An Uncomfortable Truth .

There are many uncomfortable truths in our callous society. I would like to impart just one to you today: each day, people in our society die because they cannot afford prescription drugs. These deaths are preventable and they are the consequences of decisions made by pharmaceutical executives, lawmakers, and our political system (this is an argument which I will make in a future post).

Before we explore this uncomfortable truth, I would like to dispel some myths about drug prices. First, it is undeniable that our drug prices are absurd compared to other nations and the healthcare industry knows this. In a presentation available online, an executive for Kaiser Permanante gave the example of Sovaldi, a medication used to treat hepatitis C. In the United States, Solvadi costs $84,000; in Germany, $66,000; and in Egypt, $900. This phenomenom is not limited to Sovaldi; over the years, cancer drugs have becoming more expensive at “dizzying rates,” for instance.

Second, research and development of drugs is not the only driver of drug costs. While it is expensive to develop a new drug — the estimated average cost ranges from $1 billion to more than $2 billion — this is a deceitful sleight of hand: most large drug companies spend more on marketing than researching and developing them.

It is now time to take the uncomfortable truth head-on. In a study published in 2020 by the West Health Policy Center and Xcenda, researchers estimated that 112,000 Medicare recipients will die prematurely each year for the next decade due to cost-associated non-adherence to drug therapy (i.e., they cannot afford their medications). As the study noted, this is more people that die from diabetes, pneumonia, or kidney disease.

While a shocking statistic, it should not be surprising. A 1993 study found that those without health insurance had a 25% high risk of death, between the years 1975 and 1987, than the privately insured. The analysis controlled for factors such as age, education, and income, as well as lifestyle behaviors like smoking, alcohol consumption, and exercise. A more recent study analyzed the impact of Medicare expansion in certain states after passage of the Affordable Care Act. Unsurprisingly, the authors found a reduction in adjusted all-cause mortality in those adults who received Medicare coverage.

While any argument should be based in empirical evidence, the studies above do not capture the true horror of what the effects of unaffordable medication are. In 2016, American Medical Association created truthinrx.org, a campaign to promote transparency in drug prices and collect patient experiences on paying for medications, which you can read on the website. There are dozens of stories, and although they are unique, Myra’s is illustrative:

“Sometimes I decide whether I’m going to get medication or pay my electric bill. An electric bill weighs on me a little bit more because I don’t want to be in the dark… I don’t know what it feels like to be out of pain, because I live with it every day.”

Notice, however, that our uncomfortable truth does not spare even those with insurance, as Daniel explains:

“I have to tell the pharmacy to keep my prescriptions because even with insurance I can’t afford them.”

And now it is time for my own story, which was the impetus for this article. Because of a temporary lack of health insurance, I had to pay the full cost of my sertraline prescription, which I take for my generalized anxiety disorder. (You can read about my recent withdrawal from the medication here).

Sertraline is a generic drug and was approved by the FDA in 1999 (coincidently, the same year I was born). Despite the fact that it is not new nor novel (in 2016, it was the most commonly prescribed psychiatric medication), the price at CVS without insurance was $141, whereas in Canada, the drug costs $25. I was able to afford the medication, but many people are not— at the federal minimum wage, that is almost twenty hours of work.

When confronted with uncomfortable truths, we can choose to ignore them or act upon them. But now, dear reader, regardless of what you decide to do, you must live for the rest of your days knowing that people like you are dying everyday, not because Medicine does not have an answer, but because our society chooses to let them die.

This is only partly a proclamation of despair and resentment. Because each one of us is a small cog, I am not optimistic in a revolution to change the health care machine anytime soon. But for the average patient, I do have some advice: 1) use GoodRx.com to get coupons for prescription drugs 2) use the limited ways available to reduce medical debt.

Beyond this, I only see reason for despair.