Rachel Yu, Class of 2023
An increasingly larger proportion of individuals have become dependent on prescription drugs to treat life-threatening conditions. Now, what if these prescriptions were no longer affordable to one who relied on it? This is the dilemma that many face as a result of increasing drug prices.
In 2015, the price of a drug called Daraprim increased from $13.50 a tablet to $750, approximately 550% of its original price (Pollack 2015). This happened soon after the company bought out cheaper, generic drugs. Daraprim is used to treat toxoplasmosis, a parasitic infection that can be transferred from mother-to-infant during pregnancy (Pollack 2015). Using the life-saving drug is the most standard option for those with toxoplasmosis and while there are alternative treatments, Daraprim is considered the most reliable. The company that owns Daraprim, Turing Company, justifies that “the drug is so rarely used that the impact on the health system would be minuscule” and they would “use the money it earns to develop better treatments for toxoplasmosis, with fewer side effects'' (Pollack 2015). However, the price hike results in patients paying hundreds of thousands annually.
Daraprim is not the only example of price increases. There are specialized medicines, like Cuprimine and Syprine that treat Wilson’s disease, where the body can't process copper (Petersen 2016). On the other hand, there are common drugs, like insulin or Epipens®, that have also been experiencing similar price increases. The unreasonable costs of life-saving drugs can be traced back to the beginning of biotechnology firms that patented drugs that could treat diseases that were previously considered untreatable. Dr. Roy Valego reasoned that “[he] accepted that that was the price set by the marketplace because there was no alternative” (Marshall 2017). This is a common sentiment felt by patients who rely on these drugs because the product served as the sole treatment option, allowing companies to assign any monetary value to the drug. Another cause of high drug costs comes from the structure of pharmaceutical development. In a pharmaceutical company, research for the drug is costly while the manufacturing and distribution costs are significantly lower (McLaughlin 2017). It is the discovery of the drug that is valuable rather than the cost of the physical substance (McLaughlin 2017).
Although pharmaceutical companies create products that serve to treat those with medical conditions, the continuous price hikes make it hard to distinguish whether those intentions are valid. It has become increasingly apparent that these corporations have financial motives to maximize profits that outweigh the altruism of treating those with rare conditions. With each price hike of a life-saving drug, the moral ethics of pharmaceutical companies are once again scrutinized.
Along with these companies, the ethics of the government and physicians are brought into question because they are also involved in pharmacy benefit management (Burton et al. 2001). In addition, the business aspect of pharmaceutical companies tends to conflict with the physician’s relationship with a patient. Those of a medical profession are often sworn by the Hippocratic Oath, which requires them to uphold professional ethical standards in regards to medicine (NIM 2002). This means to prioritize a patient’s care first. However, the increasing costs of prescription drugs for physicians to truly follow their ethical standards. This is a concern as the burdens of increasing prices fall mostly onto patients, who find it harder to afford the medicine they need (McLaughlin 2017). Furthermore, there is unequal access to life-saving drugs based on one’s socioeconomic status, causing those in financially unstable conditions to be the most vulnerable patients.
Since pharmaceutical companies are businesses, it is understandable that these companies attempt to achieve “economic efficiency” (Burton et al. 2001). However, it is essential that companies achieve their business ventures while respecting the moral ethics of medicine. This can be done by following what we can consider the fundamental values of medical ethics (Burton et al. 2001).
Pharmaceutical companies need to help the sick. Their role is to allow all patient’s access to drugs that are necessary for their well being.
Pharmaceutical companies need to prevent disproportionate access to life-saving drugs. This means ensuring the treatment of more disadvantaged patients.
Pharmaceutical companies need to give physicians and patients choices in treatment. Monopolizing the treatment of one condition is not an ethical practice.
Pharmaceutical policies should allow the physician to maintain ethical practices and sustain proper physician-patient dynamics.
