Wednesday, July 12, 2006
What good is an unaffordable drug?
Since becoming a doctor, I've been increasingly troubled by how hard it is to get treatment to those who need it most. Sure, there are a lot of uninsured people -- everyone knows that -- but that isn't nearly the whole story. Simply put, even for those who have insurance, medical care is expensive. The co-pays can be very costly, and if you have any sort of chronic illness, you may pay more for medicine than for rent.

Even though I'm well-acquainted with the expensive nature of healthcare, I was stunned when I read a report recently by a pharmacy benefit manager, Express Scripts. It showed that cancer drugs prescription costs went up 16 percent last year. All other prescriptions went up by an average of three percent. We are talking about cancer, where unfortunately the only parameter of success is life or death, and it is getting increasingly expensive to live. As things stand now, it costs around $1600 per month for many cancer medications.

Of course, those are all just numbers and may not mean a whole lot to some people. However, a little girl that I met a couple of years ago may shed some light on the issue.

Ally Krowski is 6 years old. This impossibly cute girl developed some really bad back pain one day. Within a few weeks, she couldn't even walk. The diagnosis: Ewing's Sarcoma. There was a tumor pushing on her spine and her doctors were not optimistic that she would walk again or even survive. For Ally, the story ended up being a good one. She was flown to MD Anderson Cancer Center and received an experimental drug that saved her life. I still remember her mother crying tears of joy when she realized Ally would live.

Unfortunately, that life saving medication was expensive, too expensive to make anymore. So, for the next Ally, a medication that could possibly save her life may not be around. We are told there is only enough left to treat a few dozen children.

It is easy to get outraged by this fact, but it's also important to understand how drug companies make these decisions. In Ally's case, her cancer, Ewing's Sarcoma, is considered an "orphan disease," one with fewer than 200,000 new cases every year. At some point, it becomes increasingly difficult for drug companies to make medications that few people will use.

To be sure, according to a recent report, the drug industry does give more than $8 billion worth of cash and products to people who can't afford medications. And drug companies do need to turn a profit in order to develop the next generation of drugs.

So how do we reconcile this problem as a society? If you make the greatest cancer drug in the world, but it is too expensive, what good is it? I am anxious to hear your thoughts.
Posted By Dr. Sanjay Gupta, CNN Medical Correspondent: 10:49 AM ET
For someone who works in the healthcare industry (particularly in patient billing), I am well aware of the rising costs of healthcare and prescription drugs. It is brought to my attention every day by the multitude of patients that we talk to and are seen here at our facility. Prescription drug costs are one of the complaints that we hear the most about.

I find it hard to fathom that the cost of cancer drugs (or prescription drugs in general) has gone so high so fast. Why is it that in order to live and survive on some medications that one has to practically bankrupt themselves in order to have the medicine or medical care that is needed/required?

There is something seriously wrong with the healthcare system in our country, and has been for some time. People are looking to other countries (particularly Canada) for medications that are affordable. A revision to the system here in the US is needed. HMO's dominate our healthcare, and with that comes strict guidelines on who a patient can see and what prescrption drugs are covered. Those drugs that are not covered (whether it be in generic or regular scripts) are nearly impossible to afford. Why does it cost so much to have a small little pill that will give a patient relief and possibly prolong their life?
Posted By Anonymous Jenniffer, Madison, WI : 11:13 AM ET
Dr. Gupta. Thank you for your story. Maybe the U.S. could set up same type of Act (or health care system) that mirrors Canada's national health program designed to ensure that all residents have access to medically necessary hospital and physician care on a prepaid basis. Otherwise,there aren't too many options available for everyone here in the U.S. which is very unfortunate.
Posted By Anonymous Luz Romero, Torrance, California : 11:24 AM ET
I believe that our government has failed us in this area. Without medical insurance one bout of serious medical problems can bankrupt an entire family. We talk about values in our society, but when a real value comes up-- like helping our population with Preventative HealthCare the discussion is soon twisted into an argument about Big Government & Taxes. I for one; fully support a national healthcare system; Ill pay my taxes to help my neighbor stay healthy because the health of a nation is directly related to the health of its citizens.

The rich stay healthy and the sick stay poor.
Posted By Anonymous Henry M.- Denver, CO : 11:29 AM ET
Dr. Gupta,

"And drug companies do need to turn a profit in order to develop the next generation of drugs."

Correct me if I am wrong but don't governments provide grants for drug companies to conduct their research?

If we were to reconcile this problem as a society then we need to educate ourselves of the companies that work towards helping people, instead of the companies that merely turn a profit. If more people purchased products from companies that give back to the community then they would win in more ways than one.
Posted By Anonymous Nicki F., Calgary, Alberta : 11:31 AM ET
I have some chronic illnesses. Since my husband death I'm on fixed income. My medical expenses equal about 45% of that income. Right now I'm surviving financially by spending down my husband's death benefits. I'm also pill splitting and in some presriptions taking only 1/2 the dose. I know that's not safe, but don't know what else to do.
What I'd really like to know is why Congress is dragging their feet on this issue. THEY have wonderful medical benefits on the public dole. I'd like to see the Congressional outrage if they had to fight for medical rights like the rest of us. So here's my suggestion. Lets cancel all of Congress benefits until they come up with a plan that provides affordable medical care for everyone. I bet they'd become very bi-partisan and work hard then!
Posted By Anonymous Lilnda, Wentzville, Missouri : 11:34 AM ET
Dr. Gupta: It doesn't seem like there is much sense at all in a drug that's too expensive for most. It almost seems like we have to pick and choose who will live and who won't. I'm from Canada and it would seem we are very fortunate the way our health care system works.There always is an alternative for us in getting these prescriptions, be it through Government plans that provide for anyone that can't afford them, or our Drs. are very good at giving out samples if you have no drug plan. It might be to the American peoples advantage for the Bush Administration to look into our health care system.
In the meantime, allowing people to cross the border for their prescription needs seems like a plan unless it would cause more problems and turn into a security issue.
Posted By Anonymous Bev. Whitby, Ontario, CANADA : 11:50 AM ET
Dear Dr Gupta.

I have been a legal resident of the USA for 3 years. I married an American and here I am, I am from close where you attended school, right across from Port Huron in the Canadian USA border.
I am surprised that a country as rich as the USA has such problems. May be Americans should look to the north to get some of the solutions to the health problems that affect the USA, Canada has universal coverage for anybody that needs it, and when you compare the cost is probably cheaper in Canada. Canadian Taxes are higher that the USA taxes, but when you add American taxes plus health coverage I think is about the same. Of course the Insurance companies will tell you the Canadian model is horrible. But remember they like the status quo, and they love to sell you insurance that at one point or another will not honor, cancel your police, or raise premiums to the point that sooner or later you can�t afford to pay.

