from the world's big
Should pharmaceutical companies pay people for their plasma? Here's why paid plasma is a hot ethical issue.
- Human blood is made up of red blood cells, white blood cells, platelets, and plasma. Plasma is the liquid part of blood. It is used to treat rare blood conditions and has an increasing number of medical applications.
- It is a $26 billion industry, and the US is a major exporter of plasma to other nations. Most nations do not collect enough plasma to sustain therapies for their own citizens. The US has such a large supply of plasma because it pays people to donate plasma—a controversial practice.
- Is it ethical for people to be paid for their plasma? Here, Peter Jaworski, an ethics scholar, explains five key arguments people make against paying people for plasma—safety, security, altruism, commodification, and exploitation—and explains his views on them. What do you think?
In 2018, cancer drugs earned the pharmaceutical industry $123.8 billion. Soon, they'll be worth billions more.
- A recent report from Evaluate shows oncological therapies were the most profitable in 2018.
- The report projects cancer drug sales to nearly double by 2024, pocketing a tidy $236.6 billion in profit.
- These projections come at a time when 42 percent of cancer patients lose their life savings to afford treatment.
Another day, another billion<img type="lazy-image" data-runner-src="https://assets.rebelmouse.io/eyJhbGciOiJIUzI1NiIsInR5cCI6IkpXVCJ9.eyJpbWFnZSI6Imh0dHBzOi8vYXNzZXRzLnJibC5tcy8yMjY2MjczMi9vcmlnaW4uanBnIiwiZXhwaXJlc19hdCI6MTY0MDYzNjM2MH0.QvSTU-fxal2478I-drk0yc5rZk-rEJiFM4uEFlJr3J4/img.jpg?width=980" id="4e27a" class="rm-shortcode" data-rm-shortcode-id="698e3f9f51f5af07463d415b939af4b8" data-rm-shortcode-name="rebelmouse-image" alt="An infographic detailing the revenue for the top eight drug therapy areas." />
Is R&D to blame?<img type="lazy-image" data-runner-src="https://assets.rebelmouse.io/eyJhbGciOiJIUzI1NiIsInR5cCI6IkpXVCJ9.eyJpbWFnZSI6Imh0dHBzOi8vYXNzZXRzLnJibC5tcy8yMjY2MjczNS9vcmlnaW4uanBnIiwiZXhwaXJlc19hdCI6MTY0MDQ5NzIyM30.NYONT4XInIDntOIFOc-YAXk3qxBU3RFaYpZv_uTAWaU/img.jpg?width=1245&coordinates=0%2C186%2C0%2C187&height=700" id="6beab" class="rm-shortcode" data-rm-shortcode-id="7b0b9f93fb90f67ca0ca6961b718a58c" data-rm-shortcode-name="rebelmouse-image" />
A tray is prepared to administer an Yttrium-90 radioembolization procedure to a patient with liver cancer.
A life for a life savings<div class="rm-shortcode" data-media_id="6U1M56df" data-player_id="FvQKszTI" data-rm-shortcode-id="da749beb0dc7a6baa658bea00b497ea7"> <div id="botr_6U1M56df_FvQKszTI_div" class="jwplayer-media" data-jwplayer-video-src="https://content.jwplatform.com/players/6U1M56df-FvQKszTI.js"> <img src="https://cdn.jwplayer.com/thumbs/6U1M56df-1920.jpg" class="jwplayer-media-preview" /> </div> <script src="https://content.jwplatform.com/players/6U1M56df-FvQKszTI.js"></script> </div> <p>True, there are other expenses to consider beyond R&D, including overhead, marketing, and, of course, battalions of patent lawyers. Tahir Amin, an attorney practicing in intellectual property law, also reminds us that many people in the pharmaceutical industry, especially scientists and researchers, remain driven to treat illnesses and improve lives.</p><p>But <a href="https://bigthink.com/videos/why-are-drugs-so-expensive" target="_self">as he told <em>Big Think </em>in an interview</a>, the business side prioritizes healthy stocks over healthy people:</p><p style="margin-left: 20px;">And I think [much as been] lost in the process as pharmaceutical companies now really start to look at their bottom line and their shareholders and what the investors want rather than what their original purpose was — to help people become healthier. And I think that the bargain of that has tilted more towards the financialization of things rather than thinking about health first.</p><p>Making these inordinate gains a bitterer pill is that they come when patients are expunging their life savings to afford treatment. As reported by <em>Big Think</em>'s<em> </em>Derek Beres, <a href="https://bigthink.com/politics-current-affairs/how-much-does-cancer-cost?rebelltitem=1#rebelltitem1" target="_self">42 percent of new cancer patients deplete their life savings</a> during the first two years of treatment.</p><p>Of the 9.5 million cancer diagnoses <a href="https://www.amjmed.com/article/S0002-9343(18)30509-6/fulltext" target="_blank">analyzed in a study</a>, the average costs came to $92,098. But that's just an average. In one case, <a href="https://www.cancertodaymag.org/Pages/Winter2017-2018/The-Cost-of-Treatment.aspx" target="_blank">the parents of a cancer-stricken girl</a> spent $1,691,627.45 on her treatment. She died on her sixth birthday.</p><p>As Parramore concludes: "The status quo is unhealthy for anyone except pharmaceutical company executives. Drug companies need a new business model that gets them back into the business of making the drugs Americans need at prices we can all afford to pay."</p><p>As the world population continues to age and live longer, <a href="https://ourworldindata.org/cancer" target="_blank">cancer rates</a> will continue in tandem. Unless drastic changes occur, it looks as though Big Pharma has some salubrious years to look forward to.</p>
