The War on Drug Prices

Cost of Drugs_cartoon
Most Americans ask the question, is the price I pay for prescription medications FAIR? In other words, what is the true cost of developing, making and selling a medicine, AND how much profit seems reasonable? This is what we tackled last week during our Community Conversation with experts from the U of Washington’s International Society for Pharmacoeconomics and Outcomes Research (ISPOR).

KEY FACTS THAT INFORMED OUR DISCUSSION
Tufts estimates that it costs $2.6 billion to develop an FDA approved drug, a number that increases 9% per year.  People in the US pay more for drugs than people in other countries for a few reasons: 1) we use more medications because we have better access to new ones, 2) we have a higher burden of chronic disease like diabetes and obesity, and 3)  in the US, the government protects drug manufacturing monopolies and limits price negotiations while other countries have more price regulation.

Another reason people in the US (and in Canada and Europe) pay more for medications is simply because, on the whole, we can afford to. Picture a world map, and picture all the people who live on Earth.  At 326 million, the US population is 4.4% of the world’s 7.5 billion people, but the US accounts for 50% of all medication sales in the world. Mind blown.

We are looking for VALUE in our medications.  We want medications that are novel and offer leaps of improved quality of life.  We are willing to pay more for medications that achieve this high bar, but there is a point for every person where price will exceed our ability to purchase a medication.

Finally, we learned about the trade-off between innovation and access.  Monopoly protection funds innovation. In turn, industry creates more new drugs in the long run that cost more money in the short run and poorer access. “But if new medicines aren’t invented, then no one can access them in the long term.” (ISPOR)  How can the market incentivize innovation if not through the almighty dollar?

DISCUSSION THEMES
Many in the room were for the first time faced with the reality that the US foots HALF the bill of medications in the world.  I don’t think anyone, besides the facilitators, was prepared for this data.  As the discussion dug deeper, we realized that our drug costs fund innovation of new medications and devices.  Despite the relationship between US drug prices and world drug innovation, many participants still did not think it FAIR that people in the US pay more than those in other countries.

Some held high the banner of altruism and seemed happy having the US play this role.  Others felt perhaps that even within the US that medication prices should be on a sliding scale based on what a household could afford.  Some shared personal stories about themselves or people they know who have had to choose between paying for their medications and paying other bills.

Yet others remained firm that prices could drop while maintaining innovation if pharmaceutical companies could lower their profits to reasonable margins.  Some attendees implied that companies could reduce their expenses by accelerating the clinical research process, a point that was strongly opposed by a former industry employee.  Pharmaceutical companies have no interest in accelerating clinical research in this manner because it would cause less confidence in drug safety.

As we were wrapping up our Conversation, we faced the question of whether or not the way we finance medications is sustainable.  Our vocal attendees had faith in the free market to correct anything that was broken.  Others remarked that the balance of medications on and off patent would also help with price competition once medications go off patent.

Our ISPOR facilitators emphasized that drug pricing is a complex ecosystem.  They recommended that consumers, scientists, policy-makers and health care providers and administrators continue to learn and share their perspectives, in venues such as Community Conversations, as much as possible in order to find a stable and sustainable relationship between medication access and innovation.

To read some excellent resources on the topic, visit the Community Conversation archive and scroll until you find the “war on drug prices” topic.

~JenWroblewski

Advertisements

Crisis in Antibiotic Resistant Bacteria: Are you Chicken? A Community Conversation Reflection

During the autumn round of Community Conversations in Portland, OR and Seattle and Spokane, How Bacteria Become Resistant to ABXWA, we discussed the concern that ongoing antibiotic use in large-scale commercial chicken farms is producing antibiotic resistant (ABR) bacteria that contribute to more difficult-to-treat human diseases. In a 2014 report on antibiotic (ABX) resistance, the World Health Organization warns of humanity heading for a “post-antibiotic” era in which antibiotics can’t keep up with ABR and the diseases they cause.

Who are the stakeholders in this situation? Large- and small-scale farmers, consumers, researchers looking for new drugs that kill bacteria and medical professionals who want healthy patients. With all these stakeholders, how are we to address this potential public health crisis?

