Drug Goes From $13.50 a Tablet to $750, Overnight

Politics and religion
242

Nesrie, Pharma spent $24 billion marketing to healthcare professionals in 2012. $3 billion went on marketing to the general public.

The way the Pharma industry markets to physicians is both immoral and unethical. That it isn’t illegal is a damning fucking indictment of the US Healthcare system and legislation concerning it.

Among other things they subvert (largely) well meaning and well intentioned healthcare professionals into becoming brand ambassadors, even when the evidence available to professionals is that the drug in question has limited efficacy (or is less efficacious than a generic or cheaper alternative). I can’t find any articles on it, but there are plenty that go into great detail on just how insidious and wrong Pharma marketing is in the US.

This quote is from a decade ago;

[quote]Most of this is spent on advertising to doctors. Drug companies spend a great deal of time deciding how many calls to make to each individual physician and when to make those calls. Narayanan’s third research project thus went into greater depth in studying the effectiveness of these efforts.

Not surprisingly, the study found that doctors learn at different rates: There are fast learners, slow learners, and those who fall in between. But currently, drug makers tend to divvy up their detailing dollars based upon whether physicians are heavy prescribers or light prescribers—not on how quickly they understand the nuances of a particular drug. “And, if you persist in detailing information about a particular drug to a fast learner, your marketing dollars are effectively wasted,” said Narayanan. On the other hand, stopping your detailing before a slower learner has absorbed everything he or she needs to know about a particular drug can end up hurting overall sales.

Pharmaceutical firms can distinguish fast learners from slow learners through statistical analyses such as how quickly a doctor prescribes a new drug based on his or her age, time since graduation from medical school, or other attributes that can be easily observed. There are consulting firms in the industry that perform these types of analyses to help drug makers target their detailing more precisely, said Narayanan.[/quote]

Does that not frighten you? What kind of statistical methods are they using now to profile HCPs to figure out which can be ‘educated’ into using their pharmaceuticals? And how much money needs to be involved in the education?

243

If you look at all the biggest cities, ever notice how most of the skyscrapers are all named after banks and insurance companies? The system is broken. Just like the education system. Its debt payments that goes up the pyramid to your illuminati overlords. don’t cry, just bend over, it ain’t ever getting fixed barring a revolution.

Obamacare will wake up a few more people when they realize they have to pay (by LAW now!) 600-700 dollars a month for ‘basic’ health care… oh that’s for one single adult w/ the awesome 1000 dollar deductible. A family of four… hmmm 2500-3000 a month?!? No wonder ppl don’t want a family anymore…

244

I really don’t act that way at all, and it’s bizarre that you think I do. I acknowledge outright that at present, some percentage of, for instance, American spending on healthcare products subsidizes definitively unprofitable ventures like African and Indian medicine sales.

What I am strongly insisting, and points like kedaha’s (and, side note, it’s worth noting that his points, links, quotes, etc. are in many ways central to this discussion and very much fall under my particular definition of ‘excessive’ as above) on the laughable overinflation of medical Marketing (something that has almost no fathomable purpose, either to the physicians themselves or the customers directly) or my own about executive overcompensation and tax avoidance schemes are supporting, is the view that these companies might somehow find a way to continue to exist–selling medicine worldwide, no less!–even if Americans stopped overpaying for their medicine to such a degree that an overwhelming percentage of our population couldn’t even begin to afford lifesaving medical care of multitudinous varieties without declaring bankruptcy.

These companies are charging massively more than is necessary to maintain their existence and research productivity, and they are levying those charges against citizens whose governments have failed to protect them. And that is, to me at least, capital-E-fucking-biblical-Evil.

245

From here: Look Who's Bearing The Cost Of Pharma's Long-Time Sales And Marketing Tactics

In a related example

[quote]In another case, whistleblowers – including one represented by my firm – exposed the outrageous sales practices of Cephalon, now a subsidiary of Teva Pharmaceuticals. Cephalon trained its sales force to disregard the FDA’s restrictions on its opioid product, Actiq – which was to be used only for cancer patients dealing with extreme “breakthrough” pain – and to promote it to treat a wide variety of pain, from migraines to sports injuries. To settle that case and other whistleblower lawsuits, Cephalon paid $425 million.

But large penalties have not deterred pharmaceutical companies from marketing opioids in ways that violate the law. Potential profits from improper marketing are too great to resist, even when American’s health is put at grave risk.[/quote]

246

Well I don’t think 3 billion is something to just sneeze at but sure the other marketing is a large amount too. What are you suggesting? if you ask the physicians and the nurses and anyone who can prescribe medication, they will claim that they are not influenced by these sorts of things. They will also say they don’t make medical decisions based on costs so in theory what they tell someone on Medicaid should be the same as what they would tell Bill Gates right?