Dr. Charles Grob was the first researcher granted FDA approval to study these drugs.
- Dr. Charles Grob began clinically studying ayahuasca and MDMA in the nineties, the first researcher to be granted FDA approval.
- Grob has also conducted studies on psilocybin and end-of-life care, which garnered great results.
- The future of psychedelics research is moving quickly thanks in large part to Grob's decades of clinical work.
Dr.Charles S. Grob, Director, Division of Child and Adolescent Psychiatry at HarborUCLA Medical Center in his office in Torrance November 14, 2011 has conducted research on hallucinogens as treatment for dying cancer patients with depression and anxiety.
Photo by Mark Boster/Los Angeles Times via Getty Images<p><strong>Derek</strong>: Your work in the realm of psychedelics in general and MDMA specifically has been so important over the decades. Having taken an interest in this field in the early seventies thanks to Stanislov Grof's work, how do you feel about the current state of psychedelics and how people are really taking to them now? </p><p><strong>Charles</strong>: I'm very pleased that the level of research has significantly improved. There are more studies being developed; more investigators jumping through the necessary hoops, getting all the necessary approvals and funding. We're seeing a renaissance in psychedelic research. That's very encouraging and very validating. It's essentially what I and my colleagues perceived many decades ago: that psychedelics held great promise and potential as a very novel treatment model, and, in particular, applicability for conditions that don't respond to conventional treatments.</p><p><strong>Derek</strong>: You were around when MDMA became a Schedule 1 drug. Do you remember at that time why the government took such a hard stance on this particular substance? </p><p><strong>Charles</strong>: MDMA became scheduled in the mid-eighties. From the early to the mid-eighties, MDMA had gone from a virtually unknown drug or a drug known only to a relatively modest number of psychotherapists who were using it in treatment. Then it suddenly became available out in the public, particularly at dance clubs. I think that trend started in Dallas, Texas in the early eighties. Its use rapidly increased and, most assuredly, alarmed public health authorities and drug enforcement authorities who then moved to put the brakes on. </p><p>There was also some early controversy about whether or not MDMA might be neurotoxic to serotonergic neurons in the brain. I think much of this concern was later put to rest, but it was a factor in the decision by the DEA in the mid-eighties to schedule it. Actually, the administrative law judge for the DEA recommended that MDMA be placed in a category where there were some restrictions, but where it could still be utilized for treatment. However, his decision was overruled by the director of the DEA at that time. </p><p>It was made a Schedule 1 drug, where except for a three-month period in late 88 / early 89 when a Harvard psychologist named Lester Grinspoon appealed the scheduling. Except for that three-month hiatus, it's been a Schedule 1 drug ever since. </p><p><strong>Derek</strong>: That was also partly due to <a href="https://maps.org/research-archive/mdma/studyresponse.html" target="_blank">George Ricaurte's work</a>, which I know you've been critical of. Could you speak to whether or not MDMA has any neurotoxic effects, and if not, what are some of the best therapeutic applications you've seen evidence of so far? </p><p><strong>Charles</strong>: The neurotoxicity debate became very vociferous through the 1990s. It really slowed considerably the development of human research in general. Myself and some of my colleagues were highly critical of some of the studies contending to demonstrate that MDMA was neurotoxic in humans. However, our voices were not heard until the early two-thousands when the Ricaurte group published an article in <em>Science</em>, a very prestigious journal, reporting that when high doses of MDMA were injected repeatedly into squirrel monkeys. These squirrel monkeys