Three doctors from Memorial Sloan-Kettering Cancer Center in New York wrote an op-ed piece in Monday's New York Times that illustrated some of why selling pharmaceuticals in America is not quite like selling soap or cars or most other things.
The link to the story is here.
Peter B. Bach, Leonard B. Saltz and Robert E. Wittes explained that they chose one colorectal cancer drug over another because of price.
Zaltrap, marketed by Sanofi aventis and Regeneron, is new, but the average monthly price they said was $11,063, which was double the cost of Genentech's Avastin and produced no better results.
"In most industries something that offers no advantage over its competitors and yet sells for twice the price would never even get on the market," they wrote. "But that is not how things work for drugs."
The doctors noted that the Food and Drug Administration generally does not consider relative costs. It's legal mission is to decide if the drug is "safe and effective."
Some politicians keep saying that the FDA should be in the business of creating jobs, but we'll leave that goofy notion for another day.
The crisis of health-care costs stems in part from the law that Medicare, the government insurance program mainly serving those older than 65, is supposed to cover every cancer drug the FDA approves. Private insurers usually follow the Medicare practice. Not always, but usually.
But not all the cost is paid by the government or private insurers, so that means choosing a more costly drug can mean greater cost for the patient.
"Ignoring the cost of care, though, is no longer tenable," the doctors wrote. "Soaring spending has presented the medical community with a new obligation. When choosing treatments for a patient, we have to consider the financial strains they may cause alongside the benefits they might deliver."
Finally, another element in this unusual market is that pharmaceutical companies pay some doctors to help with clinical studies or to speak about their drugs.
Race care drivers might get paid by Chevy or Ford to tell you one is better than the other, but you can buy whatever car you want.
Not drugs, of course, and there's probably some good in that. The drug companies pay doctors because they are the gatekeepers, the scribblers of prescriptions, so they have tremendous influence over which drugs are used.
As mentioned, Avastin, the cheaper drug in this tale, is made by Genentech.
Though you can't help but wonder how it factored into their thinking, the doctors noted their financial ties.
"Full disclosure: Two of us, Dr. Bach and Dr. Saltz, have been paid consulting fees by Genentech," the doctors wrote.