Pharmaceutical Marketing and Medical Decisions

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”

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Daraprim Part 2: Competitors Don’t Mean Competition

After last month’s famous story of how Martin Shkreli, the CEO of Pharmaceutical Company Turing Pharmaceuticals raised the price of an AIDS drug from $13.50 to $750 overnight, a new story has emerged of a competitor company coming out with a $1 version of the drug. This competitor is Imprimis Pharmaceuticals, a pharmaceutical company that mixes approved drug ingredients to fill individualized patient prescriptions. Imprimis Pharmaceuticals Chief Executive Mark Baum announced last week that they would be supplying pills containing Daraprim’s active ingredients, pyrimethamine and leucovorin, in 100 pill count bottles for $99. Baum has also announced that they will be developing generic alternatives to many other drugs that have sky rocketed recently over the years- mainly drugs treating cancer and other rare diseases that the general public does not take much notice of.

However, as much as Imprimis Pharmaceuticals is championed as a hero of the people (as they should be), it turns out that Turing Pharmaceuticals really will not lose much from this competition. Imprimis’ ability to compete with Turing is greatly limited as it is a compounding pharmacy which means it can only provide medicine after a doctor requests it, meaning that doctors have to specifically be requesting their version of the pill. As we have learned in class, there are many ways for Turing Pharmaceuticals to take advantage of this system as they may begin to incentivize doctors (whether they do it over or under the table, monetarily or otherwise) to continue prescribing their version of Daraprim. In addition, rather than pharmacies having to specifically order the new version of Daraprim every time someone asks for it, it is much easier for pharmacies to dispense a drug they already readily have on hand such as the original version of Daraprim. There is already a system set in place where if the pharmacy cannot get the insurer to pay for the medicine but cannot, the pharmacy will usually dispense the drug regardless, using either charities or –where legally possible- by making the drug maker itself cover the difference in cost. Due to these reasons, despite the fact that a $1 competitor would trigger the notion of a free market happening where the people will choose the most cost-effective drug for them –where that company would make profit and the other would go out of business because no one would buy that drug, – there is really no free-market at all. Until these loopholes are closed and something like a standard price for drugs are set, these practices will continue unchallenged, and Americans will continue to bear the consequences.

http://www.usatoday.com/story/money/2015/10/23/imprimis-pharmaceuticals-turing-pharmaceuticals-daraprim/74452030/

http://www.forbes.com/sites/matthewherper/2015/10/23/suckers-that-1-a-pill-competitor-wont-hurt-martin-shkreli-one-bit/2/

Why are medical bills so outrageously high? Who comes up with these high “charges”?

                In the article ““Bitter Pill: Why Medical Bills are Killing Us,” Steven Brill discusses the outrageous cost of hospital bills and the large disparity between healthcare costs in the US versus other countries. The prices that hospitals set in place for various services appear to be arbitrary in nature and lacking context. The name of this so called database of charges is called the “chargemasters”. I have honestly never heard of such a system. Who is in charge of establishing these costs and why are they so abnormally high? According to Brill’s research,  it appears that the hospital system is charging patients way above market price and, in turn, receiving a significant revenue while putting most of its patients into debt. Brill even comments on the fact that nonprofit hospitals make millions in revenue while their presidents make a hefty salary. To account for the revenue, Brill states, “the hospitals improve and expand facilities (despite the fact that the U.S. has more hospital beds than it can fill), buy more equipment, hire more people, offer more services, buy rival hospitals.” But what about quality of care for the patient? Despite, a large revenue we don’t seem to care about making the efficiency of the healthcare system better. We continue to struggle with problems of over utilization. Brill discusses the issue of overuse of CT scans for people who don’t always need it. Is this done for the purpose of avoiding lawsuits of malpractice and making sure that all the bases are covered or is this to help pay for the cost of the machinery since these CT scan machines can be very expensive?

Whatever the case may be, the healthcare system is a current mess and chivalry does seem dead.

