The Costs to Live – Part 3

Previously, I introduced you to many of the big pharmaceutical companies and factors influencing the high prices they charge for their medications. The effects of the high costs are highlighted below.

As many as 2 billion people (1/3rd of the world’s population) lack access to essential medicines. As I pointed out above, in America more than 25% of those prescribed a medication don’t take it and 23% cut their pills in half or skipped doses because of the high price of their medications. In developing countries the median prices for drugs are on average 2.7 times higher than international reference prices in the public health-care sector and 6.3 times higher in the private sector. Thus, you can imagine that in a place in developing countries where the prices are higher and income is lower, the even greater barrier to affording medications.

The inability to afford medication (meaning that people don’t take the right dose, skip doses, or don’t take their medicines) has an incredible cost to society. In the US alone, $100-300 billion is lost in decreased productivity from those who do not have access to medications. This does not account for the increased burden on households who may lose income to sick days. Nor does this account for the increased burdens on the health care system (especially if those who cannot afford their medicines end up in the Emergency Room). We cannot even begin to estimate the loss in productivity throughout the world.

Consider the impact of such medications:

– Life expectancy increased 40% with the introduction of medications for cancer and heart disease.
– From 1995 to 2002 medications for HIV/AIDS decreased deaths from 16.2 per 100,000 to 4.9 per 100,000.
– Antihypertensive medicines reduced deaths by 89,000 annually
– Vaccinations eradicated smallpox and nearly eradicated polio

I could go on and on. Let’s not underestimate the amazing contributions pharmaceutical companies make to society by bringing these medicines to market – saving lives. On the other hand, we cannot forget that these companies are not completely altruistic. They have other interests at heart, including (and perhaps primarily?) reaping profits. So while they contribute substantially to our health, they also create huge barriers through their pricing.

For instance, insulin used to treat type 1 diabetes was created in 1922, saving children from slow starvation. To supply 1 bottle of regular insulin costs roughly $10 per bottle of 1,000 units. However, retail price in the United States runs about $191. Granted, insulin today is better than insulin in 1922, there are synthetic insulins on the market now. Even then, the pricing is exorbitant.

Such high prices leave people desperate to save their lives. In the United States, this might mean going to Canada to get cheaper medications. In the other parts of the world, people turn to counterfeit medicines. Counterfeit drug sales alone will reach $75 billion globally in 2010, an increase of more than 90 percent from 2005. And who could blame someone for buying a cheaper counterfeit medicine wanting only to be healthy or to help their sick family members?

Unfortunately, these counterfeit medicines can actually make everyone worse off by cultivating resistance to treatments. Tuberculosis (TB) is the primary example of this, a disease that kills 1.8 million people each year, or 4,500 each day. This disease is the leading killer of people with HIV and is a disease of poverty. When TB is improperly treated because of low quality medications or skipped doses, drug resistance develops leading to (aptly named) multidrug-resistant TB (MDR-TB) and even extensively drug-resistant TV (XDR-TB). The World Health Organization (WHO) estimated 440,000 new cases of MDR-TB were reported last year in 60 countries. Again, who would blame someone for skipping medications they cannot afford or seeking cheaper drugs which may be counterfeit? And while we may think of TB (regular, MDR or XDR) as only affecting developing countries, this highly contagious disease affects the world.

(I may question though whether there might be confusion between drugs illegally imported or generics produced vs. how many are truly poor quality)

The costs of medicines aren’t just impressive when you think about the incredible profits pharmaceutical companies make and their incredible waste. The cost of medicines is most remarkable when you consider the costs of actual lives – people dying from chronic diseases, diseases that can be prevented through vaccinations, and diseases that could be treated with good quality medications.

To their credit, pharmaceutical companies will contribute to a deal between countries to share flu virus samples in exchange for access to affordable vaccines derived from them with the hope of saving lives if another flu pandemic arises. However, they’ve only agreed to provide about one-half of the vaccines needed. What will the other half of the world do?

A bit more remains to be discussed including some economics (in particular, the Trade Related aspects of Intellectual Property Rights) and human rights discourse (including how to ensure accountability). Domestically and internationally, much more remains to be done to ensure the right to health through access to affordable medications.