The One Health Initiative holds that human, animal and environmental health are all connected. ABX use practices in food animal agriculture are of particular interest, but not everyone agrees that there is sufficient evidence that the use of ABX in chickens (or other food animals) directly results in ABR infections in people.

Despite expected regional differences, participants in the Conversations were united in several areas. One, we simply need more data. The Food and Drug Administration only recently (2009) began collecting sales data for antimicrobials in food-producing animals. No one is sure what is actually being used. Legislation attempts to limit ABX use and require record-keeping both federally and in some states, including Oregon, have not garnered enough support. Two, consumer education needs are high. We are inundated with messaging and food labeling that is sometimes great marketing (rBST-free!—but there isn’t a significant difference in the milk from cows treated or not with rBST) but low on information (how are egg-laying hens treated if they are cage free?). Many of us still believe that if we have a cold for more than 3 days we are good candidates for antibiotics. Three, the conversation tends to use rhetoric that is sensationalized and prevents authentic discussion. For example, “factory farms are overusing antibiotics and are mostly responsible for this crisis.” Toxic rhetoric.

Participants rallied around some practical action items. People committed to investigating the meaning of food labels. People committed to better hand washing and to touching their faces less often (did you know 30% of people carry MRSA in their nose?). Many also committed to sharing their new knowledge both professionally and personally.

All in all, this round of Community Conversations was high in energy and commitment to better living through smarter consumption of food, data and antibiotics.

Many thanks to our facilitators Kathy Hessler, JD, LL.M and Emma Newton, MS (Portland); Heather Fowler, VMD, MPH and Paul Pottinger, MD (Seattle); and Doug Call, PhD (Spokane). Thank you to our Spokane Series Sponsor, Whitworth University.

 

Speak Up For Research Education Fund

How did science hook you?

Strawberry DNA extraction

Strawberry DNA extraction

Did you have a teacher whose lab was your favorite place to hang out in high school? Were you a biology graduate student who fought for better treatment of animals and found a calling in animal care or health ethics? Did you travel and see suffering that would be diminished with the right vaccination?

I got hooked as a member of the St John Ambulance Brigade in New Zealand where as a teenager I was able to volunteer in ambulances, hospitals and rest homes and saw evolving treatments driven by research.

I’m both excited about science and concerned about its future. I see a growing distrust in biomedical research, waning science literacy and an almost perverse celebration of anti-science sentiments; this all of course at a time when new biomedical research breakthroughs are occurring on a daily basis. Here at NWABR, we see the possibilities of science and are excited by the opportunities for young people to get hooked into fascinating and important science fields—but we also see a gap in the science education for the general public that results in twisted logic, misinformation, hijacked conversations and bad policy decisions.

NWABR bridges that gap, combats that misinformation, and leads spirited and informative conversations about complex issues related to biomedical research.  And we need your help.

Today, I’m asking readers you to join our newest fundraising initiative: the Speak Up For Research Education Fund.  Over the last two years more that 1,400 people have joined NWABR at a series of events:

  • Perhaps they volunteered for our popular Bio Expo that engaged close to 700 high school students;
  • Or they attended a Community Conversation on the ethics of end of life care, or vaccinations, or direct to consumer genetic testing.
  • Perhaps they are a professional dedicated to ethical protections for humans and animals in research and you attended one of our research conferences;
  • Or they attended our Security Conference and joined colleagues from across the country who are committed to keeping scientists, their facilities and their work safe.

This campaign to create a Speak Up For Research Education Fund is about protecting the belief and trust in biomedical research and ensuring that this work can continue robustly into the future.

Join the Speak Up For Research Education Fund and make a donation today by visiting:  https://donatenow.networkforgood.org/nwabr?code=Speak%20Up%20For%20Research

Alternatively you can send a contribution to the Northwest Association for Biomedical Research, 2633 Eastlake Ave E., Suite 302, Seattle WA 98102.

All supporters will be thanked by name in our public materials, unless of course they request to make an anonymous contribution.  All contributions will also be acknowledged with a tax deduction receipt.

This is a vital time for science – with the support of the Speak Up For Research Education Fund we can continue and expand the work of engaging students, families and communities with science.  With the support of this fund then one student at a time, one family at a time, one community at a time we will build support for, and trust in, biomedical research.

Thank you for Speaking Up For Research.