Thank you and keep the good work.

Walter a Canadian in the USA
Posted By Anonymous Walter From Pittsburgh : 11:50 AM ET
While pharmaceutical companies need to turn a profit in order to stay in business, their profits after research and development costs are massive and the salaries of their top executives are obscene, especially when people are being denied quality care at the same time.

At the same time, we have a government which somehow finds the billions of dollars necessary to fight an illegal war in Iraq, but can't seem to find the funds to provide it's people with quality care.

The problem is greed at the top of our corporations and our government. Things aren't going to change until people take priority over money, and we all know that isn't going to happen any time soon in the United States.
Posted By Anonymous Joseph Kowalski, North Huntingdon, PA : 11:53 AM ET
I think that one way to make drugs a win-win situation for both the drug companies and the patients is to develop drugs made from synthetic products. I am referring to using ingredients that can be man-made instead of from nature.

A lot of medicines, such as Taxol (a cancer drug), are made from rare plant extracts. Taxol used to be made from a tree that took many years to grow (100 or more.) Now, we no longer need to harvest the trees because this drug can now be replicated in the laboratory. This allows a greater quantity to be made and lowers the cost to the patient.

Blood products are another thing that cancer patients use a lot of and is not easily replicated in a lab. An example is red blood cells, specifically O-negative. Science has yet to clone this blood type, yet it is the most used. What makes matters worse, is that the blood must also be CMV-negative and most of the adult population is not. The statistics on this is that only half of the 6% that have the blood type donate it. Out of those 3% that do donate, less than half are CMV negative. This specific blood type is rare and people who donate it (like me) are called "universal donors." This means that the blood can be given to anyone without having to determine the recipient's type. It is also used for babies and emergency situations. Anyone who can clone this blood will become extremely wealthy.

I do believe that it will be just a matter of time before science will give us the keys to cure all cancers.
Posted By Anonymous Genevieve M, El Paso, TX : 12:00 PM ET
My aunt went through breast cancer 5 years ago. She went through chemo, had a radical masectomy on her right breast, went through radiation, then was put on pills for the rest of her life. Medical paid for the first part of her treatment, but the pills are $30 per pill. She has to take one per day. Figure 30 pills at $30 a day ($900 a month). My aunt and uncle are on a fixed income. She can get no help from medical, medicare, or any other outside agency. She had to quit taking the pills because it was a choice of paying rent or not.
Posted By Anonymous E Denison, concord, ca : 12:01 PM ET
Dear Dr. Gupta:

I believe in the free enterprise system and a right for corporations to post profits and the right to own a piece of the company as stock or bond holders. What the industry is producing in America is not working for most people.

I believe the first thing we need in America to reduce healthcare costs is to formalize the paperwork system for consumers, doctors offices, hospitals and other providers. There are so many forms and so much waste in processing these forms. This drives up health care costs. Patients are frustrated and doctors are too.

The second initiative should be preventive care. There should be some standardization of practices, policies and procedures so that all providers are paying for preventive care whether they are in CA or FL or NY.

The third initiative I would like to see is for the Medicare system to be opened up to all Americans that don't have insurance at work or for those who retire prior to age 65. I have heard media experts say it is the most cost effective system in the world.

What if we added young, healthy people to the system and they paid in premiums? Maybe Ally's family would be covered.

The final initiative is a national system for children. As a nation, we don't take care of our children as well as we could. It would be good to have a national standardized system so all children could have preventive care in all 50 states. We don't have national standards for immunizations in America let alone a total preventive care system for children. Maybe if we offered better preventive care our children would be more fit.

Americans should realize that our children are our future. We need to invest in them.
Posted By Anonymous Renee, Bradenton, FL : 12:01 PM ET
Dr. Gupta,

Your comments are an important catalyst for discussion on the rising cost of staying alive, and not just for those with life-threatening diseases.

I have a nephew with Type I diabetes who can barely afford his insulin, a husband who suffers 3-5 migraines a day and takes stadol injectables, and there are senior citizens all over this country who cannot afford simple maintenance drugs. My question is: where does the money go? How much does it cost to produce blood pressure, angina, hormones, and other simple maintenance drugs? Why does Nexium still cost so much?

I want to know that drug executives are not living the lifestyle of an Enron or Tyco executive at the expense of people's lives. I want to know that researchers and production personnel are not losing benefits or having hours cut to support executive staff.

It is frustrating to all of us to pay so much for drugs, I just want to know for sure that I am paying for manufacturing and research.
Posted By Anonymous Susan : 12:09 PM ET
It is a national disgrace that this situation has been allowed to get to the point it has in this great country. Although I am a republican and against big government, there seems to be no way out of this predicament without government intervention of some sort. We cannot allow the industries on which society relies for something as basic as healthcare become profit-driven machines paying huge executive salaries, perks, and bonuses.

We often speak of the middle class in this country, but I can tell you that anyone considered middle class would be wiped out by any kind of prolonged illness, hospitalization or chronic condition requiring daily medication. Anyone, middle class is one step away from the bankruptcy court, but for the gift of good health.

Oh sure, there are programs to help the needy, but why should anyone be relegated to the "needy" simply because they had the misfortune to fall ill.

Someone, sometime, is going to have to gather the courage to address this issue. There is certainly no one in Washington, DC today that is up to the task, republican or democrat.
Posted By Anonymous Larry G, Tampa, FL : 12:13 PM ET
It's human interest stories like these that ultimately doom our healthcare system. The majority of people who read this article will respond in this way:

Step 1: read a sad story about one person that can't afford prescription meds
Step 2: clamor for price controls
Step 3: government imposes price ceiling or burdensome regulations
Step 4: pharmaceutical companies respond to the price cap by cutting production, shifting sales to other countries, and/or raising prices to cover regulatory-compliance costs
Step 5: a shortage of supplies in the US drives prices up higher as desperate patients bid prices up, either on the black market or through insurance claims and lawsuits
Step 6: repeat.

What we want is a glut of these drugs in the US so that prices are very low, and to do this, we need to remove as many government and HMO restrictions as possible. This will pave the way for the next step: allowing the pharmaceuticals to make as much profit in as possible in the beginning so that they will flood the market with supplies, thereby causing the price to drop dramatically later.