The current trend of increasing prices hinders the fundamental ethical practices of medicine. It is, therefore, the responsibility of pharmaceutical companies to alter their policies, practices, and pricing to create a proper balance between their economics and ethical considerations.
References
Burton S.L, Randel L, Titlow K, Emanuel E.J. 2001 Sept/Oct. The ethics of pharmaceutical benefits management. Health Affairs [Internet]. [cited 2020 Jan.]; 20(5): 150-163. Available from: https://doi.org/10.1377/hlthaff.20.5.150
Marshall S. 2017 Mar. The great debate on the ethics of pricing in the drug industry [Internet]. [cited 2020 Jan]. Available from: https://www8.gsb.columbia.edu/leadership/ethicsofpricing
McLaughlin D. 2017 Aug. An ethical approach to pharmaceutical price increase in the united states. Lindmark Fellowship in Ethics [Internet]. [cited 2020 Jan]. Available from: https://digitalcommons.csbsju.edu/elce_lindmark/2/
Mozes A. 2019 Jul. Many take antibiotics without prescription, endangering efficacy. HealthDay News [Internet]. [2020 Jan]. Available from: https://cdnph.upi.com/svc/sv/upi_com/1571563884859/2019/1/db064044e5179e3570ef93ad167651d8/Many-take-antibiotics-without-prescription-endangering-efficacy.jpg
National Library of Medicine. 2002. Greek Medicine [Internet]. Bethesda, MD: National Library of Medicine; [cited 2020 Jan]. Available from: https://www.nlm.nih.gov/hmd/greek/greek_oath.html
Pollack A. 2015 Sept. Drug goes from $13.50 a tablet to $750, overnight. The New York Times [Internet]. [cited 2020 Jan]. Available from: https://www.nytimes.com/2015/09/21/business/a-huge-overnight-increase-in-a-drugs-price-raises-protests.html
Petersen M. 2016 Dec. How 4 drug companies rapidly raised prices on life-saving drugs. LA times [Internet]. [2020 Jan]. Available from: https://www.latimes.com/business/la-fi-senate-drug-price-study-20161221-story.html
In 2015, the price of a drug called Daraprim increased from $13.50 a tablet to $750, approximately 550% of its original price (Pollack 2015). This happened soon after the company bought out cheaper, generic drugs. Daraprim is used to treat toxoplasmosis, a parasitic infection that can be transferred from mother-to-infant during pregnancy (Pollack 2015). Using the life-saving drug is the most standard option for those with toxoplasmosis and while there are alternative treatments, Daraprim is considered the most reliable. The company that owns Daraprim, Turing Company, justifies that “the drug is so rarely used that the impact on the health system would be minuscule” and they would “use the money it earns to develop better treatments for toxoplasmosis, with fewer side effects'' (Pollack 2015). However, the price hike results in patients paying hundreds of thousands annually.
Daraprim is not the only example of price increases. There are specialized medicines, like Cuprimine and Syprine that treat Wilson’s disease, where the body can't process copper (Petersen 2016). On the other hand, there are common drugs, like insulin or Epipens®, that have also been experiencing similar price increases. The unreasonable costs of life-saving drugs can be traced back to the beginning of biotechnology firms that patented drugs that could treat diseases that were previously considered untreatable. Dr. Roy Valego reasoned that “[he] accepted that that was the price set by the marketplace because there was no alternative” (Marshall 2017). This is a common sentiment felt by patients who rely on these drugs because the product served as the sole treatment option, allowing companies to assign any monetary value to the drug. Another cause of high drug costs comes from the structure of pharmaceutical development. In a pharmaceutical company, research for the drug is costly while the manufacturing and distribution costs are significantly lower (McLaughlin 2017). It is the discovery of the drug that is valuable rather than the cost of the physical substance (McLaughlin 2017).
