Pharmaceutical Companies Risking Drug Safety Via Cost Controls?

Reader Francois T sent this by e-mail:

It is a well known (self-serving) assumption among business leaders that management is a “special skill” that can be applied to pretty much any field.
Alas, this, ahem, skills set seems to bring the bad attitudes also.

Problem is, this can become deadly for their costumers when those managers get into the health care field, as the case for tainted heparin made abundantly clear.

From hcrenewal blog:

Now, as reported to date only on the PostScript blog, a US government report on problems with active pharmaceutical ingredients made in China has appeared.

A new report (pdf) by the U.S. China Economic and Security Review Commission stresses the safety risks to Americans posed by pharmaceutical ingredients made in China.

According to the report, issued by a group that advises Congress on the economic and trade implications of U.S.-China relations, found that the U.S. is the number one destination for Chinese pharmaceutical raw material exports – a $2.2 billion business each year. The U.S. relies heavily on Chinese products not only for over-the-counter drugs but for active pharmaceutical ingredients (API) found in prescription drugs.

And the report makes clear that China has neither the will nor the systems in place to monitor its exports.

This begs the question that most of the coverage of the deadly heparin also begged. Are American pharmaceutical companies so besotted with the need for cost-savings that they are willing to buy active pharmaceutical ingredients with unknown provenance overseas as if they were a pig in a poke? If so, why do we allow company leadership to potentially sacrifice quality, and sell adulterated drugs just to enrich their bottom lines (and their executives’ salaries)?

Excellent questions indeed!

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  1. attempter

    Every example like this further proves the insanity of extending market fundamentalism to the very realm of human health. It proves again why the drug and health insurance rackets wouldn’t exist at all in a rational, practical, just system.

    It lays bare the evil of those who see people as literally resources to be mined and gutted for the sake of the profit of elites. (And it also lays bare once again Obama’s fundamental psychopathy, that as a fanatical corporatist he approached the idea of “health care reform” with the fixed idea that the purpose of the health care system is the profit of these rackets, and therefore by definition “reform” must help enhance the rent extraction mechanism.)

    It is a well known (self-serving) assumption among business leaders that management is a “special skill” that can be applied to pretty much any field.

    Yes indeed, thugs and flacks are fungible. Parasites, functionaries of crime, are interchangeable.

    “Special skill” – there’s another of those Orwellian phrases. Like the way the saying “there’s no such thing as a free lunch” was coined to justify parasitic rentiers by baldly asserting that any extraction has to be productive, since by definition there’s no free lunch. If someone’s eating lunch, he has to have paid for it. It’s meant to fraudulently justify theft by dogmatically asserting there’s no such thing as theft.

    So it is with today’s management. “I’m here, and I’m being paid millions, so I must be worth millions.”

    No, you’re worthless and worse than worthless, because you do nothing but steal and destroy. Getting rid of you would be a productive gain for the world.

  2. Brick

    There are a number of issues here which have not been fully explored.
    Firstly is uneffical exploitation of chinese workers where a factory is set up, runs for a few months and closes before it has to pay the workers, before moving on to another site.
    Secondly there is a problem with conterfeit drugs which do not contain the ingredients they should.
    Thirdly there is a problem with the price differentials between countries such that there are huge flows in grey market drugs occurs.
    Fourthly there is a problem with funding new drugs and with many drugs going off patent.

    All of these cost the drug companies money who pass on those costs to us. On the first and second issue drug companies are resorting to colouring and markings for drugs with wholesalers having to test batches of drugs, but this costs money. This needs to be sorted out and is highly dangerous. On the third issues then I am afraid that the business model for some drugs companies needs to change. Ideally the big manufacturers need to get involved in generic drug production, but I think there will be a lot of resistance to this change.On the fourth issue then I think governments need to think about red tape ,safety and whether they really want this activity to go offshore.
    Time for some international rules, international pricing initiatives and international view of new drug development,at the same time drug compnaies need to think about expanding their businesses into areas they have traditionally shied away from and spend a little less on lobbying. There is money to made it just will not be the easy money it has been over the last 20 years.