An example: remember when mobile phones and CD players were $2000 each? Now, mobile phones are being given away for free, and CD players can be bought for less than $20. Simple high-school economics, without the human-interest stories to cloud our judgment.
Posted By Anonymous Dennis Chang, Seal Beach, CA : 12:18 PM ET
My wife has multiple sclerosis. The monthly cost for her injectible medication is about $1,500 retail. Currently, health insurance from work covers most of that. But one day we will not be working and, if things don't change, there will be no insurance or medicare coverage for the drugs. At that time, my wife will likely stop taking the drugs because we won't be able to afford them. We know other MS patients who have already been forced into this due solely to financial considerations. It is a scary prospect.

A drug people can't afford to buy is de facto useless. This does not mean it should not have been developed. Lord knows we are benefitting now from such a drug. But there are many hundreds of thousands, if not millions, of folks who have or will drop through this financial crack on our health care system. This problem will not be solved until someone figures out how they can drop the price and still make money. A pessimistic attitude for sure, but one that is the result of research and attending insurance forums on the topic.
Posted By Anonymous Craig, Sterling, VA : 12:24 PM ET
I don't want to hear another word about how expensive it is for pharmaceutical companies to create drugs as long as there are TV and magazine (and whatever other) advertisements sending self-diagnosing patients to doctors seeking drugs. The excess wining and dining of doctors and medical practices has been bad enough. Drugs should be supplied to people who need it based on a doctor's expertise, not as a result of a multimillion dollar ad campaign. There, I just saved the pharmaceutical companies millions, if not billions, of dollars that they can now shave off the cost of medications.

I am in my early thirties, and was in a car wreck that was not my fault in my mid-20s. It took until now to get back to being strong and healthy, but I'm here. I have some minor limitations as I do have permanent nerve damage as a result of the collision, but my line of work doesn't involve heavy physical labor. I work out regularly and am really in quite good shape. All I require now is maintenance medication and medical treatment (mostly annual appointments with specialists). Not so bad, right? It wouldn't have been, until my former health insurance company deemed me uninsurable due to my injuries. (Not quite as I was told: "You'll qualify under our new plan unless you're the equivalent of a terminal cancer patient.") I never thought that this would still be ruining my life 6 years later, but I am without access to the healthcare I need and constantly struggling to find a way to pay for the medications I need. I am a well-educated person whose life has taken a massive hit because of this. Trust me, personal injury lawsuits don't cover this. This should not happen in this country, not to me and not to 1000s of other people.
Posted By Anonymous J.F., Atlanta, GA : 12:25 PM ET
This prescrition and healthcare crisis is an outrage. It is not right that you have to have moeny to stay healthy and alive. Is this what capitalism is about?

While congress is trying to change the constitution and make amendments regarding immigration and forbidding gay marriage, they are ignoring basic human rights.

Why don't they pass a constitutional amendment to abolish suffering? How about a constitutional amendment to outlaw poverty--that no American should be poor and uneducated. How about a constitutional amendment that states that all Americans, regardless of income, have a right to health care and medication and that the government will fund it?

What about that, lawmakers? It's a dream, but someone has to dream it.
Posted By Anonymous Paige Blache., Austin, TX : 12:26 PM ET
My dear friend, since Bush has come to office there is much that is too pricey to afford. Before he came to office I had medical insurance, three children at home and bought groceries regularly. Now, I have one child at home, cannot afford medical insurance , had to move from my home of ten yrs, because of gas prices and my husband's commute, and buy groceries as I can. Frankly if you can't afford medical care the whole, Can I afford the medicine?" becomes a mute point. I don't know what planet our president is living on with his the economy is rosey speech,but most middle class Americans at this point can't see a Dr, let alone buy the medicines. If my daughter gets sick, we will lose everything we have. If I get sick, "Dig a hole." Pityful state of afairs for hard working, tax paying Middle class Americans.
Posted By Anonymous Kris Van Orden, South Hill,Va. : 12:30 PM ET
I take a medication for a chronic disease; monthly cost is $1800.00. This doesn't include the cost for the oral medications that I also have to take for the same disease. I have health insurance. It doesn't pay a single penny towards the $1800.00. Thankfully, I do qualify for assistance from the manufacturer of the expensive medication and I am truly grateful. I also work at a hospital. There's a terrible misuse of the ER as a substitute for routine family care. Consequently, hospital rates go up to cover the cost of those who don't have insurance, people with insurance sit for hours in the ER waiting rooms because they are so packed. It's a terrible mess. Should we look to the government to bail us out. Absolutely not! Why do American's EXPECT that it's the Government's responsibility? I'd rather they weren't involved in my health care. Several years ago I was listening to a conversaton among folks sitting in a physician's waiting room and the discussion was the HMO and PPO programs and how they didn't like being told what physicians they could see...I suggested that they take matters into their own hands and if they felt like a victim, make a change. The mood suddenly changed from disgruntled patient to relief that all they had to pay to see a physician was a $10.00 copay and someone else could write and fight the fight. The Government is most definately involved with the recent Medicare changes...yeh, that's working out well!!!!
Posted By Anonymous Arbie Mathias, Canal Winchester, Ohio : 12:38 PM ET
Dr. Gupta, is there any way for pharmaceutical companies to create drugs that are very expensive using Just In Time methodology from engineering? If this is somehow possible, then the drugs can be manufactured only when needed and only for those that need it. I don't know anything about making medicines, so perhaps this is not feasible, but it could allow for treatments for rare diseases without undue stress on the manufacturers.
Posted By Anonymous Scott, J. San Francisco, CA : 12:45 PM ET
Sadly, it sounds like a 21st century version of creating an elite race, where only the rich people will survive in rising medical costs, the middle and lower classes dying from curable diseases simply because they cannot afford treatment.

Hooray compassion and empathy for your fellow man.
Posted By Anonymous Kate, Los Angeles CA : 12:46 PM ET
I'm a little confused. I always was under the belief the reason drug costs were so high is because of the research and development of the product (rightfully so). If all the research and development is already done on this drug, then why would it be so expensive to manufacture?

