W

ith Donald Trump finally ensconced as the Republican nominee for president, it’s high time to applaud his spot-on positions on the pharmaceutical industry.

As a physician, I believe that Trump is absolutely right about allowing cheaper pharmaceutical drugs manufactured abroad to be sold in the United States. He is right that the pharmaceutical companies essentially sell their products to the federal government via Medicare and Medicaid without competitive bidding. In other areas of the budget, such as defense, federal laws require competitive bidding. It is outrageous this doesn’t occur with drugs and devices, especially since the health care budget is right behind defense in terms of expense.

Trump is right when he says that drug companies control the landscape. He appears to be willing to call it as it is and not worry about repercussions from the powerful drug interests, and has moved in the right direction in saying he would let Medicare negotiate with pharmaceutical companies if he becomes president. Hillary Clinton, on the other hand, accepted more cash from pharmaceutical companies in the first six months of her campaign than any other candidate in either party. This lessens the potency of her claims to take similar action and suggests yet again disingenuous declarations. If she claims to be such an enemy of Big Pharma, then why are they contributing to her campaign?

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Trump looks at the world through the prism of commerce. The situation we are in with pharmaceuticals and medical devices makes no sense to him. As a physician, I think it’s near criminal that special interests come before my patients. The drug lobbies have succeeded in making the importation of prescription drugs illegal under various self-serving agendas, disguised as “for the public good” and “protecting the drug companies” so they can continue to innovate.

Both of those charades are laughable. Big Pharma is big business; its objective is to make money for its stockholders. There’s nothing wrong with that, but don’t be fooled by the avalanche of ads positioning these corporations as do-gooders. It’s well-known that drug companies’ budgets for marketing are higher than for R&D. That false tune of the cost of innovation is plain stupid and a lie.

Unlike Hillary Clinton, whose campaign coffer is loaded with contributions from drug companies, Trump has barely dipped into that pot of besmirched gold. Yes, Trump is defying Republican dogma, but he’s honestly and forthrightly calling Big Pharma on its Big Baloney.

The same indictments of Big Pharma go to the heart of medical device manufacturers. Their control of the landscape and funding of the FDA is the fox guarding the hen house.

Whether it is drugs such as Vioxx or Avandia that are released without adequate vetting under industry pressure and kill over a hundred thousand people, or a medical device (Infuse) that includes bone growth proteins that led to sterility in men, it is the same story. Money buys influence, and these companies continue to sell the Kool-Aid that their goal is to improve the health and welfare of the American public.

Back during the early part of the primaries, my son Josh’s Instagram picture wearing a “F…K Trump” headband on a Trump golf course went viral. I took a look at how he and I were communicating our opinions. I am very proud of him as a person, as an athlete, and as a student, but disagreed with his choice of sending such a picture. The message was crude and thoughtless; something Josh is not. He redeemed himself and realized his mistake with his second posting, which added the caption: “I support all presidential candidates in this race for the White House. I believe in the American system of democracy and hope that our country picks the best and most qualified person to be our Commander in Chief.”

On that point, father and son do agree.

I know it gets harder and harder to hear any rational discussion, much less debate, as we get closer to the election. But I think it behooves us all to take a breath and listen for the other person’s truth. Only that way will we be able to pick the right person to be our next president.

Charles D. Rosen, MD, is cofounder and president of the Association for Medical Ethics and clinical professor of orthopaedic surgery at the University of California, Irvine, School of Medicine.

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  • It’s easy to demonize biopharma companies. Yes, to be clear, the primary mission of almost every public company in the US is to return value to shareholders – drug companies are no different. But we should work for a system that fosters shareholder return as a result of innovation and value creation in the form of better, lower-toxicity medicines that address unmet medical needs. It’s not really fair to compare a small innovative biotechnology company that has one phase 3 product, no marketing budget and is watching every staple with the likes of Johnson and Johnson and Pfizer. The world is just not that simple.
    I do agree that it is absurd that Medicare does not negotiate price with pharma companies. In a market-based system participants should not be able to pick and choose which market forces are allowed to work. But I think your editorial ignores the real, fundamental issue: the US taxpayer subsidizes drug research and development for the rest of the world. That is, of course, why drugs are cheaper in Canada and Mexico. Companies that sell products burdened with a huge fixed cost from R&D will do so at close to marginal cost (in the case of small molecules, pills) or at a steep discount in the case of large molecule therapies that are expensive to manufacture. The governments of many countries simply dictate price, take it or leave it. Some drug companies even sell product at a loss in these regions so that patients can have access to important new therapeutics. The question your readers should ask is “how many innovative therapies have come from these countries?” Not many. Like it or not, the US biopharma companies spend billions of dollars to develop treatments for disease — an uncertain and extremely costly endeavor. Yes, some of them also send billions of dollars on marketing.
    We need to make sure that whoever becomes president preserves the incentives for innovation. Oddly enough your analogy with the military is apt here as well. The real message to Donald is let’s make sure that we get value for our dollar and that other wealthy countries don’t free-ride on US taxpayers.

