2017 Shkreli Awards
Abstract: A top ten list of the worst examples of profiteering and dysfunction in health care, named for Martin Shkreli, the price-hiking "pharma bro" that everyone loves to hate.
At the end of the year, most blogs will write a “Best Of” list for the year. But this holiday season, we’re doing the opposite — highlighting the most egregious examples of profit-mongering and lack of empathy in health care in 2017.
Welcome to The 2017 Inaugural Shkreli Awards named for Martin Shkreli, the cocky pharma “bro” that everyone loves to hate. (Shkreli, the former CEO of Turing Pharmaceuticals, is best known for unapologetically buying up long-established drugs and raising the prices astronomically.)
Our hope is not just to shock you with these stories, but to show what can happen when our health care system is based on profit rather than patient well-being. These may be exceptional cases, but waste, profit-mongering, overuse, and underuse happen every day in our health care system.
Congress leaves low-income children without insurance.
Bah, humbug. The Christmas gift that so many families were hoping to get from Congress didn’t come this year. For the first time since its creation in 1997, Congress has let funding expire for the Children’s Health Insurance Program (CHIP). CHIP covers about 9 million children and 320,000 pregnant women in the US, mostly in the low-to-moderate income level. On December 21, Congress provided funding to sustain CHIP through March, but several states are close to shutting down the program if more funding isn’t authorized before the end of January. Unfortunately, this is just the latest example of our health care system failing children.
Neurosurgeons double-booked surgeries at Swedish Health.
Overlapping surgeries, in which a surgeon is overseeing more than one operation at once, is a common practice at academic medical centers. But a Seattle Times investigation found that top neurosurgeons at Swedish Health were taking this practice to a new level, overlapping surgeries for more than half of their cases. Patients had no idea their doctor was conducting another surgery at the same time, and said they would not have consented to the procedure if they had known.
Psychiatric hospital lets patients die, still makes a profit.
In 2017, disturbing issues at the Arbour Health System, a chain of psychiatric hospitals in New England, came to light. Arbour is making a significant profit, but they have been repeatedly cited for filthy conditions, lack of quality control, and mismanagement leading to patient deaths. Possibly the most shocking example was in August, when Arbour employees failed to prevent one patient from beating another to death, and did not notify Boston Police about the incident.
Sarepta influences FDA testimony through patients’ parents.
Industry influence in patient advocacy groups became a hot topic when the FDA approved eteplirsen, a drug to treat Duchenne Muscular Dystrophy, based heavily on parents’ accounts of their children’s clinical improvement. A report from the Wall Street Journal in May found that a consultant from Sarepta Therapeutics, the maker of epitlersen, had guided patients through the approval process and helped them create “slickly packaged testimony” for the FDA. For taking advantage of parents desperate to find a cure for their children, in order to get their drug approved without sufficient evidence, Sarepta deserves a spot in the Shkreli Awards.
Insulin manufacturers jack up the prices.
This year, Eli Lilly took a leaf straight from the Shkreli playbook and raised the price of insulin, a drug that 30 million diabetics in the US need to stay alive, to $400 a month. Eli Lilly, along with the two other manufacturers of insulin in the US, have raised their prices year after year by slightly adjusting their insulin formulations to get new patents and avoid generic competition. They call it “innovation,” we call it Corruption.
Fraudulent treatment centers recruit addicted patients, then strand them.
As the opioid crisis has escalated, the need for addiction treatment has greatly increased. Unfortunately, some treatment centers have been using the crisis to exploit addicts’ insurance reimbursements without providing needed services, the Boston Globe and STAT reported this year. Fraudulent treatment centers even employ “patient brokers” to recruit addicted patients from out of state with the promise of free transportation and accommodations. This patient pipeline feeds hundreds of treatment centers in Palm Beach county, known as the “Recovery Capital of America.”
Drug companies make eye drops too big so you buy more.
Ever notice how when you use eye drops, some drops usually spill out of your eye and onto your cheek? Ever wonder why that is? Drug companies like Novartis, Pfizer, and Allergan know that their eye drops are wasteful, but they continue making them too large because it makes them more money to have patients buying eye drops more often. This may not be a big deal for regular saline drops, but for patients who need eye drops for glaucoma, that’s $295 per bottle that needs to be refilled again and again. For drug companies, that waste helps them make $3.4 billion in annual profits on eye drops.
Sackler family makes billions off opioid crisis.
We would be remiss not to include in the Shkreli awards the actors involved in perpetuating and escalating the opioid crisis. Esquire’s profile of the Sackler family demonstrates how one family has built an empire on drug marketing and continues to profit from America’s opioid addiction. The Sacklers made billions by marketing Oxycontin as a chronic pain cure-all while downplaying the risks. Their name is prominently displayed on galleries and museums, but conspicuously absent from their company, Purdue Pharma.
Child dies from lack of basic dental care.
This second award goes to the American dental health system, for allowing a 4-year-old to die from sedation during a dental procedure. The case was highlighted as an example of “an avoidable tragedy” in the journal Pediatrics, not just because surgery under sedation is not recommended for children, but because the boy’s cavities could have been prevented with access to regular dental checkups. Until dental health is recognized as a component of overall health and more effort is made to expand access to dental care, Americans will continue to be harmed from lack of preventive dental care.
Allergan transfers patent to Native American tribe.
Drugmaker Allergan gets the first spot in our Shkreli Awards for their gambit to protect a patent by transferring it to a Native American tribe. In September, Allergan announced the sale of the patent for their dry-eye drug Restasis to Saint Regis Mohawk Tribe for $13.75 million (and $15 million in annual royalties). This would allow Allergan to benefit from the tribe’s “sovereign immunity” to patent challenges. Several Democratic Congressmen harshly criticized Allergan for using a “brazen loophole” to shield themselves from competition. Fortunately, in October federal judge William Bryson ruled the patent invalid, making it clear that drug companies will not be able to get away with “renting” sovereign immunity.