I’m a physician who volunteers in safety-net clinics in St. Louis, constantly seeing patients who can’t afford the medicines I prescribe. Even patients with insurance often can’t afford their co-pays and deductibles, and many treatments simply aren’t covered by their plans.
Sky-high drug prices hurt us all, and voters from every political stripe are demanding change. More than half of American voters say passing legislation to bring down the price of medicines should be a “top priority” for President Donald Trump and Congress. However, less than 40 percent are confident that this administration will do anything to lower drug prices, and a huge majority (72 percent) say pharmaceutical companies have “too much influence” in Washington.
Despite our differences, Americans are united in the belief that drug prices are too high, that Big Pharma is too powerful, and that lawmakers must act. Sadly, most of us also expect President Trump and Congress to sit on the sidelines while pharmaceutical lobbyists set the agenda. What does this disconnect say about the power of the pharmaceutical industry, and ultimately, about the state of American democracy? What can we do about it?
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First, we need to understand how the pharmaceutical system got so far out of our control.
Drug development and manufacturing used to be considered part of the American “common good.” Two key developers of insulin — Frederick Banting and John Macleod — refused to put their names on the original insulin patent. Jonas Salk, inventor of the polio vaccine, also rejected patenting for his breakthrough; it was just too important for public health to belong to any one person or company.
As a nation, we have always invested heavily in medical research, because we believe that breakthroughs should benefit everyone. In fact, the underlying research behind almost all of today’s medicines was conducted by academic or government researchers with taxpayer-funded grants. But thanks to an obscure provision of the 1980 Bayh-Dole Act, publicly funded researchers can patent their discoveries and sell them to private drug firms, who can then — as my patients know too well — set whatever price they like. Congress could easily change this law so that tax-funded breakthroughs actually benefit the American people, not just corporate bottom lines.
By failing to invest in the public good of pharmaceutical research, we’ve let drug companies set the research agenda. Instead of solving major health problems like Alzheimer’s or Parkinson’s, private firms often just make minor tweaks to existing formulas to extend the patents — and profitability — of their products. In fact, 90 percent of newly approved drugs offer few or no new health benefits, but still win the patents and market exclusivity that keep prices sky-high.
We’ve even lost control of the Food and Drug Administration, whose job is to ensure only the safest and most effective drugs come to market. Starting in the 1990s, the FDA has been funded by corporate user fees instead of tax dollars. Not surprisingly, in the last 20 years, the FDA dramatically increased its use of the shortened approval process called “expedited review,” which requires weaker standards of evidence and raises serious safety concerns. A functioning democracy means we must invest fully in regulators that are paid to serve us, not corporate drug firms.
If you don’t like President Trump’s toothless proposal for pharma reform, you’re not alone. My colleagues at Physicians for a National Health Program just published a comprehensive proposal called “Healing an ailing pharmaceutical system: prescription for reform.” We identify seven solutions that would not only bring drug prices back to earth, but bring public health needs back to the forefront, as you would expect in a healthy democracy. While universal drug coverage would work best in a single-payer, Medicare for all system, many of these proposals could be enacted right now, if our lawmakers were willing.
Lawmakers aren’t going to do this on their own; we must demand it. If you’re angry about drug prices, it’s time to get active, talk to your friends and colleagues, and call your elected officials. Fixing our broken pharmaceutical system won’t be quick and easy. To fix health care, we must simultaneously fix our democracy. Real change starts with building a movement. With this proposal, we now have a blueprint.
Dr. Ed Weisbart is a family physician in Olivette. He is the chair of the Missouri chapter of Physicians for a National Health Program.