    • Do you mean like how Big Pharma employees ride on our taxpayer dollars when they sequester their money in offshore banking and then go to Saudi Arabia to avoid paying taxes and then complain about how may millions it costs to manufacture a drug? Cry me a river. I used to date the son of the CFO of Pfizer and I am SICK of them dominating the conversation. Yeah he was really struggling living a few houses down from the Oil Minister. Sometimes I think about how many teachers could have been hired, how many roads paved, how many health clinics opened with the millions that would have gone back into the US economy as a stimulus if there weren’t so many loopholes for them to tuck their money away.

      As someone who has spent 7 years in various research labs, investigating lens development in termites, antimicrobial properties of Red Sea sponges, the role of noncoding RNA in epigenomic scaffolding, and pharmaceutical repurposing of drugs, I can tell you where the innovation is: THE UNIVERSITIES. Of course you must already know that as a proponent of the little guy, the small biotech company which will eventually sell out to one of the larger conglomerations once profit is maximized.

      Sorry to be so cynical, but when did we forget that money doesn’t buy everything? Free thinking, TRUE innovation, and creativity are ideals that Big Pharma can only mimic by spending billions on pretty ads. The small biotech company has the choice to either be a sell-out and feed the machine or foster an environment where PIs, students, and inventors come together to address the challenges facing a rapidly changing global society. What we need is a purpose-driven economy. One day maybe we’ll look back and remember how close we came to allowing Big Pharma to stand by and cry about how many billions of dollars they’ve lost on the global market while people with AIDS die because of a treatable illness simply because they lacked access to essential medicines. Thank goodness for physician advocates like Paul Farmer who collaborated with other physicians and patient advocate groups to bring the heat to Big Pharma to take responsibility. Not from a financial perspective, but out of a moral imperative. It is what makes us human.

  • The idea that Medicare and Medicaid don’t negotiate prices isnt wrong. But it is overly reductive to the point where it is not a valid argument. Insurers negotiate to serve those plans then force drug makers to substantially lower their list prices for government formularies. That’s the rationale for not having another layer of negotiation. Also, saying healthcare spending is right behind defense spending is like saying RC cola sales are right behind Pepsi sales. Specious argument. Generally expect better than this from STAT. The fact STAT is allowing a contributor to laud the (non) ideology of an ignorant bigot is even worse.

  • One wonders if the good doctor realizes that ALL of Trump’s ideas about the drug companies originated with the Bernie Sanders campaign? Bernie is the one pounding the FDA over the head to allow generics to overcome phony patent claims.

  • Yet, this is the party that wants to shut down government – including the important work done by public health officials, the CDC, and the EIS. I think it’s a little dangerous to support Trump’s statements on drug prices (and I do agree with your concerns about paid lobbying) without mentioning that fact.

  • I guess it never entered your mind that “The fact that Medicare is forbidden in the law that created Medicare Part D to negotiate lower prices is no accident.” – this is not a Trump idea, but it is a hit against Clinton, making this a Political Advertisment, negotiation was deliberately not allowed by the GOP Senators during the debate on part D – see http://www.ncpssm.org/EntitledtoKnow/entryid/2061/negotiating-for-lower-drug-costs-in-medicare-part-d

  • It is my impression that Trump will say pretty much anything to appeal to popular “demons”–whether they be big pharma, trial lawyers, illegal immigrants, lefty journalists, etc. So his being “right” on pharma is, in my view, more or less an accident of self-promotion, not based on either real conviction or knowledge. Even if it were, it is clear his party has blocked every one of the potential changes this piece mentions. If you look at where pharma campaign contributions are going in general, they are about 65-70% to the Rs as things now stand. And whatever the President’s positions, even if sincere, will not move an R-dominated Congress.

  • Why is it that no one is bringing up the profits and salaries of physicians? Drug companies such as the ones that developed Sovaldi (which CURES hepatitis C, previously thought impossible) get cast as the bad guys. Physicians are averaging base salaries of 300k per year (excluding bonuses, referral incentives, etc.) with some making over 800k solely based on billing (and not factoring in other side business such as partial ownership of compounding pharmacies). The scientists that developed Sovaldi aren’t making anywhere near that. We blame the people inventing cures for disease while the people that administer the treatment make out like bandits.

    • Big Pharma contributes to that problem, too, in a Huge way. They employ thousands of MDs, all making from $200,000 to $400,000 and up, to NOT practice medicine but instead help promote and sell junk medicines. If those thousands were out there practicing actual medicine, the price of those professional services would inevitably drop. In just one large drug company whose records I saw, there were over 900 MDs employed to do durg promotion in one form or another. Most of the “science” is done in universities and small companies.

  • Any commentary on “medical ethics” that does not start with an examination of the role of the non-value-added insurance industry is intellectually bankrupt. Why are Medicare/Medicaid singled out for lack of negotiating power? Why is the pharma industry singled out for profit motivation?

    • Agreed, they should be the first to go and the displaced executives and workers should have no trouble finding a job since Trump is going to “grow the Economy”

  • If you would like information on the law passed by Congress in 2003 that, to this day prevents Medicare from negotiating drug prices, look up: Medicare Part D. 14 law makers resigned immediately afterwards to work in the pharma industry.

  • Avandia treats the cause of diabetes and diabetic complications; insulin resistance. It has saved my life! CVD dropped between 1997 and 2007 when Avandia use was on the rise and increased since TZD/Avandia use has fallen.

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