In Part I of this series, Dr. John Abramson of Harvard Medical School talked about changes in the relationship between pharmaceutical companies and academic medical institutions and journals regarding publication of study results. In a revolutionary change from prior experience, the drug companies are insisting on not only owning the data from their studies, but in actually writing the research study results for publication. This jeopardizes the integrity of the published results and recommendations that doctors make to their patients.

Part I concluded with statistics that show Americans pay $12,914 per person per year for healthcare while similar advanced countries pay only $6,125 per person per year.  That’s $2.3 Trillion in excessive healthcare expenses. To make matters worse, life expectancy in the U.S. is declining in comparison to these other countries.

In Part II we will be discussing reasons for these excessive costs. Dr. Abramson says there are three main factors:

• The U.S. is the only wealthy developed nation that has no formal mechanism of price negotiation.
• Since most consumers are insured, they pay only a small part of the price – so high prices don’t provide market discipline.
• As a nation, we are too mesmerized by the idea of biomedical innovation.

Historian Jill Lepore has written: “Innovation might make the world a better place, or it might not. Innovation is not necessarily concerned with goodness, but often with novelty, speed, and profit.” This means we should question whether new innovations actually represent a true value to the public.

Abramson says the U.S. is spending 96 percent of our biomedical research money on medical drugs and devices, and only four percent on how to make the population healthier and how to deliver healthcare more efficiently and effectively. Put another way, the U.S. spends $116 billion on researching new drugs and devices – which comprise only 13 percent of total health care costs – but only $5 billion on research concerning the remaining 87 percent of healthcare costs.

Why? The answer should be obvious – money. It is the job of pharmaceutical companies and medical device manufacturers to make money for their investors. Much more money is made from new drugs and devices than from studying and promoting healthy diets and lifestyles. It’s much like golf equipment manufacturers. Every company must come out with a new line of drivers to sell each year – even if there is no real improvement over last year. Why does Apple introduce a new iPhone every September, when last year’s performs just as well? To sell new phones! Many new drugs are no real improvement over existing drugs, but they are packaged as “the latest and greatest” nonetheless.

Dr. Abramson says only one out of four new drugs is actually materially better than previously available and far less expensive therapies. Germany’s Institute for Quality and Efficiency in Healthcare, an independent agency under contract to Germany’s Ministry of Health, found that of 216 new drugs entering the German market from 2011-2017, only 54 were of “major” or “considerable” benefit. Thirty-seven were evaluated to be of “minor,” “less,” or “non-quantifiable” benefit. And there was “no proof of added benefit” for 125 of the drugs. The U.S. has no equivalent method of judging the effectiveness of new drugs.

What about the price tags on these drugs?

Many new brand name drugs are being developed here in the U.S. and all of them are heavily marketed. It’s nearly impossible to watch any hour of television without being subjected to pharmaceutical advertising. The drug companies that own the patents are monopolies. In comparative terms, these drugs cost three-and-half times more in the U.S. than in other wealthy developed countries. But the most shocking numbers have to do with the rate of increase in prices. In 2008, the average annual price of a new drug in the U.S. was $2,115; by 2021, this annual average price of a new drug had risen to $180,000. In 2022, the average annual price was up to $257,000. That’s a 42% increase in one year – a rate of increase far exceeding our record-breaking rates of inflation under the Biden administration.

How do we change this situation?

For-profit companies are supposed to make profits. Abramson says, “Accusing drug companies of being greedy is like accusing zebras of having stripes.” That’s their job! Which means it’s up to others to rein in these spiraling healthcare expenses. That means doctors, and patients, must ensure these companies serve the public needs, rather than their own.

Abramson recommends:

• We must ensure the evidence base of medicine is accurate and complete, which requires independent, transparent peer review.
• We need to implement health technology assessment to ensure our doctors know which drugs and devices are actually most effective.
• We need to control the price of brand name drugs.