  3. Neil D

    Disclosure – I work in pharma manufacturing.

    Corporations have been outsourcing or moving chemical manufacturing to China for years. This is not a feature of pharma alone. Cheap labor and low production costs due to the ability to pollute freely have been driving this trend. Active pharmaceutical ingredients are no different, really, from other chemicals so it was perfectly natural for the Chinese to get into that business too.

    But Americans want $4 generic prescription drugs from Wal-Mart and the block-buster pipeline is running on empty. One way to preserve their profitability is to cut these production costs. What did you think they would do?

    1. Vinny

      “But Americans want $4 generic prescription drugs from Wal-Mart and the block-buster pipeline is running on empty. One way to preserve their profitability is to cut these production costs. What did you think they would do?”

      Another way is to charge Americans 3, 4, 5, or even 10 times more for the same exact drug, same dosage, same brandname, same box, same origin, than they charge everybody else in the world. The reason is because they can do it, because the American people do not have their government protecting them from the insane greed of these criminals. Europeans, for example, do, so they pay on average 1/4 for the same drug (non-generic, by the way).


      1. Neil D

        Ms. Smith should name this blog Naked Socialism.

        I have no particular problem with price controls on drugs but that will only drive manufacturing overseas even faster. You will be relying even more on the ethics of the Chinese manufacturers that Ms. Smith is warning us about.

        Or perhaps I am missing something?

        1. Tom Crowl

          The ‘socialist’ thing is a bit off-base. I can’t speak for Ms. Smith, but personally I believe the work here (and my own) is about reviving a truer spirit of Adam Smith and the Enlightenment along with the needed balance between the Individual and the Commons which is required for a healthy sustainable society.

          Here’s some perspective that may give some insight:

          “When Fragile becomes Friable: Endemic Control Fraud as a Cause of Economic Stagnation and Collapse”

          1. Neil D

            That’s a great paper. Do you really think pharma is looting? They provide a socially valuable product whereas banksters and many others do not.

        2. Vinny

          You are missing the point that the US has the worst medical system of the developed world, and the pharmaceuticals industry and the corruption they represent has a great deal to do with it.

          The argument that this would drive manufacturers and research overseas is a joke, and is becoming trite. The only reason it still gets you any mileage is because the ignoramus factor is so prevalent in America. It does not fly anywhere else.

          So take it from a doctor: please leave the US as soon as possible. Go to China, and let’s see how many of your “brilliant” executives get the death penalty from the communist party when you try to do there what you have been doing in the US for decades. America will be better off without greed-mongering, corrupt, despicable, and downright criminal corporations like that. End of story.


        3. ggm

          For starters, you’re missing the law which forbids Americans from purchasing pharmaceuticals from overseas, in the name of “product safety”, despite the fact that many of these drugs are actually manufactured overseas.

          This is our government explicitly working against us to protect the profits of a favored and heavily connected industry. Call it corporate communism, collectivism, socialism, whatever you prefer, but it sure as hell is not free market capitalism. Before you start tossing around those bricks, you might want to be certain that your house isn’t made of glass.

        4. liberal

          “Ms. Smith should name this blog Naked Socialism.”

          That’s funny, given that pharma patents are government-granted monopolies enforced by government courts.

          1. Neil D

            Well of course those patents are enforce by governments courts.

            Article I, Section 8, Clause 8 of the United States Constitution empowers the United States Congress:

            “To promote the Progress of Science and useful Arts, by securing for limited Times to Authors and Inventors the exclusive Right to their respective Writings and Discoveries.”

            I’m a liberal. You guys are really bad at this if you can’t convince me.

        5. liberal

          “Do you really think pharma is looting? They provide a socially valuable product…”

          Yes, but in principle so do the banksters: efficient allocation of capital.

          In practice, of course, the banksters’ work is almost 100% parasitic rent collection.

