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our national love affair with drugs

“The United States contains 5% of the world’s population and consumes 75 percent of the the world’s prescription drugs.” From the NIH’s National Institute on Drug Abuse (Popping Pills: Prescription Drug Abuse in America)

If I’ve said it once, I’ve said it a thousand times — Americans use a lot of drugs.  In fact, it would not be a stretch to say that we use an absurdly disproportionate amount of the world’s drugs; particular in light of the fact that there are dozens of nations that rank ahead of us as far as health is concerned.  Speaking of disproportionate…….

In the past few weeks, Express Scripts — a St. Louis based pharmacy benefit management (PBM) organization considered to be the 20th largest corporation in America —- released their Drug Trend Report on pharmaceutical spending as well as Super Spending: U.S. Trends in High-Cost Medication Use.  The latest statistics are so shocking they are almost unbelievable.

What’s going on in American healthcare is right now unprecedented.  In one year’s time (2013 to 2014) the number of people taking over $100,000 worth of prescription drugs has tripled.  Read that sentence again and let the magnitude of it sink in.  There are now 575,000 individuals taking more than $50,000 worth of drugs annually, with nearly 140,000 of those taking over 100,000 dollars worth (the average per person in this later category was over $160,000).  According to the reports, the American taxpayer and private insurance companies are footing 98% of the bill. 

This scenario is a Pharmaceutical Company’s wet dream —- super high-cost drugs that someone else is on the hook for.   As Express Scripts stated, “The total cost impact to payers from both patient populations is an unsustainable $52 billion a year.“Unsustainable.  Here’s why.  A group of people equivalent to just over 1/7th the population of the Greater St. Louis area (about 4 million) accounts for a whopping $52,000,000,000 per year in drug spending. Let me hit you with some “fun facts” from the report.

  • TAKING LOTS OF PRESCRIPTIONS:  The report stated that, “About 60 percent of patients in the super-spending report were taking at least 10 medicines.”  Although that sounds crazy, many Americans are taking absurd amounts of drugs (HERE).
  • SEEING LOTS OF DOCTORS:  We also found out that the people taking the most drugs were getting them, “from at least four different prescribers.” In other words, they had lots and lots of doctors.
  • DEPRESSION & DIABETES ARE COMMON TARGETS:  Although the drugs that treat these two common problems are certainly not the most expensive on the list, they are incredibly common.  The problem is that we have learned that the drugs that target DEPRESSION and DIABETES are not much better than placebo (HERE and HERE).  Others most commonly mentioned were STATINS and HIGH BLOOD PRESSURE MEDICATIONS.  All of these with the exception of Depression (some would argue that it is as well) are diseases of lifestyle.  The drugs mask symptoms without addressing the underlying cause(s) of said symptoms.
  • THE MOST EXPENSIVE DRUGS:    Even though the drugs in the previous bullet point are not cheap, no one is going to spend fifty grand, let alone one hundred or one hundred and fifty grand on these drugs.   This group of super expensive drugs were made up of specially compounded drugs as well as drugs for CANCER and drugs for Hepatitis C.  I’ve talked to patients whose chemo bills were as high as $24,000 per treatment.  Hep C is almost as bad.  The report said this about the Hep C drug Harvoni (Ledipasvir / Sofosbuvir). 

Harvoni is priced at a staggering wholesale acquisition cost of $1,125 per tablet – more than $33,000 per 30-day prescription….  Payers and patients have limited resources and simply cannot afford these prices. Absent more fair drug pricing, payers will face half a trillion dollars in prescription drug costs as soon as 2020“.  The report went on to say that, “While specialty medications represent only 1% of all U.S. prescriptions, these medications represented 31.8% of all 2014 drug spending.” 

According to the US Census Bureau, our nation’s population is currently about 315 million people.  This means that not quite .002% of our population is using up almost one third of the dollars spent on prescription medications here in America.  But trust me when I tell you that this is not where the problem ends.  When you add this to what is happening in the last part of people’s lives, you can begin to see how out of control the situation really is.


