Derek Lowe is a medicinal chemist with ~30-years of industry experience, mainly in Big Pharma. His very popular In The Pipeline blog is a must read for anyone who wants to learn more about how our industry really works, especially at the drug discovery stage.
He does get into technical details sometimes, but it’s written in an approachable manner, usually with plenty of links for those who want a deeper dive.
In other words, it’s a blog eloquently written by somebody who actually knows what he’s talking about. And, if he ventures into areas where he doesn’t, he provides links to articles written by those who do.
One of the themes which pervades Derek’s posts is the idea that drug discovery and development is very difficult, and very expensive. As he occasionally points out, a medicinal chemist can spend an entire career working in the field, only to never discover a drug that actually makes it to market.
That’s tough.
It was with these thoughts in mind that we read (and re-read) Derek’s response to recent testimony in Washington regarding drug discovery, the NIH role in drug discovery, and the return the Federal government receives on drugs discovered by the government.
The testimony is not worth the electrons used to record it, but there are links in Derek’s article for those who can stand it.
The broader issue here is one we’ve talked about before. That is, that our industry is increasingly being slammed by politicians. We’re being compared to “The Taliban” while simultaneously investing billions in new drugs to treat and even cure diseases.
To our industry’s credit, our own industry trade groups are highlighting areas which are underfunded and underserve by our industry, thereby encouraging us to do more.
Our industry has issues. But on the whole, any criticism should come from people who have at least done their homework. And, this criticism should be placed in the context of the overall health care system.
This idea of looking at drug spending/pricing in the context of the overall health care system is an important one. While our CEOs are hauled in front of Congress, we hope they have the opportunity to make the point that drug pricing is not the only issue when it comes to managing health care costs.
To be clear…there is nothing wrong with Congressional testimony from pharmaceutical company executives. The Federal government spends a lot of tax payer dollars buying both branded and generic drug products. But consider the following:
- Hospital markups on generic drugs can run 1000% (one thousand percent) or more. Patients don’t pay that, so it’s theoretically a non-issue from a politicians perspective.
- Thanks to increased use of generics, drug spending has grown much more slowly than, for example, hospital care. By the way, that statement is based on data from the Federal Government.
- Many of the most prevalent diseases (and resulting drug spending) are driven by poor diet and lack of exercise. We are responsible for our own diet and exercise choices, but is anyone in Congress investigating Big Food and their influence on what we eat and drink?
Where Is All This Headed?
Like many of you who started our careers before the age of social media and the need for perpetual outrage, we find it difficult to predict where all of this is going. Obviously, our industry will continue to be an easy target for politicians and other critics, even as our industry continues to innovate.
Ss long as elections are decided by social media-driven populism, this trend will likely continue. This is especially true as long as we collectively continue to make poor diet/exercise choices, which in turn drives so much of this drug spending on largely preventible diseases.
Yet, there is at least one light at the end of this tunnel.
Ronda’s Story
Dr. Ronda Rockett is a practicing family physician. Her practice mix was typical for family practice: diabetes, obesity, cardiovascular disease, and so forth. She followed practice guidelines and encouraged healthier choices. But she recognized that she lacked the tools to really help her patients.
So, she opened a gym.
Now, she’s essentially treating patients with preventible diseases through intense exercise and nutritional counseling.
And, she’s not the only physician that’s doing this. Hundreds of physicians are now learning how to combine high-intensity exercise programs with their medical practices, thereby “prescribing” a course of exercise and nutritional counseling which can reverse and cure preventible diseases.
Indeed, there are studies demonstrating that high-intensity exercise “…improves insulin sensitivity and reduces cardiometabolic risk in individuals with Type II diabetes.” [Emphasis added]
Imagine a time when physicians bifurcate their practices into treating preventible (largely diet-induced) and other diseases. For the patients with preventible diseases, the addition of a structured blend of exercise and nutrition directly into their practice means these patients can essentially be cured, reducing Rx spending even further.
This, in turn, allows these physicians to really focus on those patients with the non-preventible diseases…where diagnosis and therapies may be more complex, where consultations with specialists are required, and where practice and patient satisfaction can only increase as a result…with less spending on prescription drugs.
Will this model ever become standard medical practice? Perhaps. Perhaps not. But it demonstrates three things.
First, we have the tools to change the practice of medicine and reduce healthcare spending. It will take some discipline and courage on behalf of patients, physicians, and payers to think and act differently. But the tools are there.
Second, government focus on prescription drug pricing, while important, is a symptom of a much broader issue. Government needs a much bolder approach if it is serious about reducing healthcare spending, such as having more sensible food/nutritional guidance.
Third, we (all of us) are both the problem and the solution when it comes to drug spending. If all of us work harder at making better life choices, there will be fewer physician visits, less drug spending, and fewer politicians targeting our industry.