Pay No Attention to that Chargemaster Behind the Hospital Bill

As infuriating as the very existence of the chargemaster is, I believe we ought to focus on the bigger picture. That is, we ought to be questioning why medical bills are so high now rather than who should be paying them. What does it say about our health care system and our nation’s economic and social philosophy when we allow lobbyists and private groups with financial resources to single out those who are least able to pay and burden them with the highest rates? Our anger ought to be directed at addressing the issue of why there is a blatant and glaring lack of transparency in the world of medicine in America. At this very moment, hospitals are pulling the wool over our eyes and charging patients far more than what their care actually costs. Brill establishes that the gap between what hospitals charge for certain things (procedures, tests, etc.) and what Medicare would pay for the same things is mindbogglingly immense. How can we, as American citizens, feel comfortable about whatever care we are being given when we fear the associated costs and we are unaware of where these ridiculous bills are coming from? I posit that if the medical profession had more transparency, the public outrage alone would force radical reform to occur. This begs the following key questions: is total transparency in the medical field in America possible? Is this an attainable goal in the future or is our nation condemned to a future of rising arbitrary costs and exploitation of the less fortunate subset of our population? What, if anything, must FIRST happen/change in order for us to potentially achieve such radical reform? 

Consumerism and healthcare costs

With the rise of consumerism, patient independence increases; and with the internet, patients have more access to knowledge, so they have the conception that they become able to self-diagnose and even self-treat. And with the availability of medications over the counter, why doesn’t this result in decreased visits to the hospital and decreased costs in healthcare?

Drug Goes From $13.50 a Tablet to $750, Overnight

In this New York Times article, Andrew Pollack evaluates the unexpected rise in the HIV drug, Daraprim, overnight from $13.50 per pill to $700+ per pill; over a 5,000% increase. Daraprim was created in 1963, and was originally sold for $1 per pill. CorePharma then raised the price per pill to $13.50 in 2010. Nobody knows for sure what warranted this most recent price increase, but this isn’t the first time Turing Pharmaceuticals CEO Martin Shkreli has increased company prices purely for profit. Pollack writes that, “In 2011, Mr. Shkreli started Retrophin, which also acquired old neglected drugs and sharply raised their prices. Retrophin’s board fired Mr. Shkreli a year ago. Last month, it filed a complaint in Federal District Court in Manhattan, accusing him of using Retrophin as a personal piggy bank to pay back angry investors in his hedge fund.” This is not the first time a pharmaceutical company has raised the price of a drug, however, unlike many drug price increases, the Daraprim spike was not because of a shortage of the drug. Under Federal rules, Medicaid and certain hospitals will be able to get the drug inexpensively, but private insurers, Medicare, and hospitalized patients would have to pay an amount closer to the new list price of $700 per pill, which would make annual payments for Daraprim users upwards of $50,000. Continue reading “Drug Goes From $13.50 a Tablet to $750, Overnight”

No Control on Rising Costs?

Recently in the news, there has been a lot of conversation around an individual named Martin Shkreli who owns the pharmaceutical company Turing Pharmaceuticals, raising the price of Daraprim, a HIV drug,  overnight by $13.50 to $750 per pill overnight. I found this article to be really interesting as it touched on what we are currently learning about in class. Instead of focusing just on Shkreli, it focused on the general picture, being that this is a custom that is done by all pharmaceutical companies. As quoted by the article, “A 2014 House of Representatives investigation found 10 genetic drugs that ranged in price increases anywhere from 420% to over 8000% of their prices just a year before”, showing that this was already a common practice. The article then goes to talk about the monopoly effect that many pharmaceutical companies have over the drugs they sell. Lastly they go into the fact that raising the price is “not illegal, just immoral”, and because it’s not a legal case but rather one of morality, little is done to change it.

I feel like this article is greatly representative of how our healthcare system is like and why there has to be a dramatic change in action. With the pharmaceutical companies having almost total control over the drug costs, doctors don’t have much negotiating power and therefore charge the consumers for the same price. By keeping our healthcare system in this state, we allow business CEOs, focused on maximizing profits, to run the state of our healthcare. I also agree with the last point that we have to make it a legal issue. The government should be able to regulate these costs as well as the overall state of healthcare as it had with Medicare. If the government can make policies around these issues, as well as regulating prices of the healthcare system, the monopoly of drugs and treatment will be drastically reduced and many will have more access to treatment.

http://www.cnn.com/2015/09/23/health/pill-prices-are-big-business-as-usual/index.html

Healthcare as a Government Run Entity or Privately Owned Business?

