Drugs companies and patents - does the system work?

[Lumo]

Within the next few years, Pfizer's patent on the cholesterol lowering statin Lipitor will expire. This drug alone has in recent times earned Phizer over $12 BILLION in a year.

 

I know that a lot of good has come from it, and that it is the incentive of huge profits like this which drives drug companies to spend the time and money on the costly procedure of researching new drugs. However, unlike with other industries, with drugs companies I don't feel that the same free market price levelling system exists. In most developed countries (which is where Lipitor is mainly used) there is some form of nationalised health system or large uptake of health insurance. Thus, when drugs companies set a price, they are not letting the individuals in the free market decide what they are willing to pay, but telling health services and insurance companies that this drug exists and works and (in many cases) there is no alternative, so it's either buy this medicine or give patients a more old fashioned and less effective treatment. This puts the drugs companies in a position where they can set high prices and everyone, through taxes or insurance payments, even if they don't use the drug, ends up paying for it.

 

Does the patent system on drugs really work? I can see that there is no real alternative, linking the price of a drug to the cost of development would be highly complicated and stands again what happens in every other industry. But medicines are different...or are they not?

[~Andrea~]

It's an interesting question, one I hadn't really thought about before, and don't really know enough about to comment. But I'm interested in other peoples opinions, if any are put forward.

[julie]

Duncan

I don't work in the health care field any longer,but I DO take lots of prescription drugs ,so I know a little about it on the consumer end .

We have health insurance,which is fairly good ,and we use it frequently,since my body is falling apart piece by piece .

I am currently on 7 medications I have to take daily, and 7 more which are on as "as needed " basis .

The most expensive ones I take are my asthma drugs. I just developed asthma a couple years ago. Never smoked ,no clue how I got it,but it has been a nightmare to control,so 5 of my meds are daily just so I can BREATHE .

Our insurance has a CAP, or price for each type med ,that they make us pay,then they pay the rest. For my asthma meds, their CAP for us is $100 ,and one is $120 . My doc says asthma and diabetes drugs are the most expensive for chronic illnesses, because the drug companies know those are meds you cannot go without,so the sky is the limit for pricing on them .

We currently spend about 500 a month on my meds,which is CRAZY,but I have no choice .

 

The entire drug /pharmacy/insurance/hospital/doctor system kind of all links together so everyone gets a chunk of the money . I see no way it will ever get better either .

[Dr Bill]

so it's either buy this medicine or give patients a more old fashioned and less effective treatment.

 

Because something has been around a while does not mean it is less effective. Statins are a case in point. Simvastatin has been around a long time, is out of patent and therefore produced relatively cheaply. But it is still effective. Just because a drug is new and more expensive doesn't necessarily mean it is better. Unfortunately the drug companies are very good at selling their products. There is an expectation that doctors prescribe the most up-to-date medications, but that is not necessarily the most cost effective course of action. If an older drug is effective and tolerated, why not use it.

[Lumo]

Duncan I don't work in the health care field any longer,but I DO take lots of prescription drugs ,so I know a little about it on the consumer end . We have health insurance,which is fairly good ,and we use it frequently,since my body is falling apart piece by piece . I am currently on 7 medications I have to take daily, and 7 more which are on as "as needed " basis . The most expensive ones I take are my asthma drugs. I just developed asthma a couple years ago. Never smoked ,no clue how I got it,but it has been a nightmare to control,so 5 of my meds are daily just so I can BREATHE . Our insurance has a CAP, or price for each type med ,that they make us pay,then they pay the rest. For my asthma meds, their CAP for us is $100 ,and one is $120 . My doc says asthma and diabetes drugs are the most expensive for chronic illnesses, because the drug companies know those are meds you cannot go without,so the sky is the limit for pricing on them . We currently spend about 500 a month on my meds,which is CRAZY,but I have no choice . The entire drug /pharmacy/insurance/hospital/doctor system kind of all links together so everyone gets a chunk of the money . I see no way it will ever get better either .

 

Wow I had no idea people still had to pay that much even with insurance, that seems quite shocking. Here we have no idea what the medicines actually cost, we pay a set price for everything to the national health service pay the rest (the money for which ultimately comes from our taxes, so we are all paying for it in one way or another). The downside of this is that if the health service deems a drug to be too expensive it is simply not available and people have to go without, but, as you say, for chronic illnesses there isn't really the option of going without so the health service probably pays a lot for these drugs and passes the bill to the government.

