This articlein today's New York Times illustrated one example of the failure of the profit motive to prevent disease.
The article is entitled: New Take on a Prostate Drug, and a New Debate. It begins with this stark statement:
For the first time, leading prostate cancer specialists say, they have a drug that can significantly cut men’s risk of developing the disease, dropping the incidence by 30 percent.
But the discovery, arising from a new analysis of a large federal study, comes with a debate: Should men take the drug?
The crux of the debate is based on the fact that much of the harm in Prostate Cancer is Iatrogenic, a word that we should all become familiar with as it means "induced inadvertently by a physician or surgeon or by medical treatment or diagnostic procedures." Yes, since Prostate cancer is usually slow growing, it is the treatment, the surgery or radiation that often causes more harm than allowing the disease to take its course.
Buried in the article is the point of this diary,intrinsic to the economics of the pharmaceutical industry which is found in many other parts of our for-profit medical establishment. Relying on the profit motive, Adam Smith's invisible hand, often has fatal consequences.
The primary study of the original drug Finasteride provided misleading results that seems to show it was harmful. But after many years it is now known that this was a misinterpretation, and the drug could save lives. But the problem is not biological, but that of the American way of financing health care:
Now, though, prostate cancer specialists have a new problem: How can they change the drug’s image?
Drug companies are unlikely to be instrumental, Dr. Thompson and others say, because finasteride’s patent has expired, giving companies little incentive to apply to the Food and Drug Administration to market it as a cancer preventative. Without F.D.A. approval, finasteride cannot be advertised as preventing cancer and insurers may not pay for it.
O.K. the drug can save men's lives, prevent their becoming incontinent and impotent. But that's not enough to make it available in this country.
In the meantime, GlaxoSmithKline, which has a patented drug, Avodart, to reduce the size of men’s prostates, has a study asking whether its drug can prevent prostate cancer. If it can, and the drug agency approves Avodart for cancer prevention, doctors and patients may have to decide between a generic drug used off-label or a more expensive brand-name drug that does much the same thing.
So the generic drug, now shown to be effective, which can be sold for $2 a pill will never get publicized, but if a similar drug, which would be protected by patent is approved, at perhaps ten times that cost, there will be a media blitz, Doctors will get samples and trips to conventions, and, of course, Medicare and Medicaid will be pressured to pay for it.
All the financial rewards will go to the expensive drug, and nothing but doubt will accrue to the generics. This is now happening in Psychotropic drugs and many other categories. Lithium Chloride, a simple salt,was known to help manic depression for years, yet it was never prescribed.
We will have two choices in November: The republicans who will keep the status quo, and the Democrats who will expand the present system to include everyone. What is needed is a radical (to the root) evaluation of every aspect of our medical care complex, including challenging underlying beliefs, going right to our free enterprise system.
Our lives may depend on it.
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Additional links on this story are hereand here.