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photo of pillsjoin the discussion - What are your views on the efforts of states like Maine and Oregon to control the escalating cost of prescription drugs?  Are you worried that controlling prices could threaten new drug discoveries?

Dear FRONTLINE,

The research and development of drugs in the United States is estimated to be 40 percent public paid, what the drug companies like to call "innovation." Further, the fundamental biology on which all drug development is based is nearly 100 percent publically funded. The economist Dean Baker explained that if the public paid all the costs of drug development there would be a colossal saving in cost.

When a drug company describes the U.S. contribution to "new" drugs as the largest in the world (60 percent) what they are really saying is that patents and legal rights are being recycled more often in the U.S. From a biological perspective, most "new" drugs are not new.

Andrew Irons
chapel hill, north carolina


Dear FRONTLINE,

The root of the prescription drug problem may be the very free market system it's based upon. Since the best drugs and services are provided to those with the most capital resources, the elderly are almost always going to get the short end of the stick.

It seems that any attempt to address this problem must somehow remove the current emphasis on profit [public ownership of pharmaceuticals perhaps] without undermining the continuation of research and development.

Thanks for the insightful program!

David Augustini
austin, tx


Dear FRONTLINE,

It is too bad that the drugs that many in the program need are expensive, but people in America need to learn to take better cae of themselves. The program showed some of these seniors sitting on their butt watching TV, not exercising. Most of them did not look like they were worried about their next meal. We think that we can just continue to eat whatever and not exercise and then the doctors can just fix you up with a miracle pill for all your ills. If you are healthy you shouldn't need to take 7 pills a day. I understand that some conditions are beyond our control, but many can be attributed our lifestyle here in the US.

Also, I am not completely absolving the pharmacutical companies of any blame. I could go on and on about this, as one viewer noted, 1 hour is not enough to cover this subject nor is a brief paragraph written during my coffee break.

John Mueller
tallahassee, fl


Dear FRONTLINE,

While the PhRMA CEO's were talking about R&D expenses and innovation I was surprised that the following 3 questions were not asked: 1) Why should the citizens of the United States foot the bill for the research and development of new medicines that the rest of the world then gets for less money?

2) If the prices set by other countries are so unfair, why do the manufacturers agree to sell to them? If they won't sell for the prices the other countries are willing to pay it would seem to open the door to negotiation.

3) How can they keep a straight face when much of the R&D is for 'me too' drugs. Wellbutrin went off patent so now we have Wellbutrin SR...which is about to go off patent so they are introducing Wellbutrin XL.

Steve Burney
columbus, north carolina


Dear FRONTLINE,

There was a part of the show that mentioned how drug reps come in to the doctors office and paint a beautiful but biased picture of the latest drug. The state of Oregon has the right idea about telling consumers the truth about which drugs work and don't work. I worked in a doctors office for 18 months and you should see the stuff we got from the drug company sales people, along with catered lunches. Then they would spend time chatting up the medical staff about the latest drugs to push. Next time your stuck waiting for hours for your appointment, find out if some sales person didn't come in and tie up the doctors time.

Antonia Betrus
seneca falls, ny


Dear FRONTLINE,

Interesting that no salaries where mentioned for CEO's and the boards of these companies. Include stock options, loans, etc. that the club has that no one else does. People will be shocked.

moravia, new york


Dear FRONTLINE,

,,, very informative. The numbers that jumped out at me the most was the 16% of capital that is spent on marketing outpacing the 13% spent on R&D, this is not surprising when one considers the millions spent each year by pharmaceutical reps on the wining and dining and other lavish perks bestowed upon the top prescribing doctors.

As far as government intervention goes one has to wonder if it would not be wiser to spend a portion of that public dollar in educating and creating incentives for americans to pursue healthier and more active lifestyles involving better nutrition and regular exercise, in effect changing the "take a pill for whatever ails you" mentality so prevalent in north american society today.

R. Henzi
whistler , b.c.


Dear FRONTLINE,

The topic is so complex that one hour just cant do it justice. The fact is that prescription drug use has supplanted a share of healthcare costs that were formerly on the medical side (and covered by most insurances) at the time Medicare was written. Insurance was primarily for financial protection from catastrophic events. Now, more people seem to feel entitled to have insurance cover the majority of all medical and prescription services.

As a pharmacist, it was most disconcerting to see the entire retailing segment of this issue untouched. It is the one segment where legislators have had the greatest success in controling costs. California passed, and others have copied, laws which control prescription drug pricing at the retail level for Medicare eligible persons. Bottom line, there is a great deal of price shifting in our healthcare system. Oddly enough, the highest prices are often born by those least able to pay.

john oconnell
santa rosa, ca


Dear FRONTLINE,

Thank you for a good program. I was disappointed that you only had one "expert", Marcia Angell, arguing for price controls.

