Large American pharmaceutical companies cannot have it both ways

Large American pharmaceutical companies must decide which end of the drug development / delivery to patent pipeline they wish the American taxpayer to subsidize. They cannot have it both ways.

First, let me say that there has been a free-for all demonization of the drug companies or the more pernicious appellation Big Pharma. Large pharmaceutical companies provide jobs, support community services and charities. They provide the drugs and treatments that save lives and make lives better and longer. The very people for whom they provide political financial support have demonized them. Such portrayals and rank hypocrisy serve no noble purpose, no public good.

That said, it is not the place of the American taxpayer to underwrite the cost of prescription drugs for the very socialized healthcare countries that mock our healthcare model, and us as well, while at the same time to become the victims of cost shifting by the very drug companies whose product creation we subsidize. Simply put, if large American pharmaceutical companies are writing off the considerable expense and risk of research and development of a new drug against their profit, then they should not be allowed to raise the cost of those same drugs to the American public to cover the lower prices they willingly accept from the aforementioned socialized countries. In essence, Peter is being robbed to pay Paul. In the United States, we should not be paying more than any government of a socialized healthcare country pays for the same medications, especially if we underwrote the development of that same medication.

If such medically socialized countries wish to have first-line drugs and treatments accessible to their citizenry, then they must be willing to pay more for the superior product or risk having even higher mortality rates and greater productivity loses from the resultant deaths and illness that would follow the loss of up-to-date treatment.

The American people should no longer pay twice for the privilege of suffering insult from the mouths of those very people they subsidize.

Mitchell Brooks is an orthopedic surgeon and the host of Health of the Nation on Talk Radio 570 KLIF in Dallas, Texas.  He blogs at Health of the Nation.

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  • http://www.facebook.com/paul.c.weiss Paul Weiss

    Here is my question…are the drug companies selling at a loss to “medically socialized countries”, or simply at a lesser profit? My guess is the latter.

    When you say that Americans underwrite the cost of drugs to these countries, I see it differently. I see it as the drug companies selling to us at a greater profit.

    If the drug companies were as benevolent as the author frames, then we wouldn’t have shortages of necessary drugs that coincidentally aren’t as profitable.

    Tens of thousands of Americans each year die because they are unable to afford proper healthcare Many more go bankrupt due to medical expenses, even though they have health insurance. Some of the insults our system receives are deserved.

    • Anonymous

      “When you say that Americans underwrite the cost of drugs to these countries, I see it differently. I see it as the drug companies selling to us at a greater profit.”
      Uhhhhh, I think you speak of raising the bridge and I lowering the water. Net effect is equal. Further, drug companies are not benevolent, they are businesses and as such they owe their shareholders a responsibility to profit. Should you wish benevolence, then you should seek a non-profit, which, by the way, is usually profitable but shows no profit.

      Please site your source for “tens of thousands of Americans die each year because they are unable to afford proper healthcare”.  What is the exact number. Where is the greatest incidence of death by negligence? What are the co-morbidities? That is the “p” factor?

      Of course I could be wrong.

      Thank you for your considered response in either case and for taking the time to read the blog.

      Mitchell Brooks, M.D.
      http://www.mitchellbrooksmd.com
      http://www.hotnationtalk.com

  • http://www.facebook.com/people/Steven-Reznick/100000549195050 Steven Reznick

    Well put Dr Brooks. 

    • Anonymous

      Many thanks sir !

      Mitchell Brooks, M.D., FAAOS
      hotnationtalk.com
      mitchellbrooksmd.com

  • Anonymous

    Excellent piece and true. Not only do citizens of other countries pay less, what about the veterinary versions of some drugs? I bet I’d be better off financially if I were a German Shepherd. As it is, I’m an American with health insurance but no prescription drug coverage. I can only hope, should I need a prescription drug, that I can get the insured patient rate at least, and then that the bake sale goes well.

    • Anonymous

      Thank you for your kind words.

      Mitchell Brooks, M.D.
      hotnationtalk.com
      mitchellbrooksmd.com

  • Anonymous

    I don’t think there is any basis to your taxpayer underwriting theory, at least not with any regard to “socialized” countries…unless you are talking about the rampant socialism in this country.  
    “American pharmaceutical companies must decide which end of the drug development / delivery to patent pipeline they wish the American taxpayer to subsidize. They cannot have it both ways.”So, not only do pharmaceutical companies get to entitle themselves to government subsidies, they also get to decide where and how those subsidies are distributed. But that’s not socialism. That’s corporatocracy. 

