I understand the US pharmaceutical system pretty well. It is designed to maximize benefits to drug companies, not patients. Physicians and other prescribers are happy to go along for the ride, as they get financial benefits as well. Americans are severely over-medicated, which is exactly what the drug companies want, as they push direct-to-consumer ads and in-person physician marketing as far as they can legally go and then some. This is part of the RFK, Jr. agenda that I agree with–stop drug advertising and ban in-person detailing of prescribers. Never happen because the politicians make too much money from drug company contributions.
One of the most abused drug classes is anti-depressants. An astounding and frightening number of Americans are on these medications, often indefinitely. A recent article did a meta-review and analysis of over 150 studies on the physiological effects of these drugs. To a significantly varying degree across specific medications, they affect heart rate, cholesterol levels, blood pressure and body weight. It was not clear from the article whether these changes were benign or potentially harmful, but some antidepressants in other studies have been linked to sexual dysfunction and even suicidal thoughts. Please note that several of the authors have extensive funding from drug companies, which obviously would hope to minimize recognition of side effects and that many of the studies included were financed by drug companies. (Lancet Article)
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Kevin, as the former General Counsel of a PBM you might expect me to be strongly opposed to Pharma on principle, but outside of public health initiatives like clean water and proper sewage disposal, it’s hard for me to come up with a health care advance that has had greater impact on general health than pharmaceutical advances. From antibiotics to most vaccines (COVID excepted) to antivirals for AIDS to hepatitis therapies to GLP-1s I can’t think of any class of advances in the medical field that has had such a broad-based positive impact on population-wide health. Surgical advances are impressive but benefit only a relatively few patients compared to pharmaceuticals. Yes, Pharma abuses the patent system and promotes overutilization by prescriber outreach programs and advertising. But patent abuse can be dealt with by Congress if it has the will. As for advertising, there are First Amendment issues that would make banning truthful advertising challenging. On balance I believe we’re a lot better off for Pharma’s innovations than we would be without them. Don’t throw the baby out with the bathwater.
I completely agree, the innovations have made so much difference. I would almost certainly be dead of heart attacks by now if not for statins. And every year brings even more miraculous therapies, many of which are now curative. What is intolerable to me is the pricing behavior and the marketing behavior. The pricing exists solely because of the patent system and that should be the lever to fix it. The first amendment could be interpreted differently; the founders surely had no intention to give commercial speech the same protection as political speech.