I’m not sure I buy that either.

So if we can agree that drugs are expensive to research, test and manufacture, and we want people to be able to continue to do that and turn a profit doing that then put out some suggestions on how to remove the waste and still keep physicians informed of the latest offerings.

If we [quote=“ArmandoPenblade, post:244, topic:77479”]
I really don’t act that way at all, and it’s bizarre that you think I do.
[/quote]

Well you gave an example of the UK setting prices as if governments setting a price would somehow solve everything… which it wouldn’t. We know that same drug is likely selling for a great deal more here in the USA and maybe almost nothing in countries without a healthcare system at all (drug companies do give away their products all the time).

To be clear, let’s summarize my position here. I think it’s fine that Mylan turns a profit on a life saving drug. The fact that it’s life saving doesn’t change that at all. This life-saving products exists on the scale that it does largely because of their efforts and because administering it is incredibly easy. I took a brief class on how to use one because we had one in a company vehicle. If it were up to me, every business, school, airplane and ideally personal vehicle would have one because it can save a life. And there is nothing evil about making money on something a company worked hard to bring to the market. It’s not evil to earn money on work produced. I suspect most people here want to get paid too.

But I also think they crossed a line. The argument should be about defining that line, and why it’s been crossed not whether or not it’s evil to make money in healthcare.

247

Well, it makes clear that your imagined narrative of Pharma companies marketing to the general public and them walking into their local Doc and asking for Drug Z is nonsense.

There is copious research (both directly on the effects of Pharma marketing + prescription rates and on generic marketing and how it shifts perceived values) to show that this kind of marketing is unequivocally bad.

That you just handwave it away as being ‘a way to keep physicians informed’ is frightening.

248

I didn’t imagine it. The pharmaceuticals companies do market to the public. They also have their names plastered all over pens, mugs, clipboards and lanyards in every hospital I’ve been in and most physician offices too. I know what Pharmaceutical reps are. Those people tend to be young, attractive and they can make a lot of money. You can try and label me ignorant if it makes you feel better, but I am not going to absolve the general public from being part of the problem.

You also sound like someone who hasn’t talked to many physicians or nurses. Whether it’s true or not, they truly believe they are not influenced by all this exposure. That’s a tough group to change.

249

Finally, because I’m sure that no one has grown tired of reading my ravings on the subject, and because I’m waiting for my hair to dry:

A) @Nesrie, our discussion in many ways started due to my strong support of government-funded single payer universal healthcare. A very significant portion of why I support that over the current system is that insurance companies provide no medically relevant benefit to the equation of healthcare whatsoever. They aren’t actively improving outcomes, researching new treatments, or anything of the sort at all. What they are doing is offsetting the cost of America’s excessive healthcare industry, allowing the middle class access to treatments they cannot otherwise afford. I think that for-profit companies are a poor way of offsetting this cost because even if they only make 1% back at the end of the day, that still represents a 1% increase in the total cost of healthcare in America.

Now, we might argue about the efficacy of government-sponsored programs versus those run by private companies (e.g., USPS vs UPS). It’s entirely feasible that early iterations of a US gov’t-operated single payer system would be rife with inefficiencies that might well be equal to (or, perhaps if Republican fever dreams about the evil of Big Government are reality, more than!) those introduced by private industry into the equation. However, that is something that can be improved upon over time and with much work, whereas the need to skim something off the top is a by-definition component of a for-profit insurance industry.

This is intimately connected to, but semantically separate from, the discussion of

B) The cost of healthcare in America. As you yourself acknowledge in your latest post, Mylan and other companies have stepped over the line in price-gouging. The brilliance of corporate accounting guarantees that other companies have likely masked the degree to which they are overcharging in a way that Mylan’s naked greed exposed. Simply put, I (and many others) feel like the system is utterly broken and fundamentally imbalanced, and the profit motive is a very clear component as to why. Few companies want to eke by, making just enough to continue apace. They always want more, more more, and their shareholders want more, more more. That desire leads to unnecessary marketing expenditures, executive overpay, tax evasion, and (to use another industry) outright Mathematical Bullshit like the infamous “Hollywood Accounting” (because remember, Return of the Jedi never turned a profit! So how could an expensive-to-produce cancer drug, right?). Simply put, some Greater Force must be the one to force them into a less-excessive mindset. In countries like the UK and Canada, that Force is their governments. In sub-Saharan Africa, it’s simply reality.

