When even doctors think drug prices are unethically high

The Lance Armstrong blood doping scandal alerted me to a book that portrays serious problems in the functioning of America’s health care system: Blood Medicine: Blowing the Whistle on One of the Deadliest Prescription Drugs Ever, by Kathleen Sharp. The gist of her story is that the drive for maximizing profits led two pharmaceutical companies into fierce competition over marketing a drug that one of them had developed.

Sharp portrays years of unethical behavior and frequently illegal and sometimes death-causing behavior by sales representatives, physicians and medical clinics, hospitals and research institutions, and governmental regulatory agencies. The drug at the center of the feud was EPO, a relatively new drug that increases the production of red blood cells.

Although I had read the book in order to understand the use of this drug to enhance athletic performance, Sharp’s narrative had an unintended effect: it caused me to worry about the trustworthiness of the doctors, clinics, and other medical providers to whom our family turns for medical care.

This uneasiness was especially troubling because it came at a time when my wife would be resuming aggressive treatment of a cancer that will remain with her until the end of her life.

Her oncologist was suggesting that she enroll in a study that would help researchers evaluate an “investigational drug.” It was not known whether the drug “is save and effective,” nor had the drug been “approved by the Food and Drug Administration.”

Her physician is gentle, careful, thorough, and forthright. Everything about her inspires trust, and the therapies she has recommended have enabled my wife to continue her chosen way of life longer than statistical tables give reason to expect.

But I couldn’t get Sharp’s book out of my mind. On a website that reports payments to physicians by research institutes, I saw the modest amount our doctor had received for research activities during the previous reporting period. It is easy to believe that a competent physician in a cancer clinic that specializes in research could earn stipends in that amount in ways that are completely ethical and uncompromised.

In this context, any news that can strengthen trust is good news. Recently 100 physicians around the world who specialize in a dangerous form of leukemia attached their names to an editorial published in Blood, the journal of the American Society of Hematology. Their statement made the news in Portland because Brian Druker, one of the signatories, is based at a research medical center in our city and helped develop one of the drugs mentioned in the article.

These cancer experts discuss factors that are involved in setting the price of cancer drugs and the impact that these prices have on patients and on the entire health care system. They believe that the prices of these drugs need to be lowered so that more patients can afford them and our health care system can remain sound for years to come.

Especially interesting is the distinction they draw between two ways of setting prices. The doctrine of Justum Pretium (just price) holds that prices should be determined by “fair value.” They should be “proportional to the benefit to patients in objective measures.”

The doctrine of free market economics holds that prices are based on what people are willing to pay.

These physicians state that when drugs affect the lives or health of individuals, just price should prevail. When commodities are not essential to life or to alleviate suffering, free market economics can prevail. Nobody has to buy a luxury car or take a cruise, but who can choose not to undertake treatments that can control chronic medical conditions?

The 100 cancer experts discuss the ways that drugs are priced and the wide range of prices in various parts of the world. They are clear in stating their consternation with the current situation, and they outline some of the measures that they believe could bring relief to cancer patients and protect our nation’s health care system.

They conclude their editorial by stating that they propose to begin a dialogue “by organizing regular meetings, involving all parties concerned,” in which they would discuss reasons for the high prices of cancer drugs and consider solutions to reduce these prices.

My own conversations with medical providers lead me to believe that the concerns over the high cost of medical care are widely spread among doctors, nurses, and others who work directly with patients and their families. They too are troubled by artificially high costs that are billed to patients, often causing significant hardship to people suffering from serious health challenges.

My hope is that public attention will continue to focus upon the ethics of pricing medical care and that the public debate about these matters will continue so that researchers, medical providers, executives in the health care industry, hospital administrators, governmental policy makers and regulators, and even politicians in statehouses and the nation’s capitol will work together to make things better.

When it comes to pricing cancer drugs, better almost always means cheaper.

Note: This final paragraphs of this essay have been revised since the essay first was posted. 

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