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BY: Mona Begum, M.D. (

Dear West Hudson psychiatric society members, colleagues and friends:

I know many Psychiatrists including myself are disturbed by the denial of prescription
drugs for our patients by insurance companies. It is time consuming to obtain
authorization and therefore at times even inhibit us from prescribing newer drugs.
Recently, I was denied generic Geodon for an adolescent patient I have been treating in a
residential treatment center due to his insurance company’s policy “quantity limit
recommendations.” He has been receiving Geodon 60mg, 3 caps/day for one year and
they want me to lower the number of pills from 3 to 2, obviously to reduce the cost. My
reaction is one of annoyance and then retrospection. How did we as a society got to this
place that our health care system and the cost of medicine is so profit oriented? I looked
into this and one answer is GREED.

Many of you read the recent news about Martin Shkreli, who gained notoriety earlier this
year when his company, Turing Pharmaceuticals, increased the price of a drug used to
treat AIDS patients from around $13.50 to $750. Mr. Shkreli has emerged as a symbol of
pharmaceutical greed for acquiring a decades old drug and, overnight, raising the price

Turing’s price increase is not an isolated example. While most of the attention on
pharmaceutical prices has been on new drugs for diseases like cancer, Hepatitis C and
high cholesterol, there is also growing concern about huge price increases on older drugs,
some of them generic that have long been mainstays of treatment.

Prescription drug spending is the third most expensive cost in our health care system.
And spending seems to grow larger every year. Just last year, the average American got
12 prescriptions a year, as compared with 1992, when Americans got an average of seven
prescriptions. In a decade and a half, the use of prescription medication went up 71
percent. This has added about $180 billion to our medical spending.

While there are more medicines on the market today than in 1992, researchers estimate
that around 20 percent of the $180 billion increase has absolutely nothing to do with the
number of medications available, or increases in the cost of that medication. To
understand this change, one place to look is:

“An Advertising Revolution”
It used to work like this: Doctors decided what to prescribe. Drug companies — through
medical advertisers — tried to influence doctors. Patients did what they were told.

The only problem, was that the system wasn’t working out for the drug companies. For
them, the system was much too slow.

And so a large medical advertising company came up with a solution: They would
advertise directly to the patient. They’d get the patient to go in and ask the doctor for the

There was only one small problem with this solution: It was almost impossible to do due
to FDA regulations requiring that drug ads include both the name of a drug and its
purpose, as well as information about all the side effects. But side-effect information
often took two or three magazine pages of mouse print to catalog, and this wouldn’t do
for a major television campaign.

But then, in 1986, while designing an ad for a new allergy medication called Seldane, the
medical advertising company hit on a way around the fine print.

They didn’t give the drug’s name, Seldane, all they said was: ‘Your doctor now has
treatment which won’t make you drowsy. See your doctor.’ ”

This was one of the very first national direct-to-consumer television ad campaigns. The
results were nothing short of astounding. Before the ads, Seldane made about $34
million in sales a year, which at the time was considered pretty good. Their goal was
maybe to get this drug up to $100 million in sales but eventually it went to $800

Pharmaceutical companies took note.

Today, drug companies spend $4 billion a year on ads to consumers. The Nielsen Co.
estimates that there’s an average of 80 drug ads every hour of every day on American
television. And those ads clearly produce results:

“Something like a third of consumers who’ve seen a drug ad have talked to their doctor
about it,” says Julie Donohue, a professor of public health at the University of Pittsburgh
who is considered a leading expert on this subject.

“About two-thirds of those have asked for a prescription. And the majority of people who
ask for a prescription have that request honored.”

By taking their case to patients instead of doctors, drug companies increased the amount
of money we spend on medicine in America.

The good news is the AMA calls for a ban on advertising directed at consumers. The vote
reflects concerns among physicians about the negative impact of commercially driven
promotions and the role that marketing costs play in fueling escalating drug prices. I
believe APA also should join in since the cost of medicine affects the quality of treatment
of our vulnerable patient populaton.

I welcome your ideas and exchanges. Our next meeting is on February 12, at 12:30 pm in
Il Fresco restaurant in Orangeburg. I wish you happy New Year.

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