This is really a sincere question.
Posted By Anonymous Trudi, Roseville, MN : 12:50 PM ET
It's an enlightening article. Not only that, may I add that cancer patients are all vulnerable to the cost of treatment, as you said w/or wo insurance. what a pity, our gov't wastes so much $, when so many people suffer.
Posted By Anonymous J. Roman; Indialantic Fl. : 12:53 PM ET
I work for a pharmacutical company, and honestly I would not know the information that I am going to share, unless I worked here. The pharm company that I work for deals with MS patients are drugs are very expensive. We have Financial assistance programs within our company and when a pt calls in we will always help, and even while they are in the process we will send free drug. We have been lately helping Medicare D pts the most. Since January we have been sending free doses to our pat for the last 7 months. I think sometimes when you are not in the industry it is easy to blame them. But once you work in the industry you can start seeing it from both sides. I would not work for this company if I didn't want to help patients, and we do everything we possibly can to do that.
Posted By Anonymous Sue, Raleigh NC : 12:55 PM ET
Hi Dr. Gupta,
Nothing will ever change with drug companies as long as huge profit is their only goal..Most of the time human beings are at the end of line when money rules the big picture..Sadly, I don't see any glimmer of a conscience in the drug industry..Take care
Posted By Anonymous Lorie Ann, Buellton,Calif. : 12:57 PM ET
I think the drug companies are doing what they can because in a lot of poor countries if you are sick you won't get care. Of course the USA should find a way to fix this problem and make this a priority because health is too important to neglect. May be we individually should pay a tax just for healthcare that can help us if we cannot afford our own care. Just like we pay for social security. If we don't leave long enough to get that money because we are sick then it seems more intelligent to take care of our health first.
Posted By Anonymous Ndeye, east orange, NJ : 1:09 PM ET
How can drug manufacturers put a price on saving a life? It seems unethical to not continue making a product that is known to work simply because it is not economically feasible. No one should have to watch a loved one die knowing that there was a drug, no longer available, that could have made a life-saving difference.
Posted By Anonymous Christine, Canton, OH : 1:11 PM ET
Hey Dr. Gupta, As a volunteer for make a wish, I see and hear of numerous children with cancer. It really seems so unfair. My question is, are cancer statistics up in children? If so, what is causing this? Is something in the water we drink? I know the water in my area sometimes test high in amonia and chlorine.Could it have run off from farms and industry waste? I also wonder about old lead pipes in the ground. What about the air we breath? What is in the food we eat? Just food for thought. I think that if we can afford billions for a war, we can afford to make a drug to save a child's life. Children should never be made to suffer. So glad to hear about Ally!
Posted By Anonymous Betty Ann Nacogdoches, Texas : 1:17 PM ET
I need an aspirin after reading this, but can't afford it. I often wonder what would the insurance industry and the pharmaceutical industry do if we all stop paying our premiums and the pharmacists give the medicines away for nothing. Why do we only have people protesting against the war and drilling for oil in the gulf? We should protest the insurance companies and the pharmaceutical companies. If the pharmaceutical industry stopped advertising and put that money into programs that benefit the health of the people and not the "parts" of the men, we will finally be able to wipe that rediculous smile off "Bob's" face. I think it's great that "Bob" has the "assets" to enhance his shortcomings, but his winkie isn't making well the rest of the society.
Posted By Anonymous Connie Tebbe-Amoni, Norfolk, VA : 1:19 PM ET
Why the increase in cost? Can someone show me in writing in black and white where the increases are coming from? Is it in the fixed costs? Is it in the administrative costs? Is it in the product cost? I keep hearing about the rise in cost, but I never hear what is causing the rise in cost.....that is what I want to know.
Posted By Anonymous Mary Cooper, Brownwood, Texas : 1:20 PM ET
I am a scientist, working at a major pharmaceutical company here in the United States. I'd like to clear up a few misconceptions. First, we get no government money to fund our research. All of the money we get comes from the profits that we make. Governments give money to researchers at universities, who can then make a licensing agreement with a pharmeceutical company to sell the rights to their research. But this doesn't happen often. I would estimate that better than 75% of the new drugs that come on the market are driven by researchers at pharmeceutical companies, not universities. The vast majority of funding comes from the companies themselves. Why does it cost so much to make new drugs? First comes the cost of the basic research; finding the new idea and making it work on a small scale. Then you have to go through years of clinical trials to show that your new idea is safe and effective. Then, you have to make your drug on a large scale. We're talking about billions of pills or doses to be produced. Often, this involves very complex chemistry that has never been done before. Almost all drugs are made synthetically, but that doesn't mean that their cheap. The formulas may take years to develop and scale up to the point where they can be mass-produced, and then the cost may be many dollars per dose. All in all, it may take up to 15 years of testing, and many millions of dollars before a new drug hits the market. And that factors in the salaries of the many thousands of people that work on the drugs, including myself. Unfortunately, we can't do our work for free. We have families to feed and take care of as well.
It is a crime that many people have to choose between their prescriptions and other necessities of life. When the Medicare legislation was first introduced, back in the 1960s, prescription drugs were only a small part of the overall healthcare system. There was no provision in Medicare for prescription drugs. But now, drugs are a much, much larger component of healthcare. One prescription may eliminate the need for hospital stays and surgeries costing $50,000 or more. In the big picture, prescription drugs contribute much more the economy than other medical interventions, by preventing and shortening lengthy hospital stays, and getting people back to work sooner after injury or illness. Congress should have moved much faster to implement prescription drug coverage into Medicare, and they should give Medicare the right to negotiate prices with the drug companies. The Veterans Administration can do this, why not Medicare?