          IMHO pharma isn’t quite so bad, but it’s still pretty bad. What drives research and investment isn’t whether something is truly medically useful, but rather whether money can be made off of it. Because of the nature of economic rents, those two things aren’t as close as you might otherwise think.

        6. wunsacon

          >> Ms. Smith should name this blog Naked Socialism.
          >> I have no particular problem with price controls on drugs but

          I saw nothing about “price controls” before you mentioned it. Maybe your “Naked Socialism” reference is Freudian.

          Or perhaps I am missing something?

    2. Mondo

      Are you trying to say that profit counts for everything, and product safety for nothing ? Or maybe, just because Americans want their drugs to be as cheap as possible, the industry needs to deliver at $4 ? Why not $1 ?

      The duty of a pharma company should be to be open about the tradeoff. Of course they need to make money, and the current lack of new blockbuster drugs in the pipeline makes their managers nervous. However, everybody responsible for the actions of their own company should keep in mind that a major scandal due to tainted drugs, facilitated by lack of supply-chain oversight, may well kill the company anyway.

      1. Neil D

        Product safety counts for everything. That’s why sometimes these drugs cost so much. Does industry take unfair advantage? Perhaps. I would love to have all API made in well regulated factories here in the USA or Europe, but that is becoming harder and harder to justify in a profit driven industry. Pfizer stock price is down 55% in the last 10 years. Look it up. Whatever they are doing to control costs isn’t enough for your mutual fund manager.

        1. liberal

          That’s absolutely true. There’s no incentive not to use Chinese inputs, unless laws and regulations are put into place.

    3. Francois T

      Disclosure: I worked on the receiving end of Pharma manufacturing; I was a family physician. My father was an hospital pharmacist and one of my brothers did a several years stint in research for a big biotech before returning to academia.

      “But Americans want $4 generic prescription drugs from Wal-Mart and the block-buster pipeline is running on empty.”

      As consumers, who can blame them? Consumers are the same in any country.

      The blockbuster pipeline is running on empty? This is a vast topic that would require, hmm, a book or two.

      I’ll limit my self to throw some observations about that, just to stimulate the discussion:

      1) There is no doubt that the burden of regulations on Pharma manufacturing has reached an astonishing level of absurdity. Things that used to take 4 weeks, say in 1985, cannot be done in less than 6 months if not more, nowadays. A big part of this impressive difference is the need to document absolutely everything done. Several experienced scientists working in Pharma are now reduced to be QC (Quality Control) workers. Needless to say that Legal drives a lot of this. It remains to be proven that this level of systematic scrutiny truly improves safety outcomes; meanwhile the costs associated with the regulations haven’t stopped to climb. The last time I checked, the law of diminishing returns hasn’t been repealed yet, and it is very possible that it has been reached, and then some.

      2) Pharma is a very peculiar investing proposition. Drug discovery is a painstaking, frustrating process with unpredictable time lines. Got to first have an understanding of the pathology one is trying to treat, find molecular candidates, test them for selection of the most promising ones, engage in clinical trials, get approval from the health authorities, then market the stuff. Each of these steps can reveal a nasty surprise that will blow the whole endeavor into oblivion. The above means only on thing: you need to produce a very good return on investment in order to attract investors willing to take a chance on Pharma.

      3) You cannot swing a dead cat within the halls of laboratories in this country without hearing the term “translational research”, the code word for “applicable research that better produced a clinical and marketable result NOW!! The pressure to generate financially measurable results has infected basic research, to the point that the majority of original articles in surgical research for instance come from foreign countries.

      Well…guess what! It is impossible to make significant breakthroughs in science without dedicating time, effort and non restricted free will to such an endeavor. That is the nature of the beast. One must first and foremost be able to think outside the box, if not far out the left field. With government funding in basic science that has dwindled for years, the industry took over, but with “performance” strings attached. Moreover, scientists performing basic research are always on the lookout for the golden nugget that could become marketable and generate great wealth for themselves. What do you think happens to the free flow of information and exchange among colleagues in such an environment? It shrinks to a pitifully inadequate level for true scientific discovery. Now, go find the next blockbuster in such conditions…Good luck!