Kind Regards

 

Ken Gordon – Executive Director

Northwest Association for Biomedical Research

(P) 206-957-3337 (C) 206-595-2450

 

 

Local philanthropists drive biomedical impacts in the Northwest

Dear all

We are all so lucky to live here in the Pacific Northwest. We have this amazing environment, amazing weather (today for example the weather is perfect) and we live in a community of such smart and caring people.

We are also lucky that due to both current and past philanthropists – the Northwest is the place to be if you get sick. Lets be clear we are all going to die (and if you are interested in issues with end of life care you should see the planned Community Conversation that Jen Wroblewski is planning for June 3 titled “What do science, medicine and our culture tell us about end of life?”) – that said, the amazing research hospitals here in the Northwest will both prolong your life and improve the quality of care that we have during the period before we die.

There is no doubt that philanthropists have driven the development of the amazing research hospitals in our region. The Fred Hutchinson Cancer Research Center for example was inspired by the philanthropic efforts of Dr. William Hutchinson and was named for his brother Fred who died of cancer in 1964.

The philanthropic contributions to the Fred Hutchinson Cancer Research Center received a huge boost last month when the Bezos family donated $20m to support the Center’s work on cancer immunotherapy.

Paul Allen has been a major supporter of brain research with gifts of several hundred million dollars over the past decade.

The Gates Foundation in turn has been funding the development of innovative ways to stop diseases and improve health care.

There is no doubt that these significant gifts have driven a sea change in health care, and have put the Pacific Northwest at the leading edge of research driven health care improvements. I don’t ever want to get sick and I also note that getting sick here in the Northwest is one of the luckiest things that could happen – thanks in large part to all of these amazing donors.

Take care

Ken Gordon
Executive Director

To vaccinate or not to vaccinate – why is it even a question?

Dear all

Recently I had a long discussion with some fellow parents about the merits of vaccinations.  I have to confess that when it comes to vaccinations I have drunken the Kool-Aid.  I believe that vaccinations have been responsible for saving hundreds of millions of lives and improving the quality of life of billions more.  As a kid growing up in New Zealand I received all of the recommended vaccinations.  When I was in the process of moving to the United States the immigration service had to have proof of my vaccination history and the easiest way to achieve this was to be re-vaccinated for everything.  Also because I have worked in a number of developing countries I have received vaccinations for a range of less well-known lurgies.

In my view vaccinations are a public health issue.  We have been lucky in the developed world to not see epidemics of polio, whooping-cough, rubella, measles and the list goes on.  Vaccinations have been the major driver of the near eradication of many of these diseases.

It is therefore incredibly worrying to see that diseases like Polio starting to pick up in places like Syria and Pakistan.  Polio is a horrible disease that can be fatal and can lead to long periods of hospitalization and lifelong disabilities.  Polio disproportionately affects children under the age of five.

You may wonder why we should be concerned here in America about the resurgence of Polio out there in the rest of the world.  The reality is that these days – as far as disease is concerned – there are no borders.  A person exposed to Polio in Syria today – if they have not been previously immunized could be a unknowing carrier in Seattle tomorrow.  What makes matters worse is that in many of the more affluent pockets of America immunization rates for diseases such as Polio have fallen way below the target 90 percent level that is thought necessary to stop epidemics.

So why do parents not get their children immunized.  The reasons I heard in the above mentioned discussion are:

  • our children are healthy – and can therefore cope with diseases.
  • its better for a child’s immune systems to not be immunized.
  • there are risks associated with vaccines that outweigh the risks of the diseases.
  • there is a link between vaccines and autism.
  • there is a link between vaccines and autism for the next generation (i.e. we can pass on susceptibility to autism that we gained through vaccination to our children).
  • there is a distrust of western medicine and western doctors.

These views are not extreme.  Google “Vaccinations” and within a few hits you will see many of these same ideas being touted.  There is also a kernel of truth in some of these items.  Vaccines are not risk free.  According to the CDC the chance of a serious allergic reaction  to the MMR vaccine is about 1 in a million.  If you are the parent of that one in a million child then that does not feel like it is a rare occurrence.  If on the other hand your child does get measles there is a 15 percent chance of pneumonia, measles croup or convulsions.  Two unlucky children in every thousand will on average contract encephalitis, which in turn can lead to brain damage and death.  One incredibly unlucky child in every 100,000 may get subacute sclerosing panencephalitis which causes progressive brain damage and nearly always results in death.  Catching measles is many times more likely to cause death than being vaccinated – but it is true that vaccinations are not risk free.

