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"Button, button, who's got the button?" Dark-humor comment on a current thread

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Posted 9/13/2016 6:19 PM (GMT 0)
In a current thread ("opening a hypothetical, proverbial can of worms") Todd1983 rightly wonders if possible loss of company profit would hinder the release of a discovered cure for cancer which a drug company had, but had decided not to release.

Well, here's a thought on that, a cynical attempt at humor at such a situation perhaps, but also possibly one that may accurately describe the matter.

Recently while website hopping, I happened to come across a reference to a classic Twilight Zone episode ("Button, button") written by Richard Matheson, the noted science fiction writer.

The story, in case you may not remember this one, is the one where a couple with money problems somehow meets a mysterious stranger who presents them with a way to gain money, but at a disturbing moral cost. He gives them a little black box with a button on it, and tells them that if one of them pushes the button, they will receive a million dollars, but at the same time a person, someone they don't know, will die.

So after presumably doing some soul-searching, one of them pushes the button. Then the million dollars arrives, making the couple rich and gleeful. Then the stranger rises to leave. But as he departs, the couple call out to him, perhaps out of curiosity, perhaps out of fear, asking where the box is going next. The stranger simply replies, "I can assure you that it will be given to someone you don't know."

This story was even made into a film, "The Box" (2009), and here is a relevant scene from that movie:

/www.youtube.com/watch?v=QbVzoV4GgM8

Chilling, chilling. But for some reason this morality tale brought to my mind another possible version of this story, a sort of fantasy that came to me.

In this, my dark-humor version, the scene is the spacious office of a drug company CEO. The CEO is sitting behind his large mahogany desk, chatting with the mysterious stranger across from him, while the desk between them is empty, except for one item sitting on it: the little black box with the button on it.

The mysterious stranger then says: "If you push the button, your drug prices will rise, and you will make millions of dollars. But at the same time some people you don't know, namely those customers of yours who need the drug but now can no longer afford it, or don't have insurance for it, will die. What are you going to do?"

The CEO muses for a minute, then reaches over and, firmly, pushes the button.

Am I being too harsh on the drug companies with this little bit of rewriting of the story? Are they really that callous? Well, maybe and maybe not. But if the accounts are true, for example, that some drugs cost a certain amount in the U.S. and a fraction of that in Canada and maybe elsewhere, then one has to wonder just what it is that is going on.

As for the CEO's decision? Well, maybe the box moves on, and is next given to someone the CEO doesn't know.
Posted 9/13/2016 6:27 PM (GMT 0)
I love this. You had me hooked as though reading a novel. Very good post
Posted 9/13/2016 11:57 PM (GMT 0)
Ha! I remember that episode... One of my favs. Your version is a great spin and unfortunately may have come true based on current events with the astronomical increases in some prescription drugs. Good post. -JR
Posted 9/14/2016 12:45 AM (GMT 0)
Because I am not given to paranoia, I guess I don't see the issue. Here are some basics I learned while getting my MBA, quite a few years ago, but economics hasn't changed that much.

1. Someone will charge the price for their product (any product) that maximizes profits.

2. If there are no substitute products (i.e., a monopoly), they will charge a very high price to maximize profits.

3. If there are substitutable products (e.g., Zoladex and Lupron) competition will drive the price down. If it is a commodity (i.e., lots of suppliers of a generic drug), the price may eventually go as low as the variable cost of producing it (generic aspirin, for example).

4. Large volume purchasers (e.g., government health organizations) can drive prices down. Medicare in the US is forbidden from negotiating, by law.

5. Government can regulate prices if they want to. But if that makes selling the product unprofitable, the company may stop selling it.

6. Governments regulate patent policy to encourage new product development, and allow companies to recoup development costs. They often give tax breaks as well, especially for "orphan" drugs. The US government sometimes undertakes some of the early development and related costs itself.

7. Governments must also prevent price or product collusion between competitors, and must ensure competition where possible.

A drug company always wants to come up with the next best drug and begin selling it as soon as possible (whether it is a cure like Sovaldi for Hep C, or a treatment like Provenge), and because they have a monopoly on it until the patent expires, and the US government can't negotiate or dictate a lower price, they will charge a LOT for it.

Because good PR is good for business, and bad PR is bad for business (e.g., epi-pen, Daraprim), drug companies often have special free or low-cost deals for people who could not otherwise afford the drug.

