An Epic American Health Care Conundrum
“This medication is not only therapeutic, it's also
diagnostic!” These were the words of my rheumatology professor during my
Internal Medicine Residency describing one of the oldest medications. “If the
patient arthritic pain resolves rapidly after taking colchicine then he
definitely has gout. This drug is also very cheap!” he added. This medication,
which has been on the market since the sixties, is no longer available except in
one form that costs at least $5 per pill, if you are lucky.
The derivative of the seeds of the autumn crocus has some
known side effects and drug interactions. However, it has few problems because
not all its side effects were reported adequately. The major problem that Colchicine
had, however, was that its production started before the FDA was created. This
put it on the list of drugs that are “unapproved” by the reputable agency.
In 2006, the FDA decided to go after old drugs that it had
never approved. The “Unapproved Drugs Initiative” involved testing the safety
of these old drugs by certain pharmaceutical companies. In exchange, the
testing company gets market exclusivity for 3 years. And so, URL Pharma won the
market for the brand-name colchicine (Colcrys) in 2009 and suddenly in 2010,
generic colchicine became no longer available for US patients.
A drug that used to cost $3 for 30 pills now cost American
patients at least $169.99 for the same amount of tablets. Many of my patients report that they have to
pay more than $200 for the bottle and many can’t afford it. This is the story
of the American health care system in the twenty first century: Increasing costs by
not only inventing new complex therapeutic devices and chemicals that barely
increase meaningful patient survival but also by targeting old well known
medications with studies that only prove their well known side effects.
In the era when we talk about Medicare going bankrupt and
the Affordable Care Act controversies, allowing lobbyists, pharmaceutical
companies, and insurance companies to dictate how should physician care for their
patients is only going to lead to more waste and ballooning health care
expenses. Almost every politician, regardless of party affiliation, is
responsible for this epic failure. Those who protect the gains of
pharmaceutical companies with the argument of protecting the free market and
those who want to extend the health care coverage to the vast majority of
American without addressing these core problems.
The story of Colchicine is the story of every poor patient
who is passing on paying for his medications to pay for his upside-down
mortgage, for his car loan and to put food on the table. It is story of every
American who would rather fill his Vicodin to numb his pain and suffering than filling his expensive medications that can treat the cause of his
illness. It is the story of my residency professor who when he heard the news
decided to retire because this is not why he wanted to be a physician.
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