Is Putting the Care Back into Healthcare the Answer?
Two recent news articles highlight the fractured nature of our healthcare delivery system. The first article describes how a radioactive isotope (Molybdenum-99 or “moly-99”) that is vital for imaging the bones and the heart is no longer manufactured in the US. We currently rely on sources as far away as South Africa and Australia to supply it. But now there is an ambitious plan to establish production of moly-99 in the cornfields of Wisconsin. A similar story has emerged with the shortage of intravenous saline (salt) solutions needed in the treatment of the current flu epidemic. The main source has been Puerto Rico, which suffered serious damage from Hurricane Maria and is no longer able to export its goods.
Scarcities lead to price increases
Such scarcities lead to lack of access to needed care and higher prices. Scarcities and higher prices in the generic drug market have caught the attention of a group of four large hospital systems, whose leadership wants both to maintain good access to needed therapies and to achieve a manageable price point.
The fundamental problem is that when we leave the production and sale of essential medical care to free-market forces, erratic supply is almost inevitable. The truth has emerged—no profit, no product! And what has upset the new, large hospital systems group is that generic products, which should be cheap, have become expensive (because supplies are low) or unavailable (because profits are too low to encourage production).
How do the four hospital systems plan to solve this problem? Very carefully and a step at a time. A new company will be created by the hospital group to manufacture needed drugs to sell to hospitals. The idea is to have a nonprofit drug company with reliable manufacturing partners.
Care over profit
In my mind, this is an important step in the right direction. This can put the care back into healthcare. Groups need to care about the impact of scarcities upon patient needs. We need to care about the financial integrity of the whole healthcare system, with a focus on care over profit. This is one piece of a much larger puzzle. The piece that gets the most attention, though, is the investment in new drug development.
A delicate balance
As evidenced by news of continued investments and acquisitions, new drug development is currently alive and well. In particular, the frenzy around CAR T-cell therapy is palpable. The competitive forces in this area are more than capable, and their cumulative energies will lead to rapid market access for patients and appropriate profits for the developers. Over time, the costs must, however, become manageable. Balancing innovation and access is a delicate process that requires input from all stakeholders.
Stay tuned for future developments in these turbulent times! Hopefully there will be more positive steps to report.
Dr. Brian G.M. Durie serves as Chairman of the International Myeloma Foundation and serves on its Scientific Advisory Board. Additionally, he is Chairman of the IMF's International Myeloma Working Group, a consortium of nearly 200 myeloma experts from around the world. Dr. Durie also leads the IMF’s Black Swan Research Initiative®.