And it’s worth noting, that at least in part, my passion for this is exceedingly personal. I’m the partner of someone whose life has, in a gut-wrenchingly real and direct way, been fundamentally undermined, whose health has been disastrously ruined, and indeed, whose very life expectancy has likely been dramatically shortened by the the excessive cost of care in America and the systemic nature of greed that exists at every level from top to bottom to extract money from helpless, choice-free patients.

Being gouged by these sub-human fuckstains ruined her life and continues to do so every single day. I would do anything to ensure that they never have the opportunity to hurt another person like that in the name of greed.

250

Do you know that providing information to the Medicaid system and the Medicare systems are part of the reason insurance is so complicated today? That one of the reasons insurance billing has gotten to this point is because back when Medicare just sort of paid for procedures without checking much into them, physicians, hospitals and patients gamed the system.

We made the bed we lay in today, and it has become more and more complex with Medical Necessity checks, and codes on whether you get bit by a sea turtle the first or second time. It’s become complex largely due to government payors, and that’s just ICD10… which the USA moved to after much of the developed world had already moved on.

it seems to me you think that moving everyone to a government payor will some how make things less complex when the government payors are the most complex payors in the market today. Look at the VA, a government payor system that actually pushes military personnel through their doors instead of the hospital… you actually have to tell those patients they need to go to the VA when there are resources locally right there for them. And look how well that was handled.

You don’t have to convince me that healthcare costs are high in the USA. The data is right there. We spend, by far, more than any other nation, and we don’t have the stats to show for it. You know what else we have, some of the best healthcare in the world including top research being performed in our medical schools, facilities and hospitals.

And one of the reasons we can’t have real deep conversation is because you get people at a table and suddenly everyone becomes the enemy. We start seeing words like free, evil and hand-waving. Until we get people at the table to have real discussions, it’s not going to happen. Physicians don’t work for free. Hospitals can’t keep their doors open based on good will. Medical systems aren’t useful, efficient and mostly secure (everyone struggles in this area) due to impromptu volunteerism.

Show me suggestions. Give me solution. Free is not a solution. Single-payor is just a source of payment, not a change to the industry. And for gods sake, someone talk about the average age of nurses and the fact we have too few general med physicians willing to give prime care in this country…

but i guess free and evil and hand-waving… that spins better in the media.

251

[quote=“Nesrie, post:248, topic:77479”]
I didn’t imagine it. The pharmaceuticals companies do market to the public.[/quote]
And it is an inconsequential ~10% of their marketing budget. It’s also growing less, because marketing research shows that marketing to HCPs has better returns than marketing to the public.

That’s marketing to HCPs, not the public.

It is unequivocally true that they are influenced. It’s also unequivocally true that they believe they are not influenced.

That is precisely why it is so dangerous.

Thankfully, direct marketing to professionals over here is pretty much promotional material + free pens. if lucky, a handful of sample packs and the occasional not too fancy conference if you are a world leading consultant.

The largest marketing efforts are by medical device and equipment manufacturers.

(I worked in Hospital procurement for 18 months, medical professionals were not involved in pharma purchasing decisions)

Here’s a famous study from 2000 on the effect of simple drug marketing on physicians; http://jama.jamanetwork.com/article.aspx?articleid=192314

Bear in mind, marketing to HCPs was far less complex in 2000 and represented in financial terms at most a fifth of what it does now.

252

I didn’t say otherwise. If you spent less time trying to disagree with me you might realize I am agreeing with you; they focus more on the healthcare professionals than the patients. The Pharm reps are there to pitch to the medical professionals, not the patients. They just leave behind goodies that are usually under the dollar amounts that health systems, if the office is part of the system, cap when it comes to any sort of gifting policies.

I’ve love to get 3 billion back by not selling drugs to the general public, but I guess we have to go all or nothing right? Can’t work our way to desired end?

253

This is a really weird hill to die on, Nesrie.

254

It’s hard to disagree with you when your point seems to change with every single post as you go off on tangents.

That is what you originally claimed.

That statement was, to be impolite, bullshit. Direct marketing to customers is an afterthought at best, frequently counterproductive (research shows that advertising your opioid can increase the sale of competing opioids for example) and is certainly not to blame for the bloated marketing budget of Pharmaceutical companies.

