Pharmaceutical manufacturers follow the money.
Patients are left to decide whether to take the chance that they will get a rare dramatic response and spend as much as $100,000/year on a single drug or accept the reality of their fatal illness. For most people, even those with good insurance coverage, there will be out of pocket expense what with deductibles, co-pays and uninsured expenses. Many will face financial ruin in order to obtain the care they think will help.
In reality, most of these terribly expensive drugs provide modest benefits that vary from slowing disease progression with no survival benefit to one to two months additional survival. The notable exception to this is the drug Gleevac (imitinib) which was developed with taxpayer funded NIH grants and then taken private. It has dramatically improved survival in chronic myelogenous leukemia and GI stromal tumors (GIST). The drug also has yielded Novartis billions in profits.
The drug Velcade (bortizomib), referred to in the above article, has shown:
“Patients who were randomly assigned to receive bortezomib had both a significantly longer median time to disease progression than those assigned to receive dexamethasone (6.22 months vs. 3.49 months, P<0.001) and higher response rates (complete response, 6 percent vs. less than 1 percent; partial response, 32 percent vs. 17 percent; P<0.001 for both comparisons).”
“The final consideration of “tolerability” is one of cost. The charge by the pharmacy at my center (Mayo Clinic, Rochester, Minn.) to a patient with a body-surface area of 2 m2 for the nine months of therapy as outlined in the APEX trial would be $45,760 for bortezomib and $170 for dexamethasone. Though no price can be placed on the value of an effective drug to a patient or his or her family and doctor, this differential is sobering.” (medicynical note: actual prices in the community seem higher)
In Europe the manufacturer refunds half the payments for this drug if it is ineffective. There is no such arrangement here.
“NICE (Britain’s National Institutes for Health can Clinical Excellence) says that the product is an effective use of the UK National Health Service’s resources when treatment is continued beyond four cycles in those that have a complete or partial response, if J&J refunds the cost of the medication when patients do not respond.” (medicynical note: It’s too expensive and not cost effective without a refund)
The equation would be so much more simple if the price of the medication actually represented the drug company’s development and production costs plus a modest profit. Modest profit, however, is not the goal of the free market pharmaceutical industry.
Meanwhile our republican candidate suggests that to control costs the we need to set market forces free. At these prices, and profits, where do you think the market forces are going to take us? These companies have a monopoly for a generation on medications that promise (but only rarely deliver) long term life saving benefits–is that a “free market?”
We need a new financial/medical system for drug marketing and development.
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