      4) Top leadership at Pharma and health care in general sucks to no end. They suck because they pretend to be the stewards of an industry that is very complex, data-driven by fundamental and clinical science while almost none of them has any background to speak of in health care. It is so bad that teaching a little bit of medicine to health care execs was hailed as an innovation! Whiskey Tango Foxtrot??

      One can summarize the business knowledge of health care execs this way:

      * Financial Incentives Drive Good Performance (but instead, they have driven a huge number of health care dollars into the pockets of management)

      * First Movers Have the Advantage

      * Layoffs Are Good Ways to Cut Costs (still the philosophy of too many health care executives who see everyone, except themselves, as interchangable, and are quick to dispatch those with whom they disagree)

      * Mergers Are a Good Idea (but remember the mergers of NYU-Mt Sinai, UCSF -Stanford, and especially the mergers that created the Allegheny Health Education and Research Foundation, all now defunct)

      * Life and Work Should Be Kept Separate (which really meant don’t treat your employees very well, because they can always return to their lives outside of work).

      Caught between a grinding apparatus of regulations, a constrained environment for discovery and innovation, a patent system that is not up to snuff, the demands of investors for returns and more returns and a leadership that knows everything (even the most absurd management philosophy) about M&A, P/E ratio and the likes, but nothing about oncology, cardiology; not even a rudimentary knowledge of how the discovery process works, (Gee! I would’ve swear that Pharma was about drug discovery!) can anyone be surprised that Pharma is in such dire straits? The true miracle is that it is still standing. But to do so, some resort to despicable methods because they can, and punishment is systematically very lenient.

  4. Vinny

    As I stated here many times in the past, American healthcare should have been socialized a long time ago. Additionally, the FDA, which has turned into little more than a criminal agency in the pocket of Big Pharma, showing absolutely no regard for the safety of the American people, should be disbanded and a new agency be created.

    The fallacy of what just passed as healthcare reform is that the sham and the scam that has used and abused an entire nation for the sake of profits of these criminal gangsters will continue unabated for decades to come.

    Thank you, Mr. Oh’Bama. I am looking forward to your upcoming financial reform. I am convinced that your stellar performance raining in the health insurance gangs will serve as the standard we should all look forward to for your remaining 2-1/2 years in the White House.


    1. NS

      Exactly Vinny and it goes far, far beyond Pharma. A former RN and I can recant horror stories galore. We pay more, get less than any nation in the world. Our quality of care is approaching 3rd world status. Why? Well profits of course.

      Profits aren’t evil but when does it become obscene? Would say 400% per dose profit for an infant respiratory distress medication be obscene?

      Even those ‘brand named’ medications ingredients come from overseas. There is no oversight of the ‘supplemental’ market which rakes in billions, some of those are merely sawdust in a capsule promising relief from painful and chronic conditions. People resort to this as effective therapies are shunned. The DEA tie physicians hands behind their backs, the FDA continue to ignore the research done in other parts of the world revealing the decades old propaganda regarding particular classes of medications are faulty.

      I’m among the heart broken as patient centric health care that allows TIME to listen, TIME to pay attention, TIME to care and the personnel to do it LONG GONE. The #1 reason for personal bankruptcy in the nation is overwhelming costs related to health care. Why is it so expensive? Because its a cartel, it isn’t because someone ate one too many big macs. Sole source equipment providers to hospitals and clinics can charge outrageous amounts for their products because there is no competition, because they can and no one is looking over their shoulders.

      R&D is cooked now for health care products, one only needs to look back over the last 15 years to see the number of new Rx medication pulled because of overwhelming and serious side effects. Self policing doesn’t work anymore for those who stand to profit anymore than it does for the financial industry. But hey, lets market it to the masses with overly rosy pictures of improvement-those ads don’t cost a dime do they?

