But Andrew Sullivan can afford HIS drugs, so all is well in health care land.

The next step is "bootleg" drugs - pharmaceuticals made by manufacturers that simply ignore all of the patent laws and make the medicine that people need. These are already very common in the Far East and it is just a matter of time before they are going to be popular here (followed by the usual scare tactics propogated by the marketing end of big pharma to warn us about the dangers of bootleg drugs etc etc).

There is the benefit that sometimes minor changes allow companies to have a patent, and thus put financial backing behind drugs that aren't yet FDA approved but the original patent has expired. Getting FDA approval is a huge cost.

IHMO you are either for or against patents. It seems wrong to me to be for patents for all other industries but not for the drug industry.

BTW drugs are small part of medical spending.

BTW I am against patents.

Well, the DSM-V is on its way, and that's going to add a host of new disorders that Big Pharma can offer pills to treat. One of them under review is apathy disorder, particularly in relation to the dulling of highs and lows that comes with antidepressant treatment. Yep, someone's going to make a pill -- probably a combo pill -- to treat the way your SSRI makes you feel.

There was a fascinating conversation this month on CBC radio with Christopher Lane, the author of Shyness, which looks at the creation of social anxiety disorder, and the drugs that sprang up to treat it. He mentioned at the end of his interview that there's been a study aimed at getting Seroquel, an anti-psychotic drug prescribed to schizophrenics, approved to treat fear of public speaking.

There's your development cycle: create drugs to deal with how antidepressants make you feel, and get anti-psychotics out of the mental hospital and onto the TV. After all, there's no profit to be made in treating the kind of people who've typically been prescribed Seroquel.

Put more simply, there's agitation to reform the pharmaceutical market because the current structure isn't working very well. We're not getting optimal bang for our buck, or anything near it.

Ezra,

There are a lot of things in health care that don't work well. Under any objective concern over "bang for the buck," reforming the drug industry would not be one of your main concerns. The focus is on the drug industry because that's the easy politics. The real value from reforms would be best spent on reforming medical education, clinical practice of medicine, in-patient and out-patient business practices (your "integration" issue) and preventive medicine. But those issues require taking on doctors and nurses versus profitable corporations. And that just ain't good politics. So instead, we focus on an area that needs improvement (a lot of your specific criticisms and thoughts make sense) but will offer much less impact on our system.

Let's just not pretend that the focus on pharma is about concern for what's best for health care or "bang for the buck." Its about the politics, stupid.

Ezra,

Putting it a slightly different way-- there are many issues within health care that you could focus on with your blog. You have primarily focused on health systems, current policy proposals and politics of health care-- all relating to macro-level views of health care. Pharma is one of the few areas outside of this that you've covered from time to time (health IT would be the other that I recall).

Its not coincidence. You are being influenced by the politics around you. Be original-- take on a tough, wonkish issue like getting physicians to practice medicine based on what works, not what they "like" or learned 20 years ago. Or the medical establishment's opposition to "cookbook" medicine, even though that is exactly what we need more of. Don't just pick on pharma because its a winning strategy for Democrats so you been exposed to the issue. Do an objective look at the health care system, and if you still believe pharma is an important focus for you, so be it. I just think there are more important issues that aren't getting attention that are more worthy of your time and energy. If you looked at the data, I think you'd agree.

http://www.phrma.org/files/Prescription%20Medicine%20Spending%20Trends%202006%20FINAL.pdf
The Centers for Medicare and Medicaid Services (CMS) reports that spending on prescription medicines accounted for 10 percent of total national health care
spending in 2004. The remaining 90 percent of all health care spending in the U.S. paid for hospitals, doctors, nursing homes, other health services, and administrative cost. Prescription drugs’ share of spending – which includes the cost of both brand and generic drugs, along with the cost of pharmacies – is not projected to rise to 11 percent until 2015.

