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The plasma debate: The ethics of paying for human blood
Should pharmaceutical companies pay people for their plasma? Here's why paid plasma is a hot ethical issue.
04 May, 2020
- 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?
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Cancer drugs are the most profitable for Big Pharma
In 2018, cancer drugs earned the pharmaceutical industry $123.8 billion. Soon, they'll be worth billions more.
07 February, 2020
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- 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.
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<p>The pharmaceutical industry's top earners are cancer drugs — a sentence that will be read to the surprise of no one. When sussing out why oncological therapies cost so much, the usual suspect is research and development (R&D). It takes years to develop a drug, deep pockets to fund that development, and then more time to take a drug through the FDA's laborious approval process.</p><p>A 2017 paper published in <a href="https://www.evaluate.com/sites/default/files/media/download-files/EvaluatePharma-World-Preview-2019%20-%20FINAL2_2.pdf" target="_blank">the <em>Journal of the American Medical Association</em></a> (JAMA) examined contemporary R&D costs for cancer drugs. The researchers analyzed the US Securities and Exchange Commission filings for 10 cancer drugs. They found the median time to develop a new drug was 7.3 years and the median cost to be $648 million.</p><p>That's an extraordinary risk. Surely pharmaceutical companies deserve the right to recoup those expenses and squirrel away some profit for future R&D. Right? </p><p>The answer is, obviously, yes. However, <a href="https://www.evaluate.com/sites/default/files/media/download-files/EvaluatePharma-World-Preview-2019%20-%20FINAL2_2.pdf" target="_blank">a recent report by consultancy Evaluate</a> shows those profits to be in excess of a tidy sum.</p>
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." /><p>In the infographic above, <a href="https://www.statista.com/chart/18311/sales-revenues-of-drug-classes/" target="_blank">data journalist Katharina Buchholz</a> shows Evaluate's data for worldwide sales of prescription and over-the-counter (OTC) drugs. As you can see, cancer drugs handily took the number one spot in 2018 and yielded the industry $123.8 billion worldwide. That results in a worldwide market share of 14.3 percent.</p><p>By 2024, Evaluate projects cancer drug sales to nearly double to $236.6 billion, increasing its worldwide market share to nearly 20 percent of prescription and OTC drugs. That makes oncological therapies worth more than the next five drug therapies combined.</p><p>The report forecasts the main drivers of this success to be <a href="https://www.keytruda.com/" target="_blank">Keytruda</a> and <a href="https://www.humira.com/" target="_blank">Humira</a>. Owned by Merck & Co. and AbbVie, respectively, the two cancer drugs are estimated to earn a combined $29 billion in 2024.</p><p>In total, the top 15 therapy areas will earn $1.2 trillion for the pharmaceutical industry in 2024.</p>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.
<p>What about the argument that exorbitant R&D costs force pharmaceutical companies to charge such extravagant prices? As the JAMA study showed, the costs and time associated with drug development are certainly immense by quotidian standards. And Evaluate's data back up that research.</p><p>According to the report, the Swiss company Roche is the industry's top spender, investing $9.8 billion in R&D in 2018. The company is expected to spend another $9.9 billion in 2024, alongside competitor Johnson & Johnson. All told, the pharmaceutical industry's R&D investment will total $213 billion in 2024.</p><p>But that figure accounts for all R&D spending, not just cancer drugs. If Evaluate's projections are correct, the profits from cancer drugs alone would cover R&D expenses with $23.6 billion to spare. If we consider the industry's total projected 2024 profits, the surplus is $1,009 billion.</p><p>"[T]he industry's claims that high prices are vital to fund innovation are demonstrably false, according to economists who research how drug companies allocate money," cultural historian <a href="https://www.nbcnews.com/think/opinion/prescription-drug-costs-americans-are-sky-high-yes-big-pharma-ncna1109076" target="_blank">Lynn Stuart Parramore writes</a>. "The truth is that many of these companies use profits reaped from their exorbitant prices to wheel and deal with Wall Street instead of developing new and more effective medicines."</p><p>Parramore further points out that the largest drug companies no longer develop drugs in house. As we've seen, Keytruda earns Merck billions, but the pharma powerhouse didn't foot its R&D bill. The drug was initially developed by Organon International before the Dutch company was acquired by Schering-Plough in 2007, which in turn merged with Merck in 2009.</p>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>
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MDMA and Ayahuasca in Ritual and Therapy
Dr. Charles Grob was the first researcher granted FDA approval to study these drugs.
23 December, 2019
Photo by Wade Davis/Getty Images
- 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.