Continue the series:
The Costs to Live – Part 4

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4 Responses to The Costs to Live – Part 3

  1. Jennifer McGinn says:

    I have a few comments to make. First, I compliment you on the level of detail and the amount of research that is in these posts. I appreciate it, and honestly, don’t know how you have time for it. Second, I apologize because my comments do not have that level of detail or research because I do not have the time or energy for it. However, I believe that many of my statements are backed by at least some research. Third, I admit I did not read every post on this blog and only skimmed others.

    While it is true that medicine can save lives and can do some good, why does this blog make medication out to be a godsend? I recently wrote out a detailed medical history for my life and it was especially noteworthy that when I began puberty, I began getting depressed, started taking birth control pills, began getting more depressed, started taking anti-depressants, began getting acne, started taking acne medication, began having acid reflux, started taking meds for that, began getting a lot of throat infections, kept taking antibiotics for those… In my last pregnancy I had a lot of problems with my liver due to all the medications I have taken in the past. Of course! I took medications to solve problems that other medications were creating and I was loading up my liver with all sorts of synthetic chemicals! That is not good for the human body.

    This blog talks about people not being able to take medication for the problems they have because of cost. I say, “good.” Let’s start educating people that it is not good to load up your body on medication and that the underlying cause needs to be treated, not covered up by a medication. Why do we take aspirin when we have headaches, etc? Because we don’t want to address the underlying issue that we eat like crap, we don’t sleep enough, we’re stressed out about work, and we drink caffeine and sugar all day just to keep going. Why do we put young girls on birth control and anti-depressants at young ages to deal with the hormonal changes that are happening in their bodies instead of trying to naturally regulate their hormones, emotions, and menstrual cycles?

    There was mention of diabetes medication for people in Africa. How often do people in Africa get diagnosed with diabetes? I don’t know but my guess would be far less than the western world and I know it’s less for type II diabetes. In this country, why are we treating type II diabetes with medications instead of just focusing on diet, exercise, stress, and lifestyle? Why aren’t doctors telling type I diabetes patients that they need to dramatically adjust their lifestyles in addition to medication?

    I know that asthma is almost unheard of in certain parts of the world (mainly outside of the western world). What does that say about health and lifestyle correlations? Should we just keep ignoring the root of the problem and keep shoving inhalers down our kids’ throats? I’m not advocating to get rid of all medications, but they should be used properly and we should be putting at least as much money into figuring out the causes of these problems as we are putting into researching medications for the problems.

    Vaccines? Don’t even get me started. Great, they got rid of smallpox and polio. At what risk? All sorts of health problems have increased in the same time periods that vaccines began “saving lives.” Is there a correlation? The pharmeceutical companies would have you believe that there is not. The vaccines pumped kids and adults full of formaldehyde, mercury, aluminum, aspartame, tar, etc. You’re telling me that didn’t have a health effect on people? We have vaccines for chicken pox, mumps, measles, rubella, flu, pertussis, etc. Not too long ago, people got these diseases and lived through them. Now the idea that we might ever get sick is appalling to us. How dare we miss a day of work to rest our immune systems and stay healthy so we don’t become deathly ill from the flu or the measles! What does that say about our culture? We can’t see the forest through the trees. We might lose productivity now in the workplace!!! But who cares if we lose productivity 10 years from now when all our employees have cancer from the various chemicals that were pumped into their bodies. We don’t give a shit about health. This country cares about profit.

    And this blog agrees with me in that area but where we disagree is: what is health? Health is not where you have the right to pump your body with whatever chemicals you want at any cost. I agree health is a right. But it’s also a responsibility. You don’t get it overnight, especially not after abusing your body for 50 years. And you don’t get it without putting some work into it yourself. Why does this country believe that the government should tell us what to do and when to do it and how to do it? Take responsibility for your own health. Just because it’s legal to smoke cigarettes, doesn’t mean you should. We expect the government to do it all but then we tell them we don’t want to fund it. You have to go earn your health yourself. Fight for it in the face of big government and a fast-food nation.

    Medication and hospitals have a role, but a much smaller role than we allow them to have. The “costs to live” should not be the costs of medication and health insurance. The “costs to live” should be the cost of the things that are essential to health: quality food, quality water (not water pumped with more chemicals), appropriate shelter, etc. While some medical care is helpful, it would not cost our country what it does if we actually took the initiative to take care of ourselves. If we took care of ourselves, then we could have health insurance for everyone and we would not need hospitals and medications as much. Individuals who truly need medical care could get that care without going bankrupt and without exhausting the system.

