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Why do we spend so much on medicine for so little return?

2011-08-14

This will be the first entry in an occasional series on the high cost of contemporary health care.

Our first exhibit is new patent medicines.  I say “patent” medicines because all new medicines are patented by the companies that develop them.  This patent has a limited lifetime–currently twenty years–and the company owning the patent is under tremendous pressure to recoup the tremendous costs of development, by first, charging excessive fees for the use of the medicine, and second, inducing physicians to prescribe the medicine excessively.

First, the cost of new medicines is grossly excessive in comparison to the medicines’ advantages over older medicines.  For example, Lipitor, an arguably very effective and safe statin (a drug which lowers cholesterol and helps to prevent stroke and heart attack) costs $150 or more a month.   A medicine, on which the patent has expired, that does the same thing (possibly not quite as well but equally safely) costs perhaps $20 a month.

Second, the drug companies place excessive pressure on physicians to prescribe new medicines for as many patients as possible.  For example, Zyprexa, a new antipsychotic (a drug which relieves the symptoms of agitation in psychotic patients) is approved by the FDA for use only in patients with schizophrenia.  The drug “reps” (employees of drug companies who spend all their time in doctor’s offices buttonholing them) have been telling doctors that Zyprexa is good for many other conditions.  This is because schizophrenia is rare (less than one percent of the population), and other conditions for which Zyprexa is prescribed, such as post traumatic stress disorder and dementia in the elderly, are common.  Unfortunately, Zyprexa has serious side effects and has not been shown to be effective in PTSD and dementia.

The result of pressure by drug reps on gullible physicians is the excessive use of medications for patients who do not receive any benefit.  For example, Zyprexa, when used over long periods of time (months to years) very often results in excessive weight gain and the development of diabetes mellitus.  Patients who do not benefit from Zyprexa still get the side effects and are thus saddled with additional illnesses on top of their initial maladies.

These two excessive and unnecessary expenses are the direct result of the profit motive as applied to a system which is not appropriate for profits.  The development of new medicines is very expensive for many reasons.  There is an obvious conflict of interest in the process of allowing private companies to spend money developing medicines that they then turn around and produce for sale to the general public through the medium of prescription by physicians.  This must be stopped if the cost of health care is to be controlled.

There are many other reasons for the excessive cost of health care which I will address in future installments of this web log.  Stay tuned.

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