I am going to take a page out of Boz's book and write a little informational about a current subject that people, AKA consumers, should know more about.

Prescription Drugs: Why do they cost so much? Why do they kill people when they are supposed to help? Why do I keep seeing those annoying ads until I WANT TO TEAR MY EYEBALLS OUT!?

Well, hold on there, let me answer these questions one at a time.

Why do drugs cost so much?

Well, the main answer is that it costs many many millions of dollars, sometimes billions, to discover, develop and test a drug. That's before even bringing it to market. And for every drug that makes it to the pharmacy, there are 10 that don't make it through stage 3 clinical trials and there are hundreds that don't make it through stage 1, costing millions more dollars. So this must be made up by charging a lot of money for the drug while it is still under patent. But, good news! Once the patent expires, any company can now make the drug (under a different brand name) and not have to pass on any of the research,development and approvalcosts since this has already been done. These are the Generics, and for the consumer, they are a good thing.

Another reason why drugs cost so much is because of insurance plans. If insurance covers it, the consumer might not argue too hard with doctor when he prescribes something unnecessary. The doctor ain't payin it, the consumer ain't payin it (until the premium goes up) so more is better! Plus, the doctor has little incentive to prescribe a Generic, since the big drug companies come by weekly and drop off all sorts of free swag. So he won't remember the name of that Generic when he writes on his pad since the pen he is writing with has a name brand right on it. So next time, ask for a Generic even if you have full coverage.

Why do drugs hurt people when they are supposed to help?

The most famous one of this line is Viox. This drug was basically a painkiller along the lines of Tylenol and Ibuprofen, in fact most similar to Alleve. All drugs have side effects and this one has some relatively minor ones that build up over time, causing problems with people who have pre-existing heart conditions. The problem for Merck was that this was a hugely marketed blockbuster drug targeting people with arthritis, thus mostly older and prone to heart conditions. Several studies came out indicating that people on Viox were having heart attacks more frequently, and that the drug wasn't actually any more effective than other, cheaper, safer drugs (like Alleve and Tylenol). Merck might have escaped with merely losing the drug, but they sat on the studies for a year while still marketing the drug full tilt. So when the studies were finally released, they made a huge news item and the dangers were greatly blown out of proportion. And everyone who has ever taken Viox is now suing the company.

In my opinion, the true crime in this case was the misleading marketing (it is not any more effective at treating arthritis pain than a dozen other drugs), the complicity of the doctors prescribing it, and to a lesser extent, the gullibility of the patients always wanting the newest and best drugs. Viox is an extreme case, and the drug itself is not very harmful unless your heart is already in bad shape. In most cases, the bad effects of drugs are well known, especially the older, cheaper drugs. Here is another argument for generics since they have been around so long that they are well known to doctors.

Anyway, I haven't answered the question, why do the drugs hurt us? Any foreign substance is dangerous. If you eat enough Vitamin A you can overdose (don't eat too much liver) and even water can be fatal if you drink enough of it. In the case of drugs, they are generally tweaking our super-complicated internal systems to achieve some effect. And each person is different, so we don't know exactly how each drug will affect them. So the doctor is basically making an educated guess that the good effects will outweigh the bad side effects of each drug. After all, who would take chemotherapy if they didn't have cancer? It is basically a poison. We are never going to escape the side effects that drugs give us, the only thing we can do is keep testing them even after they are released and tell doctors as soon as it appears that a drug is more harmful than previously thought.

So why do we have these ads all the time?

Here is the biggest crime of big pharma. In case you didn't notice, as recently as 10 years ago there were almost no ads for drugs on TV. If you needed it, you would talk to your doctor, she would prescribe it and you'd take it. As time went on, rules on drugs have gotten more and more stringent, testing more complete, and the whole process has become hugely expensive. But the companies at one point discovered that one blockbuster drug could pay for the development of another 10 drugs, any one of which could become another blockbuster. So they really NEED a blockbuster, and the best way to get the most out of each drug is to make sure every person who could even possibly need it is taking it. So it started with 'consumer education'. I wouldn't mind this if it was necessary, but it has turned into a way to make a redundant drug into a hot seller (like Viox).

However, my biggest gripe is with 'Iterations'. Suppose I have a drug that is a blockbuster, it is the only one on the market that can treat this symptom. I can chargeA LOT for it. But now it has been out 13 years and the patent is getting near to expiration. So the scientists look at it and hypothesize that changing one amino acid will allow this drug to have the same effect but with higher stability. Great! Research it, develop it, release it- it cost a lot to do all these things, but they have been done once before by us so we know exactly what to look for. Everything costs less than half as much. We now have a new drug that costs just as much and has the same exact effect- but it is a new drug so it has a new patent! It is immune to generics! So we halt advertising on the old drug and do a marketing blitz on the new drug, making sure every doctor and consumer knows its name while forgetting the name of the old drug. After a couple years of this, the market for the old drug has dried up and the new drug has even stronger sales than the old one did. Now the generics come out, but they are generic for a drug that doctors are hardly prescribing any more.

This graph shows how Aranesp has been killing Procrit and Epo, even though they are all basically the same drug.

So my message is: New is not better. When we are speaking of drugs, 9 times out of 10, older is better. Ask your doctor for drugs that have been tested with time.

Edit: By the way, I work for a large American pharmaceutical company. I'd also like to add that those non-generic sales are what allows us to research and develop new drugs. If you think the government is doing anything except making it harder for us to do this, you are wrong. So some high prices are necessary to keep new drugs rolling out. Some thrid world countries are currently breaking patents to make some generics for their own people. I believe this is just shooting themselves in the foot- these new generics will hit the black market and spread world wide- Once the virus (OK we all know we are talking about AIDS here) becomes resistant to these drugs, what are the chances the companies will bother developing new ones? They won't do it if they think the patent might be broken.

For now, selling at cost (which most companies are doing with desperately poor nations) will probably have to be enough.