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"Working
Together on Common Concerns and Complex Solutions"
PhRMA's
"Patient
Matters" Newsletter, Fall 2000
Michael D. Miller, MD
When my family gets together in large groups, the talk inevitably turns to
healthcare. This is no surprise since I come from a family with two other
physicians, and for the last 12 years I have been working on healthcare policy
issues in Washington, DC. Two common themes have emerged from these
discussions over the years: Getting treatment for a current ailment or
illness, and a strong desire for a new medicine which will be better able to
treat or cure many worrisome diseases like cancer, arthritis, Parkinson's and
AIDS.
For
the last six months I have been working as a consultant to
PhRMA, and in that capacity I have been talking to a variety
of groups to help answer some questions they have about
issues related to pharmaceuticals, including:
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How
are new medicines researched and developed? |
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How
do the government, academic institutions, and industry work
cooperatively? |
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What
factors affect the pharmaceutical industry's research
decisions? |
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Why
is the spending on pharmaceuticals increasing? |
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Do
health systems in other countries operate differently than
those here in the United States? |
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How
can access to today's medicines be improved here in the
United States? |
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What
could happen to our healthcare system that would affect the
development of new medicines? |
As I have talked with various groups of patients, physicians,
managed care executives and others, there has been great similarity
to my family discussions. There is general agreement that
access to medicines should be improved, and about the great
benefit we all expect from potential new medicines still in the
research stage whose safety and effectiveness are still being
evaluated. However, there is controversy about paying for
medicines -- how they should be paid for, and who should be paying
for them.
It is clear that our healthcare system is complex and could be
improved in several areas. For example, about 44 million
people here in the US do not have health insurance, and 1/3 of
people with Medicare do not have coverage for outpatient
prescription drugs. International comparisons area also
interesting. For example, of each dollar Americans spend on
healthcare, only about 10 cents of that dollar goes for
prescription drugs. Whereas, in other developed countries
like Japan, England, Sweden, Canada and Germany, spending on
prescription drugs consumes 12-21 cents of every dollar spent on
healthcare.
Because our health system and its financing are complex, it is not
a simple matter to make improvements while avoiding or minimizing
unintended consequences. The practice of medicine addresses
this by making sure that any actions consider the entire
"patient" rather than just focusing solely on the single
problem of the moment. In the policy world this is done by
taking a comprehensive and integrated approach, rather than
conducting so-called "silo thinking."
Over the years there have been many attempts at both large and
small changes in our healthcare system. Some of these
attempts have been successful, some have been reversed, and others
remain ideas having never been tried. The lesson learned
from the successes is that as a society, it is important for all
parts to work together and to continue to generate ideas for
improving our healthcare. This is the best way to achieve
successful improvements and avoid painful unintended
consequences. We are in an era of economic prosperity.
Through rational and cooperative planning and action, there should
be an opportunity to improve access to prescription drugs and thus
improve the quality of healthcare in the United States.
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