The politics of drug pricing

One thing nice about the battle of vested interests in America is that, often enough, they are well matched. Take the case of drug pricing. On the one hand there are the drug companies who are heavy contributors to the electoral campaigns of officials in various offices in Washington, DC from the President to the senators and congressmen. They also employ well financed lobbyists who deal with the Federal bureaucracy.

On the other hand are the health insurance industry and the consumers. The health insurance industry members are also heavy investors in electoral campaign kitties and also employ lobbyists who do use money as a tool to influence official actions. Consumers have, on the other hand, organized to make their voices heard. This is why congressmen and senators also listen to their pleas.

The drug industry is out to extract the most returns from a drug at the shortest possible time. The health care organizations want to reduce their costs as drastically as they can. The consumers, of course, don’t want to be charged beyond their means for the essential drugs they need for health maintenance.

All these are now coming into play as a proposal has been put forward to make the three most popular and expensive allergy drugs available without a prescription. A government medical advisory panel voted overwhelmingly to advise the Food and Drug Administration that Claritin, Allegra and Zyrtec were just as safe as many nonprescription allergy medications that have long been sold in drugstores and supermarkets.

The drug industry considers the decision a setback for the makers of the drugs. These drugs contribute some $5 billion a year to their bottom line. The health insurance industry is ecstatic over the development as it will reduce costs. They have to reimburse prescription drugs bought by their members while consumers are on their own with prescription drugs.

The high cost of drugs

The New York Times quoted a Washington analyst who summarized the issues involved. The health insurance industry "has a clear vested interest in getting the cost of the drugs off their books," he said. "The drug companies are against it. And the doctors don’t like the idea that the number of office visits might fall. It’s hard to find an honest broker in the whole deal."

The drug industry and some doctors say putting these drugs off the prescription list and allowing these to be sold over the country may be dangerous for patients who self medicate. While these allergy drugs may be taken safely by ordinary allergy sufferers, those with asthma ought to consult a physician first.

The irony is the manufacturers spend millions of dollars each year advertising the superiority of these allergy products directly to consumers. "All that direct-to-consumer advertising came back to bite them," a health care securities analyst at Deutsche Bank told The New York Times.

The New York Times also reports that the current price of Claritin is about $2.13 a pill, or $192 for 90 pills, in the United States. In Canada, where it is already available over the counter, it can be purchased for about 70 cents a pill before taxes. This is why there is pressure to have it sold over the counter.

The no drowsiness feature of Claritin is the product’s strongest selling proposition. Here in Manila, Claritin is, as expected, atrociously priced even if it is sold over the counter. Yet, the growing legions of sinus sufferers due to our polluted air need it almost all the time. Maybe Mar Roxas can do something about it.

Melatonin

Still on health care, I noted a rush of press releases from a local distributor of melatonin claiming nearly miraculous efficacy of this pharmaceutical product. Not only is melatonin supposedly able to cure insomnia, it is supposed to increase sexual prowess and is actually the much sought after fountain of youth. And there are supposed studies to back up the claim.

I must confess that I too had been taken in by the hype about melatonin some years ago. After reading a full feature on Newsweek, I discarded years of lectures from my father (a professor of medicine) who normally scoffed at such reports unless backed by scientific research. The fact that the US FDA has not approved the claims of melatonin manufacturers should have been the clue.

For the benefit of our readers who might have seen those press releases, I searched the Web and found some interesting things in the website of the Scientific American. Here are a few things I found out.

Critics warn that the doses of melatonin commonly sold in health food stores – which raise levels of the substance in the blood 30-fold higher than their normal peak – could be dangerous for some people. And many researchers and fad-watchers point out that the more startling claims being made for the substance are unsupported by studies on patients. They are, rather, starry-eyed extrapolations from experiments conducted on rats and mice. These animals differ from people in many ways, especially as regards sleep, the one aspect of human physiology that melatonin clearly affects.

So there you are. As my late father used to say, how dare they compare me to a mouse. One more thing, in another website, the warning was made that "natural" melatonin is produced using part of a cow’s brain. That means, you could contract the mad cow disease using "natural" melatonin.

Play it safe. Consult your doctor about an alternative medicine for insomnia, jet lag or sexual inadequacy. Melatonin’s claims are unproven but the danger is very real.

More new definitions

Here are more new definitions from Dr. Ernie E.

Worry: Interest paid on trouble before it falls due.

Experience: The name men give to their mistakes.

Philosopher: A fool who torments himself during life, to be spoken of when dead.

Criminal: A guy no different from the rest… except that he got caught.

(Boo Chanco’s e-mail address is bchanco@bayantel.com.ph)