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Is There A Drug Shortage In This Country?

By Niall McLaren

In a fairly torrid article, Robyn Dunphy asked “Is there a drug shortage we don’t know about?… This is a rich western country, isn’t it?” Answers: No, there isn’t. Yes, it is (fortunately).

The Australian Pharmaceutical Benefits Scheme (PBS), originally introduced (over intense commercial opposition) by the Chifley Government in 1948, is envied throughout the world, and rightly so. Over the ensuing 70yrs, it has been modified and extended but it remains essentially intact as a highly effective, efficient means of ensuring fair access to essential treatment by all. We are extremely fortunate to have it and governments know that to interfere with it is to court instant death. As a medical practitioner and parent, I would fight bitterly any attempt to dismantle or restrict it.

However, most Australians don’t know that in this case, the government is most definitely on their side, pitched against the venal and utterly rapacious drug companies, now commonly known as Big Pharma. Over the past eight years in the US, these companies have been fined a total of about $40billion by the FDA for a huge range of what are essentially criminal activities. If the TGA and PBS relaxed their guard, these companies would swarm in and take control of what is a small but very lucrative market for them.

Most people also don’t know that, these days, this country hardly manufactures any drugs. Our pharmaceutical industry has gone the way of ships and shoes and sealing wax, off-shored, mostly to India, which has a very efficient drug industry, or to wherever they can be manufactured cheaply.

The function of the PBS is to decide what drugs will be made available and what the government will pay for them. This is based on what is needed, and at what fair cost it should be sold. Needless to say, the drug companies try to maximise their profits, as some recent cases in the US show. One of the worst was an enterprising and amusing scoundrel named Martin Shrkeli who achieved a lot more than 15 minutes of infamy by buying the patent on a drug needed to treat parasitic infections in AIDS etc. Because he could, he bumped the price from $13.50 a tablet to $750, or about 5,000% increase. In Australia, where we control prices, the same drug costs… wait for it… 36c a tablet. The manufacturers still make a profit, just not as much as they’d like.

That is not unusual. The potentially lifesaving injectable adrenaline sold as Epipen was recently increased to about $500 per injection (they expire after a year if not used). The adrenaline involved costs about $2.00.

New drugs can be very expensive. Drug companies are in the business, not of making drugs, but of maximising returns to their shareholders. Bringing a totally new drug to market can take years and cost hundreds of millions of dollars, occasionally billions. The companies need to know they can recover this, so they are granted patents. In Australia, patent life is 16yrs but in the US, it is 20yrs. That starts when the drug is developed, not when it comes to market, so the company has to scramble to maximise its profit before other companies can copy their drug, usually known as generics. In the overwhelming majority of cases, there is no difference between a commercially named drug and its generic copy.

However, what Big Pharma don’t tell you is that the great majority of the basic research on which their drugs are built is conducted in university laboratories at government expense. They don’t pay for that research: as is so often the case, the costs are socialised while the profits are privatised. They also don’t tell you that they spend three times as much on marketing as they do on research, and a large part of their “research” costs are elementary, such as how the drug is to be delivered.

If there are shortages of drugs in this country, they are wholly artificial. There is absolutely no reason why drugs can’t be flown in overnight from, say, the highly efficient manufacturers of generics in India. If my local supermarket can profitably sell fresh mangoes and asparagus from Peru, then there should never be a shortage of drugs here. All talk of drug companies withdrawing from this market because they can’t make a profit is simply false. If PBS doesn’t subsidise a drug, it is because it isn’t necessary.

It is true that once the patent has expired, generics may undercut the protected price charged by the original manufacturer, but they can still sell them profitably. Their production line is already fully amortized, but they normally won’t lower the price because they don’t want to undercut themselves. By investing a bit of money to convince (mostly) general practitioners that their drug is somehow better than generics, they can continue to charge the original price and make a killing. From time to time, it may be that they divert their production line to another country to make a bigger profit but I doubt this happens often. Under normal circumstances, drug consumption hardly varies. The importers know exactly what they will need in December this year: same as they needed last year, plus a little bit. In any event, it is strictly a commercial decision, although they will blame the Australian Government if possible.

Let’s look at the state of play in my field, psychiatry. At present, 10% of the adult population of this country takes antidepressants. Thirty years ago, it was about 1%. It is not uncommon to see people taking four, five or even six separate psychiatric drugs. At the same time, the numbers of people taking time off work for mental problems is rising rapidly, the numbers of people on disability payments for psychiatric disorders is rising rapidly, and we are told that depression will soon be the most damaging single condition on earth. After rising throughout the latter part of last century, the suicide rate has now plateaued but, crucially, despite all the expensive drugs, it isn’t dropping. What’s going on?