The obstacles to these needed changes are much like those that obstruct change in our public education system: politicians who accept large contributions from those who don’t have our best interests in healthcare, and in education, in mind. Dr. Abramson calls for leaders on both sides of the political aisle to come together in the interests of the country. Now that would be an innovation we could all endorse!

In some ways, American healthcare is the best in the world. There is no other country I would choose for my medical treatment than the good ole’ U.S.A. There is no doubt that doctors come to this country to receive the best medical training in the world. We are blessed with the best in medical technology, and it is readily available.

But in other ways we are falling behind the rest of the world. I have made these observations before and written about them in my most recent book, Changing Healthcare. But recently I learned some disturbing news about our pharmaceutical industry and their interactions with the academic medical journals I was not aware of.

Dr. John Abramson is a faculty member of the prestigious Harvard Medical School, currently teaching healthcare policy. In a recent speech at Hillsdale College, he reported disturbing news about changes that have occurred in the way medical research studies, particularly regarding new drugs, are reported in the medical literature.

The time-honored method of reporting medical literature is for researchers to submit their studies to medical journals for publication. Before they are accepted for publication, their editors carefully review the data provided by the researchers and compare their data to others previously published. The results are scrutinized by the editors and their expert analysts for flaws in the study design or misinterpretation of the results. There is no financial bias in this process for no money is exchanged for accepting articles for publication. The medical journals make their money off subscriptions and reprints of the articles they publish. The study authors receive no compensation for their published articles. (I have published several articles in the medical journals.)

But Dr. Abramson says all that began to change in 1981. At that time, Derek Bok, the president of Harvard University said in Harvard Magazine that the university’s reliance on industry funding for research was causing “an uneasy sense that programs to exploit (make money from) technological development are likely to confuse the university’s central commitment to the pursuit of knowledge.” He explained that because grants from the National Institutes of Health (NIH) and the National Science Foundation (NSF) were declining, scientific researchers were turning to commercial sources for funding. Today, it is common for medical schools to have commercial relationships.

How has this impacted medicine?

A 2005 article in the New England Journal of Medicine (a leading medical journal) noted that 80 percent of clinical trial agreements allowed drug companies to own the data produced by the research. Abramsons says, “In my mind, data from a clinical trial – excluding of course, manufacturing techniques and genuinely proprietary information – is a public good, because doctors are going to use that data to make decisions about how to treat their patients. But the drug companies don’t see it that way.”

In the same NEJM article, two other findings are worth noting. In 24 percent of clinical trial agreements, the sponsor (the drug company) “may include its own statistical analysis in manuscripts (journal articles).” And even more outrageously, 50 percent of clinical trial agreements allow the sponsor to “write up the results for publication and the investigators may review the manuscript and suggest revisions.”

Abramson explains, “In other words, 50 percent of the contracts that academic medical centers make with drug companies allow the drug companies to ghost write the articles. The researchers who are the named authors of the articles have the right to suggest revisions, but not to make actual corrections or edits. This is not academic freedom. Nor is it an arrangement in which medical science is going to serve the interests of the American people.”

You might ask why don’t the researchers, or at least the medical journals, simply refuse to accept articles without full disclosure and full authority to publish results that are supported by the data? The response of one respected editor of a medical journal to this very question was, “That would be a death spiral for the journal.” In other words, the editors of these journals have sold out their integrity for the sake of their budget. Therefore, the integrity of their published studies can no longer be respected and relied upon.

How is this impacting the quality of our healthcare system?

In 1980, the U.S. was just about equal with eleven other wealthy countries in terms of life expectancy. But since then, our life expectancy has fallen in comparison. Until 2014, our life expectancy was still improving, but we were losing ground to the populations of other advanced countries. By 2019, just prior to the Covid pandemic, life expectancy in the U.S. had fallen relative to that in the other countries so much that 500,000 Americans were dying each year in excess of the death rates of the citizens of those other countries.

Combine this with the fact that in the U.S. we are paying an average of $12,914 per person per year on healthcare, whereas that figure in the other comparable countries is $6,125. That’s $6,800 more per person – multiplied by 334 million Americans – which comes to an excess of $2.3 Trillion a year on healthcare – for poorer results! That’s a broken healthcare system!