were eventually sacrificed and their brains autopsied and examined. Not only was their serotonergic damage identified, but also damage to the dopaminergic neurotransmitter system. </p><p>The implications of that were very worrisome because dopamine neurotoxicity might very well lead to a high risk of developing Parkinson's disease over time. However, there's never been a clinical correlation between MDMA and Parkinson's. What's more, a year after this article was published in the early two-thousands, a retraction was published in <em>Science</em> stating that it actually was not MDMA that the monkeys had been injected; rather it was methamphetamine. Evidently there had been a mislabeling of the vials containing the drug. Whether or not that was the actual reason, I don't know. But that was the reason given for why it was methamphetamine and not MDMA. And after that point, there's been very little interest or even activity trying to demonstrate that MDMA causes neurotoxic brain damage. </p><p>Of course, that being said, I think it's important to point out that with a drug like MDMA, which does have very strong central nervous system effects, less is best. It's not a lifestyle drug, in my opinion. If used at all, perhaps only sparingly, and for an important reason, such as treatment of PTSD, which Michael Mithoefer's group <a href="https://www.ncbi.nlm.nih.gov/pubmed/29728331" target="_blank">has shown MDMA to be quite effective with</a>.</p>
Dr. Charles Grob- Ayahuasca & Hallucinogens- Clinical studies- Past Present and Future<span style="display:block;position:relative;padding-top:56.25%;" class="rm-shortcode" data-rm-shortcode-id="5339e74481a961c8155d86991978b693"><iframe type="lazy-iframe" data-runner-src="https://www.youtube.com/embed/Q4XL_Hk_L5g?rel=0" width="100%" height="auto" frameborder="0" scrolling="no" style="position:absolute;top:0;left:0;width:100%;height:100%;"></iframe></span><p><strong>Derek</strong>: There are a lot of studies happening now and people becoming more interested. There's also a lot of pharmaceutical interest in this. If MDMA is proven to be really good at low dosages for depression or anxiety, is the R & D going to be worth it to put those on the market if they're not going to make the same amounts of money from consumers as from other treatments currently being used? </p><p><strong>Charles</strong>: In regards to the treatment for depression, I think psilocybin is a more interesting case. It might need to be only administered a couple of times in the course of ongoing psychotherapy. It may be that a drug like psilocybin has sustained efficacy. This needs to be demonstrated in formal research studies. </p><p>In terms of the pharmaceutical industry, it's a shame that it comes down perhaps to a turning a profit or turning a greater profit. There's certainly plenty of that within the mainstream pharmaceutical world. The issue is the fact that conventional treatments seem to have only limited efficacy. Upwards of up to half of individuals treated with SSRIs do not have satisfactory responses. There is a compelling need to find more effective treatments. </p><p>That's one reason why ketamine has suddenly become a drug of interest. The problem with ketamine is that while it does appear to have very robust acute short-term antidepressant effects, those antidepressant effects appear to wane after a few weeks. Whereas with a classic psychedelic like psilocybin, it may very well be that there is a sustained antidepressant effect over many months or even a year or more or indefinitely. The evidence or the data that's been reported to date and various studies— including <a href="https://jamanetwork.com/journals/jamapsychiatry/fullarticle/210962" target="_blank">my own study</a> treating individuals at the end of life with reactive anxiety and depression—has been very positive. Similar studies at Johns Hopkins and NYU, which came after our study but which got permission to use a slightly higher dose, had even a stronger drug effect size. </p><p>When it comes down to the straight forward issue of whether drugs like this can be effective and can be contained safely in the treatment setting, the research to date has proved to be very supportive. Where it's going to go in the future, I don't know. There are some entrepreneurs who are investing a lot of money into developing a psilocybin treatment model. There may be expectations of deriving profit from this. That raises a variety of issues, including ethical issues, but we'll first have to see if it really does work over the long haul as more individuals are studied under rigorous research conditions. </p>
Fresh Colombian magic mushrooms legally on sale in Camden market, London.
