Re: JAMA on FDA & PHARMA: Lack of vigilance, lack of trust
From: Steve Harris sbharris_at_ROMAN9.netcom.com (sbharris_at_ix.netcom.com)
Date: 11/27/04
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Date: 26 Nov 2004 17:50:48 -0800
"Ed Mathes" <emathes@rochester.rr.com> wrote in message news:<h8Lpd.13758$1u.2106@twister.nyroc.rr.com>...
> I think meds should be the same whether they are sold in Canada, Germany,
> Belgium or the U.S.
I'll go for that, and we could easily make it happen.
> I think the "patent period" should be shortened, allowing generic
> manufacturer's quicker access to branded medications, although Claritin and
> Augmentin, as generics, aren't much less expensive than their brand-name
> counterparts. Generic Lovestatin 40mg still costs $65.00/month ...and if
> you take 80mg, double that. Or, buy Branded Lescol XL 80mg for
> $67.00/month. Generic Paroxitine 20mg = $71.00/month Vs Brand name Paxil
> 20mg @ $79.00/month Vs Paxil CR 25mg @83.00/month.
COMMENT
I think the patent period should be lengthened, actually. As a matter
of fairness; why should authors and composers have a longer period of
time to profit from the fruit of their intellectual labor than
scientists and technolgists? What do we really value in this society--
drugs that save our lives, or movies that entertain us this weekend?
Well, you get what you protect, and what you pay for.
Also, a longer tech patent would help as a matter of
amortizing/discounting the unavoidably high cost of R&D and regulatory
burden over longer time. Shorten the patent period enough and you'll
get *no* R&D (in India for more than 30 years they tried lowering it
to zero by stealing other counties' drugs, and their R&D dropped to 5%
of what it was-- all devoted to reverse engineering). A drug patent
period of 50 years would probably significantly lower the difference
between brand and generic costs.
That said, some of the high cost of generics is due to the
increasingly high cost of entry into the generic market. The FDA is
starting to charge developers for its services. I recently had to look
at the cost for application for licence for new formulation of a
generic I've developed for animals. Application fee alone to the FDA
is $119,000, and no guarantees you won't be told to turn around and do
all your animal testing again. The problem with animals is only
chickenfeed of the problem when it comes to drugs for people.
> Everyone is bitching but no one is offering anything in the way of a
> "solution".....other than close down the pharmaceutical companies and
> practice homeopathy (which will never happen).
>
> Ed
COMMENT
Since only 10% of the total US $1.5 trillion health care cost goes for
drugs, drug companies aren't the source of our problems. I would
suggest we look instead to why we pay so much more than anybody else
for health care overall. Again, it's not the drugs. We pay nearly 15%
of our GDP for healthcare, and Canada runs about 10% and UK around 7%.
The higher cost we pay for drugs can't possibly account for more than
a tiny fraction of that. If we paid half as much as we do for drugs
(comparable to Canada), we'd go down to 95% of our present spending,
which would be 14.25% of GDP. Big deal. Not the problem.
The big problem in the US, is we have a terrifically *inefficient*
health care system, which doesn't cover preventive care, so a lot of
people go without it. That's penny-wise and pound-foolish. It then
costs us, as a society, plenty when they do need it, because of course
they don't pay for it, and of course we can't just let them die when
they get really ill. So it comes out of taxes.
We also, unlike just about every other Western country, really suck at
database collection of health care data, which results in endless
duplication of services. That's not only expensive but also dangerous.
I'm tired of hearing that people aren't "covered" by insurance in the
US. Everybody's covered, 100%. The *problem* is that they're only
covered at the top end, from the point that they need a hospital (or
sometimes only from the time they collapse in the ED waiting room). So
the obese hypertensives who don't get treated for hypertension, are
covered only from the time they need dialysis for the rest of their
lives. And the obese smokers get their ventolators when they get
pneumonia, and they get their coronary bypass when they have chest
pain. But before that, they get nada. But the ICUs and ventilators
and bypasses and so forth are very expensive. They are a lot of that
extra half-trillion bucks we could be saving.
Of course, there are structural problems. People wait for non-emergent
operations in Canada, and for MRIs (big deal-- most MRIs in the US are
a total waste of money). In the UK it's a little worse, as you have a
pretty hard time getting dialysis past the age of 60, and they won't
bypass you unless they can't do anything else and you can't get out of
bed. In the US, by contrast, you can see demented 80-year-olds get
dialyzed. And if you have insurance and walk into any hospital
complaining of pain from your neck to your gain, you've eventually
going to get a cardiac cath.
What do we do about all this? Single-party payor presents itself as
an option. I hear screams about socialized medicine, and I've made
some of them myself. But face reality: we're half-way to socialized
medicine already. Literally. We only spend NOW just 20% of our health
care dollars out-of-pocket, and 30% more, as private insurance. The
rest-- that other 50%-- is paid by tax anyway. How much would it be
worth it to us to cut our total bill for all that by 30% or more, by
going to a system that costs us only 10% of GDP? The only thing that
would happen if we did that, is the out of pocket part, or maybe the
insurance part, if you like, would simply go away. All other costs
would stay the same. So the horrid socialized medicine simply makes
ALL your out-of-pocket costs disappear. In return for that you get
Canada.
Well, maybe not quite that good. As noted, Canada benefits by having
half the % obese people the US does, and a lot less illegal
immigration from their South. But we can't fix either of these
problems by denying the people involved preventive care, unless we're
really prepared to let them die in the gutter when they get really
ill. Libertarians take note. Meanwhile, we either have to build a
high wall between us and Mexico, or else change our system. We can't
really go on the way we're going.
And debates about the high cost of prescription drugs are just
diverting us from these issues. Drugs, however expensive, are mostly
preventives to more expensive stuff if you can't get them (we can sort
out which drugs that's NOT true for, and not cover them, very much as
the HMOs do). If the rest of the drugs were 98% covered for all (a
tiny co-pay to keep people from waste), and the government as single
buyor negociated directly with manufacturers in all counties for the
wholesale price for those medications, I will guess that we'd save net
money in the health care system, over all.
SBH
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