<p>In 2002, the prestigious journal, <em>Science</em>, published a research paper written by a team led by Johns Hopkins researcher, George Ricaurte, stating that MDMA can be neurotoxic in a single dose. Ricaurte had long been critical of MDMA; his research in the eighties helped the US government decide to label it a Schedule 1 drug, despite the trial judge stating that it should remain legal for clinical testing. (The newly appointed DEA head overturned the judge's decision.) </p><p>Ricaurte's research on squirrel monkeys seemed to seal the coffin: ecstasy can permanently damage your brain in a single dose. The meme that information spawned persists today. The problem is that Ricaurte used methamphetamine, not MDMA. Though the study was <a href="https://en.wikipedia.org/wiki/Retracted_article_on_dopaminergic_neurotoxicity_of_MDMA" target="_blank">retracted by </a><em><a href="https://en.wikipedia.org/wiki/Retracted_article_on_dopaminergic_neurotoxicity_of_MDMA">Science</a></em>, Ricaurte has not gone to great lengths to admit his mistake. In fact, he claimed the facility that sent him the drug mislabelled the vials; the facility says that's bogus.</p><p>At every step along the way, Dr. Charles Grob has provided a clearer story. The professor of Psychiatry & Biobehavioral Sciences and Pediatrics and Director of the Division of Child and Adolescent Psychiatry at Harbor-UCLA Medical Center testified in front of Congress in the eighties; he has <a href="https://www.tandfonline.com/doi/abs/10.3109/16066350008998989" target="_blank">written extensively</a> about the science and politics of ecstasy, among other psychedelics. As the first researcher granted FDA approval to clinically test ayahuasca and MDMA, Grob's work provided the foundation of the renaissance in psychedelics research occurring today. </p><p>I <a href="https://www.earthrisepodcast.com/podcast/78-mdma-and-ayahuasca-in-therapy-with-charles-grob/" target="_blank">recently chatted</a> with Dr. Grob about the history and future of research in this exciting field. We discussed the necessity of ritual in understanding the uses of certain psychedelics, as well as potential therapeutic applications being studied now. No proper history of psychedelics research would be complete without a discussion of Grob's groundbreaking work. He was a pleasure to chat with about the ongoing reformation of our mental health model and the role psychedelics will play in it. </p><p>Below is an excerpt of our conversation; you can read the full transcript <a href="https://herosdose.com/mdma-and-ayahuasca-in-therapy-a-conversation-with-charles-grob/" target="_blank">here</a>.</p>
<img type="lazy-image" data-runner-src="https://assets.rebelmouse.io/eyJhbGciOiJIUzI1NiIsInR5cCI6IkpXVCJ9.eyJpbWFnZSI6Imh0dHBzOi8vYXNzZXRzLnJibC5tcy8yMjE5NzIxOS9vcmlnaW4uanBnIiwiZXhwaXJlc19hdCI6MTU5NDk1NTAzNH0.ujWNQke8DPC2y11bvCNUSKg4bqjGHgNq6hqkpf_6Hac/img.jpg?width=1245&coordinates=0%2C15%2C0%2C98&height=700" id="7b676" class="rm-shortcode" data-rm-shortcode-id="648e2a22500ac2f7688cfe90cbb2756e" data-rm-shortcode-name="rebelmouse-image" />
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><img type="lazy-image" data-runner-src="https://assets.rebelmouse.io/eyJhbGciOiJIUzI1NiIsInR5cCI6IkpXVCJ9.eyJpbWFnZSI6Imh0dHBzOi8vYXNzZXRzLnJibC5tcy8yMjE5NzIyOS9vcmlnaW4uanBnIiwiZXhwaXJlc19hdCI6MTY0ODU0MjE2NH0.XlpA3vl5XYepj8Y0oCv9BJZU_dzBHdJnYZnURDhhFz0/img.jpg?width=1245&coordinates=0%2C29%2C0%2C75&height=700" id="98272" class="rm-shortcode" data-rm-shortcode-id="ff86abe909a384a2bd27f66fcfa82497" data-rm-shortcode-name="rebelmouse-image" />
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>
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Legalized marijuana linked to lower opioid abuse; death rates
A new study analyzed more than 1.5 billion opioid prescriptions over eight years.
18 December, 2019
Photo by Guillaume Payen/SOPA Images/LightRocket via Getty Images
- 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.