There is no need to kill people or suppress drugs to maximize profits, and there is no moral dilemma for private drug companies. Fraud can always occur, but mostly doesn't because of the stiff penalties if discovered. The moral issues are ours as a people, and are handled or mishandled by government policy.
Posted 9/14/2016 1:35 AM (GMT 0)
Id take it a step further, at the risk of sounding naive...
I'm on another forum, that is rather skeptical (a huge understatement) of mainstream medicine, in general. And in particular, there are some very viciferous anti-Statin folks. It seems at every turn someone is posting a link to an article implying that Statin makers and the government are aware of all these terrible side effects but don't care, and all the stats on good effects of statins, are basically lies.

My position is simple, and like I said, naive... I can't believe in my wildest dreams that all these drug companies are so evil, and that they ALONG WITH THE FDA, could actually conspire to repress such important information if it were true.

Naive? Maybe. But I still take my statins every day.
Posted 9/14/2016 2:00 AM (GMT 0)
What I see, in medical business, as well as american business in general, is that the move towards deregulation has had a major unintended consequence: While everyone does seem to embrace the theory that competition drives prices down (it does, when and where competition exists). They forget that capitalism, left to itself, with stifle competition and create monopoly. Monopoly is the true end-state of pure laissez-faire capitalism. We see it in industry after industry. As a particular corporation grows, it starts buying up it's competitors, taking the 'good stuff' they did (or not) and incorporating it into their own product line (sometimes), and in the end, everything is becoming a monopoly.

And that is not a good thing for consumers. It's great for the bottom line and the salaries of the CEO's. It's not all that great for investors either (the market is way more volatile than it used to be).

End Rant.
Posted 9/14/2016 2:31 AM (GMT 0)
One comment: $600 for an eppy pen. Nuff said

I maybe straying into troubled waters here but I would like to make a comparison. Many years back wanted ministration or another past the guaranteed student loan act. This two had an on intended consequence. Sure, it sounded good when presented but with the government paying two Wishon universities we're free to jack up the price. The price of college tuition has exceeded the average rise in income by as much as 400%. Although I am not promoting or denouncing the affordable care act but I do believe with more people receiving government subsidized Insurance that this may be the case for the cost of healthcare as well. After all the governments footing the bill they can charge what they want and things will get paid for. I maybe wrong it's just a theory
Posted 9/14/2016 2:35 AM (GMT 0)
I apologize for my last post being so difficult to read. I was dictating to my phone so you may half to read between the lines
Posted 9/14/2016 3:01 AM (GMT 0)
Halbert,

Actually, I have to admit that I see regulation working the other way 'round than you do. I think regulation stifles competition. As the level of regulation increases all players in the field take a hit from compliance costs. And, since the compliance costs don't scale with the size of the business -- the paperwork to get approval to sell 100 widgets is not that much less than the paperwork to sell 100 million -- the larger companies can spread the costs of regulation over a larger volume and, for them, the per-unit compliance costs are less. It is very difficult for a small drug company to afford to put a new drug through an approval process. One- or two-doctor practices are a thing of the past since individual doctors can't afford the specialized clerical skills needed to meet medicare and HIPA requirements. The increasing centralization we are seeing in medicine -- the mergers to form ever-larger medical and pharmaceutical companies -- is a result of a more tightly-regulated industry, not of untrammeled laissez-faire capitalism.
Posted 9/14/2016 3:44 AM (GMT 0)

Pratoman said...
Id take it a step further, at the risk of sounding naive...
I'm on another forum, that is rather skeptical (a huge understatement) of mainstream medicine, in general. And in particular, there are some very viciferous anti-Statin folks. It seems at every turn someone is posting a link to an article implying that Statin makers and the government are aware of all these terrible side effects but don't care, and all the stats on good effects of statins, are basically lies.

My position is simple, and like I said, naive... I can't believe in my wildest dreams that all these drug companies are so evil, and that they ALONG WITH THE FDA, could actually conspire to repress such important information if it were true.

Naive? Maybe. But I still take my statins every day.

Well, to quote Todd I think, "$600 Epipen, nuff said". And just before that it was some generic, been around forever drug currently needed for AIDS patients, wasn't it?

Prato, refresh my memory in case I'm thinking of someone else: you were on 3 different drugs to lower your Triglycerides, right? How many years was that for? How well did it work?

Then you recently realized a truth that is probably well known on that web site you mentioned, as well as many others and backed up by many studies: what you really needed more than 3 drugs( I hope I've got the right guy! LOL! ) was a low or at least significantly lower carb diet, is that right? And when you finally started doing that, your TGL problems were solved, right?