I have argued, at tedious length, that what is going on is a racket, a gigantic fraud, a scam [1-3]. Over the past 35yrs, psychiatry has been subjected to two intense pressures. Firstly, it has done a U-turn and headed up a particular path, one dictated, coincidentally, by Big Pharma. Whereas once it was held that mental disorder was mainly a matter of psychology, we are now subjected to a blizzard of propaganda saying all mental disorder is just a special case of brain disorder. You can even go into the toilet at the local shops and read a notice while having a leak, that depression is a disease just like any other and is easily treated, just pop into your doctor and get a script. Most antidepressants are prescribed by GPs in this country, and the rates are rising steadily.

Second, the definition of mental disorder has been widened to the point where you are either one of a diminishing number of normal people in your street, or you’re sick. And if you’re sick, guess what? Yes, you need drugs. Lots of them. For life. This pressure comes mostly from the American Psychiatric Association, which is fully intent on medicalising everything from cradle to grave, at the behest of… Big Pharma [4]. Effectively, psychiatry has been colonised by the drug companies, who decide what will go in the list of psychiatric disorders and what will be used to treat them.

Over and over we are told that mental disorder is just another medical disease. Drug treatment for mental problems is safe, predictable, effective, with minimal side effects and no risk of addiction. This message is hammered home to GPs daily, in dozens of ways, by drug companies and their tame academic psychiatrists, to the point where to question it is worse than questioning the Melbourne Cup.

Nothing could be further from the truth. Antidepressants routinely cause a wide range of debilitating side effects: drowsiness; confusion; slowed reactions; massive weight gain; loss of sexual interest and ability; intense agitation; suicidal and homicidal ideas, impulses and acts; and, above all, addiction. Antidepressants and indeed all psychiatric drugs satisfy every known criterion for true addiction, and their addictive states are intense and very long lasting. Coming off the common antidepressants venlafaxine and desvenlafaxine (Efexor or Pristiq) can lead to up to two years of intense, frightening and often disabling withdrawal effects.

If the drugs were effective, it may be worthwhile but they aren’t. Every study shows that antidepressants are only a few percent more effective than placebos (sugar pills). The weight gain is potentially lethal: 35-50kg increase over a few years is not uncommon. I am seeing a 37yo woman who went from 50 to 103kg in four years, 106% gain. All due to a drug she didn’t need and after she was repeatedly told by various people who should know better that the drug didn’t cause any side effects.

If people are told the truth about the side effects of psychiatric drugs, they refuse them, and rightly so. Most psychiatrists prescribe antidepressants for 80-90% of their patients. In my bulk-billing practice, I prescribe them for perhaps 1% of mine, and they still get better, just as or even more quickly, without losing their jobs, their figures or their sex lives. All of this has been known to the drug companies since the day they applied to have their drugs approved, and all of it has been actively suppressed [5, 6].

So if somebody tells you that there is a shortage of drugs in this country, caused by the government’s obtuse refusal to allow the nice caring drug companies to scrape a measley profit on their lifesaving products, don’t believe a word of it. It’s all part of Big Pharma’s relentless attacks on a very successful, economical and equitable scheme. God forbid that we should end up like America, where people have to stand outside hospitals and actually beg for money to pay for their medication.

References:

1.McLaren N (2012). The Mind-Body Problem Explained: The Biocognitive Model for Psychiatry. Ann Arbor, MI: Future Psychiatry Press. Chaps. 14-16.

2.McLaren N (2013). Psychiatry as Ideology. Ethical Human Psychology and Psychiatry 15: 7-18.

3.McLaren N (2016). Psychiatry as Bullshit. Ethical Human Psychology and Psychiatry 18: 48-57.

4.Whitaker R, Cosgrove L (2015). Psychiatry Under the Influence: Institutional Corruption, Social Injury, and Prescriptions for Reform. New York: Palgrave MacMillan.

5.Le Noury et al: Study 329. http://www.bmj.com/content/351/bmj.h4320?ijkey=c00f299d79c621f475530722505f37b4efe90845&keytype2=tf_ipsecsha

6.Healy D. http://madinamericacontinuinged.org/courses/antidepressants-and-disability/,

(Two lectures on antidepressants and psychotropic drugs. Strongly recommended).