    “In the United States, we should not be paying more than any government of a socialized healthcare country pays for the same medications, especially if we underwrote the development of that same medication.”

    Perhaps if  US citizens could negotiate drug prices in a free market system, that might be possible. But thanks to programs like Medicare part D, which guarantee taxpayers will not negotiate prices, the drug companies can collect whatever they desire. Could it be that these “socialized” countries are actually better at negotiating prices in a free market system than people in the US?

    What the pharmaceutical companies are doing is not “cost shifting”. It is raiding. 

    • Anonymous

      Thank you so much for your opinion regarding my blog.

      I am not sure I quite understand your points in the initial paragraphs, but I would like to take issue with your response regarding Medicare Part D. I always try to end my radio program by saying that one is entitled to one’s opinions, but not to one’s facts. To that end and to your position on Medicare Part D, permit me to suggest your read the following: http://online.wsj.com/article/SB10001424053111903554904576461752700885960.html?KEYWORDS=Part+D+Drug+prices

      Should you then wish to reconsider your position, please do so.

      Mitchell Brooks, M.D.
      hotnationtalk.com
      mitchellbrooksmd.com

      • LeoHolmMD

        Could you not do better than WSJ? How many advertising dollars do you suspect they get from Pharma?
        Not that I could even read the article, since they want to charge me for that as well. Fact: the federal government is not permitted to negotiate prices directly with drug companies under Medicare part D. http://en.wikipedia.org/wiki/Medicare_Part_D#cite_note-24Numerous other sources, including the actual legislation will verify this. Outsourcing negotiations to insurance companies (a very costly and ineffective way of doing things) does not count. Insurance companies are terrible negotiators, which is why they continue to pay the highest prices in the world. And why would they care? They just get to dump the costs back on consumers and employers. Socialism part 2. Position stands. 

  • http://twitter.com/shelleypetersen Michelle Petersen

    This article has angered me greatly, what has the floundering US healthcare system got to do with third world rural health?  The answer is to use your countries budget more wisely and perhaps you would have more money to spend on the healthcare of your citizens.

    It’s the NGO’s and NPO’s of this world that pay for third world healthcare, NOT the American people…

    Setting the arguement for cheaper drugs in the third world back decades.

    • Anonymous

      Thank you for your consideration of this piece.

      I thought I was writing about American pharmaceutical companies and not Third World health issues but if I misled you, you have my apologies.

      Mitchell Brooks, M.D.
      hotnationtalk.com
      mitchellbrooksmd.com

  • Anonymous

    Roche Pharmaceuticals decided to stop shipping all drugs to Greece because the country did not pay them for 3-4 years.  Welcome to socialized medicine in Greece.  If you are in greece now and need insulin you are taking a plane back to the US.

  • Anonymous

    Given this article about Big Pharma the martyr so unfairly treated, I can only assume the author is a paid shill of Big Pharma or lives in La La Land, not knowing all the evil and abuses of the industry in bed with many so called doctors, the government, the FDA and anyone else they can corrupt with their billions they earn on many useless but deadly drugs.  This is especially true in psychiatry as they work hand in hand with psychiatrists to invent bogus life destroying stigmas to push lethal drugs while covering up all the deadly effects with bogus studies and ghost written articles by paid shills in the academic/medical profession professing lies for their own power and greed.

    This article is pathetic.  It’s like applying this self serving praise to tobacco companies when they insisted their products were safe and did not cause addiction while secretly doing all in their power to make cigarettes all the more addictive while denying their toxic effects. 

    • Anonymous

      Thank you so much for taking the time to read my piece. 

      Mitchell Brooks, M.D.
      hotnationtalk.com
      mitchellbrooksmd.com

  • Anonymous

    The entire premise of Dr. Brooks’ commentary is compromised
    by the first four words contained in his article. By starting with…’large
    American pharmaceutical companies’ –dilutes and misinforms the American health
    care consumer on this growing critical issue. 
    Dr. Brooks should be savvy to the fact that it’s the pharmaceutical
    industry that is all inclusive and not just American companies that are causing
    the crisis.

