costs roughly 10 times the average monthly income. In the United Kingdom, the cash-strapped National Health Service overpays. And in Guatemala, one doctor faced an impossible decision: to choose two among his many patients to receive the drug.

“What’s left for me to do? To play God,” said Julio Ramírez, head of the oncology unit at the regional public hospital in Quetzaltenango, Guatemala’s second largest city. “The first patient who arrives, that’s who I’m going to give the treatment to because that’s all I can do.”

• READ: How Merck turned its wonder drug into a blockbuster — and priced out cancer patients worldwide
• READ: ‘They deny the medication that is keeping you alive’: Patients wage grueling legal battles for lifesaving cancer drug
• READ: Counterfeiters cash in on the world’s bestselling cancer drug
• WATCH: An introduction to Cancer Calculus
• ABOUT: The collaboration behind the investigation

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The International Consortium of Investigative Journalists is a global network of more than 190 investigative journalists in more than 65 countries who collaborate on in-depth investigative stories. Founded in 1997 by the respected American journalist Chuck Lewis, ICIJ was launched as a project of the Center for Public Integrity to extend the Center’s style of watchdog journalism, focusing on issues that do not stop at national frontiers: cross-border crime, corruption, and the accountability of power. Backed by the Center and its computer-assisted reporting specialists, public records experts, fact-checkers and lawyers, ICIJ reporters and editors provide real-time resources and state-of-the-art tools and techniques to journalists around the world.  More…

This article originally appeared on Transcend Media Service (TMS) on 20 Apr 2026.

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