Why did the price of an EpiPen soar to nearly $700 last year? Why has insulin grown so expensive that some diabetics are forced to ration its use? And why do Americans pay more for medicine than anywhere else in the world — when, just about two decades ago, our costs were middling compared to other nations?
Those questions, and more, are the focus of Michael Kinch and Lori Weiman’s new book, “The Price of Health: The Modern Pharmaceutical Enterprise and the Betrayal of a History of Care.” The two authors both have experience in the pharmaceutical industry and went into their research seeking to discover what had gone wrong.
A vice chancellor at Washington University and the author of previous, well-reviewed books on vaccinations and innovations in cancer treatment, Kinch explained on Thursday’s St. Louis on the Air that he went in with no preconceived thesis.
“I'm a scientist, and I'm a data guy. And I was talking with my wife, who in full disclosure works for Pfizer, and we were talking about drug pricing,” he recalled on Thursday’s St. Louis on the Air. “And she said, ‘You know, you really need to write a book about that.’”
He countered that he knew nothing about the subject. “And she said: ‘That's exactly why you need to write it. Go in objective, as a science wonk. Go in and really look at it with naive eyes and see what's going on.’ And it was revealing because I went in as a scientist assuming that science was the problem. And it is to some degree, but it's also largely an economics problem. And it's a sort of human problem.”
Ultimately, the authors write, it’s far more complicated than news reports suggest. In many cases, good intentions have combined with an overly complex system and the temptations of capitalism to endlessly escalate the price of medicine. The result, Kinch and Weiman conclude, is a labyrinthian economy underwritten by a pricing system that comes down to a simple question: “What will the market bear?” And so even as the federal government spends billions to subsidize drug development, everyone from Wall Street to universities to an endless string of biotech firms handling one part of the process have their hand out to cash in along the way.
“[I]t used to be that to develop a medicine was one company and maybe to distribute it was another,” Kinch explained on air. “Now there are three, four, five, six companies involved in that pipeline. And the consequence is that all of them want to maximize their profits, all the shareholders — which is oftentimes, by the way, you and me — want to maximize their profits. The consequence is that not only has this become more expensive, but when there are six or seven different players involved in it, they can all point fingers at the others and deflect the blame from themselves on to others.”
Added Kinch, “It's maddening, because while it's a financial game to some of these folks, it's life or death for people that can't afford their medicines.”
During the discussion, Kinch described a few specific cases of medications whose prices have soared, as well as well-intentioned policies that have only made things worse. But, he said, he sees hope for change to a broken, inefficient and bloated system.
“I'm actually very optimistic that the COVID-19 situation gives us an opportunity to rethink the system,” he said. “We've seen companies come out of nowhere: Moderna is a company that probably most people had not heard of; BioNTech, which partnered up with Pfizer. And they've had a partnership with the FDA that has allowed for truly remarkable progress to be made. And this was being made because these organizations were working together: private sector, public sector, coming together. Academics were contributing. And I think we can keep that spirit; we can move it forward.”
He believes his book can play an important role in that movement.
“We can now see what the problems are,” he explained. “And once you know what the problems are, you can start to address them. In the past the frustration has been that there are so many different types of industries involved, they can all point the finger at one another. Instead of pointing fingers, let's fix it. And I think that that's where the big hope is, that as we continue to peel back the layers of the onion — this book alone isn't going to do it — but as we get more and more pressure to do so, that will allow us to fix the problem.”
“St. Louis on the Air” brings you the stories of St. Louis and the people who live, work and create in our region. The show is hosted by Sarah Fenske and produced by Alex Heuer, Emily Woodbury, Evie Hemphill and Lara Hamdan. The audio engineer is Aaron Doerr.
