[Mb-civic] state of health in america

[IHHS at aol.com]

The State of Health in  America
Gary Null Interviews Dr. Peter Rost of Pfizer:
June 10,  2005 

On Friday June 10, 2005, Dr. Gary Null engaged Dr. Peter Rost in a candid  
discussion on the nature of healthcare and the pharmaceutical industry in the  
United States. 
Gary Null: We're beginning with an  exclusive Internet radio discussion with 
a doctor who is also, currently, a vice  president for marketing at Pfizer. He 
is not speaking on behalf of Pfizer, but  for himself. I have invited him to 
share insights on the nature of the  pharmaceutical industry. He is Dr. Peter 
Rost. Nice to have you with us  today. 
Dr. Rost: Thank you so very much. I'm very  happy to be with you. 
Gary Null: We do this more like a classroom  on the air, so please do not 
feel that you have to give us any short answers.  Give us as much of a context to 
the answer as you wish. 
Let us begin with a serious an important challenge, and that is: today many  
Americans face the dilemma of not being able to buy food or other necessities  
and buy medications they may need that can help save their lives. I find this 
 disturbing. I'm concerned that someone should have to make that choice. Your 
 position, please. 
Dr. Rost: Well my position is that I think  this is outrageous. We are one of 
the wealthiest nations on the earth yet we  have between 49 and 67 million 
Americans with out insurance for drugs. They pay  full price - cash, no rebates 
- and what that means is that they pay twice as  much as all the other people 
around the world - in Europe in Canada - twice as  much, and these are the 
ones that can least afford it. 
But it gets worse. Here in America today, the other people who have insurance 
 and various programs, they have pharmacy benefit managers negotiating on 
their  behalf [or] they have the Veterans Administration.  Those drugs are sold 
at  the same price as we're selling them in Europe and in Canada. So really the 
only  ones that we charge these high prices to are the one who can't afford 
it. 
And what that means is many of them can't take the drugs they need. And we  
know that drugs save lives. So, when you can't afford your drugs, you might die 
 or you may stay very sick. And it might also force you to go on buses to 
Canada  or Mexico or to go on the Internet to try to find a cheaper drug. But 
going on  the Internet while it's one solution and there are lots of very good 
pharmacies  on the Internet, there also bad ones. So there is a risk there, if 
you end up  with the wrong merchant. And this is what we re doing to the people 
who built  this country. It's usually the elderly in this situation. This is 
what we are  doing to the parents, the grandparents that built this country 
for us. It's  outrageous. 
Gary Null: Let's continue on. A few years  ago I had an opportunity to 
interview the commissioner of the FDA. And I asked  him, "why do we have drugs that 
are so much more expensive than in other  countries?" And without blinking an 
eye he said, "Safety. We at the FDA value  the safety of our products and 
we're concerned about Americans only getting the  best quality products." And I 
asked, "Well doesn't Germany, Israel, Italy,  France, Belgium, Austria, England 
- they also have outstanding scientists and  concerned bureaucracies and they 
have something similar to our own FDA. And it  was as if no one else in the 
world has the quality of science nor the meticulous  sense of detail for safety 
and efficacy that does our FDA. So no country,  literally none would be 
considered acceptable to take a drug that's used in  those countries that helps 
those people and bring it into the United States. 
And I said, "Well are you saying then, let me be very clear on this, are you  
saying that no scientist, no government, nothing in the world compares with 
us?"  He said, "That's correct."  
I thought, that's very arrogant, to assume that since we also have the  
highest iatrogenic rate, we have the most drugs that have been reclassified,  
relabeled, or banned because of adverse drug events after FDA approval, we've  had 
more Americans die or be injured because of medical mistakes, that we should  
also be then be assuming that we are the gold standard for safety and efficacy 
 against the rest of the world where many people are not suffering the same  
consequences in other places as we are. Now you're in a unique position.   As 
one of the higher ups at Pfizer, one of the America's leading, and the  
world's leading pharmaceutical companies, you can give us a perspective that  other 
people cannot. So give us your idea of why these drugs are not being  allowed 
into the United States, and is it true that only in America do we make  the 
safest drugs and we could not trust that any other country could make drugs  as 
safe. Your thoughts please. 
Dr. Rost: Couple of different issues.  Number one, the drugs that we get in 
the U.S. are the same drugs, manufactured  by the same company, the same 
factory as people get in Europe and in Canada.  There is no difference there. 
Second issue, America, unfortunately, while being a wonderful country, and  
being at the forefront in many areas, some of the areas we're not. We actually  
have, in my opinion, one of the unsafest drug supplies, but of course, the 
FDA  doesn't want to talk about that. 