So my question is, for however many years you were on 3 prescription drugs not even working all that well, and with most likely severe SEs at least possible, were you lucky enough to have doctors emphasizing to you a known cure for high TGLs, i.e. cut carbs? And possibly increase certain types of fats? Even if they did tell you, did they emphasize you should try that 1st, and only go to the drugs if you would not listen?

If so, I highly suspect you were in the extreme minority. I have had numerous friends over the years with high TGL problems, taking various drugs, and I even talk to them about this very subject, and I have not had one who has ever heard that excess carbs is the #1 cause of elevated blood fats known as TGLs.

Now are these doctors(same ones who gave us the infamous trans fat recommendations) really that ignorant of the science, or do most of them know but prefer to go with the drug approach? Neither option is good. And what about the FDA which approves these drugs? Don't they know the science, and that diet can easily bring down TGLs? Do they require that docs push the low carb approach first( does any doctor push low carb? more likely the opposite?), and only go to the prescription drugs when that has failed? Or are they also fine with the "just put them on the drugs first" approach?

Post Edited (BillyBob@388) : 9/13/2016 9:49:19 PM (GMT-6)

Posted 9/14/2016 5:19 AM (GMT 0)
I think Halbert said it simply.

We can argue about who suffers and who gains due to pharmaceutical price fixing. We can argue about the value of economic competition. It would be easy to portray the pharmaceutical industry as price gouging bad boys. (They are not alone)

I think we all know that free enterprise around the world has always spawned criminal like consumer pricing. The question is.. what do we do to control consumer abuse but encourage innovation.

My answer might be different than yours. Universal healthcare and government purchasing of patient needed drugs. I believe everyone should pay their fair share for healthcare (nothing is ever free), but everyone should have full access regardless of their economic position. good night
Posted 9/14/2016 1:24 PM (GMT 0)
Billybob, yup, that was me.
The problem wasn't my doc. It was me, being non compliant. He did initially tell me to watch carbs, the drugs did get my TG down from 750 to 350, but they also made me feel like I could eat what I want. (I was younger, and invincible - a legend in my own mind - little did I know)
Now, with that said, it's also a fact that most Drs are NOT trained in nutrition, and don't know jack about it. Which is something that should change.

Pricing is a big issue. But I was referring to the theory that big pharma and the FDA are hiding the fact that statins are more harmful than helpful. I just can't buy into that conspiracy theory
Posted 9/14/2016 2:23 PM (GMT 0)

Pratoman said...
Billybob, yup, that was me.
The problem wasn't my doc. It was me, being non compliant. He did initially tell me to watch carbs, the drugs did get my TG down from 750 to 350, but they also made me feel like I could eat what I want. (I was younger, and invincible - a legend in my own mind - little did I know)
Now, with that said, it's also a fact that most Drs are NOT trained in nutrition, and don't know jack about it. Which is something that should change.

Pricing is a big issue. But I was referring to the theory that big pharma and the FDA are hiding the fact that statins are more harmful than helpful. I just can't buy into that conspiracy theory


Thx Prat. I thought you may have been originally less than compliant on the carb issue, and that you might have been one of the lucky ones with a doc who actually advised you correctly regarding that. Cutting carbs did a good job on your TGLs, right? Do you still need the TGL meds?
Posted 9/14/2016 4:28 PM (GMT 0)
There will always be a few companies that take advantage, just as there are a few people who steal and murder. In general I agree with Peter in that overregulation in order to avoid the few issues that always will pop up results in lower competition and higher prices in the long run. I cut my business teeth in the wild early days of the PC and then the commercialization of the internet. Thousands of startups went out of business, but a few like Apple, Microsoft and Google have changed our lives. Regulation or large subsidies would have ruined the innovations that we are now reaping. The same is true of the drug industry. When I worked for Cutter Labs, I was amazed at the lack of innovation and efficiency because every step of the process was regulated in some way and the simplest changes would take years to implement. This is one reason costs are high in that industry.
Posted 9/14/2016 4:41 PM (GMT 0)
In response to lifeguyd.... I say we should all stop using their drugs and die😀 That will teach them a lesson lol
Posted 9/14/2016 5:47 PM (GMT 0)
John T,

Your mention of working at Cutter Labs reminded me of my own brief tenure working for "Big Pharma".

As a result of the Telecom crash early in the decade that started the millennium* I found myself scrambling to find work for several years. One of the jobs in which I found myself was a seven-month gig as a contract-staffing I.T. basement-drudge computer programmer for one of the top five pharma companies. It's not important which one.

