CODE BLUE BLOG SCOOPS NY TIMES

Today's Sunday NY Times contains a front page article about a new generation of pharmaceuticals expected to, finally, have a significant impact against cancer.

CodeBlueBlog brought the same matter to public attention 5/24/2004.

Of course, The Times and CodeBlueBlog have different slants on the economic ramifications of this new wave of research.

CBB believes that we should all pay more for our medications (especially anyone who is receiving an entitlement and has the means to pay more -- you know who you slot players are!). The Times, however, has another slant:

And when more of these drugs come to market, paying for them could strain the health care system, especially since some of the newer ones cost tens of thousands of dollars for a course of treatment. Bain & Company, the management consulting firm, has estimated that paying for all the cancer drugs likely to come to market would require $60 billion a year, up from $10 billion now. "The whole U.S. drug market is $150 billion," said Elgar Peerschke, head of the North American health care practice at Bain. "Who's going to pay for that? It's just going to become unaffordable."

The Times immediately starts worrying about the strain of the costs of these new drugs on the "health care system" – adding, I suppose to the ever-present, ever-worsening, health care crisis. Who is going to pay for these drugs?

I will.

I’ll pay whatever they ask.

You know, a friend of mine in college got into some serious legal trouble. His parents wanted the best lawyer they could get. That lawyer – and the defense of the case -- over the course of two years cost several hundred thousand dollars.

No one asked them if they could pay. No one quoted the legal care crisis to the family; nor did the family complain. They mortgaged their home. They traded in their stocks. They paid for the legal defense. My friend was acquitted. Ask the family now and they will tell you it was all worth it. Every penny.

We are not ten seconds into this new health care revolution and the Socialism mongers are already whining over the burden these discoveries will cause the health care system. How idiotic is that? Don’t try so hard to cure cancer because we don’t know if the system can afford to give it away free to everyone?

Rather we emulate Canada or Great Britain, and offer lots of free eyeglasses and canes, plenty of walk-in clinics for your lumbago and STD’s while clamping down the therapeutic claws of the real stuff needed in this modern era of ultra sophisticated health care: Specialists; Intensive care; High-Tech pre-emptive diagnostic evaluations; Miracle medications.

I say it again: SUPPORT YOUR LOCAL PHARMACEUTICAL COMPANY...the life you save may be your own.

Stay tuned to CBB for All The News That’s Fit to Blog…before you see it in The Times.

Comments

[Gerald]

You didn't respond to my comment below. What I said is a proven, established fact : a large portion of the money these drug companies take in is wasted on marketing and reinventing useless drugs.

And your analogy is hardly sound : if the legal system worked anywhere close to how it should it wouldn't matter how good a lawyer a party had. The decision making would be almost completely impartial. In a similar vein, if the drug creation system were more efficient we could have much better, more advanced drugs for the same cost we are paying now.

Finally, "I will"...ahem...as a full MD with full health insurance your declaration hardly helps. The average working american only makes 40-60k a year and can no longer afford to pay for most of the high end drugs and specialists, so the money has to come from elsewhere.

Finally, its a matter of record that free walk in clinics for "walk-in clinics for your lumbago and STD’s" help MORE people than the very sickest who need the high end care. As a nation, should we really blow the health care funds on a handful of people who will never be able to repay society for the effort to extend their lives, or help all the people who are paying and working for this whole system?

[CodeBlueBlogMD]

Basically, what your argument comes down to, versus mine, is Adam Smith versus Jean Jacques Rousseau. I believe that we are not smart enough to tinker with the pharmaceutical market-based system without the real danger of destroying an industry that is producing drugs that will change the world very soon – probably just in time to save you and yours…nonetheless; to address your specific points:

Drug companies may spend a lot of their profits on “advertising” but one should not confuse pharmaceutical advertising with traditional Madison Avenue pitching of commercial products. Nor is it correct to state that advertising dollars are “wasted.”

Much of the advertising budget is applied to physician education which is of critical importance most of the time. Many drugs have subtle differences and usages. Physicians often need to be “retrained” by the pharmaceutical companies to accept novel therapies that are necessary to replace or supplement old regimens as there is no real consistent quorum for physicians to get this information uniformly and in a timely manner.

Granted, drug companies use this situation to their advantage and over-advertise their fares; however, money would be better spent alerting MD’s to the practice (they are already aware, believe me) and letting physicians decide what’s best for the patient.