      I was never more upset than the passage of the so called health care reform. This was a golden opportunity, instead its a giant GIFT to insurance companies. No mechanism is in place to hold them to task, policy holders plans will get more expensive, they will continue to rescind if you become seriously ill and at your weakest and most vulnerable, you will also have to fight to get care and become a pauper doing it. If you are unlucky and get ill, are involved in an accident, if a child becomes seriously ill or in an accident you’re toast.

      Family friendly my ass.

      1. Neil D

        I’m all for universal and single payer health insurance, but you still need to let the doctors, hospitals, pharma etc make a modest profit. Otherwise you will have no medical innovation at all. That might be OK – we have all the treatments we need now. Who wants to live to be 100 anyway?

        You do understand that it takes a lot of money to bring a drug to market, right? Does your 400% profit margin take development costs into account? Does it take into account that the FDA and EMA are constantly making companies redesign their manufacturing operations to make drugs “safer”. Frankly, a lot of these requirements are silly if you consider the actual risk, but we cannot tolerate ANY risk so the cost to produce goes up all the time. Unless, of course, you produce in China and India where no one really cares about such things as product contamination.

        If you want to live forever, then it’s going to cost you.

        1. Vinny

          Nobody wants to live forever. People just want to get decent health care, like it is done in Europe, for example.

          You really are clueless about the incomprehensible harm and the innumerable people who paid with their lives just to support the greed of your industry, aren’t you?


          1. Neil D

            Oh come on Vinny! Drug treatment of disease has made your life longer and healthier. You have a chance at surviving infection that your great grand parents never had. You have a chance at surviving many cancers that would have killed you even 20 years ago.

            Now one might ask how much that’s worth and that is a perfectly reasonable debate to have. Yes, that people who go without treatment because of cost is a tragedy. You’ll get no argument from me on that point. AIDS and malaria in Africa kills millions because pharma won’t do the research for free and then give away all the drugs. Raise my taxes and I’ll happily pay for that and care for poor people in America.

            But who really is greedy in your little world? The patient that wants everything for free or the doctor (or pharma employee) who drives a Mercedes? Life and economics are about trade offs. Raise taxes and regulate the profits of businesses. Let all innovation be funded by the public and pay manufacturers to make what is discovered if it is deemed socially valuable. Where do I sign up?

            I’m curious – do you hate Apple for charging 500% above the cost to manufacture an iPhone or iPod? Maybe we could afford medical care for the poor if we weren’t wasting so much money on iJunk.

        2. NS

          Profit=over and beyond the cost of production, distribution and development. There is no rational defense for the predatory schemes of enrichment. I think that infant should have a shot of living a full normal life given the opportunity of progress made in medicine to allow it versus death.

          How about women who get breast cancer at the age of 35? Should the available treatments and subsequent monitoring that allow them to live productive lives be eliminated? A pattern of denying payment for care, targeting women with breast cancer was recently in the news.

          There are risks in life, we have progressed. No longer does one have to amputate a leg for a fracture, no longer do you face certain death at 40 if you are unlucky and get a bleeding stomach ulcer. Death is part of life, how gracefully one is allowed to die, the dignity of of the individual facing death is also an issue. Do we allow people to suffer long and unremitting agony or do we support them and give them relief from of their agony and pain? Have you ever seen some one suffer a long agonizing death?

          How about the bright kid who has to drop out of college because they were unfortunate enough to get appendicitis, the debt too much coupled with the expenses of a college education? How about the women who has to stop work to care for a child with a chronic disease, maybe the best thing is to let that child suffer and die? Maybe people like Stephen Hawking just have no value since the risks and cost of caring for them is just too great.

        3. Yves Smith Post author


          I’m a management consultant and have done buy side work over a broad range of industries. The R&D argument as a defense of pharma margins is spurious.

