The November 20 Detroit Free Press contained a review of the movie Mockingjay – Part 2. I didn’t actually read the review – I’m not that interested in seeing the movie – but I did find something interesting about the way the film review was presented in the newspaper. At the top of the front page there was an image from the movie and the teaser, “DELICIOUS Fulfilling Finale for ‘Hunger Games.'” This was a great play on words six days before Thanksgiving, but the tone seemed to differ considerably from the front page of the Entertainment section. There you could read, “THE GAME’S UP ‘Mockingjay – Part 2’ Limps to a Gray, Gloomy Finish.”

It seems to me that these two headlines imply different opinions about the movie. That actually may not be the case – really, I should read the review, but I’m unlikely to see the movie so I don’t want to waste the time. Nonetheless, it got me thinking about how businesses will sometimes misrepresent a product or overemphasize a consumer need in order to sell more of their wares. In the case of the Detroit Free Press, the front page teaser could entice some members of the younger generation to purchase the paper or visit the website in order to read the review. Some may even become new subscribers. That would generate additional revenues and profits for the paper’s parent company, Gannett. I think it is reasonable to assume that the demographics of the newspaper’s normal readership and the demographics of Hunger Games movie fans do not have much overlap.

This situation, if true – someone else could read the review and let me know whether there appears to be a difference of opinion – is a mild case of consumer manipulation. I am of the generation now that – gasp – watches one or more of the major network nightly news programs. It seems that almost every advertisement played during these programs is aimed at getting the viewer to ask his or her doctor for one prescription or another. There is big money in pharmaceutical products, especially when those products are under patent (probably not a surprise to most of you). That’s ‘Big Money’ in more than one way. The research and development funds required to bring a new drug to market is very high, especially when the costs of failed drugs are added in. Similarly, the potential profits from a successful launch of a patented drug are enormous. The profits will be even higher if the condition for which the drug is prescribed affects a large number of people and those people are bugging their doctors for the drug. Hence, the ads.

There’s nothing illegal with this system. In fact, because the potential rewards are so great, pharmaceutical companies are willing to make large financial bets on product development. Many of these attempts lead nowhere while others lead to unexpected places. Minoxidil began as a high blood pressure medication in pill form that caused the unwanted side effect of hair growth over many parts of the body. In 1988, the topical hair growth lotion Rogaine was developed to take advantage of this side effect.

So, is this a good system or not?

Many people feel that drug prices are too high in the United States. That high price is due to the cost of development which includes the regulatory costs to convince the Food and Drug Administration that the drug is safe and effective. It also includes all those advertisements – without the demand generated by the ads, the prices would be lower. And those high prices are also the product of our mostly employer-provided medical insurance system. In order for an insurer to sell itself to companies and their employees, it must show its value by providing large discounts on medical services and pharmaceuticals. Because the employer, employee, insurance company, pharmaceutical company and healthcare providers rely on these large discounts, the listed price of medical services and drugs are very high. (Listed price is a bit of a misnomer – it is very hard to find the price of a medical service in the U.S. until the bill comes.) Also, the system has the unwanted side-effect of financially harming the middle class. Low and high income people enjoy large discounts through their government or employer sponsored health insurance. The middle class, however, gets charged full price if they do not have employer-sponsored coverage. Many middle class families have declared bankruptcy due to debt from medical conditions. (More on this in a future post.)

So, other than the problem with high prices, do we have a good system for drug development? Well….

While there is nothing illegal with the current system, some drug companies have taken steps to increase sales that have crossed the line. At times, they have been able to convince doctors to prescribe drugs to treat conditions for which the drug is not approved, or they have convinced them that the drug is safer than it is. Pharmaceutical companies and their executives have faced fines and convictions for providing misleading information. In 2007 the Department of Justice accused Purdue Pharma, L.P., of deceptively telling doctors OxyContin was safer and less additive than other drugs. The company and several executives pleaded guilty and were fined $635 million. In 2008 Cephalon paid $425 million in fines partly for marketing its Actiq opioid to treat conditions for which it was not found to be safe and effective – migraines and sickle cell pain. The marketing of opioids as safer and less addictive that other drugs has led to a serious addition problem in the country, especially in the mid-west and south where in some states, there are more opioid prescriptions filled in a year than the total population. The U.S. has approximately 4.5% of the world’s population, but uses 56% of the world’s prescription opioids. (Time)

Okay, other than the high price issues and overzealous selling techniques, is this a good system? Yes, but….

By having market driven development, there is great effort spent on developing the next big financial winner. Research is exploding in gene modification therapy to one day make cancer completely curable. Cancer is a very scary word. Many of us would feel a huge sense of relief to know that a diagnosis of cancer would no longer mean a degrading, painful and premature end to our lives. There’s a lot of money to be made in a cure for cancer, and a lot of money is being spent now to develop those cures.

The problem is that there is not a lot of money to be made in developing drugs which combat tropical diseases that affect a large number of very poor people living in impoverished countries, or the next generation of antibiotics. There is a scary new development out of China. A new strain of e. coli bacteria has been found in pigs and in people who consumed pork products. It is completely resistant to last resort antibiotics and it can pass on that resistance to other strains of bacteria. There is now a credible threat for worldwide untreatable epidemics and for entire classes of antibiotics to become completely useless. Pharmaceutical companies are not working toward the next generation of antibiotics with the urgency that may be warranted by such a potentially devastating outcome because the profit potential isn’t as high as for products which cure cancer for insured people in wealthier countries.

I find this troubling, but without the current profit driven system, we may not have many of the drugs that have helped people age with dignity and in pretty good health. Still, untreatable worldwide epidemics – yikes. That could lead to a post-apocalyptic world. Perhaps I should do something to take my mind off these concerns. Maybe I’ll go see a movie. I wonder if Mockingjay – Part 2 is any good.