In the American mindset,
usually paying more for an item means that it is a better value. This comes
with name brand recognition, with items like Ralph Lauren and Nike clothing
costing much more per item because they are 1. Name Brand, and 2. “better
quality” because of that name brand. Recently, some doctors have been promoting
a drug called Lucentis, which treats various eye diseases. This drug costs
$2,000 per dose, and a much cheaper drug, Avastin, only costs $50 a dose. These
drugs have been rigorously tested and have virtually the same effects on
patients, both negative and positive. The only real difference between the two
is that Avastin has room for a very rare case of “doctor error” (NYT). The
doctors promoting Lucentis are almost always speakers and analysts for Genentech,
and have recommended Lucentis instead of Avastin because Genentech “has
aggressively promoted Lucentis to doctors… paying rebates to those who use
large amounts” (NYT).
This practice of corporations paying public servants at the cost of the people truly disgusts me. Lucentis is literally 40 times as expensive, with almost no difference with the inexpensive drug. In 2011 alone, the government would have saved $1.4 billion in Medicare costs if doctors had prescribed Avastin instead of Lucentis. This is an illogical and unneeded expenditure. I personally would never buy a product for 40 times the amount of another identical product, and I don’t see why my (or anybodies) hard earned tax dollars should be wasted on illogical pharmaceuticals with no scientifically backed superiority.
http://www.nytimes.com/2014/12/08/business/paid-to-promote-eye-drug-and-prescribing-it-widely-.html?ref=politics
7 comments:
Honestly, I do think that it is quite obvious Genentech is trying to earn more money with their newer version of a previous drug, but I don't really think it's a big issue. Patients still have the option to use Avastin if they would rather (which is also produced by Genentech), and to be fair, it would make sense that some are willing to pay more to ensure as high as a success rate as possible when it comes to very serious matters like blindness. The article says that Avastin shows higher risk of stroke as well as "doctor error" because of its more complicated delivery method to the eye. The article also admits that doctors claim the influence of interactions with drug companies is actually quite limited, and usually start with Avastin and will resort to Lucentis or Eylea if it is not working well or its side affects are toostrong on the patient. Ultimately, I don't think it's cool that Genentech is working so hard to promote such expensive medicine, but it is very common for there to be name brand medicine to be much more expensive than generic brand (or lesser of a name brand, in this case), so I don't think it's such a big issue when people still have the option to choose.
While I see Netta's point, I think the biggest issue here is the fact that giant biotech companies like Genentech are paying doctors money to promote their product. According to an article from the Chicago Tribune (linked in the comment below), "studies have shown that such payments or gifts, however small, alter prescribing patterns and influence how doctors practice medicine." I agree with Netta that as long as patients understand all their options, this "brand name" problem won't be that big of a deal, but unfortunately, lack of transparency and misinformation are huge problems. This is why I'm personally a supporter of the Sunshine Act in the ACA; patients will be able to make much more informed decisions.
Chicago Tribune article
Sunshine Act Info
In taking bribes from Genentech to explicitly support Lucentis over Avastin, I believe that doctors are betraying their patients' trust. The patients have faith in their doctors to give them the right treatment, the advice that they themselves believe to be most appropriate for their patients' respective conditions. Moral obligations may not affect some doctors who are receiving the extra funds, but they should begin to think about the effects that "taking bribes" would bring on their future careers. With this article coming out and describing Genentech's methods of promoting Lucentis, patients may begin to be a little more wary of the drug and even the doctors who suddenly start promoting it. This may be an extreme reaction, but potential negative outlooks on the drug are possible, especially since data shows that wide use of Lucentis costs the government much more than that of Avastin. Hopefully, this will encourage people to research medication and treatment more on their own, rather than relying solely on doctor statements.
It's a shame to see such strong influence by corporations such as Genentech towards the prescription of medicine when there are drugs that are equally as competent to treat a condition. However, unless there are stricter regulations set down, I don't think this kind of influence or advocacy will change in the future. I think the idea of profit is an increasingly corrupt, yet unavoidable presence in the medical world. With this said, I believe that such legislation as the Sunshine Act as mentioned by Valerie is highly necessary for patients who otherwise rely heavily on their doctors to provide medicine. Patients should be able to trust their doctors to provide them with unbiased insight into which treatments are most advantageous for the patients to use.
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I definitely agree with Karen about how moral obligations should be an important role in how doctors prescribe drugs to their patients and how this can affect their careers. By prescribing drugs based solely on how much doctors have been paid to promote them, it completely dilutes the trust between the doctor and patient. Furthermore, studies have shown that even small gifts that are given to physicians affect their prescribing habits. They may believe that the money doesn't affect them, but it affects their prescribing decisions on a more subconscious level. To crackdown on this, I recently read about a search tool called ProPublica. I'm definitely an avid supporter of this. In the fall of this year, companies were required by Congress to list every payment it makes to a medical professional, and what each payment is for. And in turn, ProPublica sorts out these payments so that patients or anyone for that matter can see if his or her own doctor receives money from drug companies. I believe that while it's nice to put trust into our doctors, with increasing capitalistic ulterior motives, it's really up to the patient to do his or her research to be more informed instead of relying on doctor's statements. Like Valerie said, the stream of misinformation makes it difficult for patients to make better and more informed decisions. I just hope the Sunshine Act can help doctors realize their mistakes in taking these bribes. In addition, I feel that a bill should be set into place that labels the concrete guidelines of how much could be spent on physicians. This would ultimately limit the doctor him or herself and possibly help him or her realize the error in taking the money and promoting the drug. While this article is only one example of how large corporations pay doctors to prescribe certain drugs, there are many more cases that aren't too public. For this reason, this issue is becoming increasingly problematic and even more difficult to change.
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