As bad as the drugs care is, it is better than just about any other part for the healthcare picture.

http://www.phrma.org/files/Prescription%20Medicine%20Spending%20Trends%202006%20FINAL.pdf
The Centers for Medicare and Medicaid Services (CMS) reports that spending on prescription medicines accounted for 10 percent of total national health care
spending in 2004. The remaining 90 percent of all health care spending in the U.S. paid for hospitals, doctors, nursing homes, other health services, and administrative cost. Prescription drugs’ share of spending – which includes the cost of both brand and generic drugs, along with the cost of pharmacies – is not projected to rise to 11 percent until 2015.

As bad as the drugs care is, it is better than just about any other part for the healthcare picture.

Sorry, but there's no serious reason to think the government would be any better than the market at matching up supply and demand for pharmaceutical drugs than for any other consumer product.

Yes, the government has a legitimate role in basic research and in funding the development of drugs for diseases that mostly afflict the poor. But it has no place picking winners and losers in the general U.S. market.

Wisewon and Floccina make some good points. Drugs do get a disproportionate share of attention compared to their significance in overall health care inflation, although 10-11 percent is understated. That doesn't include drugs sold in doctors offices (most cancer drugs) or hospitals, which are subsumed in their "share" of total health care spending. The true number is probably closer to 15 percent. And, it has been rising faster than any other segment, so does contribute somewhere between a quarter and half of all health care inflation in excess of GDP growth. And in the past two years, when health care inflation has slowed to just barely ahead of GDP growth, drug spending has continued to grow at a faster pace than health care as a whole, largely because of the Medicare drug benefit, which through the alchemy of Bush-era politics, was transformed into a price support system for the drug industry.

That said, Wisewon's comments that cost control has to focus on how medicine is practiced in this country is spot on. And the work of Jack Wennberg and his colleagues at Dartmouth, highlighted in Shannon Brownlee's new book, "Overtreated," is as good a place to start as any. As for reorganizing how physicians practice medicine in this country, I recommend Arnold Relman's (former NEJM editor) overlooked but stunningly impressive "A Second Opinion." He thinks all physicians should be salaried and in group practices. I agree. But how we get from here to there is another question.

I'd suggest that there are two sides to the coin: cost AND benefit.

The focus here has been primarily on cost. The benefit merits discussion as well. Drugs are only allowed on market after they have demostrated conclusively that the drugs works effectively. The same isn't true for most other things in medicine-- even most medical devices are typically approved with a regulatory loophole that has been exploited on a grand scale that limits the need to prove efficacy. Surgery, treatment paradigms, etc.-- hospitals nor physicians are required to show their practices work. So not surprisingly, the few studies that have tried to determine impact of our health care system on life expectancy, have found that drugs are largely responsible for the gains made in the past 30 years. When you then combine the benefit and cost into one metric for a "bang for the buck" analysis, drugs far and away are the best buy in the system.

As I said upfront: are there things to change for the better in the drug industry? For sure. But the overall focus of reform clearly needs to be on the practice of medicine.

If what the Drug companies are making isn't what people need, then why should we care if they are overpriced?

The government is already deep into "picking the winners and losers in the general US market". The patent system is just one way...imagine, a government enforced monopoly. No one can compete with you, and the government will arrest anyone who tries. Not bad.

Whether or not patent or copyright protection is a desirable public policy, it is undeniably a huge government intervention in the market. In the case of prescription drugs, patent monopolies raise the average price of protected drugs by more than 200 percent, and in some cases by as much as 5,000 percent. In the case of copyright protection, items like software and recorded music and movies that would otherwise be available at zero cost over the Internet, can instead be sold for hundreds of dollars. Clearly these forms of protection are substantial interventions in the economy.

Patent-protected brand drugs sell for more than three times the price of generic drugs that sell in a free market. This means that the country could save approximately $140 billion a year on its $220 billion annual bill for prescription drugs if the government did not provide patent protection and drugs were instead sold in a competitive market. In addition to raising the price for people who buy drugs, the higher patent protected price makes many people unable to afford drugs. These people either go without certain drugs or use less than their prescribed dosage because of government patent protection. Savings of $140 billion may be small as a percent of total healthcare spending, but it is not small.