THE PRICE OF HEALTH

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.