    I admit there are those individuals who truly need medical care to live. I think it’s, at the very least, less than a 1/4 of the people who get medical care right now, but nonetheless, the need exists. So whether we give them that care at any cost or not is controversial but there is another issue that remains. How did they get that need? Was it something we did to them as children to impair their health? Was it something we did to them as a developing embryo or fetus that impaired their health? Is it the polluted water they grew up on or the radiation from the power plant they grew up near? Why do these questions get ignored by those who are evaluating this country’s health insurance crisis? Do they not realize that you can only add more band-aids for so long until the cut becomes too big to cover anymore? I’m sick of hearing that there is not enough research to show that ultrasounds and vaccines and hormones in food and genetically modified foods are bad for you. There is enough research to show that Viagra gives our men hard-ons 75% of the time but nothing that even ponders why these guys are impotent in the first place?!

    I’m not trying to get all Darwinian here but do we really want these guys reproducing if there is something so wrong with them that they can’t do what God intended them to do: procreate? I won’t go down this road too far because I do believe medicine has a place, but let’s be realistic, people get sick sometimes and people die. Why are we so afraid of that? Why can’t we accept that sometimes things happen (natural things, more natural than formaldehyde), and people do die? We have unreasonable expectations and unreasonable fears in this country. We cannot expect to pump ourselves full of all sorts of crap and end up the spitting image of health. We also can’t be afraid that the germ on the door handle might render us sick in bed for a week.

    While I feel optimistic that more people are beginning to come around to similar views, I am also dismayed at the amount of people that still expect health to be handed to them on a silver platter.

  2. I think you have some great points here. I’m glad to have this discussion with you and gain more information for the readers.

    I’ll start by lauding your discussion of personal responsibility, the impact of medications that are not necessary, and understanding that illnesses happen in a context with many other socioeconomic factors.

    I may just add a bit more for consideration –

    First, Diabetes in Africa and around the world is rising – not just type 2 (and I might note that it is very hard to determine how many actually have Type 1 or 2 because of poor reporting mechanisms in these countries). You can go to http://www.diabetesatlas.org/ to learn a bit more and you can also look up the International Diabetes Foundation which tracks efforts to combat non-communicable diseases like diabetes. Furthermore, Type 2 diabetes is more impacted by genetics than Type 1. Meaning that many who get Type 2 do not necessarily live an unhealthy lifestyle (though let us NOT assume this is for everyone). Minorities are especially hard hit including Hispanic, African American and Native American populations. While diet and exercise can have an impact for many with Type 2, others will still need the assistance of medication.

    I agree that we should not take medication for every little bump and bruise, headache or strain, but the medicines I mean to discuss regarding the “cost to live” are those that really do keep people alive. Erectile dysfunction and cold medicines are not on my radar. I’m sorry if I was not clear about that – I merely listed some of the medicines you may know for each drug company so you could make the association not to imply those are essential medicines. I am especially disappointed by pharmaceutical companies investing in these medications or medications that only slightly change their formula with no extra benefit which do not improve health.

    As for other social determinants – this is going to my next post. For the right to health cannot be discussed in a bubble away from other socioeconomic factors. Clean drinking water, shelter, wholesome foods, and education are all part of getting and keeping people healthy. They work in tandem.

    Finally, as for personal responsibility. Again, you have a good point. We do need to take responsibility for how we live our lives, what we put in our bodies, and what we expose ourselves to. We cannot rely on medicine alone to ameliorate every issue we have. Unfortunately, many conditions or illnesses are not a result of unhealthy choices. As you mentioned, some are born with these illnesses and some are exposed to environmental factors that cause illnesses – whether it’s unclean water, infected mosquitoes, or chemicals. For those who have illnesses that can be prevented or ameliorated with essential medicines such as insulin, antibiotics for TB, antiretrovirals for HIV/AIDS, or anesthetics for surgeries (like leg amputations, not for breast implants) the costs of these pharmaceuticals literally is the cost to live.

    Thank you again for your response to this post and for the information and ideas you provided.

  3. […] of their medicines – what I call the Costs to Live.  (See The Costs to Live Parts 1, 2, 3, and […]

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