Cancer. It is a word the strikes fear in the hearts of many as many still equate being told one has cancer with one being given a death sentence. From that point on, one becomes somewhat of a living time bomb. However, for you, the cancer has been caught early on enough that you can still get treatment to combat the deadly illness. Immediately, one’s thoughts then go to how much will this treatment cost? For someone without insurance, the costs could be crippling. Imatinib is from a class of drugs commonly used to combat cancer. In the United States, a single year’s worth of treatment can cost upwards of $106,000. Luckily, you live in India.
In India, a year’s worth of treatment using Imatinib costs around $159. The difference between the costs for this type of drug between India and the United States is a price hike of over 66,566%. That’s right, five digits. A recent review of drug production costs and pricing presented this past September at the 2015 European Cancer Congress mapped out the money an individual would spend for a year’s treatment of three classes of drugs commonly used to combat cancer: Imatinibs, Erlotinibs, and Lapatinibs. In addition, these prices are already allowing for a 50% profit margin for pharmaceutical companies. The main reason why these life-saving drugs are cheaper in both India and in Europe (the price hike between Europe and the United States for Imatinib hovering at around 231%) is because generic versions of the drugs using Imatinibs are so much more readily available in India. The article takes the specific example of Gleevec, a drug used by people with leukemia and gastric cancer. Its patent, first approved by the FDA in 2001, should have expired this year. However, Novartis, the pharmaceutical company who has the patent, has managed to keep other companies trying to make generic version at bay by making the large amounts the drug needed to synthesize a generic version hard to attain by these other companies. This is a problem faced by many pharmaceutical companies as they try to produce cheaper generic versions of much more expensive drugs. The reason why expensive drugs are able to stay expensive is because there are no other competitors. As a result, people with these illnesses (usually more rare and not as researched) are forced to buy these expensive drugs as they have to alternative drug to turn to.
Why then, are these cancer drugs so much cheaper in India? With not as many restrictions within drug production and with drugs being so readily available, companies are able to attain enough samples to create many different generic versions of a single drug. As a result, the buying medication in India is more of a true free market as consumers can see how expensive each drug that would do the same thing is. Companies are then either forced to lower prices to beat out their competition or risk going out of business. As it would not really be beneficial for anyone (but Pharmaceutical companies) to lower drug production restrictions, the more feasible solution for the United States would be to put a cap on prices for each specific type of drug. Adopting something similar to Canada’s pharmaceutical policy where certain drugs cannot be sold within the county unless the price can be negotiated to a suitable arrangement would get affordable life-saving medication to those who need it the most without making them have to move halfway across the world to receive it.
As part of Chapter 9 in his book “How Doctors Think”, Groopman describes how deeply pharmaceutical companies can affect the decisions that doctors make for their patients through aggressive marketing strategies. By offering things ranging from free samples of drugs available to patients at the doctor’s office in order to get a patient hooked on more expensive drugs to “gifts” (monetary or otherwise) given to doctors who push for the use of specific drugs or treatments, pharmaceutical companies can easily influence the medical field’s determination of what conditions should be medicalized.
The way pharmaceutical companies in a way “buy off” doctors really reminded me of how big corporations “buy off” politicians (essentially paying for the re-election campaigns of these politicians) to lobby (for example) bills to create tax or regulation loopholes. As there is a big push right now to get money out of politics, I was wondering, why there is not a big push to also get money out of the medical field? Has medicine really become so corporatized that the priority is no longer the well-being of the patient and is now more focused on how much profit everyone in each tier of the medical system can make? A more important question would probably be, would it even be possible to get money out of the medical field, with possible solutions including but not being limited to the standardization of drug prices (like in Canada)?
In Chapter 9, Marketing, Money, and Medical Decisions, in Groopman’s book, “How Doctors Think”, he illustrates how big pharmaceutical companies influences what becomes medicalized conditions in order to profit off of consumers. These aggressive pharmaceutical marketing leads to unnecessary invasive expensive procedures and financial gain from both the doctor and patient. These pharmaceutical companies tactics include giving gifts and bullying physicians into buying their drugs.