I was also disappointed you didn't do an analysis of the R&D cost vs. profit over a period of 10 years say, for a company like Eli Lilly, which would have substantiated one position or the other.

I want to make 2 points:

1. Since many of the newer, expensive drugs (like Vioxx) were basically the same efficacy as older cheaper drugs, if we had drug price controls based on the category of drugs, the drug industry wouldn't be wasting R&D and marketing dollars on the "me-too" drugs (and then turning around & bilking the public).

2. Direct customer marketing, especially as practised by the drug industry, does not qualify as "free speech" which is only guaranteed by the U.S. Constitution to its citizens (although the current Supreme Court may end up giving Corporations that right).

Sridhar Subramanian
santa barbara, ca


Dear FRONTLINE,

I work in Research and Development for a pharmaceutical company. I have worked on 7 experimental drugs over 10 years and none have made its way into the market place. Do you know of any other industry where the product failure rate is so high? Yet the men and women of the drug industry toil for years so that the public can benefit from our work. Your one-sided story portraying us as money hungry capitalists is demoralizing and un-true.

Andy Lin
palo alto, california


Dear FRONTLINE,

When looking at prescription drugs, what we currently have in the United States is a dysfunctional market place.

What is needed is a public/private partnership of stakeholders (purchasers) to pull their purchasing power to drive market share and make drugs accessible.

We need to embrace the tools (evidence-based medicine) that Governor Kitzhaber suggested to move towards a value driven rather than an advertising driven market.

The debate in Congress should not be about first dollar coverage, but rather how can we lower the cost of drugs allowing more access. We are the only industrialized nation that does not impose some form of price control on the multinational drug companies. Sending our elderly across boarders is not being able to address the difficult questions in Congress.

Arthur Zoloth
edmonds, wa


Dear FRONTLINE,

This was a very interesting program you ran on prescription drug prices. It really hits home for me. I used to work in a new high tech start up company in the 2002 but was laid off due to the bad economy. I lost all my benefits and had to pay cash for my drugs just to make ends meet. I paid $400 a month for prescriptions. Recently I came across an ad for prescriptions mailed to your house from Canada. The ad advertised upto 40-90% savings on medications. I ordered from them and they shipped it to my house. I paid only $180 for my prescriptions.

I hope the government will change our medical benefits soon. In the mean time, I know that I still have options.

Carmen Lopez
yuma, arizona


Dear FRONTLINE,

I've read most of the emails regarding the "other" drug war in the United States. So many different responses to the same issue. I would like more time to respond, but here goes: I take 7 different drugs on a daily basis, as well as magnesium and potassium, which are Not prescription mandatory for me to take. I spend so much per month on drugs, and always look for generics.

Why doesn't the USA get France's price, or, say, Germany's or even Canada's - what's the matter, can't we negotiate. The point about government dollars going to drug research was well taken, but not aired on the program. Pleasse rerun this program. I am a boomer, and paying more every day for the title.

los angeles, ca


Dear FRONTLINE,

I work as a clinical pharmacist for the City and County Health Department in various outpatient Mental Health Centers. Despite administrative attempts to control pharmaceutical promotion the clinics are full of Prozac, Paxil, Zoloft, Zyprexa, Risperidal, etc. pens, cups, calendars, wall clocks in patient care areas...drug reps. continually sponsor expensive dinners, informational lunches, etc. pushing the lastest, most expensive drugs. Unbiased non-industry studies that would support better treatment outcomes to justify drug costs hundreds of times more expensive than older products are lacking.

As public , taxpayer funded health programs struggle to survive budget cuts the cynical joke is "Why not sell hospital or clinic naming rights to the drug companies" Drug companies developing different formulations of their existing products is most often a gimmick to extend patent protection vs. a " real breakthrough"....

Lewis Eng
san francisco, calif.


Dear FRONTLINE,

... to suggest that price-capping or additional government intervention is the answer is akin to saying the answer to losing weight is by eating more food.

By hindering the forces of market, we are cutting the wires to the motors that move us. If an individual is not rewarded for their work but instead is paid the same irregardless (ie, set prices), then they will only work just hard enough to not get fired. The same goes for the corporate level. If a business is not rewarded for research and development, if they are not rewarded for bringing new drugs to market, then the only incentive to do such is the proverbial governmental gun held to their head.

It was sickening to hear the complaint on the show that because people are poor, they *deserve* a discount. There is no clause in the constitution reserving the people's right to whatever they feel they want because that is one right the individual does not have.

Kyle Petersen
beaverton, oregon

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posted june 19, 2003

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