It's very simple. In Europe they require drugs to be prepackaged in  
individual bottles and blisters. Nobody touches your drug after it leaves the  factory 
until the patient gets it. In the U.S. we sell drugs the way we sold  sugar 
or flour a hundred years ago - in loose weight. What happens here is we  have 
big, big containers with thousands of pills shipped from the drug  manufacturer 
to the wholesalers in the U.S. There are thousands of wholesalers -  they are 
not regulated by the FDA, but by the states. It takes a thousand  dollars and 
a driver's license to become a wholesaler. Anyone listening can  become a 
wholesaler. The wholesalers then takes the big drums with drugs and  force them 
into smaller bottles. Those bottles go to the pharmacist. But it  doesn't stop 
there. The pharmacist then has to pour those drugs into the very  little 
bottle the patient takes home. Lots of entry points for contamination,  mistakes, 
terrorists, whatever. Again, it's shameful, the FDA has been looking  at this 
for many years - they have not changed anything, but they are very  concerned 
about re-importation.  
Gary Null: Thank you. I appreciate your  answer and your candidness. 
Another issue. And that is, there was a time when we could trust our  
physician. You went to your physician it was almost a sacred ceremony between  the 
openness of what you had to say, the trust you gave the physician, and the  
advice the physician gave you back to help you with your medical condition.  
Today all of that has changed. Today, with HMOs people spend very little time 
 with most physicians, and more often than not you're likely to get 
prescription  for medication whether you like it or not. And in some cases you're 
getting a  prescription because your insisting to the physician you want what you 
saw on  television. You saw someone who had a condition that you have and they 
were  happy and jumping in the air after taking the medication and you put 
pressure  upon the physician. And in the time it takes to write a prescription, 
you now  have an opportunity to benefit also from that, so you think. 
The nature of the relationship of the physician and patient has changed  
because I believe, and I'd like for you to challenge me if I'm wrong, the  
relationship between the pharmaceutical company and the physician has changed.  Where 
today it's an incestuous relationship between the pharmaceutical company  
nurturing, guiding, stroking that physician from medical school right thorough  
till today - so that he physician becomes one extension, the biggest supported  
of the pharmaceutical industry.  
Show me where I'm wrong. 
Dr. Rost: Well unfortunately, as a  physician myself I have to admit, and I'm 
not doing that with an easy heart,  that I'm very, very saddened by the state 
of healthcare and the way physicians  act today. Being a physician has become 
more of being a businessperson than  actually being somebody who cares for 
peoples' lives. 
There was a recent study where they used actors to make thousands of calls to 
 doctors pretending to have a depression and asking for a particular drug. 
Almost  all of those who showed the symptoms of depression got the drugs. But 
the  worrying part was that the other half of the actors who didn't pretended to 
have  any symptoms half of those got the drug as well. And here we're talking 
about  pretty strong stuff - antidepressants - and the patient got it because 
they  pushed for them. 
So clearly, direct to consumer advertising works, and the physician very  
often just wants to satisfy the patient. But many physicians today have stopped  
practicing good medicine. And we also have so many physicians just standing 
with  their hands out waiting for the next trip from the drug company, the next  
dinner, the next freebie. So the whole system has become so corrupted. We  
shouldn't expect this to be normal. The fact that we have freedom and anybody  
can bribe anybody else - that's not freedom, that is not good society and most  
countries do not allow drugs reps to visit doctors as often they do here and  
they do not allow drug reps to bring doctors pizzas and bagels and everything 
 else. I mean they are pretty much stewardesses in those offices bring them 
gifts  - bearing gifts. You create the relationship that way. So we can change 
this -  we don't have to have a system like this. 
Gary Null: I've recently interviewed a drug  rep who was one of the most 
popular in the United States and for two years was  in the top five most 
successful drug reps in the United States out of over  100,000. 
And she said that she had to understand the psychology of using her sex  
appeal, using her sense of care and concern, how she would approach the doctor,  
how she would set up a coffee table with donuts for his patients. And that in  
time no one even questioned anymore they almost expected when they went in the 
 office - in his office - that there would be something there, pizzas or  
whatever, given out free to his staff. And I said, "Did he at any point  
recognize that this was just a different way, a more clever way, of getting him  to 
where he will prescribe your drug?" And she said, "No. That never came up.  Sure 
he prescribed the drug. And the drug I was selling, from my company, was  the 
drug of choice for the condition that he was a specialist in, heart disease  
that he would give. It wasn't that my drug was better, that I had studies  
proving it was better, it was just that I was better able to connect with him."  
Your thoughts on this.  
Dr. Rost: Well there is a great book out  there by Jamie Reidy, called "Hard 
Sell a former Pfizer sales rep", who  describes exactly this and he had a very 
funny sentence in the book, basically  saying male doctors who were very busy 
as soon as they got a whiff of female  perfume - their innate reproductive 
desire made them drop everything else and  very willingly listen to these 
beautiful women. I don't think that we should  have our drugs prescribed based upon 
male doctors' desire for sex.  
Gary Null: But that's happening. 
Dr. Rost: That's the situation we have  today. It works equally well for male 
sales reps who can charm the office  staff. 