(Note: For more on this subject, read Part II of this series.)

Regular followers of this blog know I rarely stray from medical issues unless I feel passionately about the subject. One of those subjects is school choice. School choice is the key to educational opportunities, especially for children of low-income families – and education is the key to upward mobility. If you want to put your finger on a solution to poverty, the answer is education and that means school choice.

This has never been more clear. The Covid pandemic brought close attention to our public school system and the deficiencies of that system. Children of low-income families, especially in inner cities, have little chance of getting a good education unless they have other options. School choice gives them those options.

William McGurn, writing in The Wall Street Journal, tells us it was Nobel Prize-winning economist Milton Friedman who first identified the importance of school choice when he introduced the idea of school vouchers in an essay titled “The Role of Government in Education” in 1955. Friedman said, “Governments could require a minimum level of education which they could finance by giving parents vouchers redeemable for a specified maximum sum per child per year if spent on ‘approve’ educational services.”

McGurn tells us it took years to catch on, probably because at the time most people were satisfied with their public schools. When school-choice measures were later passed in some areas, they were almost always targeted at poor children in urban districts. The rationale was that these kids needed help to escape rotten public schools that condemned them to life on the margins of the American Dream.

I grew up in the same time-frame and attended public schools. I lived in a middle-class neighborhood and I found the schools were adequate for my needs. They must have given me a decent education for I was able to go on to a bachelor’s degree and a medical degree. At the time, I didn’t see the need for a private school, parochial school, or home-schooling education. I didn’t see anything wrong with public schools.

All that changed when teachers unions took over the public schools. The stranglehold the teachers unions have now on public schools was clearly demonstrated during the Covid pandemic when the CDC and the White House colluded with the teachers unions to determine when it was safe for children to return to the classrooms and under what precautions. Most notably, new CDC Director Rochelle Walensky was chastised by the White House, whose First Lady occupant is a member of the teachers union, when she slipped up and declared it was safe for teachers and children to return to school without AFT approval.

This brings me to the revolution that is currently taking place in our states, undoubtedly fueled by parents who are fed up with underperforming public schools and politicians who are protecting the teachers unions. The Biden Administration was so tone-deaf to the pleas of parents they complied with a request from the National School Boards Association to treat them as domestic terrorists!

The anger and resentment of parents is reflected in the words of one single mother and reporter who one of the leaders of the parent revolt in Northern Virginia that contributed to Glenn Youngkin’s upset win the 2021 governor’s race. Asra Nomani says, “For three years, school boards, activist educators and the teachers union machine have treated parents like dirt. Now an entire swath of parents – immigrants, Democrats, single moms, military families, parents with kids with learning disabilities – are championing this idea they cared little about before: school choice.” 

Already this year, four states have adopted school choice for everyone – and it’s only April. The most recent is Florida, which just extended school choice to every child in the Sunshine State. When signing the bill into law a week ago, Gov. Ron DeSantis rightly called it a “monumental day in Florida history,” State education dollars will follow the student instead of simply going to the public schools.

Florida is the most populous state to embrace full school choice. It follows Iowa, Utah, and Arkansas, which passed their own legislation this year. These were preceded by West Virginia in 2021 and Arizona in 2022. More may be coming. Four other states – Oklahoma, Ohio, Wyoming, and Texas have legislation pending. Nebraska, South Carolina, Kansas, and Pennsylvania are working on more limited versions of school choice. In Georgia, Republicans in the state House just helped defeat a choice bill, but it may come back in 2024.

Corey DeAngelis, a senior fellow with the American Federation for Children, says the mood has shifted. In the November state legislative elections, he notes, AFC-back candidates challenged 69 incumbents – and took out 40 of them. “There wasn’t a red wave or a blue wave in the 2022 midterms,” he says, “But there was a school choice wave.”

In a time of nearly-every-day bad news, this is certainly good news.