Why Your Medicine Costs So Much: Thank you Senators Kennedy et. al.

The late Senator Ted Kennedy, like most senators a self-aggrandizing hypocrite, was also a savvy politician and ultimately an effective legislator. In an egregious moment which shall stand in the halls of my memory, so long as it may continue to function, Senator Kennedy passed legislation which in retrospect was a tawdry attempt to assuage his more left-leaning followers, but which resulted in one of the most significant attacks on patient care in the history of my life. To quote Mark Twain, “To promise not to do a thing is the surest way in the world to make a body want to go and do that very thing”. And the thing the Senator promised not to do was to promote an unhealthy alliance between young doctors-in-training and pharmaceutical companies.

Prompted by a friend who called to complain that he had just moved to a new city and had developed a consuming case of jock-itch, I was moved to consider what had become of physician concern for patient welfare. Not knowing physicians in his new locale my friend searched the internet for the name of a dermatologist and was promptly given an appointment. Performing a cursory visual exam, sans any testing, the doctor concluded that my friend had a fungus infection of the groin. The dermatologist, having recently left the cocoon of a university training program, prescribed what-to-her was an appropriate and modern topical cream therapy. When the patient arrived at the pharmacy he was told the cost of the cream was 300.00. Incredulous, he asked if his medical insurance would cover its cost and was told the insurance had already covered 200.00 and the rest was his responsibility! The total cost of a tube of this miracle cream was 500.00. I responded to his lament by recommending an over-the-counter anti-fungal cream which cost 12.00!

Getting back to Senator Kennedy, the Senator deemed that pharmaceutical company gifts to medical students was influencing their neophyte prescribing patterns and worse, might create a relationship of indebtedness which would corrupt the psyche of these young doctors forever. To wit, Eli Lilly Company could no longer distribute doctor bags to medical students completing their second year of medical school and other companies could no longer sponsor trips to major medical meetings for senior residents. (I was in the last class of medical students to receive said physician bag and with no sense of disingenuousness have a great affection for the bag and its history of having accompanied me over more than 4 decades of clinical practice. I rarely prescribe Eli Lilly products because most of their products do not fall into my therapeutic armamentarium.)

Henceforth, the pharmaceutical industry would have to find other ways to communicate with medical students and physicians. Furthermore, as government funding of research would wither, the pharmaceutical industry was asked to bear the burden of drug research with the caveat that monetary gains from such research would be considered ill begotten. As these congressmen pandered to the populist cause, they failed to see the unintended consequences of knowledge deficits and loss of ingenuity that would characterize the next 3 generations of physicians. With little information in basic science and in pharmacology physicians increasingly adhered to the principal that newer is better. The pharmaceutical industry reverted to a more passive –aggressive posture of reformulating existing drugs and packaging them as ever more expensive products. The liability risks of new drug formulations became simply too expensive to justify new drug research. (This resulted in creating what we now term the biotechnology industry.) Economic and bureaucratic pressures on physicians and academia alike produced ever more expediencies in physician education. Ask any credible drug rep and they will tell you that only rarely do physicians want information regarding pharmacology and rely on drug advertising to influence their prescribing of new products. Hence young physicians are preoccupied with new drug formulations which are reformulations of older drugs sold at ever increasing cost.

Beware Senator Kennedy. You knew not what you asked for and we are paying for it in spades.

Next blog will discuss the two tiered economic system of medicinal drug distribution based on how much premium the consumer can pay for medical insurance.