Part of my role was to keep up their database of the text of everything they had ever said about any of their products. Before a pharma company can say anything about a drug the statement has to be vetted by an army of legal experts to make sure it is compliant with regulations. So they hold onto any text that has been given the OK and recycle it endlessly. Pre-vetted text is as valuable as rubies. The regulations are intended to keep drug companies from saying things about their drugs that aren't true. But it keeps them from saying many things that are true as well.

*someone must come up with a name for the decade spanning 2000-2009.
Posted 9/14/2016 8:30 PM (GMT 0)

BillyBob@388 said...

Pratoman said...
Billybob, yup, that was me.
The problem wasn't my doc. It was me, being non compliant. He did initially tell me to watch carbs, the drugs did get my TG down from 750 to 350, but they also made me feel like I could eat what I want. (I was younger, and invincible - a legend in my own mind - little did I know)
Now, with that said, it's also a fact that most Drs are NOT trained in nutrition, and don't know jack about it. Which is something that should change.

Pricing is a big issue. But I was referring to the theory that big pharma and the FDA are hiding the fact that statins are more harmful than helpful. I just can't buy into that conspiracy theory


Thx Prat. I thought you may have been originally less than compliant on the carb issue, and that you might have been one of the lucky ones with a doc who actually advised you correctly regarding that. Cutting carbs did a good job on your TGLs, right? Do you still need the TGL meds?

Nope, no drugs (i'm on 7 different prescription drugs, but none for TG and its still fluctuating 83-95, so all good with low carb. But i want to get it to 60. Gotta be more dilligent on the diet
Posted 9/15/2016 12:16 AM (GMT 0)
There is a balance point needed at some point. When essential consumer goods and services are all provided by a small handful of monopolies, then there is no competition and 'what the market will bear' becomes the pricing model. I agree, when nobody is controlling who pays the bills, then the market price will always rise because there is no downward pressure caused by consumers not buying.

However, and I say this as a person who has worked for a lifetime in an industry that is a natural monopoly (due to massive capital costs) that actually worked BEST under sane regulation. With the kinda-sorta deregulation that has happened in the power industry over the last 15-20 years, the end result is going to be..and soon...major system blackouts. It will happen. And it's because the ONLY way that anyone has ever found to encourage the capital investment required to make the system work is to guarantee a moderate return on investment. Without the capital investment, the system will collapse. And it's coming. Faster than you think.

Now, pharma is a strange beast, and I don't think anyone really understands how the capitalization vs pricing works. It certainly doesn't make any sense to me.

What I do believe to be true, is that when it became common practice to tie CEO pay to stock PRICE, then it became the ceo's job to manipulate the stock price however he could for his own benefit. And if that means gouging for profit or shutting down production facilities and laying off employees for short term gain...never mind the long term disaster that is creating......then we wind up where we are.
Posted 9/15/2016 4:25 PM (GMT 0)
One of the first things I learned in sales was "Whatever the market will bear".

So, the dilema is...Life-Saving Drugs at Life-Saving Prices seems to be an oximoron when reading on paper.

So, perhaps the correct phrase would be Life-Saving Drugs at Life-Taking Prices.
Posted 9/15/2016 5:20 PM (GMT 0)
Newton451 -

So maybe what you're saying is that when it comes to drugs we can get any two of the following, but never all three?

Effective
Cheap
Readily available
Posted 9/15/2016 8:41 PM (GMT 0)

Pratoman said...

BillyBob@388 said...

Pratoman said...
Billybob, yup, that was me.
The problem wasn't my doc. It was me, being non compliant. He did initially tell me to watch carbs, the drugs did get my TG down from 750 to 350, but they also made me feel like I could eat what I want. (I was younger, and invincible - a legend in my own mind - little did I know)
Now, with that said, it's also a fact that most Drs are NOT trained in nutrition, and don't know jack about it. Which is something that should change.

Pricing is a big issue. But I was referring to the theory that big pharma and the FDA are hiding the fact that statins are more harmful than helpful. I just can't buy into that conspiracy theory


Thx Prat. I thought you may have been originally less than compliant on the carb issue, and that you might have been one of the lucky ones with a doc who actually advised you correctly regarding that. Cutting carbs did a good job on your TGLs, right? Do you still need the TGL meds?

