Daily Archives: January 16, 2017

Some Hard Truths: Profit, Pharma, and Your Healthcare

I promise that after this, no more semi-political posts.

I read today that our president-elect plans to “negotiate with pharmaceutical companies to get the best price.” Not a bad idea, although I’m not sure how exactly that is going to work in practice.

Here’s a fact, though: Only about 10% of the national healthcare dollar went to prescription drugs. In contrast, 33% went toward hospital care (in 2013, the latest data I could find offhand). With all the hype about drug prices, I bet you didn’t know that.

So if we want to reduce healthcare spending, the way to do it is to keep people out of the goddamn hospital in the first place. In other words, if DJT really wanted to cut costs, he’d launch a massive preventative healthcare initiative. Not negotiate the 9% spent on prescription drugs to 7% or whatever.

Anyway, I know everyone beats up on pharmaceutical companies for drug prices–and there are certainly a few egregious examples of some pretty shady practices. But that’s not what I’m going to talk about right now.

With that out of the way: Let’s face a few facts: The pharma industry, like any other industry, is driven by profit. But wait, you say, healthcare shouldn’t be driven by profit!

In an ideal world, that would be true. But without the profit motive, do you think you are going to get new, lifesaving treatments? If you think scientists at academic centers are spending their time developing new cancer treatments, you are (by and large) wrong. Basic science in the academic setting is exactly that: basic, fundamental work that in many cases has no application to human health, and in other cases won’t have an application for decades to come. It is absolutely necessary to lay foundations, but it rarely produces immediate benefits.

Let’s look at what happened in a specific therapeutic area when the profit motive disappeared. Hypertension. You know, high blood pressure. Almost everyone will have some degree of hypertension as they get older, and most of these people will require medications.

People tend to think of antihypertensives as relatively benign drugs, because a huge proportion of people, especially older people, are taking them. But here’s a sad fact: most of them have fairly significant side effects, and none are particularly effective. In fact, many (if not most) people ultimately require a stew of different medications to get blood pressure fully under control.

Up until about 2010, there was massive research and development into new antihypertensive medications. What happened around then, plus or minus 5 years? A bunch of widely used antihypertensives went off patent. Now they’re available for pennies per pill, instead of substantially more.

Okay, you say, that’s great! Cheap medications! But you know what else happened? The pace of development of new antihypertensives came to close to a standstill, at least relative to the pace before the profit motive mostly disappeared.

The end result? You’re going to be taking the same crappy, ineffective antihypertensives your parents or grandparents are taking right now. Maybe there will be a few new, better drugs. But if you were running a pharmaceutical company, would you spend hundreds of millions to develop a new antihypertensive, put it through clinical trials, and then release it into a market that has hundreds of drugs available for pennies a pill? Probably not.

Hope you enjoy your chlorthalidone and hydrochlorothiazide!

Now, back to my post on Trainer Road, which I’m sure is far more interesting on a bicycle blog!

John