 

 

Because something has been around a while does not mean it is less effective. Statins are a case in point. Simvastatin has been around a long time, is out of patent and therefore produced relatively cheaply. But it is still effective. Just because a drug is new and more expensive doesn't necessarily mean it is better. Unfortunately the drug companies are very good at selling their products. There is an expectation that doctors prescribe the most up-to-date medications, but that is not necessarily the most cost effective course of action. If an older drug is effective and tolerated, why not use it.

 

Yes, I completely agree, I was just using that as an example as I had read an article about the Pfizer patent on Lipitor expiring. While perhaps not the best example, it doesn't change that when a new drug range becomes available typically one or two companies own patents for drugs in that range and can set whatever price they want until it expires or another company comes up with a similar but not quite the same drug.

[julie]

Duncan

Yes, it's really hard over here for people on several medications .It's especially sad for the elderly on a fixed income. They have to either not buy their meds at all, or buy them and split the pills in half and take smaller doses than ordered because they can't afford to take the right amount each day.Some have to choose between buying food or medicine .

It's really scarey to think that we will be in that category in 10-15 years,and we sure aren't rich by any stretch .

My daughter in law has worked for a couple different Dr's,and the drug companies actually PAY the Dr's to use their meds from their company. The one Dr was constantly being taken on vacations, fancy dinners,etc ,because he agreed to prescribe their meds to his patients.

I think our health care system over here could use some help from your country. It sounds like thing may be better there than here in the case of the meds at least.

How do they do the Dr's ? Do you get to choose who you go to, or does the government regulate that in some way ?

[Dr Bill]

Do you get to choose who you go to, or does the government regulate that in some way ?

 

Pardon me for butting in. There is no regulation (or wasn't when I was in practice anyway). Anyone can register with any doctor who is prepared to accept them (and it is difficult for a doctor to refuse). The limitations are purely geographical really. By and large people seem very reluctant to change GP's. Families tend to stay with the same practice generation after generation unless they move from the area. And that is usually a good thing - we get to know the families and there little ways over the years. I always thought of myself as a Family Doctor, rather than a "primary care physician" which is the title certain po-faced academics would have us adopt.

[Lumo]

Hi Julie,

 

We do have a choice of which GP we go to (I think GPs are called family doctors in the US?), but there are geographical restrictions on this which pretty much means we have to go to one of the ones nearby our permanent address, if we live in a city there can be quite a lot of choice, but in a small town there will probably be be fewer doctors. If we then need to see a specialised consultant there is somewhat less choice, we can't go straight to a consultant without a referral from a GP, and the GP ultimately decides which one (if any) we see. However, I think things are changing and in many areas there is now the option of picking which one we want to go to. How does it work for you?

 

One big criticism of the system here is the general attitude of some doctors, it seems to be the norm to treat people without actually explaining what the treatment is or giving them options, and the standard treatments seem to be prescribing medicines for everything. So one big part of the problem is people are being given medicines without being told why they might work and what they might do, and they are not being given the choice of treatments, it's more 'try this and see if it works, I'll give you something else if it doesn't' rather than explaining all the options and deciding with the patient which one is best. In some cases I have known people be given antidepressants for pain (as these particular ones had been shown to have some effect on that particular kind of pain) without being told anything about the medicine other than it might help pain. Luckily the patient was a psychologist and recognised the drug, but there will be many other people taking that thinking that it is a normal painkiller.

 

I don't know if doctors here get paid to prescribe certain drugs. The drugs companies certainly bombard doctors with promotional items (pens, paper, many things in the doctors office have drug names on them) but I'm not sure if it goes further. I recently had a work meal at which some people who worked for drugs companies were also at. People from one company said their company is very strict about what they buy for people not involved in the company and that they are not allowed to buy anyone anything (not even a snack) and they are also not allowed to be bought anything by anyone else (again not even a snack), this was to stop any accusations of influencing people by buying them nice meals and trips, so they had to pick their food off the bill and submit that as individual expenses. However, someone from another drugs drugs company (at the same meal) said that was very unusual and immediately paid for everyone else's food and drink.

 

I find it almost hard to believe there is a healthcare system where elderly people have to split pills in half because it is either that or not eating. I hope things change soon.