Douglas Watson, an executive in the pharmaceutical industry for 35 years, pushed for “ethical marketing” in which the aim of marketing should be the accurate education of a physician in the side effects and potential benefits of a particular agent. But, most doctors learn about their new products (drugs) from the pharmaceutical industry. Thus, as opposed to just selling the drug, the industry should help in the physicians’ education. Continue reading “Pharmaceutical Marketing and Medical Decisions”
In Groopman’s chapter titled “Marketing, Money, and Medical Decisions,” Groopman discusses the medicalizing of normal conditions done by the pharmaceutical companies. Gropper states ‘in the past decade or so, marketing directly to the public prompts people like aging men or postmenopausal women to ask their doctor for a drug even if the drug has not been proven to work for their problem.” One particular account that stood out was the prescribing of testosterone replacement products to men. Research found that “ treatment does not significantly increase strength in most muscle groups; compared to a placebo, it neither boost libido nor increases energy.”Groopman then goes on to say “nonetheless, the number of prescriptions for testosterone replacement products continue to rise sharply.” How is it ethical for doctors to prescribe drugs that are not specifically proven to target treatment of the condition the patient presents to them? Many drugs have serious side effects such as stroke and heart attack so what if the patient taking a drug that is not beneficial to their condition is harmed significantly due to the side effects of this drug? What role does ethics play in the prescription decision-making process for doctors?
In the article, “Health providers pressured by insurance, drug costs” by Tom DiChristopher, DiChristopher discusses how the financial pressures from high drugs costs, and negotiations with insurance companies effect the health care provider. This is a point of view that is not often discussed. The typical discussion that people have is about how the cost directly effects the patients. The article states that health care providers are trying to deliver high quality care at a much lower price. Health care providers are struggling with how to do this.
The biggest issue I have with health care providers trying to limit their care by how much things cost is I worry that patients will not be receiving as high quality care as they may have in the past. I believe it is not a health care providers responsibility to worry about how much things cost while they are trying to save someones life. Health care providers are trained to save lives not save money. I believe the real problem is why health care cost so much in the first place. In the article it discusses how one of the biggest problems is how much medication costs. I believe this is the core of the issue. If the pharmaceutical companies are not forced to lower their prices, health care professionals may be forced to treat patients in ways that are not as efficient. In the article it is argued that the price is justified because of the amount of research that goes into the product and they believe if they produce a life saving product they should receive a profit. I agree that there is a substantial amount of research that goes into these products, and that the scientist and pharmaceutical companies should be rewarded, however, if the product is too expensive for the patients who need it, the purpose has been defeated. Health care should put their patients first not their business.
At the end of the article Noseworthy said, “We’ve basically defunded the NIH over the last 11 years, and that’s a problem if you’re going to be the leading developer of new treatments in medicine. Our position could fall if that doesn’t turn around.” Because the United States is a leading developer in new treatments in medicine there is a lot of expectations and pressure put on us. Trying to solve the problem of high health care costs by defunded research is not the answer. They are taking the money from the wrong place. The real issue is with the pharmaceutical companies, and how the charge master prices are developed. If something doesn’t change, and health care providers are expected to deal with the business side of health care while treating patients, or high quality health care system will diminish.
Thought some of you might be interested in this upcoming online presentation hosted by the Harvard School of Public Health:
Email questions for the panelists.