In the video we recently watched “Money and Medicine, we were shown the conundrum of maintaining life for an expensive price and with many different methods. They essentially show the struggle between extending life and the price of extending life of such patients. The increasing price of healthcare is only going to increase as time goes on and mainly this is due to the unregulated costs of healthcare. I did further watching through YouTube videos and found two sources that proved quite informational. One video was of John Green talking about healthcare and it’s rising cost due to the lack of a government entity controlling the costs. The overall cost of healthcare would be run and regulated by the government in other countries and therefore decrease the price as healthcare businesses would have no control. In the U.S. however, healthcare businesses have almost total control of the cost and therefore can control it as they please due to their monopolistic control.

In a second video I found, Hank Green experienced such an event as the cost of his medicine rose 1200%, rising from $50 to $627 in a night. He originally thought that the cost would be cheaper than his previous medication, that being $300 before the drug company dramatically increased the price. This further illustrates that there is no real government regulation on the price and that a more efficient healthcare system would have this regulation.

The question then becomes whether healthcare should be regarded as a right or a benefit? Should we have the power to choose whether we want to be healthy or not and continue to let healthcare be privately run? Or should we let the government finally take the reins and be the more dominant power in healthcare, regulating the care for the U.S.?

Links are provided down below:

John Green’s View on Healthcare

Hank Green’s Experience with Rising Costs

Child Safety Measures for Packaging of Laundry Pods Are Approved

http://www.nytimes.com/2015/09/16/health/to-deter-poisoning-of-children-safety-measures-for-packaging-of-laundry-pods-are-approved.html?ref=health&_r=1

In the article, the American Society for Testing and Materials (ASTM) set a new standard for laundry detergent pods negotiating that manufacturers alter the look and taste of the products to prevent child ingestion and inhalation of the product. The problem with the pods are that children are unintentionally being poisoned mistaking the pods for candy or a toy. The Consumer Product Safety Commission (CPSC) suggested that manufacturers should make pod containers harder to open or to make containers darker to prevent visualization of pods. They also suggested that pods should be made bitter and dissolve slower upon touching saliva.  ASTM concluded that they would make further changes to the standards if the products continue to cause unintentional poisonings.

I found the topic of this article relatable and of concern to me because I know of a little girl that accidentally ingested a Tide pod. Just by looking at a Tide pod, one cannot help but to squeeze or pop it so imagine what is going on through the mind of a small child. Personally, I don’t think making the pods bitter to taste will solve the problem of accidental ingestion. I think the pod containers should be equipped with a locking mechanism similar to prescription pill bottles making opening difficult or the pods should be encased in a separate plastic wrapping requiring scissors or semi-complex dexterity to open.

One can argue that companies shouldn’t make products to resemble candy or toys however, parents should pay closer attention to their children and be mindful of where they are placing harmful products. Although pods look aesthetically pleasing, people should remember that they contain dangerous chemicals. Manufacturers can only do so much to prevent accidental ingestion.

Inflating the Price of Drugs

In this article, Rushton writes about how Turing Pharmaceuticals has increased the price of a drug called Daraprim. This drug is used to fight toxoplasmosis, “the second most common food-borne disease, which can easily infect people whose immune systems has been weakened by AIDS, chemotherapy, or even pregnancy.” In the United States, 60 million people carry this parasite that attacks the brain and can lead to blindness or brain damage (Rushton). After buying the rights to the drug from Impax Laboratories, Turing Pharmaceuticals has not increased the price of this drug slightly but by 5,000%. This drug used to cost $13.50 per pill but now cost $750 per pill. Rushton also mentions that patients with insurance may have trouble buying the medication because insurance companies put high-price drugs in a “specialty” category which requires people to pay high premiums. She also mentions that some insurances plans require patients to pay 20% of the cost of the drug, this means that patients would still be paying $150 a pill. An important point that she mentions in the article is that because of the increase, hospitals will stop stocking Daraphim which could delay patient treatment. Continue reading “Inflating the Price of Drugs”