Kristie Chapman is a Registered Nurse, Healthcare Advocate, and gifted writer from Charlotte, North Carolina. She will serve as our “local expert” on all things related to Healthcare here at “The Thirsty Quill.” Kristie’s personal blog, “A Scarlet Stethoscope,” is loaded with additional information and resources, which you can find at http://rnadvocate.blogspot.com.

Most notably, Kristie was specifically recruited to speak on Healthcare at the recent Charlotte Independence Day Tea Party. We appreciate Kristie’s contributions, and we look forward to posting more of her work at ‘The Quill’ in the days ahead. You can contact her offline via email at kchapmanrn@gmail.com.

“Getting Informed About Reform” (Part 2: The Villains)

By: Kristie Chapman, RN (Healthcare Consultant for “The Thirsty Quill”)

Enter “The Villains”…

To try to get a good, “panoramic” picture of healthcare, I want to try to explore the different aspects of healthcare that have come under fire since healthcare reform took the stage. This morning, I was watching a news show where several different folks were debating healthcare reform, and one gentleman in particular was very agitated about pharmaceutical companies: “They take a pill that costs 50 cents to make and charge $5.00 for it!”.

So, I thought I’d do some research about drug development. I know a little from working as a nurse, especially in the field of oncology. One of the reasons that people are surviving so much longer with aggressive cancers is because of the innovation in drug development. In the past 3 years that I’ve worked in oncology, there have been countless new therapies to treat cancer and the symptoms associated with it. But these therapies are expensive. One example that I use a lot when talking about healthcare reform is with a drug called Rituxan (rituximab) that is used for lymphoma – and because of new research, it’s used to treat several other diseases from rheumatoid arthritis to hemolytic anemia.

Rituxan was approved for the treatment of non-Hodgkin’s lymphoma in 1997. Since then, it has been shown to work on other diseases (rheumatoid arthritis, hemolytic anemia, et al) (2)(3), but only from continued research on the drug. There is even a study now to see if it can help with multiple sclerosis. So even though this drug is on the market, it is still involved in a huge amount of research and trials to find out what other treatment options this drug will be able to give.

I sat down with my nurse manager to find out exactly how much this drug costs. The cost that we calculated is the amount that our clinic has to pay – and one average dose is around $12,000.00. (It took me a minute to pick my jaw off the floor after hearing that!) This is not a one-time dose, either. This drug has to be given for several treatments in order to be effective. And since it has a relatively low number of side effects (compared to other chemotherapy treatments), it has turned into a “treatment of choice” for many physicians, not only because of effectiveness, but because it is well-tolerated for most patients.

Why does this drug cost so much? Hasn’t the cost of research and development already been covered? The drug has been out since 1997, after all. But in learning more about the drug, I found out some interesting stuff… This drug is a genetically engineered antibody – not merely a medicine you get from a plant or chemical. Just the production of it alone is pretty advanced – the microtechnology needed to produce a drug that is smaller than a cell is mind-boggling (the drug is an antibody that targets a protein that is on the surface of a cell (3)). And it’s still involved in trials for other diseases. Trials are pricey. Oftentimes patients that sign up for trials not only receive free drug, but the drug company covers the follow up care and diagnostic testing involved with receiving it, which raises the cost even higher.

When I started doing the math, I found that there are other recent developments that are causing rises in drug costs as well…

Not as many medications are “making it” out of the research and development phase as in years past. Right now, about one in 13 drugs put into pre-clinical development make it to the market, versus one in eight in 1995-2000: “When the costs of failed prospective drugs are factored in, the actual cost for discovering, developing and launching a single new drug has risen to nearly $1.7 billion, a 55% increase on the average level between 1995 and 2000.” (1) FDA guidelines are getting more and more stringent, lawsuits against pharmaceutical companies are skyrocketing, and part of this trickle-down effect is several drugs getting kicked out of the running early in the game.

And here’s another curve-ball: there is an increasing reluctance of insurance companies to foot the bill for new prescription drugs, and the generic drug industry is lobbying heavily to cut patent protection times (1) (which means that the drug companies will have to try to re-coup the costs of drug development in a shorter period of time). One cannot help but wonder how the government thinks that doing something like this will bring DOWN healthcare costs… This will just force drug companies to hike prices up even higher, I would think, to cover the cost in a shorter period of time and meet their overhead. And simple logic says that the higher the cost of the drug, the less likely that any insurance, government or otherwise, will cover it. If you’re dealing with a life-threatening disease that could be helped by a new drug treatment, make no mistake about it: this sucks.