Now, if we adopt your program to distribute profits, the first thing the drug companies will do is raise prices. I assume you will prohibit this in some way. One of the major problems with all schemes invented to “control” drug prices is that they wind up doing just that -- artificially -- and price controls are demonstrably bad for the industry.

Artificially set price controls have a known deleterious effect on the drug industry as a whole, and especially on the development and introduction of novel therapies. As stated by the American Enterprise Institute, controls on prices lead inevitably to fewer drugs developed, and longer waiting times for innovative therapies and both of these phenomena have been witnessed since 1990 when price controls began to become popular in many of the world’s economically developed nations.

As reported by Joseph Newhouse in a recent issue of Health Affairs:

The linkage between prices, profits, and pharmaceutical R&D is nearly universally recognized by economists. They typically emphasize that price controls are bound to blunt R&D incentives.

The claim that companies are making “useless” knockoffs of generics to “cash in” seems self contradictory. Generics, by their nature, are low-profit items, especially for the big pharmaceutical companies (compared to the major patented marquee pharmaceuticals); moreover, in general, pharmaceutical firms usually differentiate themselves into generic providers (like Ivax) or innovators (like Merck), and I cannot find examples of major innovative firms padding their accounts receivables with the sales of generics – no matter how useful or useless they are.

The costs of developing new drugs have been calculated via large aggregated analyses, including all the various different tracks the FDA allows drugs to be approved when containing already-proven assets or components. The standard figures (according to U.S. government economists) are that the estimated pre-tax capitalized cost of bringing a new drug to market is anywhere from $359 million to $500 million

These are retrograde analyses. In one estimate I studied, the break-even hurdle could only be overcome at R&D costs over$400 million from now on. (The breakdown of these costs is approximately: basic/investigative, 10%; preclinical, 15%; manufacturing/process, 15%; clinical, 55%; post-marketing, 5% -- hmmm, that marketing percentage is a bit different from those quoted by the opposition!).

My analogy to the legal system has been misinterpreted. What I meant to illustrate was that in any venue, when your life or freedom is on the line, cost is not an issue.

Not that I advocate cleaning people out so they can pay for their lawyers or medications; however, it is THE primary consideration you should keep in your mind at all times: when you or your child or your mother gets Systemic Lupus or non-Hodgkin’s Lymphoma or metastatic melanoma and the horror of what you or they face is staring you in the mirror like a black angel…you won’t care WHAT Merck spends on advertising. You just want that drug. Cost notwithstanding.

Since you don’t know what I make nor what I pay for health insurance (nor are you aware of the health of my family or their need for drugs, therapies or chronic care), then your weak ad hominen insult (Finally, "I will"...ahem...as a full MD with full health insurance your declaration hardly helps. The average working american only makes 40-60k a year) will be passed over by me as a moment of impassioned ignorance.

I will say that your average “working American” who cannot afford to pay for drugs for his kids is somehow betting $1 billion a day and losing (throwing away) $40 billion a year on slot machines.

And speaking of the average “working American” has anyone noticed that Merck, Pfizer and all the other major drug companies are publicly owned. And that 70% of the families in the U.S. are invested in the stock market? That Merck paid out $3.5 billion in dividends last year and that 100 shares of stock in Merck bought in 1990 has returned over 3,000% since then.

So who are the real profiteers?

[poormedicalstudent]

Great post, and an even better response to your previous commenter. It's always intersting to see people scream for price-controls and free drugs because inevitably they do not understand 1)economics or 2)the marketplace. it's quite easy to call for free this and free that when you have such ignorance.

keep up the good work.

[Gerald]

The problem with Adam Smith is taking it to extremes. A company, by definition, exists to make money in the most efficient way possible. If creating useless knockoffs (error, did not mean to use the term 'generics' : I was referring to the flood of blood pressure and impotence drugs because these are profitable markets yet for the most part the new drugs are not better than the old ones) with the income from patented drugs is the most profitable use of the shareholders money, then the company management has a fudiciary responsibility to spend it there.

Along a similar vein, if spending billions on both consumer and physician advertising makes more money than accelerating research on truly useful drugs, then that is what the company will do. I suppose all the free stuff and the drug reps who look like models must really help physicians make sound, scientifically grounded decision making regarding their products. They would never be swayed to the point of adopting drugs that just may kill more people than they save (certain MI drugs...)

