Monday September 22, 2008
Expensive Prescriptions Should be Election Issue
This week, White Coat Black Art has a revealing look at how new prescription drugs get on provincial formularies. On our show, we had an interview with Dr. Andreas Laupacis, former chair of he Canadian Expert Drug Advisory Committee. It weighs the costs and benefits of each new drug and recommends whether or not the provinces should pay for it.
Dr. Laupacis said the consequences of his committee's decision weighed heavily on his mind, especially at times when it recommended that the provinces not put a drug on formulary. In the past, drugs not put on formulary were still within the price range of individuals willing to fork over the cash.
Not anymore. New pharmaceuticals are becoming more and more expensive. For instance, a new cancer drug that gives a patient and extra three months of life might cost thousands of dollars per month -- far beyond the price range of most of us.
All of which is to say that the skyrocketing cost of new prescription drugs should be an election issue. The Romanow Commission recommended a national catastrophic pharmacare program. The Liberal Party of Canada has pledged to set aside $900 milliion per year for a catastrophic drug program. Both the NDP and the Green Party have promised to phase in a universal prescription drug plan. The ruling Conservative Party of Canada has promised to implement a National Pharmaceutical Strategy, which includes a common review of drugs. Most parties are promising to achieve drug cost savings through common purchasing.
Enough talk already. Expensive prescription drugs have laid waste to the concept of universal health care in Canada. If you're rich, you can afford $20,000 a year for the latest chemo or arthritis wonder drug. We need to fix this problem now.
Either that, or we'll be plumbing the depths of 'Hinterland's Who's Who' of Prescription Drugs for the best cure from 1957. Have a listen to our Hinterland entry on Prozac.
Previous Comments (5)
ARGH!!! HOW IGNORANT was this show!!!?
1. Physicians are not stupid, they do not prescribe "only drugs that are covered on provincial plans" Maybe, do you think they actually prescribe drugs that will benefit the patient's life?? what a novel thought.
2. "big pharma" do not have secret meetings with health authorities. Rather, they are interested in making their products available to all Canadians, especially those without third party coverage. The only way to do that, is to ask authorities to put the drugs on formulary. It is THEIR (the health authority)responsibility to offer these drugs to the public, not the drug companies. Stop blaming them.
How about Canadians start to educate themselves a bit more. It might start by not listening to the one sided biase reporting of CBC.
Yes, drugs are expensive. Yes, pharmaceutical companies make money - don't all businesses in Canada try to do that?
But, no, we are not "entitled" to drug coverage or free health care just by virtue of living in this country.
We should get rid of marketing in the pharmaceutical industry.
Doctor's need objective and well presented information in order to make medically appropriate decisions for their patients.
Marketing costs the taxpayer, employer's benefits and the wallets of sick people far too much, and it far outweighs the investment in R and D. By its nature, it includes activities that are persuasive beyond direct information about a product. This should be regarded by definition as inappropriate to medical ethics. The only benefit to marketing at all, is the side effect that information can be presented in a way that makes people feel more positive about what is sometimes a stigmatized, uncomfortable, and stressful event - illness. It is reduced to silliness that is an insult to patients. If a patient hears one name of a drug from one practitioner, and another brand name from another for the same drug, their confusion cannot be said to be medical, but caused by marketing.
There is a solution.
Tender contracts for firms to create a state of the art information and communication system for the relating of drug information in objective, yet clear and comfortable ways for doctors and patients to consume. Make it web-based, with e-mail listservs to update doctors on new drugs, with dense information for researchers and specialists. The communication firm(s) should be regulated as independent of the drug producers, as only able to translate standard information in standard ways. Their quality and ability to receive contracts in a competitive bidding process would be based on reducing costs, and ensuring high quality in a communications system from the perspective of all stakeholders.
Pharma companies would then submit standardized information on drugs they produce. Doctors would prescribe drugs based on the fit between medicine and disease, and prescription sales would reflect epidemiological realities. Pharma companies can focus totally on R and D for drugs that reflect disease in populations. Because marketing is not needed, R and D could flourish under greater competition from a larger number of R and D players.
Greater investments could be made by incentive towards open source R and D, meaning greater transparency, and innovative business models releasing critical medications without the high-rent costs of patents, especially for high tax burden diseases like HIV. The savings from both marketing and IP rent collection, can fund risk in a dynamic and collaborative R and D sector, where innovation is enhanced by the sharing of results along the way.
We can then have three sectors that are all dynamic and reduce costs, R and D sector, communications sector, and manufacturing sector. All could operate in competitive environments, reducing the monopolies, with public agencies involved most at the randomized-controll trial stage, ensuring transparency and safety.Arif Jinha, September 22, 2008 5:02 PM
Re: White Coat, Black Art. 2008-09-22
Since the Canadian health system has turned to a business model to solve its monetary woes, we have done nothing but dehumanized and restrict our ability to access health care; especially pharmaceuticals. With drug companies practicing “bad medicine” profiting extraordinary amounts from health misfortunes of others is a “jagged little pill” I have a hard time swallowing. I can’t help but wonder if the business of drug research, manufacturing, development, and distribution, was shifted to a public domain, would our health care medicine be easier to take?
nobody can afford $20,000 a year for drugs - not the poor and not the "rich" The difference is that some people work for companies that have generous drug benefit plans (that will cover the cost of drugs regardless of whether you are "rich" or "poor") and some don't.
It's more accurate to talk about the working poor who work more often in part-time, seasonal or temporary employment and don't have drug benefit plans. Don't turn this into an "us" and "them" discussion. Everyone in this province should be covered by a drug benefit plan of some kind.Kathy, September 30, 2008 3:58 PM
The episode on how new drugs receive provincial payment approval adumbrated the impact of non-transparent political lobbying, but hardly pushed the envelope.
According to at least one accounting of public disclosure records to the United States Senate, the health sector has, since 2006, displaced financial and insurance sector as the largest spender on federal lobbying. Within the health sector, the pharmaceutical and health products industry is the largest lobbying spender: $226 million in 2007. The same source shows a lobbying figure of $72 mill. spent by "health professionals"; that isn't far removed from the $135m., $113m. and $111m. in lobbying done respectively by the insurance, computer/Internet and electrical utility industries (Center for Responsive Politics, www.opensecrets.org - Lobbying - Ranked Sectors).
Have comparable lobbying and campaign financing tallies been made public for Canada? What behind-doors influence does Big Pharma have, and how does this affect citizens outside the top income decile?
From his perspective as a prescriber of drugs, Dr. Goldman said he didn't care what they name a drug, as long as it's effective. Such a comment carelessly overlooks the fact that in the last decade, pharmaceutical companies' expenditures on direct-to-consumer advertising, marketing and promotion have exceeded expenditures on new drug development by a factor of 2.5 to 3 times (Marcia Angell, Canadian Medical Association Journal, December 7, 2004).
This year, Marc-André Gagnon and Joel Lexchin concluded that "pharmaceutical companies spend almost twice as much on promotion as they do on R&D" (PLoS Medicine, January 3, 2008, "The Cost of Pushing Pills").
"What's in a name" has significant impact on patients remembering a new drug to ask their doctors about. You could also look at how large drug firms use underhanded strategies such as minor molecular modifications to their drugs which fail to enhance efficacy, but prolong the 20-year patent life and thus their profits.
Arif Jinha's proposals (Sept. 22) are spot on.Ian, October 1, 2008 11:24 AM