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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