As for making the US system more like Canada, we should study this long and hard before adopting it. I have spoken to many people from Canada, and who have received medical care in Canada, and it's a mixed bag. Waiting times to see doctors in Canada are very long, emergency rooms are backed up, and you may not be able to see the physician of your choice. Sounds a lot like the US doesnt' it? True, drugs are cheaper in Canada, but take a look at why that is: the Canadian government sets the prices for all the prescription drugs sold in Canada. Now, how many large pharmaceutical companies are based in Canada? None. Or in Europe, where some governments have adopted similar controls. A lot fewer than there were twenty years ago. The Canadian government buys some of their generic drugs not from the makers themselves, but from middle-men that acquire their supplies from some not-so-reputable companies. We've all heard about outsourcing of jobs to China and India. How many people want to outsource their prescriptions to China and India? Sure, you'll get it cheaper, but what about the quality? In the US, we have the FDA to oversee all of the pharmaceuticals for sale in the US, whether they were made here or not. China's and India's FDAs, if they exist, are not nearly as competent or efficient. Are you willing to trust that the life-saving medicine you need will be potent without the FDA inspecting the plant it comes from? If we start importing drugs from Canada, we have no guarantee that they were made there.
So what can be done about the high cost of health care? We need to take a look at the whole health-care industry, not just pieces of it. What about making insurance companies non-profit? Insurance companies rack up just as much or more in profit than drug companies, but no one is talking about regulating them. What about pharmacies, who is watching them to make sure they aren't price-gouging customers? We should cap malpractice insurance for doctors, and cap awards for malpractice suits. At the same time, we need to overhaul the committees that license doctors, as most of them are run only by physicians. If we can prevent more malpractice, maybe we can keep malpractice-related costs down. We should make Medicare available to everyone, so that people that can't afford private insurance can get coverage.
And for right now, if you need prescription medication, but don't think you can afford it, find out who makes the drugs you need. Check out their website, and find out if they offer discounted medication for those who need it. Most pharmaceutical companies offer similar programs to those on limited incomes. It can really help. We aren't all the bad guys that the media often makes us out to be. We care, that's why we got into this business in the first place.
Posted By Anonymous Steve, Kalamazoo, MI : 1:21 PM ET
I agree that health care is a major problem in the US, but I don't think that the cost of prescription drugs or medical care is the whole story. Why should we consider guaranteeing access to medications at a time when we do not have a way to make sure that everyone has adequate food and shelter? Medications to fight pneumonia, for example, don't help much when the person taking them lives on the street.
Posted By Anonymous Jen, Somerset, NJ : 1:25 PM ET
Dr. Gupta, The story about the girl with Ewing's Sarcoma bothered me. And I keep wondering, why would a drug company create a drug that they knew (as I'm sure they WOULD know) was going to be too expensive to reach the children who needed it? Even an experimental drug would have to be approved, on some level, by the FDA. How could this have happened?
Posted By Anonymous Max, Galveston, Texas : 1:27 PM ET
If the drug is so expensive to make then I suppose the only way to get it distributed to those that need it is to include it's cost in that 8 Billion dollar giveaway and hope for the best. The drug companies can't be held responsible because a process is so lengthy and difficult that it prices the product out of reach. What's needed is a drug that is simple to make and effective. That may not be possible. -Rod-
Posted By Anonymous Rod C. Venger, Colorado Springs, Colorado : 1:29 PM ET
There are also "Orphan drugs" those that may be helpful to diseases that they were not tested for. In the case of Naltrexone being used by MS patients to help deal with spaticity, fatigue and weakness. It is taken in a very low dose. Since Naltrexone has now gone generic it is very difficult to get anyone to do the required testing to get it approved for the treatment of MS because there is no
money to be made by the drug companies.
So in this case the drug is too cheap. In some cases, capitalism without social responsibility will leave many "orphans"
Posted By Anonymous Getty Bailey, Buffalo, NY : 1:30 PM ET
My neice has Lupus. Her doctor has recommended a new drug that would hopefully put her into remission. The problem? The drug is $12,000.00 (yes, that's twelve thousand dollars) per dose and would need to be administered weekly for months in order to be effective. How is anyone supposed to afford such a treatment? Her insurance may pick up some of the bill but certainly not all of it, not even most of it. There is simply no way that she can afford the treatment that could allow her to live an enjoyable life. Without it, she is plagued by more bad days than good.
Posted By Anonymous Karen, Sheffield, Ohio : 1:30 PM ET
I take enbryl for a skin disease and psoriatic arthritis. It is $1200 a month. I do understand. I have insurance but if I were to ever change jobs i would literally have to ask if this drug is covered in their policy. If i were to ask that question I would not be hired.
Posted By Anonymous Fred, Lincoln,NE : 1:50 PM ET
Being in the medical field is hard enough, but when you see daily what the cost of health care is doing to the public - Well, it makes you want to stop - stop trying to heal people - why try? You see million of dollars being spent on other issues more important than children's health. We are the greatest country in the world and yet we still have uninsured children - unable to have basic care. Medication isn't an option for these people. At our practice we use our drug sample closet to help. These people are called the working poor - not poor enough for gov. help, but not in a place to afford medication. Often times people are making the choice between medication and food. Drug companies are doing a great deal, but let's face it - they are in it to make money - bottom line - it's all about the money - not the health of the public. Further proof that money can buy just about anything. This is what makes you want to stop being in the medical field. Walk away - it's all crazy.
Posted By Anonymous Cheryl Raleigh, NC : 1:51 PM ET
I think we are missing the fundamental point here. There as to be decisions about how much money to put toward a goal. There are limited resources in the world and the article is about a drug TOO EXPENSIVE TO MAKE. It is NOT about the U.S. healthcare system and how it is at fault. Is CANADA making this drug today? NO because it must be TOO EXPENSIVE for them or they would contract to buy the drug. The pro social medicine crowd should investigate the QUALY system employed by the NIH in the UK and ask if the drug is TOO EXPENSIVE for the NIH. Socialized medicine countries have budgets and have to make hard decision. There are finite resources in the world mostly expressed as $dollars but there are people and labor behind those dollars. It is not just profit. The vast majority of the cost is the labor of scientists to analyze the drugs and engineers to create the machines to produce the drugs, salesmen, truck drivers, lawyers, and on and on. So next time you wonder why something is so expensive ask yourself how is the pie that is the cost divided up and ask yourself what can I do to help lower those costs.
Posted By Anonymous Ted, Chicago IL. : 2:02 PM ET
When I was diagnosed with 2 chronic conditions 5 years ago, the co-pay on my prescriptions was $40. Every year since then the cost of insurance for everyone at my company has increased by at least 10% per year. Even though I am paying much more for insurance, today the co-pay on the same medications is more than $200. Since all the medications are at least 6 years old I asked both of my doctors for generics and they said there were none available so I stopped treatment for one of my illnesses.

