Sunday, January 31, 2016
The nightmare of medicine is the absurd price we have to pay
A grandmother develops a boil that turns out to be a difficult-to-treat staph infection (MRSA). She needs high-powered antibiotics. A middle-aged man who received a blood transfusion decades ago now has hepatitis C and needs anti-viral medicine. A young woman with HIV develops golf-ball-size lesions in her brain, has toxoplasmosis and needs anti-parasite medicine.
The marvel of medicine today is that we can treat all three infections, and save the lives of these patients and countless millions of other Americans. Yet the nightmare of medicine today is the absurd price we have to pay.
Pfizer Pharmaceutical charges $56.31 per pill of Zyvox which treats the MRSA infection. So a 10-day treatment course costs over $1,000, equivalent to the cost of a dozen doctor visits.
Gilead Pharmaceutical charges $1,000 per pill of Sovladi to treat hepatitis C. So a 12-week treatment course costs over $84,000, equivalent to over a month’s hospital stay.
Turing Pharmaceutical charges $750 per pill for Daraprim to treat toxoplasmosis. So a course of treatment is hundreds of thousands of dollars, equivalent to providing health insurance to hundreds of individuals.
As an infectious disease doctor who sees the plight of such patients daily, I feel there is something wrong about the cost of medicines in our health care system. In a market-driven economy, I am OK with medical services to flourish and providers to prosper. But when there is price-gouging because a pharmaceutical company has monopoly on a drug, I feel someone has to step in.
Over the years, the government has regulated the payment from Medicare and Medicaid to providers. For the most common outpatient visit, doctors are paid $70, and for an average inpatient day, hospitals are paid over a thousand dollars. Now even insurance companies must apply 80 percent of the premium towards clinical care of patients. Yet government does not regulate the prices patients have to pay for medicines at the pharmacy.
This is not an accident, but by design. In fact, Congress specifically prohibits Medicare from negotiating lower drug prices with pharmaceutical companies. And so the irony is drugs are countless times cheaper overseas and across the border, since other countries sensibly negotiate with pharmaceutical manufacturers to get the best price for patients.
A few years ago during a family vacation to Canada, my father made sure to purchase his medicines at the pharmacy there. And recently when he needed a blood thinner, he called his sister in India to mail him the medicines. Ironically, it is the same manufacturer and the identical medicine that he would have had to pay far more for at his neighborhood drugstore.
Oftentimes drug manufacturers blame the high prices on research and development costs and the arduous FDA approval process necessary to bring a drug to market. Yet studies and a report in the Wall Street Journal show that is not the case. And much of the basic science research is conducted by government-funded researchers and agencies such as the National Institutes of Health.
Experts agree that drug pricing is not research- or manufacturing-cost driven, but rather profit-driven. Take the case of Daraprim and Turing Pharmaceuticals. A hedge fund manager purchased the company and raised the price of the drug from $13.50 a pill to $750 a pill overnight. Some pharmaceutical companies making cancer drugs and cholesterol drugs are doing the same.
As I watch patients and families forgo the optimal and sometimes the only treatment, I wonder how greed overrides sanity — even basic morality and humanity. What can we do?
Sadly the voice of the pharmaceutical lobby is Washington is louder than that of sick patients, the grandmother, the middle-aged man, and the young woman. They are us. Unless the public is outraged and raises a voice with Congress, the pharmaceutical companies will continue to reap a profit at the cost of patients’ pain — both physical and financial.