255

Here I will clarify what i meant by that. The general public want to hold the pharmaceutical companies to the fire for prices and outrageous practices. But they want to maintain the right to demand a brand name drug when the generic is available and affect. Why?

Now there are some who have adverse reactions to the generics or get better results with the brand names, but those are smaller group. When there is a generic available and it works, why should a patient force the healthcare system to pay that premium, regardless of who the payor is?

Everybody want’s to save money but nobody wants their choice taken away.

256

Ok, sure, whatever.

In 2012, there were ~72,000 Pharma sales reps in the USA. There were ~ 79,000 family practice Physicians.

This is the breakdown of marketing expenditure

On the role of face to face marketing and free samples:

Prescribers prefer people: The sources of information used by doctors for prescribing suggest that the medium is more important than the message

(Note, UK study)

The role of commercial sources in the adoption of a new drug.

Influences on GPs’ decision to prescribe new drugs—the importance of who says what

[quote]Factors influencing the prescribing of new drugs by GPs Awareness
The significant first stage in the decision-making process is awareness of a new drug. The most important sources (Table 2) were the pharmaceutical industry, in particular the company representative, non-peer-reviewed literature, the mass media (largely the reporting of sildenafil) and, to a lesser extent, hospital colleagues. Peer-reviewed literature or independent drug information sources were rarely significant at this stage.

Most prescribing decisions were multifactoral. The most frequently cited biomedical influences were the failure of current therapy and adverse effect profile of alternative medicines. Decisions to initiate a new drug were influenced by its perceived economic or pharmacological advantages (216 reasons) over alternatives; however, in 157 incidents, the new drug was prescribed because treatment with first-choice drugs in a patient had been suboptimal. Mentioned more frequently, however, was the pharmaceutical industry, specifically the representative. Colleagues, especially in hospital, and also nurses were next most important. Patients were also a significant influence, in particular a patient’s request for a drug, patient convenience and acceptability. Written information was of limited importance except for local guidelines.

In 389 cases, initial information was considered inadequate and the GP used additional evidence or opinion before prescribing. However, exposure to new drug information tended to be reactive, implicit and ad hoc. GPs undertook an active search for information on new drugs in only 33 (5%) incidents. Furthermore, in 227 cases (37%), the initial informant was both the only information source and the major prescribing influence. The pharmaceutical industry was the prime mover here in 208 incidents, especially the representative (179 incidents).[/quote]

There are many more.

Slightly related,

The Accuracy of Drug Information From Pharmaceutical Sales Representatives

This was from 1995.

Two more studies on the factual quality of pharmaceutical advertisements:

Quality of Pharmaceutical Advertisements in Medical Journals: A Systematic Review

Accuracy of pharmaceutical advertisements in medical journals

Going off topic now. Will stop.

257

Understood.

258

Does it matter that it’s an unusual hill to die on? I mean, I wouldn’t have figured Nesrie, out of all of the people at Qt3, to be the one stepping up to defend for-profit pharmaceutical companies, but it’s certainly make for a fascinating conversation, and that’s what I look for here.

259

[quote=“Nesrie, post:223, topic:77479, full:true”]Japan is also “First World” and has a higher life expectancy.

Single Payor does not equate to no profit… it changes the system of payment exchange.
[/quote]

Eh, Japan’s healthcare system is very, very similar to some European systems, so I don’t really understand what you are trying to say. It is first world and has high life expectancy, and a similar healthcare system as most first world countries (much better managed and more regulated, I would say).

I would consider Japan as a Single Payor system.

260

I believe that the Netherlands has private health which is pretty efficient. One thing to keep in mind is that doctors and CEOs of hospitals get paid several times more in the US then in most European Nations. Pretty much everything in the US is more expensive when it comes to health care, and it isnt completely the fault of insurance. I would argue that the majority of costs falls to big pharmacy, but also big hospital. Sadly, big insurance isn’t a solution.

261

Most analysis I’ve read about why the US system is so damn expensive point to pharma costs plus a customer-satisfaction-first policy (as opposed to customer health first, these don’t go together) that generates unnecessary testing that raises cost and negatively affects health of patients (on average) due to unnecessary interventions and medications that (somewhat) reduce life expectancy and quality of life (and definitely do not improve anything but the hospital’s revenues).

I guess doctors are part of the equation (if they earned less the extra tests wouldn’t be as expensive) but it doesn’t seem to be the main cause.

Of course, the customer-satisfaction first policies are consequence of the hospitals being private for-profit organizations, that prefer keeping patients than actually doing what’s best for them (which many times is telling them they have nothing and please go home, stop worrying).