 

EDIT: didn't see your reply Dr Bill, must have been writing mine at the time, but that's interesting that many people stick with the same doctor after moving, I didn't know that happened.

Edited December 7, 2011 by Duncan

[julie]

Pardon me for butting in. There is no regulation (or wasn't when I was in practice anyway). Anyone can register with any doctor who is prepared to accept them (and it is difficult for a doctor to refuse). The limitations are purely geographical really. By and large people seem very reluctant to change GP's. Families tend to stay with the same practice generation after generation unless they move from the area. And that is usually a good thing - we get to know the families and there little ways over the years. I always thought of myself as a Family Doctor, rather than a "primary care physician" which is the title certain po-faced academics would have us adopt.

 

Hi Dr. Bill,

You're not butting in at all. You are perfectly welcome. The only reason I wondered that is, that some insurances here ,if we have what is called a PPO, then they tell us what Docs are on the list who are on our plan,and we either have to choose one of them, or go elsewhere on our own. They will help pay if the Dr is not on their list,but at a smaller amount .

Our insurance pays for our family Dr ,almost the entire bill. All we pay is the co-pay which is $15 . If it's a specialist, it's $25 co-pay (IF they are in our network )

I recently had to start going to a renal specialist .He takes our insurance ,but is NOT in our network,so we have to pay for a large part of his bill (which is BIG money ). I have asked their office to please file paperwork to become a member of our network .(Doesn't cost them anything ,other than filling out a paper),so I am hoping that he will do that for me. We don't have a very wide selection of renal docs in our area .

We hear things about Canada's health coverage,which sounds a little like yours, I think . I heard once that they don't get to choose their doc,that one is appointed to them for the area they live in. not sure if that is accurate or not .

It sounds like you had a really good practice there. It must be quite interesting to have patients, their kids,and maybe grandkids,all attend you . Do you miss it, or are you glad for the break ? It sure does take a big commitment to be a Dr,doesn't it ?

Edited December 7, 2011 by julie

[julie]

Hi Julie,

 

We do have a choice of which GP we go to (I think GPs are called family doctors in the US?), but there are geographical restrictions on this which pretty much means we have to go to one of the ones nearby our permanent address, if we live in a city there can be quite a lot of choice, but in a small town there will probably be be fewer doctors. If we then need to see a specialised consultant there is somewhat less choice, we can't go straight to a consultant without a referral from a GP, and the GP ultimately decides which one (if any) we see. However, I think things are changing and in many areas there is now the option of picking which one we want to go to. How does it work for you?

 

One big criticism of the system here is the general attitude of some doctors, it seems to be the norm to treat people without actually explaining what the treatment is or giving them options, and the standard treatments seem to be prescribing medicines for everything. So one big part of the problem is people are being given medicines without being told why they might work and what they might do, and they are not being given the choice of treatments, it's more 'try this and see if it works, I'll give you something else if it doesn't' rather than explaining all the options and deciding with the patient which one is best. In some cases I have known people be given antidepressants for pain (as these particular ones had been shown to have some effect on that particular kind of pain) without being told anything about the medicine other than it might help pain. Luckily the patient was a psychologist and recognised the drug, but there will be many other people taking that thinking that it is a normal painkiller.

 

I don't know if doctors here get paid to prescribe certain drugs. The drugs companies certainly bombard doctors with promotional items (pens, paper, many things in the doctors office have drug names on them) but I'm not sure if it goes further. I recently had a work meal at which some people who worked for drugs companies were also at. People from one company said their company is very strict about what they buy for people not involved in the company and that they are not allowed to buy anyone anything (not even a snack) and they are also not allowed to be bought anything by anyone else (again not even a snack), this was to stop any accusations of influencing people by buying them nice meals and trips, so they had to pick their food off the bill and submit that as individual expenses. However, someone from another drugs drugs company (at the same meal) said that was very unusual and immediately paid for everyone else's food and drink.

 

I find it almost hard to believe there is a healthcare system where elderly people have to split pills in half because it is either that or not eating. I hope things change soon.

 

EDIT: didn't see your reply Dr Bill, must have been writing mine at the time, but that's interesting that many people stick with the same doctor after moving, I didn't know that happened.

 

Hi Duncan

Yes, we call our Family Docs GP's,they are also known as Primary Care Physicians . It sounds like a good setup there,as far as going to a Doc located close to you, for convenience at least. I like having a Doc close, since I have to go frequently. My Doc is a lady, and is about 10 minutes away . It sounds like we have some similarities,such as the need for specialists. Our Doc chooses who to send us to .I have 5 specialists , most of them either once or twice a year .