I agree that pharmaceutical companies need to make a profit, but given the amount of taxpayer $$$ that are funding research and development and the fact that citizens in other countries can get the drugs more affordably, I wonder just how much profit is enough?
Posted By Anonymous liz, Montgomery, AL : 2:07 PM ET
Encouraging the government to effectively nationalize the pharmaceutical industry is patently absurd. How many innovative drugs has Canada developed? Zero, a track record of success it shares with the former Soviet Union. Rather than demonize the drug industry maybe we should demand our politicians penalize the real drivers of skyrocketing health care costs: Obesity, smoking, environmental pollution.
Posted By Anonymous Tyrone Gafford, Lynchburg VA : 2:10 PM ET
Dear Dr. Gupta,

I've gone through six months of Cytoxin chemo, then six months of CHOP + Rituxin chemo, and six surgeries for non-Hodgkin's lymphoma. That was two years ago. Since then, I've been receiving Rituxin therapy every six months as a possible preventative. My chemotherapy bills run an average of $55,000 for three Rituxin treatments. That does not include the CHOP treatments, which ran about $65,000. My insurance has paid for most, but I'm paying my percentages. I can't pay in one lump sum, so I've been making payments, with threats of being sued for not paying the lump sums. I'm a legal assistant by profession. I don't even make in a full year what one session costs in chemo. I'm also very thankful that I'm capable of working, and have worked, through my entire treatment, so that I could keep my insurance, and be able to pay my co-pays. What would happen if I could not work, lost my insurance, and could not make any payments?
Posted By Anonymous Ilona, Garfield, New Jersey : 2:16 PM ET
Dr. Gupta,
Perhaps it's time for our nation to take a cold hard look at priorities, or lackthereof. We pay and place on a pedestal sports stars and celebrities, yet we severely penny pinch pay in the healthcare field. Do we hear about a local surgeon seen fashionably vogue while dining at Charlie Trotters? Never. How many bright medical school students are attracted to research as a career choice? Not many. Salaries in medical research are unrealistic.
Why not look to other countries more successful in the healthcare field than we are? Socialized medicine might not be the solution for the USA, but it makes sense to weigh the pros and cons. The USA desperately needs an alternative that opens that door of medical assistance to all versus only the healthy who don't need it, and the wealthy who can afford it.
Posted By Anonymous Rebecca, Chicago, IL : 2:16 PM ET
I've worked on clinical trials for one of the largests pharma's and have a bit of a problem with everyone pointing fingers at us. Yes, "blockbuster" drugs pull in big money, partly bc of the big money put into advertising. Yes, we have big profits here. But, most of this money is turned right around to R&D. As someone else posted, it takes 8-15 yrs to get a drug on a market. First, you have to figure out the mechanism of the disease and formulate a drug. Then test it chemically, ramp up production, and go through 3 phases of human trial before going on the market. That takes years and millions of dollar to do. More importantly, many drugs stop or stall during the process, which means the company can invest a hundred million in a new drug that never makes it to market bc it's found to not work in a large population (something impossible to tell until you try it). Some statistic like 1% of all conceived drugs make it to testing, and less then that make it to market. That's a lot of money spent looking for a cure.

What's the solution? Who knows. If you cut down the approval process, you risk being sued if someone dies. Stop advertising? You can lose out on sales that recoup your costs and help build the way for a new pipeline. Anyone that works in business knows that advertising is a necessary evil. Blame Bush? He's not the all powerful Oz. As much as he bothers me, at least he tried with Medicare Part D- which may not be perfect but it did make progress for a good number of elderly.

There's no easy solution since it's political suicide to try. People will just as quickly ask the goverment to fix it as they will protest that the government is meddling in their personal affairs too much. One side will have to relent to make it work, and I just don't see that happening.
Posted By Anonymous Barbara, Washington, DC : 2:32 PM ET
My wife has Stage IV breast cancer and $1600 a month for medication would be a bargain. Let me see if I can break it down for you - and all of these are *wholesale* costs:

Herceptin (trastuzmtab) - $3672 every three weeks, or approximately $4700 a month.

Abraxane (paclitaxel) - $1000 for every treatment, given once every three weeks. Figure $1300 a month here.

Zofran (ondanestron HCL) - an antinausea medication. wholesale, $261 every three weeks (six tablets). $339 a month.

This doesn't count premidication for chemotherapy, office visits, CT scans, heart function tests, blood tests, IV solution or the cost of administering the drugs.

I got sued a couple years back for a month of chemotherapy including administration costs and stuff since my insurance company dropped the ball - $36,000.

That's right, thirty six thousand dollars. For one months' treatment.
Fortunately once I got an attorney everything got cleared up but it still cost me $150 to make the problem go away.

When we first started this cancer journey my wife and I decided we'd try hard to keep one person's credit afloat (mine). Her credit rating was destroyed by stuff we just couldn't pay.

Things are fixed now, but I think your $1600 estimate is a tad low.
Posted By Anonymous Allan Grossman, Battle Creek, MI : 2:36 PM ET
I used to work for a petrochemical company. We have 10,000 products and we make a batch of this and a batch of that and store it. Why doesn't the pharmaceutical company make a huge batch of this rarely used drug and store it? No one says that they have to mass manufacture it, but they can certainly manufacture enough, just once, and store it until it runs out. I don't accept that it is too expensive to make. I just don't. They have the batch ingredients, just do it. Unless they are dropping liquid gold in it, there is nothing to expensive to put in a batch and make. Period.
Posted By Anonymous Mary, Houston, TX : 2:46 PM ET
As a member of the medical community, I can tell you first hand that part of the problem with the rising drug costs is not only the ads on television sending everyone to their doctor with their self-diagnosed illness, demanding a drug (which, when the insurance company denies, the office has to fight with the insurance company to get the patient reimbursed), you also have the catered lunches, dining out and the seminars that are held at the best restaurants with very expensive dinners, desserts and all the wine you can drink.

You delete all that and you might have reasonable drug costs. I also agree that insurance companies should be non-profit. As soon as you get rid of the shareholders and having to please them, you might have a chance to save this industry.
Posted By Anonymous Kathy, Laguna Hills Ca : 3:04 PM ET
I have parents on a fixed income who need medications that cost them hundreds of dollars a month. One suggestion I have is for drug companies to reduce their billion-dollar marketing budgets (e.g. perks for physicians) and redistribute that money to lower the costs of medications for consumers.

It angers me when I walk into a physician's office and see a drug rep carrying in lunch for the entire staff. I think it's unethical for a drug company to "buy" a doctor's time and commitment to prescribe a specific medication, and even worse for a doctor to accept such a "bribe."

If drug companies want to distribute pens and notepads with prescrption names on them, fine, those items are relatively inexpensive; but lunches, dinners, golf outings, movie screenings, etc., are going way beyond necessary marketing strategies.
Posted By Anonymous Laura Santoski, Scranton PA : 3:15 PM ET
"the drug industry does give more than $8 billion worth of cash and products to people who can't afford medications"

The problem here becomes qualifying for the help. Most people who need the help, don't qualify and have to decide between food and medication.
Posted By Anonymous Lin, St. Louis, MO : 3:15 PM ET
Does anyone remember at the beginning of Bill Clinton's first term when they proposed national healthcare coverage for everyone? The Republicans turned it into a political issue and they were squealing like a dog when someone steps on it's tail. If they would have let Hillary do what she intended to do back then we would not be in the mess we are in today concerning the health care crisis.
Posted By Anonymous Mike E. Indiana : 3:26 PM ET
The reason orphan drugs are outrageously expensive is that it takes outrageously large resources to develop a drug. That is not a scandal, it is a fact of reality. The truth is that we could probably pick any disease and if we devoted half the country's financial resources to it, we could solve it. There comes an point, unfortunately, when cost the cost of healthcare exceeds what society (or any individual) is willing to spend.

Here's a little thought experiment: I propose that each US citizen contribute $1,000 to pay the research for the orphan drug Dr. Sanjay described. All in agreement?

Canadians and Europeans brag about their universal healthcare, but they omit the fact that those who can come to the USA for the best treatment. They fail to mention the 3 month queues for elective surgery. And as they tut tut the cost of US drugs and healthcare, they sit back and let our drug companies do the heavy lifting in research dollar expenditures.