On the other hand there is no truth to the myths that there are links between autism and vaccinations.  This myth derived from bad research – since disproven and withdrawn – but the myths persist.

The hardest argument to counter is that western medicine and doctors can not be trusted.  This is an area that we work on at NWABR.  People trust people who are honest, who acknowledge mistakes, who acknowledge that they do not know everything, and who continually strive to improve.  At NWABR we are working to both show all of the amazing gains that biomedical research has brought to the world and to also be as honest as we can about areas where things went wrong and where we need to do more work. We believe that there is no other way to rebuild trust – that has so clearly been lost.

I can’t persuade any person to change their mind about vaccinations.  But what I can do is really hear their concerns, attempt to distill some clarity from all of the opposing positions and provide data to support conclusions.   The parents that I was talking to will do what they will do.  Their children are healthy and for them the risks are  definitely at the low-end.  My only hope and wish is that if their children ever do become sick that they don’t then unwittingly become carriers of their disease.  Their children’s robust systems may well be able to cope but the record low levels of vaccinations do mean that many more people will get to share their disease, and some of those people will not do so well.

Regards

Ken Gordon

Executive Director

 

 

 

 

Half of US adults 40 to 75 eligible for statins

A report in today’s Seattle Times suggests that cholesterol lowering statins will be in most of your futures.  Based on research from Duke University (which surveyed 4,000 people) it is now estimated that half of US adults between the ages of 40 to 75, and nearly all men over the age of 70 meet recently changed criteria for the use of statins. 

The guidelines for the use of statins were devised by the American Heart Association and the American College of Cardiology.  The Duke study estimates that half a million strokes and heart attacks over a ten year period could be prevented if the new guidelines were followed. 

There is some criticism of the new guidelines which favor the use of statins over other lifestyle changes (such as not smoking or working to reduce stress).

Ken Gordon

Executive Director

Community Conversation – 23andMe – What Can Your Genes Tell You

Last evening (Tuesday March 18, 2014) the Northwest Association for Biomedical Research (NWABR) hosted a Community Conversation that explored the issues around Direct-To-Consumer Genetic Testing.

These Community Conversations are a partnership between NWABR and the Institute for Translational Health Sciences at the University of Washington.  The purpose of these Community Conversations is to enable members of the public to become engaged with emerging issues in the bioscience realm.  Our hope is that an engaged public will be better placed to think through complex scientific and ethical issues, make informed contributions, build relations with experts in the field – and most importantly – provide those same experts with feedback from a community perspective on these issues.

At the Community Conversation hosted yesterday evening around 35 people gathered to discuss direct-to-consumer genetic testing services.  The company 23andMe has been providing this service to customers and approximately 650,000 people have both had their DNA tested and agreed to share their records to help build a DNA database that will, hopefully, in the future improve the accuracy of the findings that 23andMe can report to their customers.

The FDA has asked 23andMe to stop marketing the health benefits of this testing service and to no longer provide direct findings to customers about any health implications arising from the genetic tests that they perform.  The FDA is concerned that a consumer may misinterpret the results that they receive from 23andMe and subsequently make poorly informed health care decisions.

Yesterday’s Community Conversation was held at Kakao Chocolate + Coffee in Westlake.  The Conversation was facilitated by Sarah Nelson and Lorelei Walker, who are MPH and PhD candidates in Public Health Genetics at the University of Washington.  Following the presentations from Ms. Nelson and Ms. Walker the participants had a wide ranging discussion that touched on: privacy, trust, potential commercializing of DNA, the need for access to this information. the need for help in interpreting the information, resistance from some members of the medical community, the current lack of diversity in the 23andMe database, support for and frustration with the FDA and much more.

As we the staff at NWABR watched the conversation progress we were amazed that such a great group had come out on a Tuesday evening, given up their own time, and dived so eagerly into this complex area.  We were again reminded of just how rich discussions can be when these two sometimes diverse worlds come together.

Regards

Ken Gordon

Executive Director

Northwest Association for Biomedical Research