“People fear what they don't understand and hate what they can't conquer.” -Andrew Smith
This quote comes to mind when reading the news stories of Congress coming down on Turing and Valeant execs and the various blogs and posts poking at the “injustices” being done by pharma with pricing drugs out of reach for those that need it. I believe a lot of this outrage stems from the lack of understanding of how it all works, from drug R&D and approval process to the complex pharmacy distribution and reimbursement system.
The Long and Costly Journey That Very Few Complete
It is easier for the general public to understand the price of a gallon of milk is what it is, at a high level… there are the costs for farm (manufacturing facility), costs for cows (manufacturing equipment), costs for feed, hay, water (raw materials), labor and operating costs to extract and process the milk (product). If a farmer had to raise 5,000 cows to get just five producing ones, would not we expect the price of milk go up? Why can’t we expect the same for life-saving pharmaceutical products where only five of 5,000 products make it from lab to medicine cabinet? In addition, the costs that go into “raising” those products are unbelievable. Most Americans have little understanding of this journey and those of us in the know probably do not do a good enough job of sharing, explaining and teaching that.
Complexity by Design
The challenge of understanding the intricacies and complexities of getting the product to the patient is something I would imagine many struggle with, as I did when I entered the space. In the land of wholesalers, rebates, co-pay cards, contracts, PBMs, payers, specialty pharmacy... the list goes on… you can get lost very quickly as a casual observer. I now have a better understanding of the drivers of most of these hands touching the “pill” on the way to the patient, but feel we may be adding bandages on top of a wound… a wound that needs some serious surgery and it is getting more complex rather than simpler. There is also an associated cost for the value of each participant in this chain, although the sentiment of the general public would have you believe that big pharma is the only one that has control of costs direct to the patient, which is not the case.
What Can You and I Do?
Without me trying to get way in over my head here and speculate on things out of my immediate (and probably yours) control, like health system overhauls, I am going to keep this to things that we all can do. I am going to continue to share these stories and facts to my friends, family and colleagues in the hope that the more people that better understand the “system”, the more educated our public will be. I do believe all of us really have the same goal of getting the right treatment in the hands of the patient at an appropriate cost (yes, making money is part of that). Creating broader transparency and understanding is one of the keys to less fear and loathing.
“Nothing in life is to be feared, it is only to be understood. Now is the time to understand more, so that we may fear less.” -Marie Curie