Wednesday, December 09, 2009

The Cost of Drugs (and a Soapbox or Two)

In Romania, as everywhere in Europe, you can walk into a pharmacy and simply ask for a vast array of medicines. Drugs that in America would require a prescription from a doctor, which, in America, is most drugs. And they’re cheap here. Like $3-9 for a month’s supply of most drugs. Not the copay, the total price. When I first got here I thought it was the craziest thing I’d ever heard. Ok, maybe third crazy to the number of steps and papers required to get a visa and the sheer number of dogs everywhere. But I just thought, “How could this possibly be a good thing? Don’t people just self-diagnose and go in and ask for something that could be potentially harmful??” Then I realized I was looking through my American lenses and took them off for a second. And what did I see? People just… don’t.

You know why? One reasons is that here, unlike America, people still think of doctors as experts, still think that it’s valuable to have a PROFESSIONAL diagnose you, a person who spent a bajillion years training for their profession to tell you what medicine you should use. They’re not these hyper need-to-know postmoderns who revel in information overload and value choice simply for the sake of choice. The average Romanian would never even THINK to figure out what’s wrong with them, go online and look for the various drugs that treat it, and then go to the store and get it. Heck. No. But I would be willing to bet that the average American might be so inclined. Of course this would depend on the person and disease and a whole lot of things, but I’m just saying. In general.

You know what I think has the biggest impact on this difference? Direct-to-consumer (DTC) advertising. As in, all those ads for drugs you see on TV and in magazines. The old couple in a bathtub overlooking a vineyard. The woman running through fields of flowers. The little purple pill. And on and on I could go. But did you know that DTC marketing is only legal in two countries in the entire world? America and New Zealand. I learned this a few years ago, and I am pretty sure it is still true (though someone surely will let me know if this is inaccurate). As in, I could never turn on a TV in Romania and see an advertisement for Viagra. Or any other drug for that matter. It’s illegal.

If you think this isn’t a big deal, think again. To put this into perspective, let’s look at advertising budgets for other products. How about Barack Obama in the 2008 Presidential election? Yes, he’s a product. Exceptionally well-packaged and marketed. A big to-do was made that he broke President Bush’s record of $188 million in advertising spending, finishing at a bit over $200 million. That’s $200,000,000. Two hundred million dollars. Spent to convince you and me to vote for a guy. It’s also about how much the advertising budget is for Pepsi each year. Obama and Pepsi, both big products, central to the brand of America, as it were. Well, $200 million is also how much Astra Zeneca spent promoting Crestor, a cholesterol drug, in 2004. One drug. In 2004. Add ‘em all up and you’re talking more than $5 BILLION each year. That’s more than the GDP of about 40 countries in the world. A lot of money is spent to convince you and me to “Ask your doctor” about this or that drug.

So is this a good thing? I haven’t read too much literature on this, but what I have read and my experience in healthcare says no. Yes, maybe patients are more aware about certain drugs that are out there (though a limited subset to be sure). Yes, maybe it gets people to do some research so they’re more informed. But you certainly can’t say that the advertisements themselves are informative. For the most part they make me want to gag with their overly sentimental and emotional drivel (synonyms I also considered include blarney, hogwash, poppycock, and flapdoodle, courtesy of my Mac Thesaurus Desktop Widget. Gosh I love Macs). And they make me want to punch the drug companies in the proverbial face with their ridiculously general and broad claims, whether explicitly or implicitly stated. So ok, this is no different than advertising in general- it’s all designed to make you think if you buy THIS PRODUCT then your WHOLE LIFE will be better- you’ll get the hot guy, the great house, and be happy happy happy. Cause that’s what’s really matters, right? But somehow it’s more pernicious with drugs. Anyhow, I’m getting off on a big ‘ol tangent because I hate DTC marketing so much. But that is not what this post is about. It’s about cheap drugs in Romania. Really, it is.

My point is that this $5+ billion a year industry has unquestionably created a culture in which people are going to doctors and DEMANDING to have this or that drug. Because they’re convinced- simply convinced!- it’s the right drug for them. I know this is true, just ask any doctor how many times a DAY patients do this. I am fully aware that there are other factors that play into this trend, but I believe it’s fair to state that in a culture where $5 billion a year is spent on DTC advertising for drugs and in which patients (for this and other reasons) go to the doctor demanding Drug X, if most medicines were available just by asking at the pharmacy, there would be an insane amount of abuse of the system. Since this is not the case in Romania, it’s totally fine.

My second point is the price. At first I didn’t understand how drugs could possibly be so cheap here, but then all the REALLY BIG NUMBERS about spending on drugs in America went through my mind. $5 billion a year for advertising. $1 billion (on average) to develop a drug and bring it to market. Just one single drug. So with these crazy costs, you can imagine (partly) why drugs are so expensive in America, even with insurance covering some of the cost. I could write another entire article on the ridiculousness of health care costs in America in general, but since you all probably read about that everyday with all the hullabaloo in the government right now, I will spare you.

But this system works quite well for me, for several reasons. 1) I have several minor health quirks that come up every once in awhile, so it’s nice to simply know what I need and just go to the pharmacy and get it. This prevents a trip to the doctor as well as all the ridiculousness of going to a doctor in a foreign country where you are not fluent in the language and where care is notoriously awful. 2) If something comes up, me and my American self (though reasonably well-informed in this area, to be fair) can go online, figure out what medicine I need, and go get it. This is totally a hypothetical perk, because unless it were totally clear to me, I probably wouldn’t actually do this. I’m impulsive and crazy, but not foolish. Usually. I at least would call one of my doctor friends first just to check. 3) I have individual health insurance, but it doesn’t have prescription drug coverage, so it’s really splendid to live in a country where paying the full price for monthly drugs isn’t an incredible financial burden.

With that, I will close this (rather long) muse on drugs in Romania (and America). And if you need a supply of something, let me know, I’ll get some and bring it home next time I visit the States. *wink*

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