Niall McLaren is an Australian psychiatrist, author and critic, not necessarily in that order.

 

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17 comments

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  1. Jaquix

    Anti-depressants and anti-anxiety medications also allow many people to function as they should, happily and healthily, and mainrain important relationships. My own family included. The difference is too important to be dismissed as blithely as the author dismisses them.

  2. Jason

    It is concerning a psychiatrist disregards anti depressants so publicly without regards for individual circumstances and the biggest risk of permanent death – suicide. These medications can save lives like my own.

  3. Niall McLaren

    Jaquix and Jason: Your comments do not address the thrust of my article: that there are other methods that can achieve the same result quicker, at less cost and inconvenience, and no risk of addiction.

  4. Matters Not

    Great article. Highlights some real problems.

  5. Jaquix

    Jason, agree totally. In the 3 hours since I posted my above comment, my family has been thrown into turmoil for that exact same reason,. So quickly things can change. Good for you, I wish you all the luck in the world and a long and happy life! Thank goodness for these drugs. Dont be tempted to stop taking them either, which is causing the concerning situation we are dealing with here – and of course we are the baddies!

  6. bobrafto

    Jaq & Jas

    Perhaps you may have been included in ‘In my bulk-billing practice, I prescribe them for perhaps 1% of mine’.

  7. bobrafto

    If anyone has any severe lower back pain, Dr Bob recommends Valium 5mg x 2 every 6 hours till pain subsides.

    The pain comes from the muscles knotting and the Valium relaxes the muscles. Before the Valium I had physio, acupuncture and cortisone injections to no avail and the pain was horrendous where I was limited to walking a few yards at a time before I had to sit down.

  8. Robyn Dunphy

    Bobrafto, I have to agree about the muscle relaxing efficacy of Valium. Given my mother committed suicide by overdose, I have always refused to take Valium or similar medications. However, in absolute agony one day some years ago due to a muscle spasm, I was prepared to take anything the doctor recommended, even Valium. What a relief!

    Perhaps the author missed the follow-up research in the comments on my article, where it was clear the products are diverted in some cases.

    The side effects of many drugs, not just psychiatric drugs, are horrendous. Some of those side effects are not yet recognised or documented. On one drug that I ultimately stopped taking (nothing to do with psychiatry) I lost all sense of direction. I would feel as if I was driving in the wrong direction and want to turn around, even though I knew I was going in the correct direction. I would turn right instead of left coming out of doorways. I constantly got lost – in car parks, shopping centres, walking around my own neighbourhood. It was awful – not life-threatening, but awful. The driving was the worst – I would actually feel considerable anxiety, even if I wasn’t driving.

    When I decided that drug wasn’t doing anything for my AI condition, I requested a change of medication. Within a week my sense of direction had returned to normal. Only then did I realise it was related to the previous drug.

    @ Jason & Jaquix – as the child of parents who both committed suicide, I feel for your situations. I agree with you that the author has written in a way that perhaps sounds more as if it belongs at a medical conference than to be read by those whose lives are directly affected by such conditions. What I hear is that he is frustrated with the status quo. Even so, I do agree with the author’s message that as a society we are lulled into a sense that medication will solve everything when in fact it often brings many other problems with it. It becomes a cost benefit analysis – am I prepared to risk a fatal blood disorder to slow the progression of my AI arthritis, for instance. Big pharma don’t help. In America the prescription drug ads on TV are almost non-stop and always show BEAUTIFUL healthy people. It is insidious and seductive. I always return to Oz so grateful we have no such ads here – yet I heard some on the radio the other day that were SO close I was surprised to hear such an ad in OZ.

    The reality is we actually do no know how or why some medications work – or appear to work. The drug information sheets I get for some of my drugs clearly state that. I am left wondering how then was it decided to even try this drug for this condition? Medicine had come a long way in the last 100 or so years – yet not all of it is completely understood.

  9. Jaquix

    My family member is fine if he takes the nedication, functions like his true delightful self. Without it, turns into something else – angry, irritable, thinking out of whack, impossible to live with. I cant make him go to a doctor so just have to see what happens. He did see a GP but no idea what was said. Just hoping fir the best. Perhaps a Valium for me!

  10. Graham King

    I work in the public health system and we regularly get circulars telling us of unavailibity of certain drugs.