<p>Pain is important. It informs us of problems that need attention. Our biological pain system can go awry: some people don't feel any pain while others experience chronic pain with no evident cause. There's mental pain, which from a physiological perspective is no different than physical pain, which is why aspirin is <a href="https://www.sciencedaily.com/releases/2018/02/180206090700.htm" target="_blank">sometimes used</a> to treat emotional duress.</p><p>Our relationship to pain seems to become more problematic as societies acclimate to higher levels of comfort. The habit of pill-popping to counter any negative biological reaction is so engrained that we rarely question their chemical composition or long-term consequences. The shift from aspirin for minor aches and pains to the surge in opioid consumption signals a culture unwilling to deal with even the slightest discomfort. </p><p>Of course, there are good reasons for some opioid usage, but the scourge of addiction has hit us hard. Families across the nation have lost loved ones. Indeed, over a two-decade period, more than <a href="https://www.cdc.gov/drugoverdose/epidemic/index.html" target="_blank">700,000 Americans died</a> from drug overdoses — the bulk of them opioid-related.</p><p>As I've <a href="https://medium.com/@derekberes/we-need-better-treatment-for-pain-lets-start-with-psychedelics-530b1db3ada3" target="_blank">written about previously</a>, over a one-year period I was given access to 120 Oxycodone tablets for surgeries due to cancer and a meniscus tear. Both times I took one and discarded the bottle. Instead, I turned to cannabis for pain management, which was not only more effective but also did not leave me susceptible to addiction. </p>
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><img type="lazy-image" data-runner-src="https://assets.rebelmouse.io/eyJhbGciOiJIUzI1NiIsInR5cCI6IkpXVCJ9.eyJpbWFnZSI6Imh0dHBzOi8vYXNzZXRzLnJibC5tcy8yMjE2OTg0Mi9vcmlnaW4uanBnIiwiZXhwaXJlc19hdCI6MTYyMTQ1MTk4N30.DN9LaY9A4e_GR41u3AoBOijDH4OZd7Fh7I41ppCYdjA/img.jpg?width=1245&coordinates=0%2C94%2C0%2C12&height=700" id="6c7b2" class="rm-shortcode" data-rm-shortcode-id="920c587de79cbabbeabf19017a549fe4" data-rm-shortcode-name="rebelmouse-image" />
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>
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Illinois set to approve insulin price cap of $100 for month supply
The move reflects a broader nationwide effort to lower prices of the life-saving drug.
26 November, 2019
Photo credit: Erik McGregor / Getty
- 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.
<p><br></p></div>
<p>Illinois is set to pass a measure to cap out-of-pocket insulin costs at $100 for a 30-day supply, a move that reflects a broader effort to lower costs of the hormone across the nation.</p><p>The bill is currently in the hands of Illinois Gov. J.B. Pritzker, who has expressed support for capping insulin prices, saying the rising costs are "an enormous burden for too many Illinois families," and that Illinois sees health care as "a right and not a privilege," according to the <em><a href="https://www.chicagotribune.com/politics/ct-illinois-legislature-insulin-price-cap-20191114-ocjrltqstbh3dbajs62mdxzdnq-story.html" target="_blank">Chicago Tribune</a></em>.</p><p>The cap applies only to commercial insurance plans, and it was <a href="https://www.cnn.com/2019/05/23/health/colorado-insulin-price-cap-trnd/index.html" target="_blank">modeled after a bill in Colorado</a>, which became the first state to cap insulin prices earlier this year. If passed, the Illinois bill would take effect Jan. 1, 2021.</p><p>"For over a million Illinois residents, insulin is an absolute necessity," said State Sen. Andy Manar (D-Bunker Hill), who sponsored the bill. "Without it, they will die. Pharmaceutical companies are leveraging that fact in order to maximize profits. It's time we hold them accountable." </p>
"Insulin belongs to the world, not to me"
<p>Insulin is an essential and naturally occurring hormone that regulates blood sugar. About 30 million Americans have diabetes and must take insulin because they either don't produce enough of the hormone or don't respond to its effects. Before the discovery of insulin in the 1920s, a diagnosis for Type 1 diabetes was often considered a death sentence.<br></p><p>In 1923, Frederick Banting, James Collip, and Charles Best sold the first insulin patent to the University of Toronto for $1 each. They believed the drug — which meant Type 1 diabetes was no longer a death sentence — shouldn't be kept from the public for the sake of profit.</p><p>"Insulin belongs to the world, not to me," Banting reportedly said at the time.</p><p>But a century after their discovery, insulin is one of the most expensive liquids in the world, and it remains prohibitively expensive for millions of diabetes patients worldwide, many of whom risk facing blindness, strokes, foot amputations or premature death without access to the drug.</p><p>"You don't know if you will have enough of a freaking liquid that your whole life depends on," Marina Tsaplina, who has diabetes, told <em><a href="https://www.businessinsider.com/insulin-lifesaving-prescription-drug-so-expensive-pharma-industry-2019-1" target="_blank">Business Insider</a></em>. "You don't know if you have enough life. That's what being not sure if you can afford your insulin means."</p><div id="edd83" class="rm-shortcode" data-rm-shortcode-id="CP7V881574808435"><blockquote class="twitter-tweet twitter-custom-tweet" data-twitter-tweet-id="1165708129805504515" data-partner="rebelmouse"><div style="margin:1em 0">The sixth most expensive liquid in the world?