    1)     
    Approximately 50% of the drugs consumed in the
    USA come from foreign domiciled drug companies, and this usage is growing
    exponentially. When you consider the reported dollar value of drugs consumed in
    the USA and then look at the revenues generated by foreign drug companies such
    as Glaxo, Norvartis, Roche, Bayer, Teva, sanofi, Astra-Seneca, Hoffman-LaRoche,Boehringer,
    Takeda, Astellas, Merck, AKZO, Solvay, H.Lundbeck, just to name a few of these gigantic
    companies, one can see the issue isn’t just large American pharmaceuticals that
    are part of the problem.

    2)     
    Though the above mentioned pharmaceuticals companies
    are foreign entities that have restrictions placed on them by their local
    governments, they are unfettered as to what they can do as for spending money
    here in the US to dictate what consumers here end up paying for their drugs.
    One must understand that pharmaceuticals spend more money on marketing of their
    drugs than they spend on development expenses. Visit the home countries of these
    behemoths and you won’t find the citizenry bombarded with TV and newspaper
    advertisement where the drug companies are seeking patients for the drugs, as
    opposed to seeking drugs for the patients. This simply means that here in the
    US, drug companies have a product and they create the disease for the drug by
    implying to their advertising audiences that their drug will cure their
    ailments. Recent studies indicate that patients are more and more coming in to
    see their doctor and tell them they want to try a particular drug—with apparently
    their decision coming from what they had seen in advertisements. If they can’t
    get it from their first doctor, they merely find another doctor. What doctor
    wants to lose a patient when the issue is prescribing a drug advertised on the
    national news program at 5; 30 p.m.

    3)     
    As if the unfettered advertising efforts aren’t
    enough, we still have the major drug companies operating with unscrupulous marketing
    practices that have resulted in billion dollar restitutions in which the guilty
    parties admit to committing fraud against the US citizenry. Pfizer, the world’s
    largest drug company was recently fined nearly $2 billion dollars in which they
    admitted to fraud. United Healthcare, one of the largest health insurance companies,
    it was determined their ousted CEO and the company itself were guilty of fraud,
    resulting in their combined restitution of approximately $1 billion dollars.
    HCA, one of the largest hospital operators, until recently had the distinction
    of having the largest forced restitutions of any health care entity. In total,
    over the recent few years companies in the health care industry, across the
    board, have admitted to fraud and forced to refund billions of dollars. This
    money being refunded because of fraud doesn’t come from a money tree, it’s
    coming from their drug patients and apparently because of their intake of patient
    money they can pay out these legal settlements and still have money left to
    move to their next effort to defraud the consumer.

    With Dr. Brooks being a surgeon, one would think that he
    would know that you can’t excise a portion of a patient’s cancer and expect the
    remaining tumors won’t reoccur in the patients, and grow larger.  Just as he shouldn’t expect that if you don’t
    stop the total source of the money greed being the root cause of our disastrous
    health care system, our nation will never solve our problem.

  • Anonymous

    The entire premise of Dr. Brooks’ commentary is compromised
    by the first four words contained in his article. By starting with…’large
    American pharmaceutical companies’ –dilutes and misinforms the American health
    care consumer on this growing critical issue. 
    Dr. Brooks should be savvy to the fact that it’s the pharmaceutical
    industry that is all inclusive and not just American companies that are causing
    the crisis.

    1)     
    Approximately 50% of the drugs consumed in the
    USA come from foreign domiciled drug companies, and this usage is growing
    exponentially. When you consider the reported dollar value of drugs consumed in
    the USA and then look at the revenues generated by foreign drug companies such
    as Glaxo, Norvartis, Roche, Bayer, Teva, sanofi, Astra-Seneca, Hoffman-LaRoche,Boehringer,
    Takeda, Astellas, Merck, AKZO, Solvay, H.Lundbeck, just to name a few of these gigantic
    companies, one can see the issue isn’t just large American pharmaceuticals that
    are part of the problem.

