The Price of Health: The Modern Pharmaceutical Enterprise and the Betrayal of a History of Care

by Michael Kinch, Lori Weiman

Overview

From "pharma bros" to everday household budgets, just how did the pharmaceutical industry betray its own history—and how can it return to its tradition of care?

It’s an unfortunate and life-threatening fact: one in five Americans has skipped vital prescriptions simply because of the cost. These choices are being made even though we have reached a point in the conveyance of medical options where cancers can be cured and sight restored for those blinded by rare genetic disorders. How, in this time of such advancements, did we reach a point, where people cannot afford the very things that could save their lives?

As the COVID-19 global pandemic has pointed out, we need the leadership of scientists, researchers, public health officials and lawmakers alike to guide us through not only in times of a global health crisis, but also during far more mundane times. For the first time in decades, people from all walks of life face the same need for medicine. It is time to discuss the tough questions about drug pricing in an open, honest and, hopefully, transparent manner.

But first we must understand how we, as a society, got here. Medicines are arguably the most highly regulated—and cost-inflated—products in the United States. The discovery, development, manufacturing and distribution of medicines is carried out by an ever more complex and crowded set of industries, each playing a part in a larger “pharmaceutical enterprise” seeking to maximize profits. But this was not always the case.

The Price of Health is the reveals the story of how the pharmaceutical enterprise took shape and led to the present crisis. The reputation of the pharmaceutical industry is suffering from self-inflicted wounds and its continued viability, indeed survival, is increasingly questioned. Yet the drug makers do not shoulder all the blame or responsibility for the current price crisis. Deeply researched, The Price of Health gives us hope as to how we can still right the ship, even amidst the roiling storm of a global pandemic.

How have medicines have been made and distributed to consumers throughout the years? What sea of changes that have contributed to rising costs? Some individuals, actions, and systems will be familiar, others may surprise. Yet the combined implications of these actions for will be surprising and at times shocking to both industry professionals and average Americans alike.

Like so much else in human history, the history of the pharmaceutical enterprise is populated mostly by well-intended and even noble individuals and organizations. Each contributed to the formation or maintenance of structures meant to improve the quality and quantity of life through the development and distribution of medicines. And yet systems originally created to do good have often been subverted in ways contrary to the motivations of their creators. Only by understanding this disconnect can we better tackle the underlying problems of the industry head on, preventing foreseeable, and thus avoidable, medical calamities to come.

Product Details

ISBN-13:	9781643136806
Publisher:	Pegasus Books
Publication date:	04/06/2021
Pages:	336
Sales rank:	1,187,302
Product dimensions:	6.00(w) x 9.10(h) x 1.50(d)

About the Author

Michael Kinch is a professor at Washington University in St. Louis. He is the author of Between Hope and Fear (Pegasus Books), The End of the Beginning (Pegasus Books) and A Prescription for Change (UNC Press). Beyond his current work documenting the sources of innovation responsible for new medicines, he has led cancer research activities at the biotechnology company MedImmune and the development of medicines to prevent pandemic virus outbreaks at Functional Genetics, Inc. He led drug discovery at Yale University before moving to St Louis.

Lori Weiman is a senior strategic communications adviser and business executive with experience in the biotech/pharmaceutical, IT, finance, accounting, and legal industries. Ms. Weiman is the founder and principal of Weiman Strategic Advisers, LLC, which provides strategic communications counsel and support to publicly traded, private and nonprofit organizations. Ms. Weiman has been a member of senior management and enterprise-wide teams, helping to establish, build and brand cutting-edge businesses by leading a broad spectrum of corporate affairs and investor relations functions. Throughout her career Ms. Weiman has served on the boards of a number of trade associations, private-public partnerships and nonprofit entities.

Table of Contents

Foreword Mark Cuban ix

Introduction xi

1 The Law of Unintended Consequences 1

2 A History of Medicine Men (and Women) 10

3 The More Things Change, the More They Stay the Same 27

4 I Fought the Law (and the Law Won) 38

5 The Man behind the Curtain: Wizard of Odds 60

6 Finding a New Purpose in Life 75

7 Self-Inflicted Wounds 85

8 As Seen on TV 109

9 I'm From the Government, and Am Here to Help … 126

10 Odd Couplings 138

11 Generic, But Not Uninteresting 154

12 The Costs of Complexity 167

13 Smart Bombs and Dumb Money 187

14 Reputation Decimation 206

15 How Are Drug Prices Determined? 219

16 And You Thought Pharma Was Opaque 225

17 American Exceptionalism 240

18 A Stomach-churning Story 250

19 Views of an Archaeologist 260

20 All Roads Lead to Washington 275

21 Future Shock Already Happened 298

Afterword Lori Weiman 321

Postscript 325

Acknowledgments 333

Endnotes 335

Index 359

Editorial Reviews

2021-01-28
A dispiriting behind-the-scenes look at how prescription drugs are manufactured and distributed in the U.S.

“The systems to discover, develop, distribute, and pay for pharmaceuticals has become excessively complex, with too many mouths to feed and too much temptation for profit-seeking. All of these problems come at the cost of public health.” So write Kinch and Weiman in this vigorous examination of the countless players involved in the production of pharmaceuticals, a process that was initially designed to create safe, effective, available, and affordable medicine. The authors walk us through the ever increasing complexities that led from the corner drugstore to big pharma, showing how the introduction of new levels of bureaucracy and management—often with the good intention of increasing safety and decreasing costs—almost always spawned unintended consequences, not least of which were rising medical expenses for consumers. “Industry consolidation and outsourcing,” write the authors, “facilitated the creation of ‘middleman’ organizations, usually venture-backed startup companies, which in turn were required to generate profitability to keep the doors open and satiate their investors.” The authors do an admirable job dissecting an unwieldy industry that operates with utter opacity (original chemical formulas understandably, pricing not so much). Each additional layer—e.g., molecular chemistry for production, bulk manufacture, chain pharmacies and the elimination of competition, early regulation, the FDA, clinical trials, sales and marketing, advertising, mergers and acquisitions, pharmacy benefit managers, patent law, outsourcing research and discovery—adds further costs, usually hidden and passed on to consumers. Working with the information at hand, the authors contend that pricing has all to do with what the market will bear, a common theme in any profit-heavy industry. Though some readers may get tangled up in the numbers, such is the nature of the beast, and the resulting portrait is clear—and largely disheartening.

A solid exegetic demanding further analysis—and answers from big pharma.

Kirkus Reviews