The accountants rule

I have nothing wrong with accountants. They pay attention to the little details in numbers that I some how don't understand. I have an accountant I use to do my taxes and take care of my financial stuff. My husband has an MBA and he can explain all the financial stuff on a level that I need to understand.

I used to work for a company where each year when I had to present my budgets to accountants, they drew straws on who would have to deal with me. Because I wasn't enough of a numbers person for them. I know they are important. But they also can be too focused on numbers and not on people.

Now we have a problem. Big pharma companies are beginning to focus on their profits and not on creating better medications for patients. Why? Because now that the accountants are beginning to rule.

In the last few decades it has not been unusual for pharma companies, and others, to merge, move, and streamline themselves for financial reasons. Have a competitor? Buy him out, problem solved. Some one designed a good product? Buy them out and take advantage of their technology.

But now big pharma companies are taking it a step farther. They are letting their accountants take over and make BIG financial decisions to take better care of their bottom line. First they are moving to countries with lower tax rates. Then they will lose a lot of staff and potentially stifle innovation as they hire new scientists who start over in development, but they will save a lot of money over all. And example of this is Pfizer which is buying Allergan.

"Pfizer is the largest drug maker in the United States, but after striking a deal on Monday to buy Allergan, the company is on the verge of becoming Irish.

For shareholders, this may be their lucky charm. After the merger, Pfizer will be able to shift its legal headquarters from New York to Dublin and pay lower taxes, which should bolster its bottom line. 

But in the process, scientists are likely to lose their jobs, innovation may suffer, and consumers could pay more for Pfizer medicines."

To me this deal sounds like only the accountants and share holders will be happy. So I must ask: What about the patients?

Maybe its time for the politicians to step forward and say the US will negotiate with pharmaceutical companies for their medications, only if they are based in the US, paying US taxes, and hiring American citizens to work there? Just an idea.

Rich pharma companies, poor patients.

Pharmaceutical companies are getting rich on the backs of their patients. Don't believe me? Here's some proof.

First we have an article from New Jersey on how Roche's profits are up 10% and its revenues are up 4% on profits from its breast cancer drugs. The company is now focusing on cancer drugs and hopes to find more high profit drugs as generics come available for drugs such as Herceptin.  By the way, their cancer drugs cost between $70,000 and $100,000+ annually per patient.

If you ask a pharma company you get the standard lines: 'no one pays those prices', 'they are covered by insurance', 'we do have programs for those who are uninsured to help with the costs'.

But my point is why are they pricing them so high in the first place? List prices do not reflect costs, they usually reflect positioning. A price tag of $90,000/year reflects exclusivity. 'It must be good if it costs so much.'

Do you see the problem here? As other pharmaceutical companies, Roche is supposedly pricing its drugs so high to compensate for their high research and development costs. But look how profitable they are. This is a graph of their 2012 sales from their website:

And then here are are the sales from individual products:

(These numbers are in billions (with a b, not an m) Swiss francs which are currently worth $0.93.) Paltry profits of $16 billion on sales of $44 billion? That's pretty damn profitable if you ask me. Mabthera is an RA drug, Herceptin, Tarceva, Avastin, Xeloda are for cancer, Pegasys for Hepatitis C, and Lucentis is a diabetes drug.)

Also of note is the fact that Roche has negotiated with other countries to slash prices of the drugs there - I found examples in South Africa, India, and European countries. So the other countries - read the 'rich' US - gets to pay the big bucks? How not fair!

I'm sorry but I don't feel sorry for the pharmaceutical industry and how their research costs cause them to price drugs so high. But if their profits are so high and their employees are paid so highly, why are the patients bearing the brunt of the costs?

[I will note here that I am not targeting Roche for any reason. I came across the article from NJ.com on their profits in cancer drugs which I read and then did a little more research. I could probably write a similar article on other large pharma companies as well.]

When business interests come first

If you have wondered about why drugs cost so much? Here's an example where a pregnancy drug is going from $10 per dose to $1500 per dose.

It is a form of progesterone that has been available through compounding pharmacies for decades but now the FDA has approved a branded version which will be for sale for $1500 for each dose. The owners of the branded version will make lots of money. Compounding pharmacies will face lawsuits if they continue to offer nonbranded versions of the same formula. Doctors will be forced to prescribe the branded version because it has been tested and proven.

I don't blame the FDA here. Some one wanted to offer a branded version and jumped through the FDA's hoops to get the approval. I don't blame the doctors here either. If you were practicing and concerned about potential malpractice suits by telling patients to get an untested drug when there is a tested version out there, which would you prescribe to your patients?

I don't blame the insurance companies here either or the pharmaceutical companies. I blame the system that allows the business interests to come ahead of those of the patients. If something has been made available for years cheaply, why can some one brand it and offer it for such a high price? On the other hand, why can't they brand it either? I mean if they have a special compound and want to protect it, why not? Then there is the issue of lawsuit ready patients who are ready to sue at the drop of a hat.

But why does the system allow business interests to come ahead of the interests and health of patients and controlling costs? We are capitalists but shouldn't health come before wealth?

Respecting Patient Needs

Every person has their own comfort zone and needs which need to be met to ensure that they are able to cope with their medical appointments. Sometimes your comfort zone gets invaded but you also have to cope.

At my first cancer surgery, I was mortified to find out I woke up after the operation wearing a different gown than when I was sedated. Did they see me naked???? I didn't dare ask. I also remember the first time I went for a gynecological exam and it was a male doctor!!!! I had grown up with a female pediatrician and wasn't used to male doctors. I coped and was okay with it but mortally embarrassed.

In the case of Muslim men and women where there are strict guidelines on men and women being in the same room, never mind touching each other, if they are unmarried, medical exams can be restricted or just very difficult. It is not just Muslims that have this issue where their religion forbids it but anyone who's comfort zone does not allow for someone of the opposite sex to touch them. Some people are also just very modest and don't want someone of the opposite sex to touch them.

When my husband needed a primary care physician, I asked him his preference - male or female - and he definitely wanted a male doctor. To this day, I usually prefer a female doctor myself. Currently, the only male doctor I have is my back pain doctor. I think all the others are female, some by my decision and some by chance.

If you think about it, boys and girls are different (in many ways) and I prefer a doctor who has the same body parts I have. Ovarian cysts don't happen to boys. Hysterectomies don't happen to boys. I want a doctor who can understand my body better and what is going on with it.

I am not saying women should only have female doctors and men only have male, I am saying that this is what I am comfortable with personally. This is my comfort zone. If someone has the added issue of religious dictates, they should be respected as much as possible.