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Health controversies

7 Pages

Social Science
Course Code
SOSC 1801
Jon Johnson

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The Pharmaceutical Industry and Health Canada: Values in Conflict – Joel Lexchin • Medicine is an essential component in modern health but the bad thing is that they are produced by companies that are looking for a profit. Introduction • Pharmaceuticals is an essential element of modern medicine- it provides extremely good affects when it is used properly- for example when medicine was made for HIV/AIDS  saved so many lives • The amount of money being spent on pharmaceuticals makes it necessary to understand the dynamics of pharmaceutical industry • The industry does not stand alone- it is intertwined with the state (term used to describe a collection of government and government controlled institutions within a country) – how? Public sector does the basic research that causes new developments • Government has established set of regulations that need to be passed before they are given to the public – the money spent on meds is mostly from the public • Legislation also means that only professionals can give out meds • This industry is not considered a social determinant of health but still has a very important impact on health status of Canadians- mostly because of the money and how people can’t always afford medicine.  this has become a very big concern for Canadians. • The data in this article is mostly Canadian- not all of it though Characteristics of the Pharmaceutical Industry • Pharmaceutical Industry – profit is main motivation – there like any other enterprise in a capitalist economy • Mission statement: Canada’s Research – Based Pharmaceutical Companies emphasizes that it’s a social responsibility to improve health but the pharmaceutical industry has never claimed to be motivates by altruism but rather by profit for survival Profits and Public Values • When profits and public interest come into conflict its profit that comes first for the companies • Dr. Anne Holbrook – McMaster University wrote a paper on gastrotestinal medications – AstraZeneca’s drug Losec was no different than two cheaper medicines  AstraZeneca sent her a letter saying that she would be contravening Canadian federal law and that you can assume that our client will take appropriate steps to protect its interest  AstraZeneca quickly apologized claiming that the letter was misdirected and it was actually for the Ontario government • Over 30 years profit in the pharmaceutical industry have outstripped other industry profits -1970s drug companies had 8.9 percent profit in comparison to 4.4 for all 500 Fortune industries. In 1980 the pharmaceuticals had a profit of 11.1 and in 1990s they had a profit of 15.1. • Now the pharmaceutical company has fallen down from the first place but it still outplaces other industries • Two arguments to justify its high profit levels  new drugs is highly risky venture in which one out of hundreds and thousands make it to the market hence high profits are mandatory in order to keep the investors to keep putting their money in • But usually developing drugs is not always risky- when the drug is found to be not good it’s usually early on when the cost is minimal • Second arguments  cost of developing a new drug – its takes close to 800 million dollars to produce a new drug but this is debatable – this amount came from the companies, 12/24 companies responded for the information, this estimate is done without government subsidies, taxpayer funding etc, since this wasn’t done the costs were reduced by 50% - Dimasi and colleagues try to defend their work but acceptance of it is far from universal Research Priorities • In order to deliver the types of returns investor have expected the companies need to produce medicines that will in excess of 1 billion. – Companies are focused on products that can be patented (focus on two types of patients) and that will be used by large numbers of people with chronic diseases who live in first world countries because these people can afford the medicines • Medicines for the unprofitable diseases are barely found – between 1975 and 2004 only 21 out of 1556 medicines were made for neglected diseases • In 2011 20 companies were surveyed about 11 responded 8 of these did not spend anything on neglected diseases- seven spent less than one percent on them – five out the of twelve were not conducting any research and many did not want to enter this area • Many of the few drugs that were made were not proper – not affordable, poor safety profile etc. • Companies tend to copy successful medicines to obtain a part of the share and profit – in the end the new medicines don’t provide a difference in what is already available – Patented Medicine Prices Review Board: between 2001 and 2008 only 19 percent of 177 new medicines gave proper therapeutic gains • Even in the French market this is visible- out 983 medicines only 4.1 percent gave a major therapeutic gains – 10.8 percent had value but didn’t cause a gain – in Europe there were 12 new anticancer medicines and it was concluded that none of them caused a gain/improvement – there were also 61 new biotechnologies and only 2 were approved Value of Research done in Canada • Research that the pharmaceutical companies do test the medicine on humans (clinical drug trials) • $723 million out of 1.26 billion go on clinical drug trials whereas $200 go on basic research – to explore this: 40 key medical figures surveyed that were engaged pharmaceutical research – happy about the money and expressed misgivings about the funding  90 percent: conflict of interest, 80% deemed pharmaceutical clinical research, 75% saw it as might as well research, 40% worried about a potential delay in the publication of unfavourable results • The drugs that are made for infertility ignore things like behavioural factors involved in both the cause and prevention of infertility – this bias has important consequences  focuses attention towards in a particular direction – directed towards indivuals rather than the social causes of the problem • Example: infertility is due to sexually acquired diseases caused from unsafe sex and unsafe sex is related to socio- economic class – but there is barely any funding to look at socio-economic construction of sexual practices Drug Promotion • $31.4 billion spent on R&D and $57.5 billion spent on promotion- In Canada between 2.4 and 4.8 billion is spent on promotion and 35,000 and 70,000 is spent on the doctors – most of it is medication samples left in doctors’ offices • 5200- sales representatives in Canada, over 77,000 visits to doctors’offices to promote Celebrex • The pharmaceutical companies are also involved in indirect promotion – Direct promotion involves advertising in medical journals/ provide hospitality to doctors – the hospital is used as an opportunity to expand businesses • Indirectly  provide financial support to people to attend international CHE event – 70% continuing medical education programs • New drugs – promoted heavily in order to generate revenue – Doctors are also more likely to prescribe medications based on promotion rather than it being the appropriate medication • Little is known about the medication that has been on the market for a while in comparison to those that have been on the market for a long time - people are potentially exposed to unsafe products • Example: Vioxx and Baycol were heavily prescribe – taken off the market due to 140 thousand cases of coronary heart diseases User Fees in Drug regulation and their consequences • Health Canada operates through a system called clientele pluralism : high degree of concentration of power in one agency but a low degree of autonomy • Pharmaceuticals – responsibility on Health Canada – but the state does not possess the power to undertake clinical trials to provide safe medications nor are the willing to mobilize sources that wold be necessary to do this • Since 1990s the relationship with regulatory agencies and the industry has intensified - pharmaceutical agencies now need to pay a fee for each drug to be marketed and they pay an annual amount for each drug on the market  1/3 revenue to deal with medicine is by industry the goal is to make it 2/3 • It takes more time for the drug to appear on the market now – R&D emphasizes that it needs to be done faster
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