          1. R&D in the US is massively subsidized by the NIH and tax breaks.

          2. Big Pharma does everything permissible to classify expenses as R&D (I have this from former executives at top pharma companies).

          3. Big Pharma nevertheless spends MORE on marketing than it does on R&D. And it is hugely expensive marketing. I can think of NO other industry, save sunglasses (which has extraordinarily large gross margins) in which small businesses get in person sales calls.

          1. Neil D

            Why do people object to marketing? Do you think that people are taking drugs they don’t need and therefore should not be allowed to ask their doctor for Lipitor or Viagra or whatever. I’m OK with that if you can sell it to our GOP friends, but I can hear the howls of protest already, “Keep your bureaucrat hands off my Viagra!”

            As for R&D costs – they exist and must be recovered or absorbed by society via taxation. Take your pick. No one likes companies profiting from the pain and suffering of others. It’s unseemly, but your doctor does the same thing. So does that nursing home taking care of dear old mom and dad. If you want to set prices for all these things, go ahead.

            President Obama tried it and couldn’t pull it off. We’re not ready. I’m just trying to live in the real world as it exists today. Demonizing doctors, nurses, hospitals, nursing homes, medical device makers (hips etc), and pharma for performing a service and charging what the market will bear won’t solve the problem.

        4. liberal

          I’m all for universal and single payer health insurance, but you still need to let the doctors, hospitals, pharma etc make a modest profit.

          Absolutely, thoroughly, completely wrong.

          An efficient medical industry—yes, here I’m talking about hospitals, doctors, pharma, etc, and not insurers—is one which maximizes long term care outcomes subject to a budget constraint.

          It is impossible for a free market to do this. Why? Because there is no incentive not to treat. Doctors, hospitals, etc get paid nothing for the decision NOT to apply a particular treatment. They get paid less to apply a treatment which is effective or almost effective but cheaper.

          Now, of course, you could just say, well, if people paid out of pocket, then cost/benefit decisions would be rational. Impossible, though, because of information asymmetries, not to mention the nature of medical need (high variance necessitates insurance).

      2. Vinny

        Pharma is lying all the time. All this “research and approval is costly” is just BS. They can afford to sell the same precise drug (not a generic) in Europe for 5 times less, so they should be able to do it in the US as well. But in Europe the governments are actually looking out for the interests of their people.

        Another really crazy concept you hear a lot in the US is “cost-benefit”. You can’t read an American article or study not to see it. For example, “well, this uninsured guy need not receive Rituximab for his lymphoma because it’s just too expensive… but we better give it to this Wall Street bankster right away because he’s so much more important to the world.” Doctors across the world cringe when reading about “cost-benefit” in American studies (studies which are becoming more and more discredited by the day, by the way).

        All you hear about in the US health care is profits, profits, profits. The whole humanist aspect of medicine has been completely lost. This is why, as a practitioner, I believe the system needs to completely collapse. It has become an evil, cancer of society, and like any cancer, it needs to be destroyed before it destroys you.


  5. MJ

    My letter to Senator Murray. I urge you to write to your senators as well and send them Ives post.

    Your reason for voting against the drug reimportation bill was the safety of the reimported drugs. This theory may have political support but not empirical support. For example the drugs used by Canadians, have not be proven unsafe.

    According to a new federal report, the ingredients for big Pharm that are manufactured in China present safety problems for the American public. I note that China has low manufacturing costs and even though we pay top dollar for our Pharma, we may not be safe. Pharma looks for the lowest in order to make the largest profit and profits at the risk to us.

    In light of the article below discussing this problem are you ready to ban manufacturing in China of these ingredients in order to comport with you concerns for the safety of the public?

    1. Neil D

      Drug imports from Canada are a waste of time. If you want Canadian prices for your drugs, then pass a law implementing Canadian style price controls.

      From my friend Wiki undoubtedly shilling for Big Pharma.

