In Lessons Blog

This week, I was invited to participate in an hour-long panel discussion on the NPR show 1A alongside with two other physician leaders, Dr. Victoria Sweet and Dr. Aneesh Singla. Our topic: The challenges patients face in getting the right medication, understanding the alternatives, and the shortcomings of the current system.

National Public Radio’s 1A is a show for (and about) changing America. Hosted by Joshua Johnson and focused on the most important issues our country faces, 1A seeks to “act as a national mirror,” helping America look at who we are and, more importantly, who we want to be.

Joshua began the show by informing listeners that he and his team had invited a half dozen different drug companies and representatives from the pharmaceutical industry. All had declined to participate. Given the number of TV advertisements for Big Pharma these days, you have to wonder why they would miss the chance to offer their views to over 2 million listeners on a nationally syndicated program.

Dr. Sweet talked about her experience at Laguna Honda, a hospital in San Francisco, and the value of physicians having the time needed to explore in detail the specifics of the medications they prescribe. Prompted by an extremely articulate caller, Dr. Sweet recommended that patients obtain all medications from a single pharmacy where a pharmacist can review the various drugs that have been prescribed to make certain there are no negative interactions among them.

Dr. Singla, a pain specialist, spoke about the opioid crisis in the America. With over 80% of the world’s oxycodone used in the United States and with tens of thousands of drug overdoses, the over-prescription problem is impacting patients across the nation. He emphasized the alternatives, which include physical therapy, steroid medications and non-narcotic medications, including ibuprofen.

I was asked to participate because of what I wrote about the drug industry in my book, “Mistreated: Why We Think We’re Getting Good Health Care—and Why We’re Usually Wrong.” In it, I lament how drug companies have moved away from making major R&D investments in difference-making medications, and how they now focus on gaining market control for marginally better products and then raising prices 500 to 1,000%. I pointed to a recently published article in JAMA Internal Medicine that studied 10 cancer drugs and followed them for an average of four years after approval. The study found “the median cost of developing a single cancer drug was $648.0 million. The median revenue for these drugs was $1.66 billion.” Further, “the total revenue from sales of these 10 drugs since approval was $67.0 billion compared with total R&D spending of $7.2 billion.”

I also spoke about how drug companies select and make payments to doctors for their “advisory committees.” Of course, the main selection criterion was not the doctor’s skill, expertise or value of the doctor’s advice in developing new medications. They’re selected because they prescribe the drug company’s most profitable medications in higher quantities than their peers. I noted that patients can find out if their doctor is receiving payments by going online and accessing “open payments” databases created by section 6002 of the Affordable Care Act, better known as the “Sunshine Act.”

In response to a question about what I would recommend for patients regarding their drug prescriptions, I stressed three points:

  1. Always make sure you are educated by your physician, including the benefits and complications from each drug, and whether less expensive alternatives exist, including generic, biosimilars and older medications that often are safer than the newest on the market.
  2. For patients taking numerous medications, schedule a visit at least once a year to review all of them, and be certain there are no problematic interactions. Make sure all your medications are still necessary. Too often this is not the case.
  3. Maximize your health through exercise and proper diet to reduce the need for medications and avoid the complications of chronic disease that increase the likelihood of being prescribed even more. This is particularly important relative to diabetes, heart disease, stroke, depression and anxiety.

Throughout the program, host Joshua Johnson kept the conversation moving forward, and hundreds of listeners called in with their comments and questions. As a fan of 1A, it was a privilege to participate. Based on the feedback I have received, the program was educational for many and well received.

You can listen to a recording of the show here: https://the1a.org/shows/2017-10-11/rethinking-rx

And please leave a comment below. I’d love to hear what you think.

Dr. Robert Pearl is the bestselling author of “Mistreated: Why We Think We’re Getting Good Health Care–And Why We’re Usually Wrong” and a Stanford University professor. Follow him on Twitter @RobertPearlMD

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