The doctor can't see you now

America's drug problem

We dive into the pharmaceutical industry, so buckle up! As a side note, we reference Karendia (finerinone) as an expensive drug (around $800 a month list price) with minimal benefits. It provides 3-4% reduction in people having decreases in their GFR (a measure of kidney function) over 4 years, but no benefits in death, kidney failure, hospitalizations, heart attacks, strokes or any of the other things they measured. This is one of the medications that is being pushed on everyone with kidney disease but really is far too expensive to make sense with that little benefit. It would cost over $1,000,000 over 4 years for 1 person in 30 to not have a 40% reduction in the GFR with no other appreciable benefits. Here's the trial - https://www.nejm.org/doi/full/10.1056/NEJMoa2025845 References: https://repository.si.edu/bitstream/handle/10088/97768/Daemmrich%20PharmaMfg%20PharmHist%202017.pdf?sequence=1 [https://repository.si.edu/bitstream/handle/10088/97768/Daemmrich%20PharmaMfg%20PharmHist%202017.pdf?sequence=1] - history of pharmaceutical manufacturing https://pharmaphorum.com/r-d/a_history_of_the_pharmaceutical_industry [https://pharmaphorum.com/r-d/a_history_of_the_pharmaceutical_industry] - more history https://jamanetwork.com/journals/jama-health-forum/fullarticle/2811344 [https://jamanetwork.com/journals/jama-health-forum/fullarticle/2811344] - PBMs https://www.help.senate.gov/imo/media/doc/big_pharmas_business_model_report.pdf [https://www.help.senate.gov/imo/media/doc/big_pharmas_business_model_report.pdf] - profits in Pharma https://www.fda.gov/drugs/special-features/manufacturers-mouth-your-ears-direct-consumer-advertising [https://www.fda.gov/drugs/special-features/manufacturers-mouth-your-ears-direct-consumer-advertising] - DTC advertising https://www.propublica.org/article/doctors-prescribe-more-of-a-drug-if-they-receive-money-from-a-pharma-company-tied-to-it [https://www.propublica.org/article/doctors-prescribe-more-of-a-drug-if-they-receive-money-from-a-pharma-company-tied-to-it] - Doctors’ prescribing patterns https://lowninstitute.org/more-than-half-of-doctors-receive-industry-payments-with-some-making-millions/ [https://lowninstitute.org/more-than-half-of-doctors-receive-industry-payments-with-some-making-millions/] - industry payments https://jamanetwork.com/journals/jama-health-forum/fullarticle/2804378 [https://jamanetwork.com/journals/jama-health-forum/fullarticle/2804378] - drug research money source https://www.raps.org/news-and-articles/news-articles/2019/4/how-biopharma-companies-use-nih-and-vice-versa [https://www.raps.org/news-and-articles/news-articles/2019/4/how-biopharma-companies-use-nih-and-vice-versa] - NIH royalties https://www.gao.gov/prescription-drug-spending [https://www.gao.gov/prescription-drug-spending] - Govt prescription spending https://oig.hhs.gov/reports-and-publications/featured-topics/drug-spending/ [https://oig.hhs.gov/reports-and-publications/featured-topics/drug-spending/] - Govt drug spending https://www.aafp.org/pubs/afp/afp-community-blog/entry/will-the-high-price-of-gene-therapy-for-sickle-cell-disease-put-this-cure-out-of-reach.html#:~:text=The%20approval%20of%20Casgevy%2C%20which,distributional%20cost%2Deffectiveness%20analysis%20standards [https://www.aafp.org/pubs/afp/afp-community-blog/entry/will-the-high-price-of-gene-therapy-for-sickle-cell-disease-put-this-cure-out-of-reach.html#:~:text=The%20approval%20of%20Casgevy%2C%20which,distributional%20cost%2Deffectiveness%20analysis%20standards]. - sickle cell example https://www.fiercepharma.com/pharma/top-20-pharma-companies-2023-revenue [https://www.fiercepharma.com/pharma/top-20-pharma-companies-2023-revenue] - Pharma Revenue https://www.npr.org/2024/04/12/1244509038/u-s-drug-makers-see-big-profits-but-many-pay-taxes-far-below-the-corporate-rate [https://www.npr.org/2024/04/12/1244509038/u-s-drug-makers-see-big-profits-but-many-pay-taxes-far-below-the-corporate-rate] - drug company taxes https://www.gao.gov/products/gao-18-40 [https://www.gao.gov/products/gao-18-40] - drug company profit margins https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2690298/ [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2690298/] - History of drug advertising https://www.pharmacytimes.com/view/are-pbms-downplaying-their-profits [https://www.pharmacytimes.com/view/are-pbms-downplaying-their-profits] - PBM profits https://www.nbcnews.com/health/health-news/gaming-us-patent-system-keeping-drug-prices-sky-high-report-says-rcna47507 [https://www.nbcnews.com/health/health-news/gaming-us-patent-system-keeping-drug-prices-sky-high-report-says-rcna47507] - “Evergreening” and patent thickets