      Prescription drug prices in the United States are the highest in the world. “The prices Americans pay for prescription drugs, which are far higher than those paid by citizens of any other developed country, help explain why the pharmaceutical industry is — and has been for years — the most profitable of all businesses in the U.S. In the annual Fortune 500 survey, the pharmaceutical industry topped the list of the most profitable industries, with a return of 17% on revenue.” However, national expenditures on pharmaceuticals accounted for only 12.9% of total health care costs, compared to an OECD average of 17.7% (2003 figures). The high price of prescription drugs is one of the major areas of discussion in the U.S. health care reform debate.

      Although the cost of manufacturing a drug is relatively low, the cost of inventing a drug is relatively high, and the United States’ high drug prices allow the U.S. pharmaceutical industry to invent a highly disproportionate share of all drugs. Although the United States is only 5% of the world’s population, it accounts for 36% of worldwide research and development of pharmaceutical drugs. A study by Battelle Memorial Institute estimated that drug research will save more than $750 billion in treatment costs for just five illnesses (AIDS, heart disease, cancer, Alzheimer’s, and arthritis) over the next 25 years. Schizophrenia drugs which cost $4,500 per patient per year save more than $70,000 per patient per year by rendering hospitalization unnecessary.”

      And oh by the way, are Canadians coming to American to get those cheap $4 generics at Wal-Mart?

      “Prices of brand name drugs in the United States are significantly higher than in Canada, India, the UK and other countries, nearly all of which have price controls. Prices for generic drugs tend to be higher in Canada.”

      Have a good day all. Take some Prozac and some Viagra then have a good time! Have a steak dinner and then take Lipitor. Have some coffee and cigars after dinner then take some Ambien and Advair. Don’t forget to feed your kids Ritalin or they will drive you crazy!

      1. NS

        Neil you must be young. I remember a time when RX medication were NOT advertised to the public. It raises the price burden significantly and I might add significantly added a burden to health care professionals.

        People are being sold FEAR, people are being sold a bill of goods of rosy improvements for serious chronic and debilitating conditions. Those ads seek to replace the education and experience of physicians. Many of these medications are extremely expensive and are last resort medications on clinical criteria, are not universally appropriate for the particular condition and furthermore, insurance balks at paying unless strict criteria is met…even then they balk.

        So that person with a painful degenerative disease wants what the ‘as seen on TV ad says’. The physician has to take the time to explain why is isn’t appropriate and in this world of health care…TIME IS MONEY.

        I thank you Yves for your reporting and insights on this matter.

        People have been encouraged to diagnose and treat themselves. Distrust bred over years of the industry and rightfully so as a result. Health care isn’t an INDUSTRY it is a SERVICE. Not all health care professionals are part of the problem. The problem arises when business models are applied to health care as if it is to a Toys-R-Us. You can’t exactly shop around for a total knee replacement, we can’t all execute the caveat emptor lacking a foundation in the SCIENCE of medicine and health care. Most people know more about how their cars work than their bodies.

        and to Neil, in the world of Karma, may you personally experience soon the consequences of your life changed forever, never to recover financially or physically; so a disconnected few may profit wildly from it.

        1. Neil D


          Do you realize that, in the extreme, you are asking all who work in health care to work for minimum wage so that you can have it for free? Otherwise, all we are doing is negotiating price. That price comes either via taxation or paid to for-profit businesses. All we have to do is decide what this is worth. There is no need to demonize me in the negotiation over the cost to prolong your life.

          FYI – I work in the most apolitical part of pharma. I’m an engineer supporting an injectable drug filling operation. I make sure the product your doctor injects is pure and sterile. I do this for a salary and because I know that these drugs – whatever they might cost – actually help people. I hope you don’t get sick, but if you do, I might just have made the drug that saves your life and alleviates your pain. So sorry.

          1. NS

            Fear and threats of any change will result in professionals working for nothing. I think not. I’ve worked in health care as a professional since the late 70s before ‘managed care’, before MBAs insertion of themselves into micromanaging without every walking the hall of a hospital, and before Rx medications were outsourced and hawked like jello.

