Here’s an article that I found fascinating. It’s a blow by blow examination of how an existing drug, one with proven value to a small group of patients, can continue to go up in price for years on end, despite the appearance of competitors. That’s not how the free marketplace is supposed to work, is it? Why doesn’t competition drive the price down, the way we’re taught in Economics 101?

Check out the comments that follow the article, for a sample of the discussion around this issue.

We read plenty of headlines about rapacious Big Pharma execs like Martin Shkreli, the notorious “PharmaBro”, but examples like the one above are far more common. They’re also more difficult to correct, and in some ways, more damaging to quality of life for the sick. When an illness is rare, drugs designed specifically to treat it are called orphans.  I can’t help picturing a little girl with curly red hair, with a Daddy Warbucks (Big Pharma) hovering protectively in the background. Overprotectively, it seems.

What’s at work here is an ongoing battle between business and government, based on the need to create profits versus the need to deliver care to the sick. As I’ve said before, there’s no remaining advantage in pointing fingers at big business for doing what big business is intended to do, which is to greatly increase its value to its investors. Big Pharma has its counter arguments close at hand, and is ready with a fierce defense and highly paid defenders.

I look at things from a different perspective: what will this sort of publicity do to the public’s perception of healthcare? Which after all is so dependent on what we read and hear in the popular media. That may turn out to be the most important outcome of all.

Healthcare– whether it comes in the form of your doctor, a hospital, a health insurer, or the larger public health system– operates like a business, but it’s never just a business. Think of it as a giant edifice built on the trust of the consumers. The public needs to trust the people and institutions that provide the care they depend on when they (or those they love) are sick. If the consumers lose that trust– which I believe is happening rapidly– the whole gigantic edifice trembles.

The pharmaceutical industry has become a villain in media accounts. If you can write a decent story about abuses by Big Pharma, you can find someone in the media to run it.  That’s good for us, the consumers, because it increases transparency. But if what we see and hear undermines our confidence in the product– well, as the Godfather might say, it’s “bad for everybody’s business”.

The abuses of some can’t help but infect the reputations of the whole. That may not be fair, but then neither are most things in life.

The answer? Restore the public’s trust. It won’t be easy. It’ll require cooperative action by business and government, where now there’s mostly conflict and manipulation. It’ll require some explaining to investors about the drop in their share price, and a loss of some political capital for the politicians who  support it. Temporary, of course, but uncomfortable. But necessary.

Somebody make the first move, please.