Cost of insulin on the rise, health risks of homelessness, and conflict between law and health

February 25, 2016

In order to bring you more of the news you want to read, RightCare Weekly summarizes and interprets three important articles and provides headlines linking to the many other articles and editorials you’ll find interesting. As always, RightCare Weekly presents articles related to moving our healthcare system toward the right care for all patients.

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Insulin is one of the oldest drugs around, yet the price of this essential medicine keeps rising, with no generic in sight.  In the face of insulin’s rising price, some diabetic patients are skipping doses or skimping on their recommended dose. Three pharmaceutical titans manufacture insulin in the U.S. and their combined profits for 2014—made up partly by insulin sales—accounted for more than $12 billion. In a New York Times piece, endocrinologist Kasia Lipska says that Eli Lilly, Sanofi and Novo Nordisk have extended the lives of the patents they hold for insulin products by making small tweaks to them, preventing generics from entering the market. At the same time, pharmacy benefit managers (PBMs), companies that are supposed to negotiate drug prices on behalf of insurers for employer and government plans, receive hefty “rebates” from pharma based on sales they broker (along with other criteria). “Benefit managers are supposed to be driving down costs, but the system incentivizes them to choose the products with the largest rebates,” asserts Lipska, who calls for transparency in pricing. “Sure, we need to protect the intellectual capital of pharmaceutical companies so that they continue to invest in innovative new drugs. But those drugs should ultimately result in better health for patients, not just wider profit margins.” MarketWatch reports that Eli Lilly increased its U.S. revenue by 15% for the fourth-quarter, in large part due to insulin sales. When John Lechleiter, the CEO, was asked by analysts about the high cost of its drug, he acknowledged it and said “but disease is a lot more expensive.”

Being homeless is bad for your health, as illustrated by an outbreak of meningococcal infection among the homeless population in Boston. The Boston Globe reported that the outbreak led to one fatality and compelled public health officials to launch a vaccination campaign for the hundreds of Bostonians who live on the streets or frequent adult homeless shelters. A Forbes writer, Judy Stone, points out that “the rise in homelessness in the wealthiest country comes at the same time as we spent 54% of federal discretionary spending, or $598.5 billion, on military spending…equaling that of the next nine countries’ military budgets combined.” She concludes “the meningococcal cluster in Boston’s homeless population suggests that perhaps we would do well to reassess our priorities.” The waste in U.S. health care is perhaps another misallocation of money that might be better spent alleviating homelessness. At least one person, a San Francisco software developer, should take note. On Wednesday, Justin Keller’s caustic open letter addressed to the mayor and police chief of Fog City lit up social media; the millennial had been inconvenienced by the “riff raff” who were turning the city into a “filthy shanty town. I shouldn’t have to see the pain, struggle, and despair of homeless people to and from my way to work every day,” he wrote. Poor him.

David Berger, MD, district medical officer in emergency medicine at Broome Hospital in Australia, wrote this week of the incredible “conflict between today’s law of the land and the right of doctors to do what they think is best for their patients.” As Berger reported in The BMJ, the Australian government plans to return a young baby of asylum seekers to a refugee detention center, a place with leaking tents and a rat infestation, where her doctors believe she will not be safe. These doctors are now protesting the government’s decision by refusing to discharge her, and may face jail time for doing so. Berger explains, “The actions of the Brisbane doctors, then, are not simply a piece of political grandstanding, but the courageous stand of professionals seeking to do the right thing by their patient and to live up to the standards of an ethical code by which they are morally and quasi-judicially bound, and which places patient welfare at its pinnacle.” Sometimes doing the right thing requires action and bravery.



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