CELEBRITY DRUG PUSHERS?

        Terry Bradshaw sharing his shingles, Blythe Danner dancing through her osteoporosis, Arnold Palmer and Kevin Nealon teeing off with AFib, and Phil Mickelson "feeling great" after his Psoriatic Arthritis -- what do these have in common?  During every hour of network television, four out of six ads are for prescription medicines today.  And after providing many ways in which these medications can control your symptoms and offer a better quality of life, the caveats of side effects are equally illuminating in listing potential suicide, death, depression, sepsis, and/or life threatening reactions as a result of taking these recommended meds.  Why would anyone take such drugs after hearing about these potential risks?

         My initial reaction is why is Big Pharma advertising on TV ?  Who is their target audience?  As a patient, I have never directed my doctor regarding what prescription medication I need to take to alleviate my symptoms.  That is why I go to a doctor, for his expertise in discerning the best medication for my presenting problem.  He decides, not me.  And knowing that our doctors are constantly courted by pharmaceutical reps with gifts, luncheons, and free samples, our physicians do not need national TV ads to inform them of available drugs.  So why the need for the constant ads?  Is it my role to be the messenger by mentioning "I saw there was a new drug on the market named 'Barfalot' that relieves stomach pain like mine, what do you think?"  Perhaps so, but my doctor is moving much too fast to the next patient while writing out the prescription of his choice to have such an in depth conversation about my RX.  And yet, DTC (Direct To Consumer) advertising has been shown to be instrumental in assuring that brand named drugs are used 72% more often than equally effective generics.

           A more important issue is the add-on to the already astronomical costs of drugs due to promotional expenses.  Consumers are often told that the ever rising costs of medications are due to the high costs of research and development in bringing a new drug to the market.  But actually, research indicates that marketing costs are DOUBLE that of the research and development costs. The same drugs cost much less in other countries, where television drug advertising is prohibited. The United States and New Zealand are the only two countries in the world which allow TV marketing of drugs. The FDA even found that 55% of the content included in TV drug ads was misleading.   Advertising may be an expensive component, but only represents ten percent (10%) of the marketing costs.  The remaining ninety percent (90%) is targeted directly to doctors, hospitals, prescription insurance providers, samples, entertainment, and extensive lobbying efforts.  Since Medicare, by law, is not allowed to negotiate bulk discounts on drugs, volume is of no benefit in controlling prescription costs.

           So what are the reasons for runaway drug costs?  As usual, the bottom line is money.  The profit margins for the top eight pharmaceutical providers is between 18% - 24%.  In today's world, such a net profit is off the charts. Only Banking and REITs (real estate investment trusts) have equivalent net profit margins. Big Pharma justifies their high profit margins by pointing out that due to the limited patent terms for new drugs, the companies have only a short period to re-cap their R & D costs and enjoy a profit before their drug is allowed to be marketed by other companies as a generic. Plausible?  I think not.  First, lobbying efforts have been successful in restricting the sale of generic formulas in countries outside of the US.  Some of our new trans-national trade agreements contain small print clauses specifically prohibiting trading generic drugs with other countries, thus opening a wider market for US pharmaceutical developers.   Second, Big Pharma has been able to prolong their patents through a practice called 'Evergreening,' where a patent is extended based on an added chemical and off brand usage.  Brand name drug companies have even been known to pay manufacturers of generics to delay releasing their more cost effective formulas.   Finally, new drugs are provided a twenty year patent at the time of application. By the time a drug is brought to market, 12 to 10 years remain on the patent.  With the rapid advances in medical research today and a movement towards targeted therapies, ten years is a long life for an effective drug to have a monopoly on the market.

            The real question, should we as a nation be marketing health care?  The World Health Organization asserts that there is an inherent conflict between the legitimate business goals of drug companies and the medicinal and health needs of the public.  Are the rewards so great in the drug industry that the ethics of health care have been lost?   The drug industry supplies 98% of  all information regarding drugs and their efficacy to the public.  Six companies in the world provide 62% of the drugs.  While highly capitalized, commercial drug development has little incentive to find cures for diseases.  Critics claim drug companies would rather have a patient spending $1 a day for a pill that might control symptoms for years, rather than create a one-time $100 pill that could cure the disease. On one hand, no one wants more regulations.  On the other, can much needed medications be priced based on a free market economy allowing patients to die because of a lack of funds?  Does eradicating disease and suffering take precedence over run away profits?  Can we rely on billionaires' pledges of philanthropy to solve our world health care problems or should pharmaceutical companies have their profits somewhat capped by being required to provide a portion of their drugs at a lower cost based on need?  Is health care in the US always going to be viewed solely as a business or as a public necessity?  Just wanted to start a conversation..........