Workers at the Moosehead Brewery in Saint John have been locked out for three weeks in a different kind of labour dispute: over high drug costs. The company says it can no longer afford to pay 100 per cent of these costs to its retirees, and wants employees to kick in 30 per cent — a reminder of the pressures of drug costs on private as well as public plans.
Meanwhile, one of Quebec’s foremost public health specialists, Dr. Fernand Turcotte, co-founder of the Laval medical school, recently announced a shattering realization: “that the things I had been teaching my students for 35 years were not true.”
He was talking about the illusions surrounding pharmaceuticals, in particular the tendency to “medicalize normal human functions.” The Viagra/Cialis caper was just the most visible of these, wherein it is implied that if you’re anywhere from 40 to 70 years old and have something other than hot sex on the brain, you’re sick.
Drug costs are the fastest-rising part of a public system said to be heading for the rocks, but are equally tough on private drug plans, which account for over half of drug spending in Canada. The drug companies, the most profitable corporations on Earth until a couple of years ago, are often accused of what Dr. Turcotte calls “ethical bankruptcy” in marketing their wares through high mark-ups and deceptive influence. Now there’s pushback all over the world.
Something has to crack, and maybe it’s happening now. The New York Times is reporting that the drug companies are falling on hard times — patents running out on their blockbuster drugs and few new ones in the pipeline, huge lawsuits over withheld information on the negative effects of some drugs, shares down, credit rating downgrades, huge layoffs, and talk in the U.S. about more pills being developed by public research institutes which already do most of the research the drug companies profit from.
What exactly this portends is not yet clear, but for the rest of us the need is obvious — to halt the rise in drug costs before they break us. But how?
In that regard, I’ve been talking to a couple of interesting fellows, Ed Fedora and Paul Graham, who have a Sydney-based company called Prescribed Solutions. Both spent 18 years working for the drug companies, in which the game was to promote new and more expensive drugs to physicians, then quietly phase out the old (but equally effective) ones.
They’ve converted, and are now promoting the cheaper drugs to doctors on behalf of clients — mostly private employers but also the P.E.I. seniors’ drug plan. The key in both cases is that doctors have no time to study the relative value of different drugs and tend to respond to whatever convincing case is made to them.
Their company has a board of medical industry professionals, and they have had a pilot project which they say confirms their work experience — that doctors are responding to the message, saving their clients considerable money.
Indeed, in the wider sense, doctors in Nova Scotia have shown themselves particularly sensitive: 82 per cent of them have voted to reduce their contracted four per cent salary increases for the next two years to one per cent. But, says Graham, unless the annual seven per cent increase in the province’s nearly $300-million annual drug bill is halted, the doctors’ gracious gesture will just cover that increase in the next two years.
There are many companies in the U.S. doing what he and Fedora are doing, says Graham, but few in Canada. There is a benefits consulting industry, he says, but it has failed: “It’s what has led the Mooseheads of this world into their predicament.” They have projects throughout the Maritimes and hope to expand to Ontario.
He adds, ominously: “Most employers we have spoken to are deliberating either a severe reduction in drug plans or a cancellation altogether.”
Meanwhile, in the public domain, there have been dramatic moves to cut the prices of generic drugs in Ontario, B.C. and Quebec. Nova Scotia is studying its options, with a deadline of next summer.
There is hope. Here’s a story. Remember the rumpus over Lucentis, the drug for macular degeneration that costs $2,000 an injection? The province finally caved in and decided to fund it last fall. Now the British institute that establishes national clinical guidelines has declared it insufficient value for money.
Another drug, Avastin, which costs $30 an injection, is laying claim to be just as good. Many eye doctors are apparently using Avastin based on their own experience with it, although Roche, the company that makes both, has been madly trying to get them to stop. A huge study in the U.S. is underway to settle the issue. Maybe Nova Scotia won’t be paying top dollar for the treatment after all.
There are many stories like that in the drug business.
Ralph Surette is a veteran freelance journalist living in Yarmouth County in Nova Scotia. This article was originally published in The Chronicle Herald.