Intro There are many different participants in the ongoing battle for (and against) universal health care. Each special interest has its own needs. For instance, if you manufacture stents for diseased coronary arteries, you want a lot of money set aside to treat folks who develop heart disease, but you are ambivalent about public health expenditures to reduce obesity, smoking and the other risk factors of preventable heart disease. If you are a private insurance company, you want the law to require that everyone buy a private insurance policy---everyone except those with certain expensive chronic diseases.
They should be covered by the federal government. A law which requires everyone not on Medicaid or Medicare to buy insurance is your cup of tea. If you own a chain of hospitals with intensive care units, you will be especially concerned about any federal initiative to encourage people to write living wills, since care at the end of life can be very lucrative.
If you think that Big Pharm does not want the current U.S. health care system to change, you are wrong. They would love to see more of us have access to physicians who can diagnose and prescribe even more medications. There are fifty million people out there who are currently uninsured who could have high cholesterol---which is money in the pocket of any company that manufactures one of the red rice yeast clones known as
statins . Companies like Pfizer, which I will discuss in a few moments.
The Republican authored Medicare Part D is the model of what the world’s drug companies desire. Universal insurance coverage that includes drug coverage
but forbids any type of collective bargaining to lower drug prices . Oh, and they do not want anyone comparing various treatments for relative cost and efficacy, either. That means no formulary of approved drugs. Instead, they want to continue direct to patient advertising and (especially) their lucrative practice of bribing health care providers—mostly doctors---to prescribe
their product, often for diseases it was not intended to treat.
Pfizer Gets a Hand Slap Today the federal government announced that Pfizer, the biggest drug company in the world, will have to pay over $2 billion in fines for bribing doctors to recommend its products and for other practices designed to increase their revenue at the expense of the public well being.
Announcing the penalty as a warning to all drug manufacturers, Justice Department officials said the overall settlement is the largest ever paid by a drug company for alleged violations of federal drug rules, and the $1.2 billion criminal fine is the largest ever in any U.S. criminal case. The total includes $1 billion in civil penalties and a $100 million criminal forfeiture.
Authorities called Pfizer a repeat offender, noting it is the company's fourth such settlement of government charges in the last decade. The allegations surround the marketing of 13 different drugs, including big sellers such as Viagra, Zoloft, and Lipitor.
http://finance.yahoo.com/news/Pfizer-to-pay-record-23B-apf-1176280604.html?x=0Note that Pfizer was not tripped up by some loophole in some new law. They have been doing this---and getting their hand slapped---for years. There is only one reason why a company would continue to break the law, when they know that they will be punished for it. Someone at Pfizer did a cost analysis and decided that there is more money to be made in doing the crime than there would be money lost in paying the fine. If you refer to the link about Neurotin lower on this page, you will see an estimate of $1 billion/year profits from a drug that would have brought in only $50 million/year without the illegal marketing practices. Add this up over a few years and multiply it by the number of Pfizer's top selling drugs and you will see that even $2 billion is just a wrist slap.
Now, I want you to consider the following scenario. How would you feel if you found out your doctor had you on Lipitor, because he got an all expense paid trip from the drug company? How would you feel if you developed liver disease, one of the more common side effects of the medication, and you found out that there were alternatives that did not harm the liver? But your doctor did not consider them
because he just got back from an all expense paid vacation, courtesy of Pfizer?
Note that one of Pfizer’s crimes was making recommendations to its (bribed) doctors to use its products for non approved uses.
The government said the company promoted four prescription drugs, including the pain killer Bextra, as treatments for medical conditions different from those the drugs had been approved for by federal regulators. Authorities said Pfizer's salesmen and women created phony doctor requests for medical information in order to send unsolicited information to doctors about unapproved uses and dosages.
Use of drugs for so-called "off-label" medical conditions is not uncommon, but drug manufacturers are prohibited from marketing drugs for uses that have not been approved by the Food and Drug Administration. They said the junkets and other company-paid perks were designed to promote Bextra and other drugs, to doctors for unapproved uses and dosages, backed by false and misleading claims about safety and effectiveness.
Bextra, for instance, was approved for arthritis, but Pfizer promoted it for acute pain and surgical pain, and in dosages above the approved maximum. In 2005, Bextra, one of a class of painkillers known as Cox-2 inhibitors, was pulled from the U.S. market amid mounting evidence it raised the risk of heart attack, stroke and death.
