Drugs for the People: Rethinking the global pharmaceutical supply chain
thebaffler.com
thebaffler.com
It seems the pharmaceutical industry has largely forgotten why it makes drugs in the first place: to save lives.
No, not really. They are in it to make money.
We used to think of medication as something you took occasionally during a crisis. Now we take it as a given that a large percentage of the population will be on maintenance drugs for life.
Then we act all shocked at the fragility of the global pharmaceutical industry and the growing issue of antibiotic resistance.
But if you make some prosaic observation about this overall pattern, you can expect to be basically booed, not taken seriously as trying to talk about the problem in some sensible fashion.
If you outlined a pattern in your comment I failed to deduce it. Something about negative externalities of increased drug consumption? I’m sure there is a point there that deserves a better argument.
And then we wring our hands when this leads to the kind of situation described in the article. But I know from long experience that no one will take you seriously if you try to talk about non drug solutions.
Not disputing this, and it certainly supports your point about the pharmaceutical industry making money.
But is there evidence that we are actually worse off for it? Did previous generations benefit from better mental and physical health than we do now.
My instinct is that we're healthier than ever before. We're treating conditions that weren't even identified a generation ago. Now that might not be due to our pharmaceutical intake, but I'd be surprised if it wasn't partially responsible.
Of course it's possible we've gone farther towards drugs than needed, which perhaps was your original point.
There are a large number of differences between the past and the present. It's really hard to talk about comparisons between the past and present and try to boil it down to a single metric.
Many years ago, a friend and I were talking and I was making sort of the same argument you are making -- that things are better than they used to be. And she stopped and said something like "I'm not comparing it to the past. I'm comparing it to what I think is possible given present day knowledge and technology."
And she also said something about "low standards" or "low expectations" -- like "Why should we settle for this crap just because the past was worse?"
And that really stuck with me.
I have gotten off all drugs for a condition where that isn't supposed to be possible and that strongly shapes my views and opinions in ways that I can't back up with studies or the like to the satisfaction of other people. But I'm convinced we can raise the bar and do better than this and one path forward is to begin thinking more broadly about the fact that "life is chemistry" and stop acting like a pill is the most important and powerful means to interact with human biochemistry when it's really just one of the most convenient ways to manipulate biochemistry that is profitable in our current economic arrangements.
As a drug wholesaler, this drug increased from ~20$ for a 100ct bottle to ~$100 for a 100ct bottle. At its height of popularity in late April, all supply chain went to McKesson/Cardinal/Amerisource with daily allocations to smaller independent/regional wholesalers. State boards of Pharmacy specifically changed law to make sure this drug was given to those that actually needed it for RA.
The author does make great points on big pharma and absurdity of patents/costs, but HCQ is not a great way to illustrate that point.
Lastly, HCQ was so overproduced that by the end of July 100ct bottles were selling to smaller regional wholesalers off contract at $3-5 per 100 ct bottle. Patients can probably buy this cash pay from an independent pharmacy for $10 now.
I believe that the US being a net exporter of food, and a net importer of medicine is an acceptable situation. I think that to frame out ‘reliance’ on India and China for medicine ignores China’s ‘reliance’ on the US for soybeans, or India’s reliance on US warships in the Indian Ocean for strategic defense. We are codependent, and that codependency is going to keep us all from killing each other again.
Should we have emergency stockpiles of food, water, medical equipment, energy, and shelters? Absolutely. Let’s remember that any inefficiencies in our manufacturing base serve to make us less competitive internationally and raise the prices that consumers spend. There’s only so much emergency preparedness we can reasonably expect.
Insulin for example is just worked up GMO yeast metabolites. That's not a particularly new or complex idea.
America's great as long as you're not sick.
I lean left and right on many different issues, but holy shit America's healthcare system is ass-backwards compared to the rest of the world, which has figured out how to keep people alive if some unfortunate event happens without making them worry about deciding to pay for groceries or pay for medicine/healthcare. Anyone that thinks otherwise is brainwashed. Yes there are horror stories in other countries, but they don't include bankrupting people who were grossly overcharged for their care, or people rationing their medication because they can't pay for it. Fuck the current US healthcare system.
A single-payer system makes sense and it works everywhere else on the planet. The American people's refusal to get it reminds me of the not-invented-here syndrome we see in tech everyday.
Nope, you're just being taken for a ride because they can. Remember that the biggest line item for pharmaceutical companies is their advertising budget, not their research budget.
Also, this kind of thinking is some weird sort of Stockholm Syndrome, you're basically trying to frame being taken advantage of as some sort of altruism.
There seems to be some tension between that and a $14,000/month leukemia drug. The drug companies shouldn't really need to advertise life saving medication.
The world is full of surprises, but I assume the advertising budget is more for the less important medications where people have to be more active in seeking them out.
It is a matter of incentives. If you want them to spend less on advertising, you’d have to provide them with a much longer time to recover development costs. Which also has significant downsides.
Gleevec did not take many years at all for Novartis to recover its trivial relative costs and generate billions of dollars of profit for nearly 2 decades. The problem is when you have a disease and there's only one treatment around, you'll literally pay whatever it costs - because not having it means you're dead.
These companies then turn around and extract as much money as they possibly can. They're monopolies, pure and simple.
I've seen this with my son's diabetes as well. The costs continue to rise (insulin, Dexcom sensors/transmitters, etc.) I've turned down jobs because their health benefits only covered a lousier insulin pump / glucose monitor due to an exclusive agreement with their chosen health insurer.
The problem is if you or a loved one isn't sick, this doesn't affect you one damn bit. My dad (an italian-born immigrant) has always complained to me about our healthcare system (and he had a great healthcare plan as a GM employee.) I didn't really paid it much attention because I was young and healthy. Now, quite a bit older and with family members with a variety of health issues, I realized that he (in my opinion) was right.
These things cost a certain amount of money to produce. What you are complaining about is how that cost is distributed among the people that might consume it. However, the implications of redistributing that cost are not particularly palatable either. Ultimately, someone has to pay for development and there are only so many places you can hide the necessary revenue that no one wants to pay. These costs don’t automagically disappear through political sleight of hand.
Perhaps not to you, but socialized healthcare is being advocated for by several elected officials, so it's not completely off-the-table.
This isn't me speculating there's some benevolent reason for high costs. This is me speculating on whether or not the US, if it dealt with these issues head on, would inadvertently cause prices to rise elsewhere. And if it did, that would simply mean the world, and not just the US, would have to deal with the systemic issue at hand.
There's a lot wrong with US healthcare, but IMO a sticker price of $14,000 is actually a signal of a different problem, which is... that the prices are fake.
Nobody is actually expecting individuals to pay $14,000/mo. In the circumstance that an uninsured individual is on the drug, they'll be put on a payment plan which works out to an income-based-repayment: they know they won't get half a million from the patient, they'll get what (they think) the patient can afford.
For insured patients (realistically, almost everyone who could have afforded such a high sticker, because of employer-based healthcare) the sticker price is meaningless, because there's a negotiated rate between the insurance company and the provider. Likely negotiated inefficiently with each individual insurer, but the end money transfer a small fraction of $14,000.
I'm not trying to argue that there's not a ton of waste here. It's dumb and the lack of price visibility means nobody at any level makes informed choices. But the $14,000 price shouldn't be viewed as a real price in any meaningful sense.
For better or worse, only country that can break the monopoly is China imo. I hope they follow a different model of rewarding useful research.