Insulin in the US.</div> — Andy Slavitt (@Andy Slavitt)<a href="https://twitter.com/ASlavitt/statuses/1165708129805504515">1566761450.0</a></blockquote></div>
The insulin crisis
<p>The soaring prices of insulin have sparked outrage. In 2016, the average monthly cost of insulin was about $450, but nearly 25 percent of Americans with diabetes are unable to routinely afford these prices, and so they resort to rationing, skipping doses or even obtaining insulin illegally.<br></p><p>What's driving up prices? One explanation lies in the fact that there are only three major insulin makers in the U.S.: Eli Lilly, Novo Nordisk and Sanofi, each of which is able to negotiate drug prices with private insurers. These "big three" insulin makers have also been accused of price fixing in <a href="http://www.natap.org/2019/newsUpdates/022719_01.htm" target="_blank">several lawsuits</a>.</p><p>Typically, competing drug companies would be able to make generic versions of insulin, which would help lower prices. But no such generic insulin currently exists. That's in part because insulin makers have made incremental changes to insulin drugs over the decades, which allow them to keep their designs protected by patent laws. Some of these changes have resulted in improved diabetes care. But others seem designed to extend patent protection.</p><p>The result is that it's hardly profitable for alternative manufacturers to produce older versions of insulin.</p><p>"Older insulins have been successively replaced with newer, incrementally improved products covered by numerous additional patents," states a <a href="http://www.thelancet.com/journals/landia/article/PIIS2213-8587(17)30041-4/fulltext" target="_blank">2017 <em>Lancet</em> paper</a> on insulin price increases.</p><p>What's more, navigating the patent laws is difficult and potentially dangerous for competing companies, as David Gaugh, senior vice president of sciences and regulatory affairs for the Association for Accessible Medicines, told <em>STAT</em>.</p><p>"There's all types of patents that are involved," Gaugh said. "Whether it be process patents, manufacturing patents, device patents É packaging patents, labeling patents and trademarks, all those are different methods used to prevent [competition]."</p><p>Patents aren't the only factor preventing a generic insulin from entering the market. In fact, a true generic — or even <em>biosimilar</em> — insulin is impossible to create, according to U.S. law. That's because generic drugs are derived from chemical-based medications, whereas insulin is a biologic-based drug. As such, any "generic" insulin is more complicated to manufacture and more difficult to get approved by the Food and Drug Administration.</p>More affordable insulin
<p>In 2018, the American Diabetes Association <a href="https://www.ajmc.com/newsroom/ada-issues-recommendations-designed-to-fix-insulin-pricing-accessibility-crisis" target="_blank">recommended</a> several steps U.S. lawmakers can take to make insulin more affordable:</p><ul><li>Streamlining the biosimilar process</li><li>Increasing pricing transparency throughout the insulin supply chain</li><li>Lowering or removing patient cost-sharing for insulin</li><li>Increasing access to healthcare coverage</li></ul><p>Earlier this year, members of Congress <a href="https://www.washingtonpost.com/news/powerpost/paloma/the-health-202/2019/04/03/the-health-202-a-major-insurer-is-announcing-insulin-savings-amid-heavy-hill-pressure/5ca3aa251b326b0f7f38f2ee/?noredirect=on" target="_blank">pressured the "big three" insulin makers, along with pharmacy benefit managers, to start lowering the costs of insulin</a>. In November, the World Health Organization announced it would begin <a href="https://news.un.org/en/story/2019/11/1051241" target="_blank">testing and approving</a> generic versions of insulin, a process designed to make it easier for United Nations agencies and organizations like Doctors Without Borders to bring the drug to developing countries where it's in short supply.</p><p>"Four hundred million people are living with diabetes, the amount of insulin available is too low and the price is too high, so we really need to do something," Emer Cooke, the W.H.O.'s head of regulation of medicines and health technologies, said.</p><p>The director of the Affordable Insulin Now campaign, Rosemary Enobakhare, <a href="https://www.nytimes.com/2019/11/13/health/insulin-prices-generic-who.html" target="_blank">said</a> in November that the W.H.O. move is "a good first step toward affordable insulin for all around the world," but that it wouldn't help diabetes patients in the U.S. To make a difference in the U.S., she said, would require "Congress to grant Medicare the power to negotiate drug prices" instead of leaving it up to insulin makers.</p>
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