Dr. Gupta's complaint is with the constraints of reality, not our healthcare system.
Posted By Anonymous Jim Immordino, Red Bank, NJ : 3:29 PM ET
The problem is, US drug companies are funding the world's drug research. Billions of dollars go in to finding new drugs. Only a handful of those drugs get approval from the FDA for production. Then what happens? companies in other countries like India and China copy the drug and sell them for their own profit without paying the patent holder a licence fee. So the money that the US company would have received from international sales is greatly reduced. In essense, the US has to foot the bill for most research throughout the world.

Most research and development money spent outside the US goes toward copying the current drugs on the market today. Very little is spent on trying to find new drugs.

I remember seeing a news program on this once. The doctor they were interviewing said that the US companies don't invest in a lot of drugs to treat non-US diseases since they won't make the money back. For instance, malaria isn't a big US disease so they don't spend the money to find new drugs for that. The scientist said that if you wanted to find the cure to a disease, you needed to make it a US disease, otherwise, no one will spend the money to find the drug to treat it.

If you look at our medical profession vs the ones in other countries, you'll notice a profound difference in the quality and speed of care. Our hospitals and doctors make more money when they see more people, so they work faster and longer to maximize profit. Other government run programs have quotas and there's no incentive to see more than their fair share. Why work 12 hours days when you're only paid for 8? There is no incentive for those doctors to put in the extra time. Don't be naive and expect doctors to work nonstop for humanitarian reasons. Doctors are people too, with lives and priorities. If you don't reward them for work, they will do what is required and not much more. When was the last time you went out to do a civil service like picking up trash along the road or volunteering at a government office? Maybe then the government would have more money to spend on Medicare. Everyone expects someone else to do something. Unless you're actively working toward a solution, all you're doing to blowing a lot of hot air.
Posted By Anonymous Matt, Fairfax, VA : 3:31 PM ET
The drug companies need to make a profit? Of course they do but how much of a profit are we talking about?
There could be the answer to the ridiculous prices.
Do we think it's just a lucky coincidence that even during an economic downturn, the pharmaceutical industry continues to thrive?
I read a book called The Big Fix:How the Phamaceutical Industry Rips off American People awhile back and wasn't really shocked to learn that top pharma execs make about $6 million a year--without their stock options.

Kate from Los Angeles posted: "only the rich people will survive in rising medical costs, the middle and lower classes dying from curable diseases simply because they cannot afford treatment"
Sad but true....
Posted By Anonymous Sheri Short, Toronto, Ontario Canada : 3:41 PM ET
I wish that people who hold up the Canadian or various European systems for price controls on pharmaceuticals understood that these price controls are partially to blame for the high cost of pharmaceuticals in the United States. As a disclaimer, I used to work in the pharmaceutical industry, and someday hope to again.

As I see it, there are two basic drivers for the costs of pharmaceuticals. The more basic one is the cost of research and the rate of failure of compounds that enter clinical testing. Less than 1 in 10 prospective drugs that start testing in human beings ever complete those trials and are approved by the FDA or other regulatory body for sale and use. That doesn't include the 50-200 compounds that are made and tested in the lab and possibly in animal models that never make it into clinical trials. All told, depending on cost models and how one accounts for things like opportunity cost (the fact that you can't spend time on two projects at once), it costs somewhere between $100 million and $750 million dollars to bring a drug all the way from concept to market. When there is a 10% success rate, and you have to cover the partial costs of those other failures, the costs really start to add up.

The other cost is the expectation of return by investors. While there are some philanthropic types who invest money in the pharmaceutical industry out of the goodness of their hearts, most of it is invested either directly or indirectly (via pension funds, mutual funds, and such) by people who want to make a profit on their money. If the drug companies don't make a profit and pay dividends (or at least give the illusion of paying bigger dividends in the future), people won't buy their stock, and they won't be able to raise any more money in the capital markets. In the stock market, Merck, Pfizer, Lilly, and their ilk aren't just competing against each other for capital, but also with Microsoft, IBM, General Electric, and every small start-up on Nasdaq that is showing a 20% growth curve for the past 6 months. If the profits aren't there, the stock sinks, and that is, in many ways the end of the game.

Into this mixture of high costs and high expectations come countries with single payer health insurance schemes (which I do, in fact support) and a determination to control costs. They negotiate contracts with the drug companies that say that they will only pay a given price for a given drug. Since this is the only way that the company can realistically sell their wares in that nation, they have little choice but to agree, How are they going to cover the gap between what they are paid and what they feel they need to take in to meet all those expectations? They raise the cost in a place where the cost isn't regulated. The cost of medication in the US is covering most of the R&D costs for the rest of the world and the profits that the investor community expects.