Photo by Photofusion/Universal Images Group via Getty Images<p><strong></strong><strong>Derek</strong>: With psilocybin and you've also done research in ayahuasca, you probably recognize it's very hard to decouple the psychedelic from the ritual context. Do you think that these substances could have similar effects when you take it out of that context and have a different model?</p><p><strong>Charles</strong>: Especially with ayahuasca, it's very important to understand how it's been used traditionally by native peoples in the Amazon basin. The use of ayahuasca has also been utilized by syncretic churches, particularly in Brazil, which have also established themselves in this country. From our studies and my observations, I felt ayahuasca is far more safely contained and far more likely to be effective in regards to its potential antidepressant effects or overall psychological wellbeing effects if contained within a highly structured context. </p><p>The Brazilian religions may at times not be the best fit for individuals coming from North American culture. Nevertheless, we can learn from what they've done and we can also learn the value of a ritual structure, regardless of what the ritual is or even what the belief system is. These are not just psychiatric medicines; these are psycho-spiritual medicines, which makes them highly unusual from the get-go. But I Taking that into account, it will be important to develop ritual structures that acknowledge and optimally utilize that psycho-spiritual range of effects. </p><p><strong>Derek</strong>: This specific work is part of what has created this renaissance of psychedelic studies, kicked off when Michael Pollan <a href="https://www.newyorker.com/magazine/2015/02/09/trip-treatment" target="_blank">wrote about the Hopkins study</a> a few years ago. What do you think that the mushrooms offer end-of-life patients when they're at this point in their life and they're facing the end, what do they get out of it? </p><p><strong>Charles</strong>: Well, first of all, the set and setting have to be optimized. That's your starting point. Once that has been put into place and patients have been properly screened and prepared, a psilocybin treatment appears to have a remarkable facility to address the existential crisis that individuals have at the end of life. At the end of life, an individual's sense of self starts to erode. He or she loses connection with that person he's always or she's always been. </p><p>Psilocybin appears to reconnect them and instill a renewed sense of meaning and purpose into their lives even with the limited time span remaining. The alkaloids in the mushrooms appear to have an uncanny facility to go right to that great existential question. Individual experiences are of various types, but the outcomes are fairly consistent: they have a restored sense of self and a restored sense of meaning and purpose to their lives. </p><p>--</p><p><em>Stay in touch with Derek on <a href="http://www.twitter.com/derekberes" target="_blank">Twitter</a> and <a href="https://www.facebook.com/DerekBeresdotcom" target="_blank">Facebook</a>. His next book is </em>Hero's Dose: The Case For Psychedelics in Ritual and Therapy.</p>
A new study analyzed more than 1.5 billion opioid prescriptions over eight years.
- A new study analyzed over 1.5 billion opioid prescriptions between 2011 and 2018.
- Researchers discovered opioid prescription reductions of 11.8 percent and 4.2 percent in states that passed recreational and medical cannabis laws.
- The U.S. government needs to reschedule cannabis because researchers believe it has therapeutic value.