There was a time where pharmaceutical companies were wheeling and dealing with the best of salespeople. There were gifts, dinners, you name it. That has changed – but it changed long before Barack Obama ever came to office. New “pharma” (PhRMA) guidelines set forth by the government shut down many of these marketing tactics of drug companies in the past year. (4) The “wheeling and dealing” came to a screeching halt, and pharmaceutical companies had to learn to tighten their belts and re-think their marketing strategies. Whether you like it or not, the pharmaceutical industry has changed a great deal in the past years, and the practices that the public found unscrupulous have been banned. It was a much-needed overhaul, and hopefully has been a cost-saving measure for drug companies. But when the other factors coming down the pipeline hit (like cutting patent protection times), the combination of all of these factors hitting along with a new “government option” healthcare plan could be destructive on the development of new, life-saving drugs.

Now…about generic drugs. I’m the LAST person that will rat on generics. I LOVE generics. I’m the first to get in line at Wal-Mart for $4 prescriptions every chance I get! There’s a lot to be said about drugs that have been well-tested and researched, and on the market a good, long time – it’s a ‘known’, it works, and works well. A patient is much more likely to be compliant when they are prescribed a generic drug that is gentler on the wallet. My concern is for those specific diseases where the only options are the newer drugs on the market. What will this new healthcare reform mean for those patients? As health insurance companies are putting more and more pressure on by raising premiums and raising deductibles, people are much less able to afford these kinds of medications because out-of-pocket expenses are skyrocketing. My fear is that someone will run to this “public option”, thinking that it will provide everything that they need for a lower cost. This is not the case. If nothing else, it will be even more stringent on what prescriptions are covered, and if it doesn’t come in generic, logic tells me that it won’t be covered at all. Especially when you look at how current government plans like the VA work. Just an aside, there have been some changes in the VA program, too…now, every appointment a VA patient makes, every diagnostic test they need, has to go through a huge bureaucratic approval process, and patients are waiting longer and longer for treatments. It’s a dangerous new policy and might just be a preview of what’s to come for all of us if we don’t pay attention NOW.

This is an old and tired argument, I know, but I think it bears repeating here: in the past weeks, I’ve heard several commentators yell about how horrible the healthcare system is here in America, and frankly I don’t appreciate it. I’m part of this healthcare system, and I’m proud of it, and will be the first to say it is by far the best in the world. People come to America from all over the world because of new and innovative treatments – because they are so readily available, and they don’t have to wait in line to get it. Our doctors and nurses are highly skilled and many are specialized, and the care is patient-specific. If it’s so bad, why are so many people coming here to get it?

One other thing…just an aside…if government healthcare is so good, why is it that in Canada, people are going to (illegal) private clinics and paying out of pocket to receive medical care? (And why are doctors and nurses going to work at these clinics if they are illegal?…hmmm…) Could it be because people have to enter a lottery just to get a primary care doctor? Because doctors and nurses are tired of not being able to give patients what they really need and being bound and gagged by a healthcare system where the government holds the purse-strings?

It’s something to think about.

More information to come…I’m working on “profiling” the rest of the players in the healthcare reform saga, the insurance companies and doctors that Barack Obama loves to tout as “villains”…should be interesting!

REFERENCES

1. Drugresearcher.com: “Drug Development Costs hit 1.7 Billion”, http://www.drugresearcher.com/Research-management/Drug-development-costs-hit-1.7-billion
2. WebMD: http://www.webmd.com/drugs/drug-5206-Rituxan+IV.aspx?drugid=5206&drugname=Rituxan+IV
3. Rituxan.com, Genentech/biogen idec inc.: http://www.rituxan.com/
4. Medical News Today: “New PhRMA Guidelines Ban Gifts to Physicians from Drug Company Marketing Campaigns”: http://www.medicalnewstoday.com/articles/114660.php

Kristie Chapman is a Registered Nurse, Healthcare Advocate, and gifted writer from Charlotte, North Carolina. She will serve as our “local expert” on all things related to Healthcare here at “The Thirsty Quill.” Kristie’s personal blog, “A Scarlet Stethoscope,” is loaded with additional information and resources, which you can find at http://rnadvocate.blogspot.com.

Most notably, Kristie was specifically recruited to speak on Healthcare at the recent Charlotte Independence Day Tea Party. We appreciate Kristie’s contributions, and we look forward to posting more of her work at ‘The Quill’ in the days ahead. You can contact her offline via email at kchapmanrn@gmail.com.