The drug maker AstraZeneca will now be able to market its cholesterol drug, Crestor, as a preventative drug to people who don't have cholesterol problems. While the drug's backers -- including a doctor who led the study, patented the test that will determine whether patients qualify for use of the drug, and thusly stands to make millions -- say it cuts the risks of heart attacks, strokes, or bypass surgeries roughly in half, it's half of a very small number. When you break it down, using the drug as a preventative measure helps 2 out of 1,000 people. All of this is according to the story in The New York Times.
It's worth noting that, as much as Republicans like to say health-care reform will put a bureaucrat between you and your doctor, drug makers are the people who stand between you and your health under the status quo. Drug makers are the kind of innovators that objectors to health-care reform were scared to lose. This is how they innovate, though -- by creating new markets for new and existing drugs in ways that ultimately treat us all as sick rather than concentrate on keeping us well. The Times story quoted a doctor saying as much:
'The benefit is vanishingly small,' Dr. [Steven] Seiden said. 'It just turns a lot of healthy people into patients and commits them to a lifetime of medication.'
It's not that drugs don't help people. It's that there are a number of ways in which our health is best served when we take lifetime measures that prevent us from ever going into a hospital or taking a drug in the first place. For example, a lifetime of eating peanuts instead of potato chips. The problem is, not going to the hospital and not taking a drug makes zero money for the innovators.
Atul Gawande noted the problem this week in his New Yorker piece about an effort at Children's Hospital Boston to improve asthma treatments. The hospital took many commonsense measures at its own expense, like having nurses visit children's homes to make sure they were using asthma inhalers. But because this work reduces the number of hospital visits, it might ultimately bankrupt them. In other countries, reduced hospital visits are a good thing. Government or nonprofit insurers need to reduce costs because they have to cover everyone, on limited funds, and have no incentive to make money off needless procedures. It's only in America where we have perversed incentives to create sickness. Unfortunately, the health-care bill doesn't go far enough to fix that, though it hopefully it opens the door to the possibility for change down the road.
-- Monica Potts