    2)     
    Though the above mentioned pharmaceuticals companies
    are foreign entities that have restrictions placed on them by their local
    governments, they are unfettered as to what they can do as for spending money
    here in the US to dictate what consumers here end up paying for their drugs.
    One must understand that pharmaceuticals spend more money on marketing of their
    drugs than they spend on development expenses. Visit the home countries of these
    behemoths and you won’t find the citizenry bombarded with TV and newspaper
    advertisement where the drug companies are seeking patients for the drugs, as
    opposed to seeking drugs for the patients. This simply means that here in the
    US, drug companies have a product and they create the disease for the drug by
    implying to their advertising audiences that their drug will cure their
    ailments. Recent studies indicate that patients are more and more coming in to
    see their doctor and tell them they want to try a particular drug—with apparently
    their decision coming from what they had seen in advertisements. If they can’t
    get it from their first doctor, they merely find another doctor. What doctor
    wants to lose a patient when the issue is prescribing a drug advertised on the
    national news program at 5; 30 p.m.

    3)     
    As if the unfettered advertising efforts aren’t
    enough, we still have the major drug companies operating with unscrupulous marketing
    practices that have resulted in billion dollar restitutions in which the guilty
    parties admit to committing fraud against the US citizenry. Pfizer, the world’s
    largest drug company was recently fined nearly $2 billion dollars in which they
    admitted to fraud. United Healthcare, one of the largest health insurance companies,
    it was determined their ousted CEO and the company itself were guilty of fraud,
    resulting in their combined restitution of approximately $1 billion dollars.
    HCA, one of the largest hospital operators, until recently had the distinction
    of having the largest forced restitutions of any health care entity. In total,
    over the recent few years companies in the health care industry, across the
    board, have admitted to fraud and forced to refund billions of dollars. This
    money being refunded because of fraud doesn’t come from a money tree, it’s
    coming from their drug patients and apparently because of their intake of patient
    money they can pay out these legal settlements and still have money left to
    move to their next effort to defraud the consumer.

    With Dr. Brooks being a surgeon, one would think that he
    would know that you can’t excise a portion of a patient’s cancer and expect the
    remaining tumors won’t reoccur in the patients, and grow larger.  Just as he shouldn’t expect that if you don’t
    stop the total source of the money greed being the root cause of our disastrous
    health care system, our nation will never solve our problem.

    • Anonymous

      The entire premise of this response lies in the final words; that is, “the money greed”.

      If I were writing about fraud and abuse the examples that were elucidated in the last of your trilogy would obviously be included. I wasn’t.

      If I were writing about money and greed, I would be writing a treatise on the human condition and how mankind is generally wired. I wasn’t. Parenthetically, I would almost have to give substantive mention to the great Gordon Gekko. I didn’t.

      If I were writing a blog about patient and personal responsibility, I would most certainly would have addressed the items so clearly set forth in the second of idclaire’s three mini-treatices. I wasn’t.

      That brings us to item “1″, and I could not agree more with Mr. or Ms. idclaire. But once again, if I were writing about all pharmacy companies, I would have certainly been “savvy” enough to know that half our drugs come from foreign companies. I wasn’t.

      So, here’s the nut: the point made by the writer supports the treatise; that is, that American pharmaceutical companies can only drink from the trough but once. Their overhead costs are their overhead costs and this includes advertising, but that tangential bit of screed has nothing to do with the end game and that game is that we, as Americans, will not pay more that foreigners do for their pharmaceuticals. We will no longer pay twice for American drugs, nor will we be cost shifted upon by our own pharmaceutical companies who do business with socialized countries, and by implication, we will not pay more than socialized countries do for drugs produced by foreign companies.

      In the end, if idclaire wishes to write about corporate greed, then I would suggest to him/her that greed is everywhere and is a human condition. The piece is not about the morality or the ethics of greed. If that be the bent of Mr. or Ms. idclaire, then perhaps this is not the correct forum for this sort of discussion. Might I suggest a return to Academia, where this topic has been the fodder of tenured malcontents for decades, and if were are talking about greed, well, then tenure be thy name!

      As to my surgical skills and carcinoma, I would suggest to Mr./Ms. idclare, that as in this particular topic, before one “cuts” anything, one must identify,locate and stage a tumor. Planning and a complete understanding of the tumor, its identification, behavior, characteristics and recurrence rate, and not a cursory examination, is what’s called for. The issue of what a drug costs is complex and involves several constituencies and numerous trade, diplomatic and patent issues. Merely identifying the obvious, that is, “greed”, and basing a response on only one aspect of the issue will most assuredly lead to not only its return, but to its increased malignancy.