Presented in Collaboration with Reuters and in Association with Harvard HealthPublications
Steven Pearson, President of the Institute for Clinical and Economic Review and Lecturer at Harvard Medical School
Aaron Kesselheim, Director, Program on Regulation, Therapeutics, and Law, Brigham and Women’s Hospital, and Associate Professor of Medicine, Harvard Medical School
Meredith Rosenthal, Professor of Health Economics and Policy, Harvard T.H. Chan School ofPublic Health
Lowell Schnipper, Clinical Director, Beth Israel Deaconess Medical Center Cancer Center, and Chair, American Society of Clinical Oncology’s Value in Cancer Care Task Force
Caroline Humer, Correspondent, Reuters
Through the readings and conversations in both lecture and discussion, the apparently “flawed” US healthcare system has now become apparent to me. The biggest eye opener of this course thus far is the fact the US healthcare is revolved mostly around money, that being either how is the doctor or how is the institution being paid. When I say eye opener I should clarify; I knew that US healthcare, being a private sector, was mostly about money but after the readings and discussions I never thought it was this bad.
Continue reading “Process Reflection 1”
After watching the video “Sick Around the World” on my own time. I wonder if the US has any intentions to possibly use one of these different health care systems as a new base for health care reform in our country. Its been shown that each of these health care system delivers health care for everyone and still has better health outcomes and spends less money on health care than the US. The question I pose is if we had to choose one of these health care systems as a replacement system in the US, which one would be the best for our citizens? Or if we could create a hybrid version of a health care system, in which we would pick and choose what aspects of each health care system we want from each country to implement in ours, which elements would we choose to create an “ideal” health care system?
Continue reading “Which is the Best Health Care System that Can Serve as a Base for Health Care Reform in the US? Or Would A Hybrid System Work the Best?”
Throughout life, I often considered myself well informed in regards to the topic of health care and administration, largely as a result of my interest in media ranging from articles and books to documentaries and movies centered on the United States medical field. My interest was so great that I decided early on to obtain a doctorate in medicine. However, upon entrance into Boston University’s Sociology in Healthcare class, I realized I had much to learn about my future career path, especially in terms of what defines a doctor and a patient, their roles in the socioeconomic and political spheres of America, as well as the effects of commercialism on the costs of treatment.
To begin, my ideal image of a doctor always depicted a wise individual in a white coat, whose ultimate desire was to cure and ease the minds of his/her patients by extolling his/her medical wisdom and skills. While the patient was free to discuss their issues, the doctor was the one who held most authority in the care process. While I understood that economic gain played a part as well in the behavior of the medical specialist, I assumed such influences engaged in a somewhat smaller role in comparison to moral compassion. After reading Rothman’s article “A Century of Failure: Healthcare Reform in America” and portions of the textbook such as the influence of “Big Pharma,” I was shocked by the extent of my misconceptions. Disappointingly, rather than my ideal, most doctors of today were more entrepreneurs than anything else, seeking to increase hospital profit and in turn their own paychecks by over-treating patients, recommending more expensive medication sponsored by large pharmaceutical corporations, and etc. Even more heart wrenching though was that such a situation was not simply the fault of the corrupt, but of the US health care system as a whole as it valued and promoted individual profit over social benefit and widespread access to affordable care. Thus, patients were and will perhaps remain delegated to the role of weak consumers with little ability to negotiate the costs of treatment due to social, economic, and political forces beyond their control.
The business of medicine has greatly altered my perception of the doctor-patient relationship, as well as my goals as a future practitioner. Rather than a sole authoritative position, I realized that, as a current “consumer,” perhaps it is more helpful and cost-reducing for patients to play a more interactive role with their primary care providers. Thus, as I age and ultimately make my way into medicine, I hope to more equilibrate such roles by allowing my patients to have greater say in the routes they take in treatment.
This first period of the semester has been very enlightening because it has opened my eyes to some of the inefficiencies in the American health care system. I had never previously thought of the healthcare system as a consumer market. That is, I had not realized the competition amongst providers, the business strategies in pricing insurance and services, and the consumer mentality of patients. This realization is tremendously useful in understanding how the system works. However, it has set the frame work for the rewarding knowledge that I have amassed. Continue reading “Reflection on Learning: Part 1”