  11. Annie B

    I am glad to see this article written by Niall McLaren. .. It contains much truth ( as I can see it, from personal experience and from a lay-persons’ point of view ). …

    Robyn Dunphys’ original article written along the same lines – posed the question about drug shortage in this country. … I replied on that, and mentioned the generics made in India – which Niall McLaren has confirmed, and he has added that they ( India ) have a good reputation for making and supplying drugs : “There is absolutely no reason why drugs can’t be flown in overnight from, say, the highly efficient manufacturers of generics in India.” … well, those drugs, made there, haven’t killed me yet !! And personally, I appreciate knowing of Indias’ reputation in regards to producing these generic drugs ( OTC and prescription ). … I wasn’t totally sure about that !!! 😉

    I do not take anti-depressants, but have in the past. …. they were a terrible experience. … Was suffering from panic attacks, but not depression – they are NOT mutually inclusive. ( I DO know what depression is like from many years back ) …. and a doctor in recent years ( who I no longer see ?? ) … prescribed ‘cymbalta’ for my panic attacks, which – according to its’ pamphlet, can result in seizures.

    The GP also said, it would ‘take the place of’ Valium’, ( wrong ) which I have been on for 20 years, and will be on for the remainder of my life ( given at the time of anti-epileptic meds, weaned off those when I stabilised – and I remain on Valium for disturbances that occasionally happen. Except for a few episodes per year, I am seizure free ). The introduction of ‘cymbalta’ caused two seizures inside 4 weeks ( both within a 2 week period of that month ) … and I weaned myself off them immediately …… AFTER re-reading the pamphlet supplied – it shocked me. … Valium, btw, while it can be addictive, does not have the awful side effects that some anti-psych, and anti-depressant drugs can have.

    My comments however, do not in any way slam as inconsequential – the use of brain altering drugs, when they are needed – as in the case of my cousins’ schizophrenia. … He went off his meds. and was found hanging in his mothers back garden – gone. … Problem is, many people on hefty anti-psychotic drugs, DO go off their meds, because they ‘feel better’ … and the result of that is often gruesome and unutterably sad.

    Jaquix and Jason – I honestly do empathise.

    Waaay too many dynamics and manifestations to go into in detail – about the incidence of causes, symptoms, and treatments of mental illness – ranging widely. .. But that’s not the thrust of this article. The situation is, as Niall noted – subsequent governments in our country, have left well and truly alone, any alteration to the PBS here … and would dare not touch it without a complete wipe-out of themselves in terms of people voting.

    All is reasonably well, as we can ascertain – and we still get our prescribed drugs – chemists see to that, and often rely on one another to be sources to provide.

    Compared to many many other countries ( including the U.S. which is shameful ) … we are in pretty good shape.

  12. Robyn Dunphy

    By the way, Niall, as torrid goes, I do think you win by a good league or more. ?

  13. Annie B

    Robyn … Thank you for that link to a PDF, which I have downloaded and read to about 2/3rds of the way down of the actual submission.

    It is more than interesting. !! Also the link you provided at 9.15 pm … is very thought provoking.
    Seems that a lot of ‘shuffling around’ of diagnoses is on the agenda all over the place, and medicos’ of specific pursuits, cannot agree with what is what.

    A comment in that article / link – jumped out at me big time … that being ” A new category of ”behavioural addictions” initially has gambling addiction as its only member, but there is a growing push for internet addiction to sit alongside.” … No big surprise there ! …

    That entire article was excellent – and somewhat frightening… Have to wonder if these ‘changes’ of diagnostic ‘labels’, have to do with the increasing numbers of captured perpetrators of crime these days, who are resorting to some form of legal loop-hole, citing ‘ a mental disorder’ … which seems to be becoming more prevalent. …

    Just sayin’.

    Will catch up with you privately, elsewhere – if I can, and if your specific settings allow it.

    Cheers …..

  14. Photontrace

    Annie B, you certainly have a point about perpetrators attempting to avoid responsibility for their crimes.

    It does not really seem rational, to me, to alter diagnostic criteria to accommodate them. I doubt that those responsible for the classification of disorders would want to risk their reputations by being “led along” by such people, and besides, the perpetrators would not have opportunities or incentive to work together to influence the statistical outcomes.

    Despite these considerations I do agree with you that some perpetrators will look more favourably upon the risks of treatment versus the risks of punishment, which could be a poetically just mistake at times. That last sentence perhaps says more about me than about them, I don’t happen to feel friendly towards those who will falsify mental illness for their short term gain. Their actions harm the interests of people who genuinely need the resources they are using up.

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