Regarding the meds -- yes, that is also true here. My doc has given me meds that are supposed to help one disorder ,but is used for something else .I am one of the unlucky ones who has the severe allergic reactions to meds. I currently have a list of 26 meds I cannot take ,all ones that she has given me . Yes, they prescribe anti-depreessants for pain,which I think is very dangerous. I'm not a Dr., so I'm just looking at it from a patient's standpoint. I think they should be better informed about the drug they are given: What it does to your body,what it's also used for, what the dangers are,etc. Drugs are given here just like you say,they toss them at you and say go home and try them,if they don't work,we'll try another. It's gotten where I don't even READ the papers that come with the meds .I make my husband read them before I take a new one,so he knows what to watch for .

I have taken 2 that I almost died from, so new meds are VERY scarey to me .

 

Yes, it is VERY true that a lot of elderly people either cannot afford their meds at all, or cut them in half to make them last longer . My parents had to sell their house to keep paying their health insurance .They are old enough to receive some government help for partial health care,but they have to supplement it with their own insurance too . It's a real struggle for them to pay the premiums to keep the insurance .

 

The low income people have it better in one way -- they receive more help to pay their bills,but they also recieve substandard care by free clinics .If you are poor with no insurance, most Docs will refuse to treat you . Everytime you call or go to a doc, their FIRST question is what insurance you have. The Rheumatologist I went to ,actually had a sign up in her waiting room that said : If you do not have insurance ,and do not have the full amount for an office visit, please tell the medical assistant at the window. You will need to reschedule your appointment when you have the cash to pay on the day of your visit. (She charges 475 bucks for an office visit).

 

I was in the pharmacy one day to renew a medication,and a young guy came in .He was just diagnosed with asthma,and given a prescription to fill. He had no insurance and had lost his job recently. They told him how much his med would be ( 250 bucks) .He said he didnt have enough money to buy it. SO they called his Doc and asked if they could order him a lower cost one. NOPE,he didnt have money for it either. In the time I was waiting ,they had called 3 times to change the meds and he still was unable to pay . It made me feel terrible,when I picked mine up,and he is still standing there, unable to pay for his meds. I still wonder what they ever did for him .

 

That's why our health care is such a HUGE issue when we have presidential elections.They all promise to fix the problem,but it never gets fixed. We need to use your setup. It sounds so much better than ours .

 

Sorry to ramble on about this,but it's a pretty touchy subject to me .

[Dr Bill]

 

I don't know if doctors here get paid to prescribe certain drugs.

 

No, certainly not

 

The drugs companies certainly bombard doctors with promotional items (pens, paper, many things in the doctors office have drug names on them) but I'm not sure if it goes further. I recently had a work meal at which some people who worked for drugs companies were also at. People from one company said their company is very strict about what they buy for people not involved in the company and that they are not allowed to buy anyone anything (not even a snack) and they are also not allowed to be bought anything by anyone else (again not even a snack), this was to stop any accusations of influencing people by buying them nice meals and trips, so they had to pick their food off the bill and submit that as individual expenses. However, someone from another drugs drugs company (at the same meal) said that was very unusual and immediately paid for everyone else's food and drink.

 

This used to be the case, but it is now much more restricted. Promotional items are all low cost and expensive meals are much less common if they happen at all.

 

 

EDIT: didn't see your reply Dr Bill, must have been writing mine at the time, but that's interesting that many people stick with the same doctor after moving, I didn't know that happened.

 

That's not quite what I meant. If people move well out of a practice's general area then they are expected to change to a GP nearerr their home. There is no regulation that says they must as far a I know, but it is not really practcal to haver patients miles from the surgery. What I really meant was that patients do not tend to chop and change from one practice to another unless there is some major disagreement.

 

Of course we now have "drop in" centres where people can see a health care professional. Trouble is the professional doesn't know the patient and vice versa. I appreciate it might be convenient for minor ailments but anything complex would create difficulties

[pontalba]

I don't have a clue as to what the solution is, as far as I can tell, there is no practical one available.

On one hand, it doesn't seem fair that medicines should cost so much, or that hospitals and doctor visits should be so out of reach for some. It is a terrible thing that people die and/or suffer simply because they don't have the money, or insurance, or money to have insurance.

