The High Cost of High Drug Costs

DECEMBER 05, 2018
Simon Murray, MD
At no time in human history has more been known about therapeutic approaches to treating disease than at this very moment. That knowledge is powerful, and the pace of its development is incredible. Just look at our life expectancy, which is one of the clearest indicators of well-being: in the last 60 years, it has climbed from mid-fifties for American men to almost 80.

Much of this has to do with recent advances in public health measures, vaccines, and health practices. But without question, pharmaceuticals play a major role. What intrigues me is that despite the tremendous advances in science and research and their resulting benefits, many patients and growing numbers of their physicians are skeptical of taking medications and often question the motives of pharmaceutical companies.

The High Cost of High Costs

One of the issues leading to this mistrust is the fact that medical costs are spiraling out of control, with one of the key drivers being the high cost of prescription medicines. Economists have dire warnings about our ability to pay for new therapies, and while many claim to hold the solution to reigning in the cost of care, the truth is that the days of cheap pharmaceuticals are probably gone forever.

This is of course borne out of the huge expense of research and development. I predict that the cost of producing innovative drugs will continue to rise much faster than our ability to pay for them. There has always been a large expense associated with drug production, but the rate of rise now is faster than ever, and for good reason. Pharmaceutical companies aim to develop therapies that target specific genetic defects using targeted immunologic, radiologic, and chemical agents. Developing these kinds of therapies is no easy task and will undoubtedly remain expensive as more and more antibodies are discovered. What’s more, these treatments will prove to be nearly impossible to produce generically. FDA data illustrates this difficulty: Just last year, the agency approved 80 generic drugs, but exactly zero biological agents.

I am afraid that we will reach a point where we as a society will, except in limited circles, be unable to afford these amazing new products. I remain doubtful that research costs can be reduced, because even if the FDA were to loosen standards that govern the approval process, no one wants to produce medications that are unsafe. How ironic that scientific knowledge will be throttled by the cost of discovery.

If we take a step back, we can see that despite all the derision aimed at the pharmaceutical industry, medicine is so far ahead of what was known even 5 years ago in great part thanks to their innovations. Pharmaceutical science may double every 2 years, somewhat akin to Moore’s Law for computer science.

The pharmaceutical industry cannot be derided for trying to create the newest, best, and safest therapeutic agents for cancer and other diseases. The ironic thing is that we will reach a point where no one can afford the therapies.

It is also tempting to blame the legal industry for their endless lawsuits, but while lawsuits are expensive and often frivolous, in reality they are only a small (but not inconsequential) part of the problem, so tort reform will not solve the problem.

I assert that the costs of medicines could be spread more fairly so that Americans are not paying the brunt of research. However, exactly how that could be accomplished has eluded medical economists to date. I think that it will become necessary to carefully choose which patients to treat or not to treat on a case by case basis. And as the price of genetic mapping comes down, there will be savings—unencoding the complete human genome has dropped from $5 million per patient to $1000 or less in a few short years. Even this cost savings comes with an equal and opposite reaction: As genetic sequencing becomes cheaper, the need for scientists capable of interpreting those results will grow rapidly. Quite frankly, medicine does not have nearly enough qualified genetic counselors in present times, and the pipeline of future scientists is thin.

Better Therapeutics, Better Prevention, or Both?

On top of all this, as therapeutics become better, lives are extended, which ironically will add more cost to treat people who will live to a greater age. This effect will be compounded by another recent sea change: Tobacco use in the US is now at the lowest point ever recorded, with about 12% of Americans smoking. This trend, should it persist, will likely show long-term economic benefit and a different burden on health care systems.

Smoking cessation plays an important role in preventing disease, but as the world becomes more affected by pollution (solar, noise, chemical, violence) the magnitude of benefit diminishes. It is obvious we need to know more about what preventative methods work to thwart disease. Americans are spending huge amounts of money and effort to employ unproven treatments to improve their health. More science needs to be applied to studying the effects of diet, environmental toxins, and psychologic stressors that underlie many of the diseases we are treating.

On first blush, prevention seems an obvious way to reduce the need for expensive therapies to treat diseases, but in fact, we are still not sure how much benefit we will get. Furthermore, preventative measures actually may keep people healthy for longer periods of time until they are old enough to develop other illnesses later in life when they may be more expensive to treat. To my knowledge, there is not any dietary strategy proven to extend life except for calorie restriction, at least in earth worms and rats. The fact is we don’t know if eating more carbohydrates is worse than eating more fat. Irradiated food products may pose risks, but no one has proven that to my satisfaction. Exercise has tremendous benefits, but it is not known to what degree it will prevent serious illness. In fact, evidence suggests that exercise may even cause more diseases if done excessively, or incorrectly.

Looking Ahead

The pace of research is amazing but there are many unresolved issues that we will need to face. In terms of preventing illness there are more questions than solutions, but it wouldn’t hurt to follow the advice given by countless mothers: Eat vegetables, get enough sleep, don’t drink too much, learn from your mistakes, be grateful for what you have, and realize things will happen the way they are supposed to if you let them.

Simon Murray, MD, is an internist based in Princeton, NJ. The piece reflects his views, not necessarily those of the publication.

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