      Mitchell Brooks
      hotnationtalk.com
      mitchellbrooksmd.com
       

  • Anonymous

    Thank you Dr. Brooks for your sarcastic respone in “thanking” me for reading your article in that based on your other responses you implied I did not read your article.  I see what you mean about equitable payment issues, but again, there is so much corruption among drug companies and medicine in general now that this is the major issue that has to be addressed because whether nations or patients are bilked for useless drugs that cause huge harm euphemistically labelled “side effects,” not only is this a huge waste of money and grossly unfair in terms of charging people to destroy their lives, but also, this is the most critical issue in medicine because our medical system is so very broken.  I have two master’s degrees and have done tons of research in this area having suffered much harm from the medical symstem myself as well as witnessing it in others.  Many noble doctors have written excellent books and web articles exposing the fraud in all areas of medicine with psychiatry the worst offender with their bogus, voted in stigmas to push lethal drugs with BIG PHARMA.  This led me to find that Statins prescibed for cholesterol also had many corrupt doctor with drug company ties lowering the levels of so called dangerous cholesterol levels to push these drugs on healthy, normal people as does psychiatry.  There have been many exposes that much heart disease treatment and operations are useless and dangerous when preventive medicine is the real answer.

    So, the sad thing is that I avoid prescribed drugs like the plague for the most part because when they’ve been prescribed and I researched them in one case I would have died because the drug was pulled off the market when the corrupt FDA was forced to do so, in another case my son would have been forced on a questionable synthetic thyroid medication for life when he really just needed more iodine and on and on.  Also, the book, ANATOMY OF AN EPIDEMIC has shown that countries not subjected to the mental death profession in bed with BIG PHARMA pushing their toxic drugs were far more inclined to recover and live much longer lives.

    So, you are right that you focused on a small area of concern regarding BIG PHARMA, but you miss the BIG PICTURE when you deny the most important issue of concern is the fact that this plutocracy has gained far too much power and has corrupted our government, politicians, the medical profession, the healh insurance industry and all too many others with total disregard for their psychopathic behavior as described in the movie and book, THE CORPORATION as well as such books as SNAKES IN SUITS: WHEN PSYCHOPATHS GO TO WORK.

    Just as with the Tobacco companies that preyed on me as a teen and addicted me to smoking, the fact they cost $8 a pack now and exposure of their evil and psychopathic ways has helped me and others to see though them and quit, making toxic drugs like atypical antipsychotics from BIG PHARMA too expensive to afford like other lethal products like cigarettes can only be a huge gift and blessing to mankind.

    So, I did read your article and I think America and other rich nations should be more concerned about how they spread their psychopathic evil in the guise of medicine throughout the rest of the world by BIG PHARMA and other huge industrial plutocracies than their culture of materialism, greed and narcissism.

  • http://medschoolodyssey.wordpress.com/ Med School Odyssey

    Given that large companies are able to influence public policy so effectively, I’d have to disagree with the author – they absolutely CAN have it both ways!

    • Anonymous

      Sir or Madam:

      My response was anything but sarcastic. However…..

      It would do me no good to respond to either of your dicta regarding plutocracies, the rich , the filthy rich, the in-between filthy rich or the fact that those over the age of 55 and who make more than $250K a year do indeed use Crest toothpaste (a product sadly from yet another plutocracy, the evil consumer goods lobby) and have in fact, 45% fewer cavities. The latter is, as well, grossly unfair, and I propose making it a Federal Law confiscating two tubes of crest from its manufacturer for every one that is sold to a family whose aggregate income is greater than $250K. Then, of course, we would have to impose a toothbrush tax on those very same families because those making less than 3x the poverty level are likely not to have the proper dental implementations such that they can compete fairly in the “Smile” market, putting them at a distinct disadvantage in obtaining a better job because of poor oral hygiene and a lack of regular dental professional care. Needless to say, this situation would significantly impact the number of Brits we here accept as immigrants in this country.

      Please regard the above paragraph in the same manner and see it in the same way that I saw and regarded your initial response to that which I wrote. As such, it initially did me no good to respond to you in anything but a polite and brief manner. As you thought that initial response to you was sarcastic, I offer you the above paragraph to consider as being sarcastic.

      Thus endith the lesson!

       

  • Anonymous

    Thank you so much for considering my blog and in responding to that to which you do not agree.

    Mitchell Brooks, M.D.