I don't have any easy answers to any of this. I just don't think it's fair to assign the blame solely to the pharmaceutical industry when there are so many other factors that come into it, including every one of us whose retirement hopes are tied up in equity funds.
Posted By Anonymous Andy Boston, MA : 4:02 PM ET
One of the drugs that was part of the protocol for my leukemia treatment cost over $11,000 for 3 follow-up rounds of chemotherapy (first round was done in the hospital) at a cost of ~$200 per day. While that is very expensive and even seems outrageous, it meant that I could have the treatments as an outpatient and actually save tens of thousands of dollars on hospital costs. When presented that way, my insurance company agreed to pay the prescription cost. It took some effort on my part and my doctor's, but it was worth it and benefitted all parties involved. If I hadn't had insurance, it would have been a very different story!
Posted By Anonymous Cathy, Wheeling, WV : 4:03 PM ET
Perhaps foundations like the Bill and Melinda Gates foundation will step in and under-right the drugs which are too costly to produce. Or, even better, we as a nation start operating under the premis that health care is a right and not a luxury. It shouldn't be dictated by a company's bottom line.
Posted By Anonymous Natalie Kessler NY, NY : 4:04 PM ET
The biggest threats to drug development are anti-corporatism from the left, where corporate profits are considered evil; and Christian conservatism from the right, which considers the development of certain drugs to be contrary to the will of God. A great first step would be to block the ability of special interests to influence drug companies through either undue regulation or legislation.
Posted By Anonymous Brian Dunning, Laguna Niguel, CA : 4:10 PM ET
I agree with you. I have medical insurance. But the medicine is still overwhelming. I have two teenager that were taken off of my policy at my work because they were not full time students. Neither have any kind of insurance. When I had insurance I had braces put on my daughter. Now she can't even get a check up. I hope the braces weren't in vain. She has molers coming in which could effect everything that has been done. If we as parents are willing to cover our children for a longer period of time then why can't we? It is not like we aren't going to pay it; it's payroll deducted. I work at a major Hospital and University,
Posted By Anonymous D.Westenskow Durham NC : 4:14 PM ET
I agree with Lilnda and Kate. Things would be much different in this country if Congress had the same "retirement Options and benifits" as the rest of us poor slobs. John Kerry wanted to give the American public the same deal as the U.S. House and Senate have! Thats why I vote Democrat and will continue to do
so! Also, I think it is very possible that keeping the poor and middle-class sick and broke is a deliberate plan to keep us controled. Ever hear of that expression about keeping women "barefoot, pregnent and in the kitchen"? Well it seems that the Republican Congress wants to keep the American public stupid, sick and broke! What better way to stay in control!
Posted By Anonymous Susan Prock, Fort Pierce, Florida : 4:19 PM ET
The pharmaceutical companies all say they spend a lot of money on research & development (R&D), but they will not reveal how much. That's a business secret, for some reason. If they reveal a number, it's the cost of administration, advertising, and R&D combined. Why should I believe an assertion that is not backed up by any facts? Even so, this combined ad & R&D number is pretty small compared to their overall budgets. Saying that R&D will die off in the US without obscene drug company profits is questionable at best, perhaps a lie.
What they also will not tell you is that drug companies did not do the basic research for most of the biggest money making drugs on the market today. Universities and the federal government (mostly NIH) paid for the research, but the drug companies are making the profits. Yes, someone has to make money, but when the US taxpayer pays for most of the big drugs out there, we should pay a fair price. There is a law saying that any drug licensed from NIH has to be sold at a fair price. The current administration is simply not enforcing this law.
Congress passed a law saying that Medicare could NOT negotiate price discounts, even theough the Veterans Administration can and does get discounts. Drug companies are huge contributors to the Republican party. What a coincidence.
Posted By Anonymous Jerry, Frederick MD : 4:29 PM ET
Some of the reason for the costs at a pharmaceutical company and for the need for large executive salaries comes from lawsuits. In this country we are quick to sue the drug companies(and their top officers) as well as doctors who provide care. The liability insurance costs alone could bankrupt a company.
Posted By Anonymous Amy, Dallas, TX : 4:34 PM ET
At the age of 8, my best friend was diagnosed with Ewings Sarcoma. In 1981 she was given a 10% chance of survival. She beat it. Eighteen years later, at the age of 27 it came back. She died 1 week after her 28th birthday - 9 months after being diagnosed. I wonder if she would have lived had this wonder drug been available to her? Would my best friend still be here with me and her family? How sad that the mighty dollar can dictate life or death.
Posted By Anonymous Amy, Trinity North Carolina : 1:37 PM ET
Living with chronic or critical illness will condemn a person to a poor existance. I am considered employed with insurance (with two jobs, no less), but my out of pocket expenses for just the meds to treat Type I diabetes (not including a list of subsequent medical complications) runs me more than $400.00 per month. I am too young and make too much money for any form of assistance, but the physical impact of this illness is severely compromising my health, keeping me from seeking a third job to support the illness. I also should be taking additional heart and cholesterol medication, not to better quality mention meds for the ulcers that hospitalized me three times in the past two years. But there is no way that can happen, unless I do without transportation or housing.
The worry about how to pay to continue my life weighs heavily every day, and I've barely reached 40 years old. I know the stress of paying for the insulins and other medical supplies, all the while trying to pay rent and utilities, contribute directly to my high cholesterol, high blood pressure,and ruptured ulcers. But as long as we do not have some form of universal system, some of us, like me, are simply destined to die.
Posted By Anonymous C. Ann, Dover, NH : 1:55 PM ET
I have also had to stop medications that are necessary for my illness and I am taking a chance of becoming seriously ill. I simply cannot afford them. My prescriptions are not nearly as high as some of those I am reading about, but high nonetheless. It's sad to live in one of the greatest country's in the world and have such a health care crisis. There has to be something everyday citizens can do about this - any suggestions?
Posted By Anonymous J.B. Atlanta GA : 2:04 PM ET
Wow, the misinformation is running rampant in these comments...

I've just reviewed the publicly available financial statements of several pharma companies and they all differentiate between r&d and selling, general and administrative costs.

The majority of R&D expenses in pharma research comes from Pharmas, not the NIH - although the NIH does have a good size budget to conduct research on their own, the majority of their research is general disease state. That benefits Pharma r&d, but not to the level for them to develop a drug.

I'm no pharma apologist, believe me. They've been my client long enough for me to realize they spend a lot of money in useless ways - but R&D isn't one.
Posted By Anonymous Phil, Philadelphia : 4:17 PM ET
Thanks, Dr. Gupta for opening a door of opportunity to express our views about health care in the U.S. I have lived in the U.S. for 25 yrs. now and very lucky to have a job with the state which I believe with good benefits. Four yrs. ago I was diagnosed with cancer and I am now in stage 4. Although I went thru lot of aggressive treatment because of my case I did not pay so much out of pocket cause of my work insurance and my medical bill is a lot. Now,I am force to go back to work even with this situation because of my medical insurance. I cant understand why a very powerful and very rich country will allow this to happen to lesser fortunate citizen. If they could find a solution for terrorism, they could also find a solution for death to poor people in this country.
Posted By Anonymous Nanya Will, Seattle, Wa. : 5:04 PM ET
Dear Dr Gupta,
As a relative of a young Ewing's Sarcoma patient, I know Ally's story and appreciate your bringing attention to it. Please continue to advocate, particularly for pediatric cancers. Many people don't realize they need different treatments than adult cancers, and are also rare in comparison. Bluntly put, drugs for children's cancers often aren't a profitable priority.

Cancer is still the number one killer disease of children! And any family who faces the loss of a child is grief-stricken and outraged when life-saving drugs are "too expensive to make."

There's such fearfulness in the world right now, calamities loom and distract attention from problems that are less immediate ... like getting wonder drugs to our most vulnerable patients, for whom time runs out - often needlessly - all too often. Nothing interrupts the wheeling and dealing of big business, including the pharms, so there IS time and there are capabilities - it's focus and leverage we lack. Thank you for helping draw attention, please continue!

Debbie Morrow, Volunteer for Coaches Curing Kids' Cancer
Posted By Anonymous Debbie Morrow, Asheville NC : 5:17 PM ET
(I believe that our government has failed us in this area.) They did not fail,there getting richer each day. while we decide to buy meds or food.We will always be soldout when the great dollar is involved.
Posted By Anonymous jim louisville,ky : 5:38 PM ET
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