Follow the money

Tatumn, Krista and Matt cover a broad overview of the perverse incentives in American healthcare and the many parties involved in making it happen. Resources: https://www.commonwealthfund.org/publications/fund-reports/2024/sep/mirror-mirror-2024?utm_source=twitter&utm_medium=social&utm_campaign=Improving+Health+Care+Quality [https://www.commonwealthfund.org/publications/fund-reports/2024/sep/mirror-mirror-2024?utm_source=twitter&utm_medium=social&utm_campaign=Improving+Health+Care+Quality] - America vs peer countries https://data.worldbank.org/indicator/SP.DYN.LE00.IN?end=2022&most_recent_value_desc=true&start=1960&view=chart [https://data.worldbank.org/indicator/SP.DYN.LE00.IN?end=2022&most_recent_value_desc=true&start=1960&view=chart] - world bank life expectancy  https://www.pgpf.org/blog/2024/08/how-does-the-us-healthcare-system-compare-to-other-countries#:~:text=In%202022%2C%20the%20United%20States,per%20capita%20across%20similar%20countries [https://www.pgpf.org/blog/2024/08/how-does-the-us-healthcare-system-compare-to-other-countries#:~:text=In%202022%2C%20the%20United%20States,per%20capita%20across%20similar%20countries]. - US spending per capita  https://www.definitivehc.com/blog/the-difference-between-non-profit-and-for-profit-hospitals [https://www.definitivehc.com/blog/the-difference-between-non-profit-and-for-profit-hospitals] - non-profit vs for-profit hospitals https://lowninstitute.org/the-rising-danger-of-private-equity-in-healthcare/ [https://lowninstitute.org/the-rising-danger-of-private-equity-in-healthcare/] - private equity https://www.jabfm.org/content/early/2024/08/30/jabfm.2024.240187R0 [https://www.jabfm.org/content/early/2024/08/30/jabfm.2024.240187R0] - EHR burnout https://www.reuters.com/legal/litigation/healthcare-software-giant-epic-hit-with-lawsuit-over-us-patient-records-2024-09-23/ [https://www.reuters.com/legal/litigation/healthcare-software-giant-epic-hit-with-lawsuit-over-us-patient-records-2024-09-23/] - Epic lawsuit https://www.pgpf.org/blog/2023/04/almost-25-percent-of-healthcare-spending-is-considered-wasteful-heres-why [https://www.pgpf.org/blog/2023/04/almost-25-percent-of-healthcare-spending-is-considered-wasteful-heres-why] - waste in healthcare https://www.ama-assn.org/press-center/press-releases/ama-studies-show-continued-cost-burden-medical-liability-system [https://www.ama-assn.org/press-center/press-releases/ama-studies-show-continued-cost-burden-medical-liability-system] - malpractice burden on physicians https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3048809/ [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3048809/] - costs of litigation

The doctor can't see you now

Dive into the primary care crisis with Tatumn, Krista and Dr. Matt. We discuss why it's so hard to get in to see a doctor and things fueling the primary care crisis in America. Links to research/resources: https://www.ecgmc.com/insights/whitepaper/the-waiting-game-new-patient-appointment-access-for-us-physicians [https://www.ecgmc.com/insights/whitepaper/the-waiting-game-new-patient-appointment-access-for-us-physicians] - appointment waiting times https://www.jucm.com/pros-and-cons-of-urgent-care-vs-primary-care-billing-for-urgent-care-services/ [https://www.jucm.com/pros-and-cons-of-urgent-care-vs-primary-care-billing-for-urgent-care-services/] - Cost of Urgent Care https://www.debt.org/medical/emergency-room-urgent-care-costs/ [https://www.debt.org/medical/emergency-room-urgent-care-costs/] - Urgent care vs ER costs https://bhw.hrsa.gov/sites/default/files/bureau-health-workforce/data-research/state-of-primary-care-workforce-2023.pdf [https://bhw.hrsa.gov/sites/default/files/bureau-health-workforce/data-research/state-of-primary-care-workforce-2023.pdf] - Primary care shortage https://link.springer.com/article/10.1007/s11606-022-07707-x [https://link.springer.com/article/10.1007/s11606-022-07707-x] - time for primary care visits https://www.jabfm.org/content/29/4/496.full [https://www.jabfm.org/content/29/4/496.full] - panel sizes https://jamanetwork.com/journals/jama-health-forum/fullarticle/2802144 [https://jamanetwork.com/journals/jama-health-forum/fullarticle/2802144] - appointment times https://www.usnews.com/news/best-states/articles/2020-03-17/10-states-with-the-longest-emergency-room-wait-times [https://www.usnews.com/news/best-states/articles/2020-03-17/10-states-with-the-longest-emergency-room-wait-times] - ER wait times