 

Of course reasearch is horrendously expensive, but should it be? Should drug companies be allowed such huge profits? OTOH, we have a free system that allows such profits. I have no argument with that, we need the free enterprise system.

Who should have control over such things? and how could it be accomplished in a fair and humane manner?

 

As the King of Siam would say....." 'Tis a puzzlement...".

[julie]

Hi Pontalba

I agree, there doesn't seem to be an easy fix for the whole thing . I really don't know what the solution would be. It seems up here in our area, there is one huge copany that has bought out all the smaller hospitals and Dr's offices ,making a monopoly . The standards of care have dropped drastically . The hospital I used to work in was very small( 100 beds ) ,but it gave excellent care. Plenty of nursing staff for each patient and people got really good care.

Since the new company took over, they have built on several times to the building,so it's much bigger,but they are working with the bare number of nurses possible,so the patients really don't have the care they deserve .It's really sad. The building is beautiful,but who cares about that if the care is lousy ?

I certainly wish that someone could come up with a better plan,making health care and treatment available to anyone, no matter what their income . I'm sure not smart enough to figure it out,but I wish someone could .

[Michelle]

Just a few quick points, as I work as a practice nurse. Drug companies have recently been stopped from giving out all those little goodies such as pens, post-its etc. They are still allowed to bring us sandwiches and the such if they attend a lunchtime meeting, but that's it.

 

I do appreciate that many GPs aren't very good at discussing treatments / medications, but some are good - and I hope I am when discussing the things I issue.

 

Finally, there are many types of drugs which have multiple uses, and anti-depressants are sometimes used as painkillers, as are anti-epileptic tablets. It's quite safe if it's a licensed use.

[julie]

Hi Michelle

I definitely know you are right on target . The nurses tend to always do well with explaining things to the patients,so they sometimes fill in the gaps that a Doc may leave .

I'm glad they are cracking down on the freebies for the docs who use their meds.

 

I'm aware that some drugs are used for multiple purposes . I happen to be one they have tried seizure meds and anti-depressannts to control migraines. Thankfully, they are among the ones I cannot take. They make me really ill. I think it's maybe the fear of taking such powerful drugs that are ued for such serious illnesses on a daily basis. Pretty scarey to me, but if they work well for someone, and they are ok with taking them,then that's great .

 

So is a Practice Nurse like a practical nurse here or an RN ?

 

And yes, there are definitely some really good docs out there. They aren't all bad ,most are wonderful .

[Michelle]

I'm a registered nurse. The 'practice' bit is because I work on a 'GP Practice'. I know it's confusing... my daughter thought I was still practicing to be nurse - I qualified 18 years ago! LOL

[Dr Bill]

It sounds like you had a really good practice there. It must be quite interesting to have patients, their kids,and maybe grandkids,all attend you .

 

It had its compensations

Do you miss it, or are you glad for the break ? It sure does take a big commitment to be a Dr,doesn't it ?

 

I miss the contact with (some) patients. When you have looked after them and their families for 30 years it is inevitable that a ccertain fondness grows. Mind you, there were plenty that I was glad to see the back of - the unreasonably demanding, the rude and abusive. They were few in number but made a big impact on life. I also miss (some of) my working colleagues and the staff we worked with.

I miss the science. I miss the learning. But do I miss the job itself? Do I miss working at night? Do I miss seeing 40-50 patients a day and trying to give them all a good service? Do I miss spending hours working through piles of paperwork? Do I miss getting home in the evening too tired to play with my children? Do I miss ther disruption of family life? Do I miss the constant threat of litigation and complaint if I didn't give way to every unreasonable demand? What do you think?

[julie]

Michelle

Congrats on the RN degree ,that is wonderful ! A great job that you know is making a difference in lots of people's lives .

 

 

 

Dr Bill

It sounds for the most part as if you are glad to be retired. I can't say I blame you.It must take a huge chunk out of your life .

I know my doc told me once that she thought she had chosen the wrong career,because she has missed out on so much with her kids, her job is pretty much her entire life,so she's not able to have a normal life like everyone else. She is all the time working ,or getting called on her off hours,so it's very demanding . I think it'd be even worse for a lady than a man,so hard to have kids, then never get to be with them while they are growing up .

I'm sure you have many patients whose lives you made better through the years and will always be grateful to you .