Gary Null: The next area and I only have  two more questions for you because 
I know you're on a short schedule. But it's a  very important one. I own a 
food store. It's a natural food store. There are  about twelve different 
departments - from produce, organic produce, whole  grains, breads, the deli, and 
groceries. At the end of the day I know my markups  and they range from about 25% 
to as high in some areas as about 75%, but average  about 40%. That's not a 
lot and it's real hard to make a living. It's hard to  stay in business with the 
rent you're paying, the staff, the insurances, taxes,  etc., but you manage 
to etch out a living. It's not going to make you rich. 
I'm also an author and I've published a lot of books, and I've been fortunate 
 enough to have some very popular selling books. But I know exactly to the 
penny  how much that book costs my publisher. I know how much the binding, the 
ink, and  everything and I know the markup. I know if I want to buy my book I 
get maybe a  40% discount unless I buy a humungous amount then I get 50%. But I 
know the  actual cost of the book because I frequently buy a lot of those 
books and give  them away free to the poor and for years to non-commercial radio 
stations I gave  books. 
And then recently I did some research on pharmaceuticals because I was  
listening to a debate, this goes back about a year, and the debate was this: The  
reason we have the most expensive drugs in the world in America is because so  
much money goes into research and development - upwards of a billion dollars 
and  I'm thinking, "Is that possible?" I didn't know - I wasn't going to make a 
 decision until I had my facts. And I began to look carefully at this and 
here's  what I have and I'm willing to put this on the record and have it 
challenged.  
Let me take a few products. Let me take for our arguments sake take two. I'm  
going to take Prozac, 20mg, 100 tablets. Retail price currently is $247.47. 
The  actual generic active ingredient for 100 tablets, for all hundred tablets 
for  Prozac is 11 cents. Do the math - that is a 224,783% markup. One more, 
Xanax - 1  mg, 100 tablets, currently as of today $136.79. The actual cost for 
those 100  tables of the generic active ingredient is two tenths of 1 penny. 
That means the  markup is 569,858%. Let me say that again -569,000% markup from 
the cost of the  generic active ingredient in that 1 mg dose of Xanax to 
$136.79 for the actual  retail price. I have never in my life seen markups like 
this. I know of no other  business that has markups like this and as a person who 
knows something about  pricing and economics I'm absolutely flabbergasted by 
that. Your thoughts  please. 
Dr. Rost: Well this is what you get when  you don't have a free market. Drug 
companies claim that the U.S. is the only  free market. That's really untrue. 
The U.S. drug market is a monopoly - they can  charge whatever they want. What 
are you going to do? If you have car that costs  too much you can walk away, 
but when you're sick you can't walk away, you need  the drug to survive, to 
live, to go on. And when you don't have a good partner,  a strong partner to 
negotiate with as you can imagine you're going to pay the  highest prices. 
Where does this money go? Very simple - it goes into two areas. Number one -  
profits. Number two - into marketing and selling even more drugs. As a mater 
of  fact in 2002, if you look at the fortune 500 list of the largest 500 
companies,  you take just the drug companies, the top 10 drug companies, together 
the top 10  drug companies had a higher profit than all the other 490 largest 
U.S.  corporations. That's what you get.  
Gary Null: Wow. That I was not aware of - I  appreciate that insight. My 
final question for you - why is it that the board of  directors, the top 
executives of these pharmaceutical companies are not put to  the task of acting, not 
just responsibly for their company and their products,  which they have a 
responsibility both fiduciary and a moral responsibility, but  also the issue should 
they not charge a reasonable price to make a reasonable  profit so that the 
public that may need that drug can actually afford it instead  of having to not 
be able to afford it. Why isn't there some moral equation that  is not 
discussed? And as a medical doctor, as an executive one of the largest  
pharmaceutical companies in the country I'm sure at some point this issue has  arisen 
somewhere in the corporate headquarter system has it not?  
Dr. Rost: Well you know the problem we have  is that when you are that 
wealthy, you're also equally powerful and there are  many people and many 
politicians with their hands out asking for assistance. One  example is the Medicare 
drug bill, which was going to give free drugs to the  elderly in 2006 - it's 
still going to cost $3000 out of your own pocket for the  first $4000 of drugs. 
But in addition to that, that drug bill included  legislation that made it 
illegal for the government to negotiate drug prices.  You know it's so completely 
counterintuitive. Why should the taxpayers pay full  price when the government 
could have negotiated? When you have a powerful  industry that can buy its way 
into a democratic government that's what you  get. 
Gary Null: I want to thank you for your  candor, your openness, and your 
honesty. It is a refreshing discussion instead  of the normal propaganda and 
defensiveness that I would hear from other  individuals from within the industry. 
Dr. Rost I thank you very much for being  with us today. 
Dr. Rost: You're very welcome. It was  really a delight. 
Gary Null: That was Dr. Peter Rost. He is  also senior vice president at 
Pfizer, medical doctor and answered some very  important questions for me. So I 
hope you enjoyed that. 
Transcript, courtesy of Roman Bystrianyk, Health  Sentinel
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