National Review of Unused Medicine: Our Emerging Medical Dark Age and the Economics of Pharmaceutica

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National Review of Unused MedicineOur Emerging
Medical Dark Age and the Economics of
Pharmaceutical Inaccessibility

• 3rd Annual Maine Benzodiazepine Study Group
  International Conference
• October 12, 2005
• Edward Pontius, MD
• President-Elect Maine Association of Psychiatric
  Physicians
• Medical Director, ACCESS Team, Portland Maine

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• The term Dark Ages now has a pejorative tone,
  but can be legitimately applied to the period of
  lost economic and technological capability after
  the fall of Roman Empire AD 476-1000
• The Pantheon was build 27-25 BC during the third
  consulship of Marcus Vipsanius Agrippa.
• Largest surviving structure from antiquity.
• Largest dome in western Europe until 1436.
• Concrete technology Roman engineers used for this
  public structure was lost for more than 1500
  years.
• Early medieval period in western Europe was
  clearly less capable of building monumental
  structures than was the Roman Empire- a
  contrasting Dark Age.

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Our Emerging Medical Dark Age and the Economics
of Pharmaceutical Inaccessibility

• We are experiencing an unprecedented growth in
  the number of potentially useful medical
  technologies, including useful medications
• The gap between what we know how to do and what
  we actually provide to populations is is more
  significant than ever before
• In the United States, the worlds most expensive
  medical system is the least effective at
  distributing medical care
• Communication technologies ensure that an
  increasing percentage of the worlds population
  appreciate fully their lack of access to
  potentially life-saving medical care
• Our Emerging Medical Dark Age is not a dark age
  of contrast to a previous era, but an age of
  contrast within our own time, between the
  brilliant medical services we now know how to do
  for a few and what we know how to provide for all.

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Key Contributors to Our Pharmaceutical Dark Age

• Pharmaceuticals As Luxury Purchases
• Maximizing profit rather than public good
• Multiple Markets and Elasticity of Demand
• Protection of High Profit Market Through
  Segmentation
• Product differentiation
• How to see more appliances while keeping prices
  high?
• How to sell more laser printers while keeping
  prices high?
• Samples, Coupons, Compassionate Use Programs
• Lack of negotiated national purchasing ability
• Consequences
• Highly inefficient distribution system
• Highly unequal access to needed medications
• Reduces opportunities to improve safety

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What Can We Do?

• Public Education is our best strategy
• We cant afford to settle for samples
• In the long run, maintaining a minimum standard
  of access to medical care is one of the most
  cost-effective strategies for dealing with
  increasingly expensive social problems
• Americans are capable of sacrifice for the
  common good- what defined our Greatest
  Generation