Medical Industrial Complex Tramples US

I continually run across stories on health care costs in the US that make me gasp in disbelief at how we are being legally robbed (sometimes robbed to death) by the Medical Industrial Complex and their partners in crime, the FDA.  The latest is an article published in the NY Times about Asthma treatments.  It includes many of the infuriating facts driving drug costs in the US.

Pulmicort, a steroid inhaler, generally retails for over $175 in the United States, while pharmacists in Britain buy the identical product for about $20 and dispense it free of charge to asthma patients. Albuterol, one of the oldest asthma medicines, typically costs $50 to $100 per inhaler in the United States, but it was less than $15 a decade ago, before it was repatented. 

Rhinocort Aqua, a prescription drug that was selling for more than $250 a month in Oakland pharmacies last year but costs under $7 in Europe, where it is available over the counter.

Unlike other countries, where the government directly or indirectly sets an allowed national wholesale price for each drug, the United States leaves prices to market competition among pharmaceutical companies, including generic drug makers. But competition is often a mirage in today’s health care arena — a surprising number of lifesaving drugs are made by only one manufacturer — and businesses often successfully blunt market forces. 

Thanks in part to the $250 million last year spent on lobbying for pharmaceutical and health products — more than even the defense industry — the government allows such practices. Lawmakers in Washington have forbidden Medicare, the largest government purchaser of health care, to negotiate drug prices. Unlike its counterparts in other countries, the United States Patient-Centered Outcomes Research Institute, which evaluates treatments for coverage by federal programs, is not allowed to consider cost comparisons or cost-effectiveness in its recommendations. And importation of prescription medicines from abroad is illegal, even personal purchases from mail-order pharmacies.

“Our regulatory and approval system seems constructed to achieve high-priced outcomes,” said Dr. Peter Bach, the director of the Center for Health Policy and Outcomes at Memorial Sloan-Kettering Cancer Center. “We don’t give any reason for drug makers to charge less.”

And taxpayers and patients bear the consequences.

See also this story on the FDA,  this story on high health care costs, and this story on Novartis in particular, as well as this one.

Oregon DOJ Goes After Doctors Taking Kickbacks

The Oregonian is reporting that doctors who receive money from medical device makers have to divulge that to their patients as a potential conflict of interest.

The case could ripple nationwide, exposing a little-known but common practice of payments to doctors from implant manufacturers. Locally, for instance, the practice is tolerated by the biggest hospitals in the state who do not require patients be informed of such payments. The DOJ case could do for the artificial-implant makers what similar court cases did for drug companies' payments to doctors, says Jerry Avorn,  a Harvard Medical School professor who has written about the ethics of undisclosed physician payments.
"The patient has a right to expect that whatever device is implanted or procedure is recommended is a decision that is based solely on what that patient would most benefit from," he said, calling the case "potentially so important."

Oregon's Unlawful Trade Practices Act requires that professionals disclose this sort of information when providing services. And by failing to, the doctors were leading the patient to believe they were free of any conflict of interest and doing the implants "for the exclusive benefit of the patient ... when this was not the case," according to the DOJ.

I'm glad to see this practice receiving more scrutiny.