In Support of Compounding Pharmacies
Big Pharma has been, as usual, busy feathering its nest. We need only to follow the money, observing the incestuous big pharma-federal government relationship over the past 80 years. I’ve written about carrying water for Big Pharma before here on Substack. No doubt Big Pharma has paid for many governmental favors with expensive lobbyists to influence our legislators, the Federal Drug Administration (FDA), and the Department of Justice (DOJ), all involved in making official decisions about drugs.
For example, in the mid 90s, Big Pharma convinced legislators that doctors shouldn’t own hospitals by convincing them that doctors would pad the hospital bill if they were allowed to do so. No one seems to have noticed the padding corporate medicine does with their bills or the non-profit hospitals with all kinds of profit-making subsidiaries. Doctors are not allowed to own controlling interest in pharmacies, hospitals, or insurance companies, but Big Pharma can own pharmacies, hospitals, clinics, doctors and insurance companies. Follow the money.
Hospitals can, for some reason or other own doctors, but doctors can’t open hospitals. This causes a large problem for doctors who are forced to have allegiance to their employer as their first priority. If they don’t behave, their employers can punish them in many ways, including loss of money or even loss of their licenses. Patients come second. And we wonder why, as a nation, we are generally receiving decreasing healthcare grades.
Physicians for thousands of years have had a personal relationship with their patients, but what hasn’t been around for thousands of years is Big Pharma, Big Insurance, Big Hospitals and Big Government. None of these entities are necessary to the patient-doctor relationship. All these entities have placed themselves between the patient and doctor, destroying the real practice of medicine. Dr. Hans Duvefelt does a wonderful job of describing the real practice of medicine in his Substack posts.
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Big pharma, big hospitals and big insurance can own doctors and worse yet, tell them how to practice. As I reported in my previous Substack article on Big Pharma, in the fall of 2018, CVS bought Aetna, an insurance company and with it the CVS pharmacy benefits manager (PBM) entity as well.
The purpose of the PBM was to protect the public from price gouging by Big Pharma. It was designed by the federal government as a protective device to shield the consumer, and it was not supposed to be owned by any pharmacy because it was intended to be a pharmacy watchdog. So, PMB being owned by Big Pharma wouldn’t even make any sense to the original lawmakers who were trying to protect the public. The PBM started as a buffer.
Aetna, as an insurance company, had a PBM branch to protect the insurance company from price gouging by the pharmaceutical industry, including CVS. Aetna fell on hard times and was billions of dollars in debt. It needed rescuing. Along came the CVS telling the DOJ that they had an INNOVATIVE plan to develop clinics and employ doctors. CVS told the DOJ it could purchase clinics and doctors and by their innovation increase access to healthcare.
Why the DOJ, which is supposed to prevent monopolies, could be so easily convinced to overlook this responsibility is totally beyond my comprehension. So what actually happened? For some logic-defying reason, the DOJ was so enamored of the CVS’s notion of INNOVATION that they failed to protect the public. The DOJ forgot all about its antitrust responsibility to the public. All these shenanigans are hard to understand unless you follow the money. CVS’s CEO is paid 22 million per year. And CVS continues to purchase clinics and doctors.
A very round tally of CVS’s purchases of insurance companies, clinics, and doctors comes to more than $88 billion—not millions, but billions. If this doesn’t sound like monopoly activity, then nothing does. The question that every consumer needs to ask of their legislators and the Washington bureaucrats in the DOJ is “Where did the $88 billion come from?” The answer is this money comes from the public.
In this country 41 percent of the people struggle to pay medical bills. That should have bothered the DOJ. We’ve seen a lot of government agencies “carrying water” for big pharma. Look at Wyeth’s Premarin. For six decades, Wyeth did their own studies extolling the virtues of Premarin. For half a dozen decades, healthcare providers were told that Premarin would prolong life, decrease the risk of strokes, decrease the risk for heart attacks, decrease the risk of dementia, mend osteoporosis, eliminate bladder infections, treat hot flashes, and rid millions of women of dyspareunia (painful intercourse). Some doctors were so enamored of Premarin that they actually refused to see patients who would not take it.
As one could predict, Big Pharma wants to destroy most, if not all competition. It appears that Big Pharma is now interested in eliminating compounding pharmacies. They couch their concern for public safety in the reproducibility of compounded medications. In other words, what and how much is in the compounded medication?
Years ago, I had some local pharmacies mix up prostaglandin E2, a special kind of prostaglandin. The pharmacies made the E2 into a gel by taking the existing E2 suppository of 20 grams and mixing portions of it with KY jelly. The compounding pharmacy offered two dosages. One was a .5 mg dose and the other was a 5 mg dose. The point made by those who want to eliminate pharmacy compounding is that it’s possible for the .5 mg gel to have a .45 mg dose or a .55 mg dose.
The concern about .05 percent variability is totally irrelevant as far as I’m concerned. because in patients these two doses would offer no danger. They would both get the job done. For people who are nervous or neurotic about compounding, think of generics. Generics are generally not made in this country because they can be made for much less money in foreign countries such as India, China, Israel, Mexico, Indonesia and many South American countries.
For our brand-name medicines made in this country, there is some control over the manufacturing process. For example, they are supposed to list the amount of each product and the vehicle for delivering the medications listed on the label. No unlisted agent is supposed to be present in these pills.
In this country, there are consequences if it is discovered, for example, that an ingredient in a drug is found by accident to be carcinogenic. We have no control over what’s listed on the label of a generic produced in a foreign country. All we can say for certain about these generic medication’s is that we can understand what is in the pill if we examine it. We have no idea and no control over what is in the other millions and billions of pills Big Pharma imports as generics every year.
Problems with imported generics often don’t land much press. Recently there were 200 deaths of children taking a medication imported from Indonesia which contained antifreeze. The makers of the poison cough syrup claimed they were innocent of wrongdoing because they had no intention to poison anyone. Eh?
This problem and these deaths are precisely what can happen when we have no control over generics which are made in other countries. How can Big Pharma, our FDA, our DOJ, our Centers for Disease Control and Prevention (CDC), or our National Institutes of Health (NIH) explain how they let the importing of generics go unregulated?
You may be worried about the amount or kind of active ingredient, mixer, or possible carcinogens might be in compounded medications. But understand that this problem is 100 times greater for generics imported from other countries. The difference is that Big Pharma makes no money on medications compounded or prepared by small pharmacies in the U.S. but Big Pharma makes a lot of money on the low cost of generics they acquire from other countries. Actually, they make more money on these imported generics than they do on many of their brand names meds.
Once again, money talks. Remember that Big Pharma makes a lot more money importing cheap generics than they would by having U.S. controlled generics made in this country. In summary, the push to eliminate compounding medications in small pharmacies in this country has much less to do with quality control, and much more to do with making a profit. Big Pharma has big money and can purchase lobbyists to mislead regulators in this country.
What amount of profit makes all of these deaths worthwhile? How do they, the these federal organizations explain this to the families of the dead children? The report from Indonesia is neither the beginning, nor the end of this problem. I am aware of a mouthwash that killed several people in one of the hospitals near me. Was the amount of money saved on the cheaper product some kind of consolation to those who died from that mouthwash?
The only way to prevent contaminated imported generics from killing people is to have generics made in this country where they can be regulated.
Our state and federal governments, legislators, lobbyists and bureaucrats have caused a lot of trouble for the American people because they have allowed themselves to be seduced by money. This spiderweb of mischief will take a long time to resolve, but the beginning of the solution would be for our legislators, lobbyists and bureaucrats, state and federal to understand that they need to keep in mind, always, the best interest of the public, and not to be seduced by money, profit, or political finagling.