Although pharmaceutical companies create products that serve to treat those with medical conditions, the continuous price hikes make it hard to distinguish whether those intentions are valid. It has become increasingly apparent that these corporations have financial motives to maximize profits that outweigh the altruism of treating those with rare conditions. With each price hike of a life-saving drug, the moral ethics of pharmaceutical companies are once again scrutinized.
Along with these companies, the ethics of the government and physicians are brought into question because they are also involved in pharmacy benefit management (Burton et al. 2001). In addition, the business aspect of pharmaceutical companies tends to conflict with the physician’s relationship with a patient. Those of a medical profession are often sworn by the Hippocratic Oath, which requires them to uphold professional ethical standards in regards to medicine (NIM 2002). This means to prioritize a patient’s care first. However, the increasing costs of prescription drugs for physicians to truly follow their ethical standards. This is a concern as the burdens of increasing prices fall mostly onto patients, who find it harder to afford the medicine they need (McLaughlin 2017). Furthermore, there is unequal access to life-saving drugs based on one’s socioeconomic status, causing those in financially unstable conditions to be the most vulnerable patients.
Since pharmaceutical companies are businesses, it is understandable that these companies attempt to achieve “economic efficiency” (Burton et al. 2001). However, it is essential that companies achieve their business ventures while respecting the moral ethics of medicine. This can be done by following what we can consider the fundamental values of medical ethics (Burton et al. 2001).
Pharmaceutical companies need to help the sick. Their role is to allow all patient’s access to drugs that are necessary for their well being.
Pharmaceutical companies need to prevent disproportionate access to life-saving drugs. This means ensuring the treatment of more disadvantaged patients.
Pharmaceutical companies need to give physicians and patients choices in treatment. Monopolizing the treatment of one condition is not an ethical practice.
Pharmaceutical policies should allow the physician to maintain ethical practices and sustain proper physician-patient dynamics.
The current trend of increasing prices hinders the fundamental ethical practices of medicine. It is, therefore, the responsibility of pharmaceutical companies to alter their policies, practices, and pricing to create a proper balance between their economics and ethical considerations.
References
Burton S.L, Randel L, Titlow K, Emanuel E.J. 2001 Sept/Oct. The ethics of pharmaceutical benefits management. Health Affairs [Internet]. [cited 2020 Jan.]; 20(5): 150-163. Available from: https://doi.org/10.1377/hlthaff.20.5.150
Marshall S. 2017 Mar. The great debate on the ethics of pricing in the drug industry [Internet]. [cited 2020 Jan]. Available from: https://www8.gsb.columbia.edu/leadership/ethicsofpricing
McLaughlin D. 2017 Aug. An ethical approach to pharmaceutical price increase in the united states. Lindmark Fellowship in Ethics [Internet]. [cited 2020 Jan]. Available from: https://digitalcommons.csbsju.edu/elce_lindmark/2/
Mozes A. 2019 Jul. Many take antibiotics without prescription, endangering efficacy. HealthDay News [Internet]. [2020 Jan]. Available from: https://cdnph.upi.com/svc/sv/upi_com/1571563884859/2019/1/db064044e5179e3570ef93ad167651d8/Many-take-antibiotics-without-prescription-endangering-efficacy.jpg
National Library of Medicine. 2002. Greek Medicine [Internet]. Bethesda, MD: National Library of Medicine; [cited 2020 Jan]. Available from: https://www.nlm.nih.gov/hmd/greek/greek_oath.html
Pollack A. 2015 Sept. Drug goes from $13.50 a tablet to $750, overnight. The New York Times [Internet]. [cited 2020 Jan]. Available from: https://www.nytimes.com/2015/09/21/business/a-huge-overnight-increase-in-a-drugs-price-raises-protests.html
Petersen M. 2016 Dec. How 4 drug companies rapidly raised prices on life-saving drugs. LA times [Internet]. [2020 Jan]. Available from: https://www.latimes.com/business/la-fi-senate-drug-price-study-20161221-story.html
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