Of money and meds

“Yesterday, a cancer patient of mine came in, and he was really sick,” said Enloe Medical Center oncologist Dr. David Potter during a recent interview. “We took some blood tests, and his diabetes was horribly out of control—in fact, he’s in the hospital now. I called him and asked, ‘Are you taking your insulin?’ He says, ‘No, I had to stop my insulin a couple months ago because I can’t afford it.’”

While insulin alone is relatively inexpensive, Potter said, the exorbitant cost of cancer drugs forced his patient to forego his diabetes treatment.

“That was a very pointed example of how you can go bankrupt paying for [drugs], or end up in a hospital because you couldn’t afford to take them,” he said. “Neither of those options makes much sense.”

As a Chico-based oncologist who, during his 31 years of practice, has prescribed medication for which many patients—including those with insurance—struggle to pay, Potter will offer a local perspective on issues regarding the national pharmaceutical industry during Enloe’s upcoming June 11 seminar, The High Personal Cost of American Drugs.

Featured speaker Dr. Donald W. Light, Enloe clinical pharmacist Danny Abifadel and Potter will discuss the high price and dangerous side effects of pharmaceutical drugs, flaws inherent to the U.S. Food and Drug Administration’s drug-testing methods, and drug companies that “create a pill for everything that happens in life,” Potter said.

As a renowned sociologist, and editor and co-author of the textbook The Risks of Prescription Drugs, Light will offer “a good view of how the pharmaceutical and health-care industries interact, with a view from 20,000 feet,” Potter said. “Danny and I, we’re down on the ground, rolling around in the dirt with the patients, trying to get each patient taken care of. As a social scientist, [Light’s] perspective is more, ‘How does the whole system work? What are the consequences of this system?’”

According to The Risks of Prescription Drugs, the consequences are dire. It reads: “A review of studies in 1998 concluded that ‘overall, 2,216,000 hospital patients experienced a serious ADR (adverse drug reaction) in the United States in 1994.’ An estimated 106,000 died.”

Applying the same rates to the most recent census data available, pharmaceutical drugs are responsible for 2.7 million hospitalizations and 128,000 hospital-based deaths a year, making it the fourth-leading cause of death in the nation.

“Medical impoverishment is distinctive of American health care,” Light said from his office at Harvard University, where he is on a fellowship. In his extensive study of the health systems of European nations, he has concluded that “other affluent countries don’t allow people to become poor just because they’re sick.”

Light believes the U.S. pharmaceutical industry is increasingly designed to extract as much money from patients as possible while offering too few “breakthrough” medical advances. Rather, drug companies often produce medications that are “minor variations” of pre-existing products, Light said.

Potter’s experience with cancer-treatment medication reinforced Light’s view.

“In the last year, we’ve had 12 new cancer drugs,” Potter said. “Of those, only three showed benefits in terms of people living longer. … Eleven of those came in at a price greater than $100,000 a year. It’s ridiculous—even for people with insurance, [cancer drugs] become prohibitive.”

Light also finds error in the testing methods used in clinical trials conducted by the U.S. Food and Drug Administration.

“We can no longer trust the FDA,” Light said. “The rules by which they operate are heavily shaped by the [pharmaceutical] industry.” He said that current guidelines encourage drug companies to “make up new endpoints, to expand types of diseases within a category, or come up with new [diseases].

“If you [make up] a new disease, and then test a drug for it and it has some benefits, then you have a whole new market at monopoly prices.”

Light said he finds the FDA’s practice of testing new drugs against a placebo—rather than against established medication for which there is “more data in actual use [as opposed to] an artificial trial”—particularly troublesome.

“When you do a placebo trial, it’s as if no other drugs exist, because you’re comparing it against nothing,” Light said. “If it’s the first drug ever discovered for a condition, then it makes sense to compare it to nothing. But when it’s the fourth or fifth diabetic or hypertension drug, then it doesn’t make any sense at all.”

Further, the FDA’s rules for what constitutes an acceptable trial allow companies to manipulate results by selecting young, healthy subjects and excluding individuals from certain demographics, Light said, producing test results that don’t accurately represent how the drugs will affect real patients.

“Many drugs get prescribed quite heavily to people who are older, people who have two or more health problems or are disabled” Light said, insisting tests omitting such groups serve only to prove “effectiveness in an ideal population.

“Then, the FDA approves the drug without any real evidence that it’s effective.”

Potter agreed, adding that, due to the way FDA studies are conducted, “you certainly don’t know all the side effects before you start using something. We have a new drug for breast cancer—which is actually very effective—but you really couldn’t tell from the studies what the side effects would be.”

Anyone who tunes into a major TV network’s nightly news program will be met with a barrage of advertisements for drugs claiming to cure “things that are a normal part of life,” Potter said with a laugh, noting that the side effects associated with the drugs are often considerably worse than the conditions they’re designed to treat.

“Which pill are you going to take for your overactive bladder?” Potter asked rhetorically. “Maybe, don’t take any—then you won’t get any of the side effects the voice-over guy is listing.”

So, with seemingly endless medication options for every illness imaginable, what would Light recommend consumers do to minimize their risk of taking a medication that has not been properly researched?

“I would ask them to consult their doctor, encourage them to consider the alternatives and, if possible, take an older, established drug, because we have much better evidence for how safe it is,” Light said. “Newer drugs are riskier.”

Light also pointed to the Consumer Union’s website, Best Buy Drugs, as a resource for “readable head-to-head comparisons of drugs within different classes” (go to www.tinyurl.com/bestdrugs to learn more). The site also provides clear descriptions of how the drugs work, likely side effects and prices, so you can find which drugs “have the most benefits, the least harm and lowest prices,” he said.