Slate says 'Blame Canada' but that is not what worries me

by Michael S. Kaplan, published on 2005/05/10 12:01 -04:00, original URI: http://blogs.msdn.com/b/michkap/archive/2005/05/10/415996.aspx

In Slate, Sydney Spiesel reports in a piece entitled Blame Canada about the decision in Canada to ban Adderall XR, and what.

Now I am not a huge fan of what many intelligent people consider the over-mediation and misdiagnosis of children with Attention Deficit Hyperactivity Disorder. And in many cases the real diagnosis of kids who have trouble paying attention or sitting still is that they are, well, children.

I find even the possibility of a financial motivation to ban a drug in Canada more than a little disturbing. Especially when where I live the folks making decisions have a helluva lot more reason to have a financial motivation.

Now it is Slate after all, so maybe I shouldn't worry. But frankly if it is happening in Canada then it is almost certainly happening here too, and on the whole folks here are better at making sure we never hear about it.

I hate having to think that in the USA the only protection we have from the greed of the insurance companies is the greed of the pharmaceutical companies. It's a pretty lousy way for the USA to have a 'better' system (for some values of better). If you know what I mean....

Drug companies spend more money on marketing than they do on research. When they do invest in research, it's for drugs aimed at the planet's rich. Their ideal product doesn't cure or prevent any disease, that would be a horrible market because it doesn't provide long-term income. Don't believe me? Why aren't the drug companies developing cures for tuberculosis and ebola, and why are so few in the business of developing vaccines? The US is begging companies to make flu vaccine.

No, drug companies want products that alleviate symptoms but do not cure, ones that ideally need to be taken for the rest of the patient's life. They want a subscription plan that generates long-term income, and the products they develop reflect that.

I agree with the linked article; if Canada believes that the drug is just too expensive when there are equally effective and inexpensive alternatives they should come out and say that. Don't hide a legitimate healthcare budget issue behind a product-safety excuse. Level with people that there is not some unlimited pool of money for health care, and that the drug companies are exploiting patients to drive those costs up.

Medical care is unusual because we want to deny that it follows normal market forces. "You can't put a price on a human life" and all that. But who will pay, and for what? Can the patient come into a doctor's office and demand a drug they see advertised on TV, even when a similar generic drug works as well and costs one-tenth as much? How can we control the costs of a system where the user demands the product but doesn't pay the cost?

In this case we're talking Canada and its public health care system. They have some fixed amount of money that has been appropriated by the legislature. They need to prioritize to use that money wisely. Perhaps eliminating this drug was part of that process. If so they should say so.

US insurance companies, being motivated by profit, may be driven to save money when it would not be in the best interest of the patient. But they still need to prioritize, just like the Canadian system, so that they can offer the best plans at the lowest cost.

For most Americans, health care coverage is purchased by employers and the actual medical bills are paid for by an insurance company. The patient has very little incentive to control costs. Who cares if Nexium costs ten times what generic Prilosec costs? The guy on TV said the New Purple Pill was better and that's what I want. Doctors have no incentive to argue with the patient about it--heck, they may be good friends with the drug rep--so they just write the prescription and let insurance pick up the tab.

Is it any wonder that the insurance company ends up being the heavy in this system? They're the only party in the system that actually cares what things cost.

In most cases, insurance companies have means (such as co-pays) to help enforce the idea that they should care about costs, too.

I am not claiming that all pharmaceutical companies, or all insurance companies, or the Canadian government, or anyone is evil. But I am claiming that none of them are entirely good, either. They are all working from self-intrest, in addition to whatever nobler motives they may or may not have....

Hi Marty -- thats a little scary from my point of view (with medication that are costly!).

What about medications while you are in the doctor's office or hospial? In the US they do not fall under the "prescription" benefits of insurance, they count like with medical procdures. If Canada makes the same distinction than what they do with Tysabri if it makes it back will be interesting (since it will very costly for Canada!).

Your comment suggesting remedies to my blog-coding issues led me back to yours. By the by, Michael, my father had MS and I lived *near* it, though not with it, for years. It is really a crazy, baffling disease and I've spend large parts of my life trying to understand how it did what it did to him. Through all that it did to his body, though, he maintained a fantastic sense of humor and really a fascination with the pathology of the disease that was crippling him. It's one of those things: it would be very very interesting if it weren't so damned lousy.

Best wishes,

-R