Bluntly put, if a company made the most money killing people and if it were not legally stopped then it would continue to exist and grow larger. Organized crime and tobacco companies amount to this.

The 50% figure is what the companies actually SPEND every year, not what it COSTS at a minimum to get a drug to market. So, out of the 60 billion the country spends on drugs half of it goes to these 'advertising' costs.

And ALL of that is wasted, even the bit about "physician education". Why? Simple : to use an argument you just made : if someone's life is on the line you cannot trust biased information. A competent physician completely ignores the crap the drug companies spew out in terms of 'education' because while the information could be valid, many times in the past it has turned out not to be. The role of 'physician education' is already served by journals, studies, and so forth...under my proposal drug companies would be allowed to fund these.

I'm not advocating price controls : companies can charge whatever under this proposal, but they cannot spend the profits on anything else but R&D for new drugs, shareholder return, and overhead. If no drug company is allowed to advertise directly to consumers or to physicians with more than a small percentage of the budget, then none of them will need the advertising. That is how the ad game works.

My "weak ad hominen insult" was not intended to be such. I'm merely pointing out that given you are PROBABLY (based on averages for physician income and the usual professional courtesy they are afforded) not hurting for health care in quite the same way as the average Joe. So a declaration that you can afford much more expensive drugs and don't really care how expensive they get doesn't mean as much. You're saying you wouldn't care if a lifesaving drug you needed had nearly all the money you paid for the drug put in a bonfire and burned - you would consider it the right of the company, which holds a patent enabling it to charge 100x the production cost of the drug, to burn your money. I mean, I'd pay it if that were the only choice, but I would resent it and call for action taken to stop this.

I agree about the 40 billion spent on slot machines. It should not be legal for anyone receiving public assistance of any kind to gamble. Interestingly, you apply my own argument. Its a waste of money that should go to health care when the slots are played, its a waste of money when the drug companies try to out-shout each other and make knockoffs of patented drugs when the knockoffs are no better. Just like you know that a microchip in a slot machine makes the game a bonfire of money, I know that billions in ads and drug reps giving it all away is also a waste. You should be able to make the same connection.

A final note : the "70% of families" figure is a classic misuse of statistics. Two of your major assumptions are flawed : one, that wealth is distributed evenly more or less among americans (and the ones with less must not have 'earned' it and vice versa) and two, that most americans have roughly the same wealth and lifestyle you likely enjoy.

But, if this were the case this whole issue wouldn't exist. The truth is, almost all of those families have basically no stock and benefit little from drug comapny profits. The top few percent own more than half the actual wealth. Interestingly, this also applies to the gambling : a much smaller number of wealthy seniors are the ones blowing most of the money (and generally have plenty of money left to pay for their health care...).

The point isn't to accentuate class envy : facts are facts, though. I'm not calling for socialist crap like redistribution, merely pointing out the realities as they exist.

[poormedicalstudent]

not all information coming from drug reps is crap. in fact, many times it's the best condensation of studies relating to said drug that is available. but, much like reviewing studies funded in part by pharm companies, doctors must use common sense when reviewing company literature.

you advocate letting drug companies pay for more studies, etc. but this would effectively produce journals of 'advertisements'. personally, i believe that pharm supporting studies is fine, as long as it is clearly noted. i think advertising on television and in magazines is complete crap. the entire marketing budget should be geared towards the physicians, with the lion's share going towards free samples that are given out to those who cannot afford a complete course of antibiotics, etc.

regarding producing drugs that do the same thing, it's not quite that clear cut. while cialis and viagra work towards the same end (helping ED), their MOAs are different, and so will work differently in different patients. restricting the market to only producing 1 SSRI, 1 NDRI, 1 ACEI, etc. is not the way to go.

[Gerald]

Poormedicalstudent : everything you say makes sense. I'm not really hung up on a a particular solution, I just think that given the main problems, action needs to be taken up to free up wasted money first, rather than increasing health care spending. I'm also all for the formation of a different system for evaluating malpractice suits to free up more money from reduced unneccesary testing and insurance premiums. Your modification of my proposal is fine. (some sort of board like structure with a panel of experts with some ordinary folk to give them some voice seems fair. )

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