Doctor’s Tip: Pharma, device makers like health system as is
This is the fourth and final column about what Robert Pearl M.D. calls the legacy players in his recent book “Mistreated, Why We Think We’re Getting Good Health Care — And Why We’re Usually Wrong.” He describes the four legacy players, medical insurance companies, hospitals, specialty physician societies and pharmaceutical/medical device companies, as entities in our health care system that are benefiting financially from the status quo and therefore resist needed change.
According to Dr. Pearl, pharmaceutical manufacturing and sales may be the most profitable industry in the world. Like hospitals, pharmaceutical companies charge a lot because they can. In particular, they take advantage of those in dire need of the drugs they manufacture. According to an editorial in this month’s issue of the American Family Physician journal, “in 2013, an average of $858 was spent on medications by every man, woman and child in the United States; costs increased an additional 12.6 percent the following year.” And “some people with cancer, multiple sclerosis or autoimmune disorders incur annual medication costs of $100,000 to $200,000 or more.”
Here are some specific examples of the problem:
• Nexium prevents the stomach from making acid, and is beneficial for those with conditions such as acid reflux. It costs $30 a month in Canada and $305 in the U.S. Yet because of the political influence Big Pharma has, it is illegal to import pharmaceuticals from other countries.
• Gleevec is a chemotherapeutic agent for a type of leukemia. It costs $989 per month in New Zealand and around $8,500 per month in the U.S.
• Asthma is a common, sometimes life-threatening disease. An Advair inhaler costs $310 in the U.S., $35 in France.
• EpiPen contains epinephrine, which is made by the human body and is inexpensive. For adults and children with conditions such as nut allergies this substance can be lifesaving. The safest and most practical way to inject it is with an auto-injector now made by Mylan called an EpiPen. NASA developed this device over 34 years ago. Mylan bought the rights and charged $100 for the unit. Between 2007 and 2015 the price increased by 600 percent, because Mylan knew that patients with severe allergies literally couldn’t live without it. During the same period, the salary for Mylan’s CEO rose 671 percent, from $2.5 to $18.9 million a year.
“Evergreening” involves tweaking an existing product about to become generic, so the new “me too” drug is marketed as something wonderful and new that patients then request. Many other countries don’t allow “me too” drugs.
“Pay for delay” occurs when a pharmaceutical company pays a generic manufacturer not to produce a generic, which is equivalent to the company’s expensive brand-name drug.
People with insurance, including Medicare Part D, don’t realize the cost of pharmaceuticals, but their high cost raises insurance rates for all of us. Doctors usually don’t know the cost of medications they prescribe. Most other countries don’t allow the direct marketing we see here, which leads patients to request expensive, brand-name drugs. And Big Pharma is shameless about marketing to physicians. It always bothered me that Glenwood Medical Associates allowed pharmaceutical reps to buy lunch (usually unhealthy) for the doctors and employees several times a week. The reps knew how many prescriptions for their drug each physician was writing, and they pressured us to prescribe their drug.
According to the American Family Physician journal, the industry claims that “revenue is plowed back into research and development.” However, “critics point out that the major pharmaceutical companies spend a greater proportion of their revenue on sales and marketing ($5.2 billion in 2015).”
Let’s end this column with an example of how medical device makers gouge us:
Robots for robotic prostate surgery cost $1 million, and this surgery is much more expensive than nonrobotic surgery. Marketing tries to convince patients that robotic surgery is the latest and greatest thing. Once one hospital purchases a robot, neighboring hospitals feel they have to buy one too. However, according to Dr. Pearl, robotic surgery usually takes longer and the outcomes are no better than with nonrobotic surgery.
Here’s how the industry really makes money: Each robot has two disposable arms, which are very expensive to replace. The arms are probably good for 100 procedures, but “each arm has a built-in obsolescence factor that forces hospitals to replace them after 10 uses.” And as you might suspect, the company charges a lot for the replacement arms.
In summary, Dr. Pearl notes that “much of the blame for our current health-care problems can be placed squarely on the shoulders of the legacy players.” The best way to avoid the need for medications and medical devices is to live a healthy lifestyle.
Dr. Feinsinger, who retired from Glenwood Medical Associates after 42 years as a family physician, now has a nonprofit Center For Prevention and Treatment of Disease Through Nutrition. He is available for free consultations about heart attack prevention and any other medical concerns. Call 970-379-5718 for an appointment. For questions about his columns, email him at firstname.lastname@example.org.
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