National health care crisis: Is your medicine working for you?
Life-saving medicine can be cheaper per unit than candy, and intravenous nutritional supplements may fetch even less than bottled water. But does such cheap medicine come at an unbearable cost?
As a physician in the Department of Intensive Care Medicine at Chi-Mei Medical Center, Dr. Che-kim Tan is nothing if not meticulous, doing everything in his power to save critically ill patients.
“Intensivist physicians are like guardians of the gates of hell. Oftentimes we only get one chance at saving a life,” says the doctor, a man with the muscular physique of a rugby player.
But lately his confusion has grown as, despite their obvious youth and good chances for survival, some patients have been unable to outrun the Grim Reaper.
At first Dr. Tan chalked it up to the nature of illness, until one day when he happened upon a paper in an international medical journal that compared an original branded manufacturer’s antibiotics against 23 generic products. The study found that, with the exception of one generic medicine that had the same ex vivo efficacy as the branded medicine, the other 23 medicines were only 60 to 90 percent as effective.
Among the medicines shown to have only 80 percent efficacy, two of them were vital weapons he frequently relied on to save patients’ lives.
“Could that have been one of the reasons?” a shocked Dr. Tan wondered.
Though he was aware of the difficulty of proving that the efficacy of a single medicine was compromised or had any connection to whether his patients lived or died, the question still gnawed at him.
With a heavy heart, in an en- try on his personal blog entitled “Please Give Intensivist Doctors Life-saving Weapons,” he wrote the following: “With the constant downward adjustment of medicine prices by (Taiwan’s) National Healthcare Insurance system, a considerable number of original pharmaceutical manufacturers have abandoned Taiwan, citing nonexistent profits. Meanwhile, those sticking around are taking action in response to the excessively low rates. So the question is, when the price of a pill is less than a piece of candy, how can we expect vendors to care about safety and quality?”
In his interview with CommonWealth, Dr. Tan stressed that he does not insist on using only drugs from branded original manufacturers, nor does he dismiss generic drugs out of hand, insisting, “I just care about being able to use good quality medicine.”
Over the past year, in his dual capacity as an intensive care de- partment physician and his hospital’s director of patient safety, he has delivered a series of talks at a number of medical conventions. At them, he has encouraged doctors to inform hospital authorities and conduct further evaluations if they suspect that the clinical efficacy of drugs their hospitals have switched over to could be lacking.
“Doctors believe that the medicine they prescribe has the same efficacy as it says in the book. However, they are unaware just how many different brands are out there, as well as all of the business jostling that goes on before they get their hands on it, let alone the fact that there are differences in the quality of different drugs. That’s scary!” exclaims Dr. Tan.
Cheaper in Taiwan than China
Taiwan’s National Health Insurance system is world-renowned for its cost controls; from new drugs to old drugs, the cost of drugs in Taiwan is famously low.
Janice Chen, chief of the Center of Education of Comprehensive Drug Utilization at the Sun Yat-sen Cancer Center in Taipei, has been a member of the NHI’s Pharmaceutical Benefits Advisory Committee since the scheme’s inception two decades ago. As such, she has long observed the artificially low prices for new drugs in Taiwan.
Her investigations have found that the approved pricing for new drugs under the NHI system is a fraction of what new drugs cost in the top 10 most advanced countries, greatly dampening the big global pharmaceutical companies’ interest in introducing new drugs to Taiwan.
“Our new drugs reach the market here four or five years after the first country that gets them, and the situation appears to be worsening,” says Professor WengFoung Huang of the Institute of Health and Welfare Policy at National Yang-Ming University.
And never mind the low prices; Taiwan even further slaps a tonne of restrictions on the use of new drugs.
One of professor Huang’s Ph.D. students is writing a doctoral thesis comparing new drugs for preventing osteoporosis. Overseas, patients use the drugs as a preventative measure before they break their bones, whereas in Taiwan they only take it once they have suffered bone breakage — an absurd practice.
In addition, average annual outpatient visit drug costs in Taiwan are lower than the international trend, hitting US$322 (NT$10,000), which is around 70 percent of that of South Korea, less than half of that of Japan, and only one-third of U.S. prices.
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A packet of pills is shown in this photo taken Feb. 11 in Quimper, western France.