“It was one of those great stories that you can’t put down at night.  The hero know what he had to do and he wasn’t afraid to fight……    And the reason that she loved him, was the reason I loved him too.  He never wondered what was right or wrong; he just knew.  He just knew.” – David Crosby and Phil Collins from 1993’s Hero (Thousand Roads).

Let’s be honest with each other for a moment.  We all love to play the hero.  Over and over again as a kid, pretending to hit the winning home run, score the last-second touchdown, or hit the 30 foot buzzer-beater for the national championship. Or saving the damsel in distress?  Or conquering (anything) against all odds?  Remember the very end of the first Star Wars film?  Who wouldn’t want to be up on the podium receiving their medals for saving the galaxy right alongside Luke Skywalker, Han Solo, and Chewbacca?   I don’t think healthcare providers (self included) are much different. 

I take great pleasure in helping people GET THEIR LIVES BACK.  Not that I would consider myself in this category of “hero”, but there are plenty of heroes in healthcare.  My brother is an ER doc, and there’s no telling how many lives he’s saved.  But……..

If you take this concept of spending huge dollar amounts on small segments of the population one step farther, you land at end-of-life care.   Dying has historically been looked at as a normal part of living.  No one really wants to do it, but sooner or later it’s one of those things we’re all going to be faced with.  Because of our seemingly deep pockets, we have become a society willing to spend astronomical dollars at the very end of people’s lives, prolonging miserable situations sometimes by mere days or weeks with “heroic” interventions (HERE is a prime example).

Because we know that a huge percentage of health care dollars are spent at the very end of people’s lives, we can start to see how our medical spending is a true double whammy of waste and deception.  The waste part is easy to see.  As for the deception part, people are being deceived into thinking that the drugs and procedures they are given are going to provide a miracle.  Rather than me chiming in personally, allow me to show you a few studies on this matter. 

The June 13, 2013 issue of Insight Research Tools; the official journal of The Medicare NewsGroup — an organization whose motto is, “Understanding Medicare: Care, Cost, Control and Consequences” — carried an article called End-of-Life Care Constitutes Third Rail of U.S. Health Care Policy Debate.  The article carried these statistics concerning end-of-life care.   “In 2011, Medicare spending reached close to $554 billion, which amounted to 21 percent of the total spent on U.S. health care in that year. Of that $554 billion, Medicare spent 28 percent, or about $170 billion, on patients’ last six months of life.

Forbes Magazine ran an article by Michael Bell about six months prior to that in January of 2013 (Why 5% of Patients Create 50% of Health Care Costs) that revealed some rather shocking statistics. 

According to one study (Banarto, McClellan, Kagy and Garber, 2004), 30% of all Medicare expenditures are attributed to the 5% of beneficiaries that die each year, with 1/3 of that cost occurring in the last month of life.  I know there are other studies out there that say slightly different things, but the reality is simple: we spend an incredible amount of money on the last year and the last month.” 

The same article went on to give us more research into how well this misguided attempt at compassion is working.

“In the Archives of Internal Medicine, a study asked if  a better quality of death takes place when per capita costs rise.  In lay terms the study found that the less money spent in this time period, the better the death experience is for the patient.  It seems that no matter how much money you use during that last year / month, if the person is sick enough, the effort makes things worse.  A lot of the money being spent is not only not helping, it is making that patient endure more bad experiences on a daily basis.  The patient’s quality of life is being sacrificed by increasing the cost of death.”

I could go on and on, but I think you get the point.  The reality of the situation is that we don’t really have a “healthcare” system in America, we have a sickness care system, with an extremely small segment of the population using most of the resources.  Unfortunately, I rarely if ever see patients who are given any sort of meaningful advice on things like diet (HERE) or lifestyle changes (HERE) during their doctor visits. 

What I do see is a system that is so focused on making massive amounts of money (HERE) that they have sold their collective souls.  If this system of healthcare delivery is not reigned in and reorganized (preferably not by the Federal Government, who has already proved they can’t be trusted (HERE), the ZOMBIE APOCALYPSE will be here sooner, rather than later.


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