Nope, no drugs (i'm on 7 different prescription drugs, but none for TG and its still fluctuating 83-95, so all good with low carb. But i want to get it to 60. Gotta be more dilligent on the diet

Sweet, no drugs for TGL! It was a cutting of the carbs you needed all along, apparently! I wonder what % of docs are telling their patients that? I wonder if the FDA knows this and requires this info be disseminated prior to prescription, especially prescription of 3 different drugs?(somehow I doubt it) It is no wonder some folks at some web sites caste a jaundiced eye towards some of our medical authorities. IMO anyway. And considering the OP, and the other thread it refers to, there may be reason to think that profit motives often- or at least sometimes- over rule what is best for the patient.

I know you said your doctor had emphasized the carb/TGL connection and you just refused to listen. But, where did you first read strong enough arguments that would convince you that you should try it? ( EDITED to remove a sentence after I realized it referred to a thread recently locked at the OP's request)

Post Edited (BillyBob@388) : 9/15/2016 2:52:29 PM (GMT-6)

Posted 9/16/2016 12:09 AM (GMT 0)
81GyGuy, more or less, without Government intervention, yes, I agree with your para-phrasing.
Posted 9/16/2016 1:14 AM (GMT 0)
81, and that is actually the ultimate dilemma of the medical system. "We the people" want 3 things, and the reality is we can only have 2 of the 3:

"latest and greatest"
"low cost"
"easy access"

Start pairing them up and see how each pair automatically excludes the thired.
Posted 9/16/2016 4:24 PM (GMT 0)
I don't buy the two out of three. I've run two public companies and have consulted for many fortune 500 companies. The management skill set to accomplish any two is also the skill set required for the third. Look at Walmart and Amazon; latest, cheap and readily available. It also applies to drug companies. The difference is the large R&D cost required to find and test one successful drug and fund all the costs for the thousands of failures. The management mind set for the drug companies is regulation and documentation, not efficiency or low costs.
Also unless you are well funded or self funding through cash flow, you really don't run your own company. Investors or bankers are calling the shots, forcing you to think and act in the very short term. If you don't make the quarterly numbers you won't be around to make long term changes, just like politicians who have to concentrate on reelection vs the long term interests of the country.
Posted 9/16/2016 6:06 PM (GMT 0)

BillyBob@388 said...

Pratoman said...

BillyBob@388 said...

Pratoman said...
Billybob, yup, that was me.
The problem wasn't my doc. It was me, being non compliant. He did initially tell me to watch carbs, the drugs did get my TG down from 750 to 350, but they also made me feel like I could eat what I want. (I was younger, and invincible - a legend in my own mind - little did I know)
Now, with that said, it's also a fact that most Drs are NOT trained in nutrition, and don't know jack about it. Which is something that should change.

Pricing is a big issue. But I was referring to the theory that big pharma and the FDA are hiding the fact that statins are more harmful than helpful. I just can't buy into that conspiracy theory


Thx Prat. I thought you may have been originally less than compliant on the carb issue, and that you might have been one of the lucky ones with a doc who actually advised you correctly regarding that. Cutting carbs did a good job on your TGLs, right? Do you still need the TGL meds?

Nope, no drugs (i'm on 7 different prescription drugs, but none for TG and its still fluctuating 83-95, so all good with low carb. But i want to get it to 60. Gotta be more dilligent on the diet

Sweet, no drugs for TGL! It was a cutting of the carbs you needed all along, apparently! I wonder what % of docs are telling their patients that? I wonder if the FDA knows this and requires this info be disseminated prior to prescription, especially prescription of 3 different drugs?(somehow I doubt it) It is no wonder some folks at some web sites caste a jaundiced eye towards some of our medical authorities. IMO anyway. And considering the OP, and the other thread it refers to, there may be reason to think that profit motives often- or at least sometimes- over rule what is best for the patient.

I know you said your doctor had emphasized the carb/TGL connection and you just refused to listen. But, where did you first read strong enough arguments that would convince you that you should try it? ( EDITED to remove a sentence after I realized it referred to a thread recently locked at the OP's request)

Dont recall, i think i knew all along that it was about carbs. it wasnt about knowlege, it was about fear. like i said, i felt invincible. until i was diagnosed with CVD. i would add that its also about weight. before my fear diagnoss, i started weight watchers. still ate carbs, bread, etc, and lost 30 pounds, with a commensrate drop n tg to about 150. it was after the cvd diagnosis and the fear set in that i drastically reduced, almost eliminated wheat and grain of all kinds. with that, TG fell below 100, with another 15 poound weight loss.
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