Could Cannabis Be A Solution To The Opioid Crisis?<span style="display:block;position:relative;padding-top:56.25%;" class="rm-shortcode" data-rm-shortcode-id="d19fc15e6113ad7339a6b2aeeebae51d"><iframe type="lazy-iframe" data-runner-src="https://www.youtube.com/embed/dp1WYSFVWb4?rel=0" width="100%" height="auto" frameborder="0" scrolling="no" style="position:absolute;top:0;left:0;width:100%;height:100%;"></iframe></span><p>I'm not alone. While there have been numerous reports about the benefits of cannabis for pain management instead of opioids, a <a href="https://www.sciencedirect.com/science/article/abs/pii/S0167629618309020?via%3Dihub" target="_blank">new study</a>, published on Dec. 14 in <em>Journal of Health Economics</em>, analyzed over 1.5 billion opioid prescriptions given between 2011 and 2018. The researchers confirmed the hype: states that legalize marijuana see sizable drops in opioid consumption. </p><p>Opioid prescriptions <em>quadrupled</em> between 2000–2015. As with the mental health industry and SSRIs scripts, pain management in recent years has relied on a money-making band-aid instead of actually treating the cause. It's much easier to write a prescription and send the patient on their way than to root out a diagnosis and plot out an extensive plan to help them overcome it. This trend also revitalized heroin consumption, which became a cheaper solution when pill bottles could not be found. </p><p>Enter the burgeoning field of cannabis science. As the researchers write, </p><p style="margin-left: 20px;">"One policy option that has the potential to reduce opioid prescriptions and opioid-related deaths is the passage of cannabis access laws. These state laws facilitate access to cannabis by removing state legal barriers — though possession of cannabis remains illegal under federal law."</p><p>The researchers, from the University of Alabama School of Law and Vanderbilt University, list numerous studies confirming cannabis's efficacy in pain management, again calling into question why it remains listed as a Schedule 1 substance. Regardless, society is moving quicker than legislation. People want to feel better, not become beholden to a drug whose efficacy is clinically worse than marijuana.</p>
Marijuana activists hold up a 51-foot inflatable joint during a rally at the U.S. Capitol to call on Congress pass cannabis reform legislation on Tuesday, Oct. 8, 2019.
Photo by Caroline Brehman/CQ-Roll Call, Inc via Getty Images<p>The team analyzed roughly 90 percent of all opioid scripts written over an eight-year period. They compare regional data with the passage of both Recreational Cannabis Laws (RCL) and Medical Cannabis Laws (MCL), discovering prescription reductions of 11.8 percent and 4.2 percent, respectively. When people are given the option, they are more likely to go with the <a href="https://www.marijuanamoment.net/everyday-marijuana-use-reduces-opioid-consumption-by-chronic-pain-patients-study-finds/" target="_blank">proven track record of marijuana</a>. The team concludes,</p><p style="margin-left: 20px;">"The evidence reported here presents the most accurate picture of the effect of cannabis access laws on prescription opioid use to date and can therefore inform the ongoing state and national debates over the legality of cannabis as well as other policy options to combat the opioid epidemic."</p><p>Pain affects aging populations more, and so the researchers looked into RCLs and MCLs affecting Medicare and Medicaid rates. If all states passed MCLs in 2014, Medicaid savings would have been over $1 billion. They also found, as has been widely reported, states that pass MCLs and RCLs experience lower mortality rates from opioid overdoses. </p><p>There is an ongoing debate about whether you can become addicted to cannabis or just dependent, yet one thing is clear: marijuana is not nearly as dangerous as opioids. Pain management is a discussion the medical industry needs to have with their patients. Avoiding pain at any cost is not worth it. For those suffering from pain, there is at least one viable solution. Our government needs to recognize this fact and change the scheduling, while doctors have to honor science instead of lobbying and marketing efforts by pharmaceutical companies. </p><p>--</p><p><em>Stay in touch with Derek on <a href="http://www.twitter.com/derekberes" target="_blank">Twitter</a> and <a href="https://www.facebook.com/DerekBeresdotcom" target="_blank">Facebook</a>. His next book is </em>Hero's Dose: The Case For Psychedelics in Ritual and Therapy.</p>
The move reflects a broader nationwide effort to lower prices of the life-saving drug.
- Some 30 million Americans have diabetes and must take insulin, but about 25 percent of them can't routinely afford the drug.
- In recent decades, the cost of insulin has skyrocketed, partly because only three companies make insulin in the U.S.
- There's some indication that recent efforts to make insulin more affordable are picking up steam.