The number of people with arthritis is relatively small. The number of people who have surgery or pain is much larger. Drugs companies will commonly test a product for one disease only, get an FDA clearance and then start promoting it for everything from male sexual dysfunction to baldness. This is illegal, but that does not stop them from doing it, since so called “off label” use of a drug can net them more money than its use for the problem it was intended to treat. For instance, Neurontin is
indicated for 1) post herpetic neuralgia and 2) seizures. However, it is commonly prescribed for people with migraine headaches, painful diabetic neuropathy, pain from pinched or damaged nerves as well as any other kind of chronic painful condition. Now, how many people do you know with the first two problems? And how many folks do you know who suffer from one of the last four?
Here is what a Pfizer employee had to say about his company’s off label marketing strategy:
“I was trained from day one to market the drug illegally...My job was to promote Neurontin and motivate doctors to experiment on patients. After being hired as a medical liaison, I was selling drugs. The uses promoted were from the “snake-oil list” of 13 medical conditions."
http://www.ahrp.org/cms/content/view/623/9/The problem with handing Neurotin out like candy is its side effects. Like many seizure medications, it can increase the risk of suicide. So, if there is a medication available that is indicated for the treatment of pain that does not cause suicide, that would be the safer choice. And there are lots of pain medications, many of them not on patent.
In Europe, They Control Drug Costs It is clear that federal legal action, like that described above, will not affect how companies like Pfizer do business. On the other hand, a public option/federally run single payer insurance program has the potential to stop all the drug company shenanigans. For proof, we need only look across the water to Europe. Charged with the mission to keep the public healthy but costs down, the boards which regulate medicine in Western European countries create lists of effective and affordable therapy and instructs doctors to use these medications. So, for instance the National Health Service in the U.K generally does not cover the mega-expensive Tarceva that might give some lung cancer patients eight more weeks of life.
In Britain, the National Health Service doesn't pay for Tarceva, with some rare exceptions. It's one of the tough decisions the National Health Service has had to make. In order to provide coverage for everyone, the NHS has to put limits on medical treatments. By rationing care in this way, the NHS has managed to keep costs down to about $3,800 per person a year — a little over half of the average American's yearly medical bill.
http://www.npr.org/templates/story/story.php?storyId=91996282In the United States this would be decried as “rationing healthcare”. Pretty big talk coming from a country where many millions of Americans can not even get a bronchoscopy to
diagnose their lung cancer…because they have no insurance.
Note that while the British are quick to ridicule us for our broken health care system which leaves out millions, they object to efforts being made to rein in the costs of our (world’s most expensive) health care system. From the Guardian:
It has become fashionable at the White House and on Capitol Hill to try to cut costs at the expense of the pharmaceutical industry, although this sector has been one of the nation's most innovative and successful: in other words, the standout workhorse.
President Obama seems determined to cut the horse's rations further, to eke out huge cost savings at drug companies' expense. "You've heard that as a consequence of our efforts at reform, the pharmaceutical industry has already said they're willing to put $80bn on the table," he said at a town hall last month. "We might be able to get $100bn out or more."
Starving this industry would be short-sighted.
http://www.guardian.co.uk/commentisfree/cifamerica/2009/aug/21/healthcare-obama-pharmaceutical-industryYes, I know this sounds pretty funny coming from a country which carefully regulates its own drug costs so that it can afford to provide universal coverage. But as I documented in my last journal, Great Britain is the home of Glaxo-Smith-Kline, the world's
third largest drug company, and GSK makes most of its money in the U.S.
http://journals.democraticunderground.com/McCamy%20Taylor/430What is up with the British press, which wants us to expand the number of people who have insurance but which does not want us to fund this expansion by reining in runaway drug costs? They want to have their cake and eat it, too.
Do not be surprised if Big Pharm quietly joins with the nation's private ensurers to back a law which will require all Americans to purchase private health insurance. They secretly want those 50 million uninsured Americans as their customers. Publicly, they will express intense disapproval of even the most watered down health care reform---while indicating that they might be willing to change their minds if Congress decriminalizes bribes paid to doctors, off-label marketing and other scams to increase sales. Oh, and any effort to cut the costs paid out through Medicare Part D will be attacked, too, as genocide against the elderly. Never mind that the drug companies are waging their own kind of war against the American people by forcing the wrong medications down our throats.
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