            What are you so afraid of, that risks be spread out rather than concentrated is why single payer systems work better and quality of care improves and costs are reduced.

            Its not free, I paid in spades ALL my working life, up front. I paid for private insurance, I paid into SS, the first generation to do so their entire working lives. I’ve paid taxes including for likely YOUR education despite not having children myself. OK? So what are you afraid of? I worked off the clock, I volunteered and considered myself a productive member of society.

            So, if I fall and break my hip you say you shouldn’t have to pay for it? That the MD and RN tasked with my care shouldn’t get paid? PUH-LEEZE. That’s a little over the top doncha think? But we know what you think…just let me die since I am no longer useful….TO YOU.

          2. liberal

            There is no need to demonize me in the negotiation over the cost to prolong your life.

            No one is demonizing you. At it’s most basic, we’re saying you don’t understand what economic rent is, and you don’t understand the incredible distorting effects that incentives to collect rents create.

          3. liberal

            I hope you don’t get sick, but if you do, I might just have made the drug that saves your life and alleviates your pain.

            It’s also possible you will have made the drug that is no more effective than an older, off-patent drug which is 1/10 the price, but which the unwitting patient (well, really, those who pay the insurance premiums) pays for because your company, which has its eyes on those juicy patent rents from the newer drug, effectively bribes MDs into using it.

  6. Neil D

    Dear NS – I suggest you scroll up and read all my comments. I have advocated raising taxes to provide medical care for people in Africa and America. I have proposed regulating industry profits to limit the cost of health care. I’ve even called out our materialistic society that values iPhones over affordable health care.

    I would gladly pay for your broken hip via a system of universal health insurance provide by the government. What’s it worth to you?

    1. liberal

      I have proposed regulating industry profits to limit the cost of health care.

      But the entire problem is that much of those “profits” aren’t really profits at all, but rents.

  7. molecule

    Everyobody wants “something for nothing”. If we want perfectly safe drugs we should also want perfectly safe food and perfectly safe airplanes. Yet we don’t have any of these. Planes crash every once in a while and food poisoning (with salmonnella or E. coli for example)is common. People die. Food is imported from all over the world as are airplane parts.

    Even given unlimited time and money, perfect reliability is difficult, see NASA’s space shuttle flight record(crash record?) if you still have doubts.

    It costs too much to make things perfectly safe. Every part, screw, apple and tomato would have to be checked, double-checked and triple checked to ensure 100% safety.

    If you insist on perfect safety the supply of goods would shrink dramatically, so trade-offs must be made if we want goods to be produced.

    1. Francois T

      You’re so full of it, it’s not even funny!
      Everyone KNOWS perfect safety doesn’t exist; that is a non-sequitur deluxe.

      There is a world of difference between total intolerance to uncertainty of safety, and the certainty that China has neither the will nor the systems in place to monitor its exports.

      And you suggest…what exactly? That we should be OK letting trade of pharmaceuticals flourish willy-nilly in such a situation?

      Are you willing to take the Chinese Blue Pill, Neo?

  8. Pat b

    The tail end of communism, the Russian drugs were no good.
    Factory managers had to hit quota quality be damned.
    Now in the tail end of radical capitalism, quality is damned.

    All that matters to the randians is profit.

  9. gordon

    Thank you for bringing this topic! This is about the FDA, and their lack of regulation and funds to keep up.It’s not about protectionism/socialism. It’s about a huge threat to our lives. I read that almost all the Arabic gum and ascorbic acid(Vit C)is from China. Arabic gum is in almost everything, I bet including every frozen dinner. Vit C from China? Is that from citrus irrigated with polluted water? Do the Pharmas care if people die, or they blame it on the “importing country’s” inspection?
    Farm-raised fish is from China using polluted water, fungicides and antibiotics. They give crappy white fish a Monk nickname and smuggle it in the US as Monk Fish. Read the labels on frozen fish, and the name.

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