Beat the Press

Dean Baker's commentary on economic reporting

5/04/2006

Corruption in the Pharmaceutical Industry: Why Is Anyone Surprised?

The New York Times has run many excellent articles over the years describing various forms of corruption in the pharmaceutical industry. (The latest describes the battle over monitoring the prescribing practices of individual physicians.) The one thing missing from these articles is any economic analysis.

Every person who has suffered through an introductory economics class has heard the story about how government intervention in the market leads to corruption. Economists always rant above how trade protection or various forms of government regulation inevitably lead to gaming of the system and rent-seeking behavior. If we expect to see such corruption when a tariff or quota raises clothes prices by 15-20 percent, why wouldn’t we expect to see such corruption when drug patents raise prices by 200 percent or more?

Calling government protection a “patent” or defining it as an “intellectual property right” does not change the economic model one iota. The sort of incentive for corruption from protection is the same, except the magnitudes are many times larger. For this reason, the predictable result of the government granted monopoly known as a drug patent is that drug firms will lie about their test results, conceal evidence of harmful effects, use illicit political influence to get drugs approved by the FDA and purchased by government agencies like Medicaid, make payoffs to doctors for prescribing their drugs, make payoffs to generic manufacturers to prevent competition, etc.

The Times has performed a valuable service in documenting many instances of these abuses over the years. However, the media needs to expose the underlying problem in the incentives created by the patent system so that we can have a serious debate over the best mechanism for financing prescription drug research.

54 Comments:

  • At 9:14 AM, Blogger Shag from Brookline said…

    My doctor recently took me off Lipitor after several years switching to Zocor, which is quite a bit more expensive. This change took place as a result of a refill that required authorization and not at a visit. At first I thought that perhaps it was a matter of "reciprocation" of some sort. But then I learned from NYT that Zocor's patent is about to expire. That's the good news. But the generics are battling for position to keep the generic price high by limiting competition. I have a visit coming up and will ask Doc why the change?

     
  • At 12:55 PM, Anonymous Erik L said…

    I don't see what patents have to do with your argument. The analogy to trade barriers seems flawed. Your saying if there were no patents but somehow the drug industry still produced and sold large numbers of pills at a reasonable profit there would be no incentive to cheat? I can see if your point was to game the system to increase patent protection time (which drug companies do). That would be analogous to trade barriers.

     
  • At 5:02 PM, Blogger colorless green ideas said…

    erik,

    i think the point is that the monopoly on production that a patent offers allows profits that are way, way above what the price would be in a competetive market. is also a huge incentive to lie, cheat and cover-up in order to get access to those monopoly profits.

    a patent is comparable to a tariff in that it is a government intervention that raises prices which are paid by the consumer, and are higher than what the market would allow under competitive conditions.

    you question whether drug companies would even produce drugs without the patent incentive. that is a fair question, but you are assuming that patents are the only possible incentive for production. it is entirely possible that the costs imposed on consumers (and society) by allowing monopoly profits are higher than the benefit received, and that it is time to expore alternate methods of funding

     
  • At 3:47 AM, Blogger Laurent GUERBY said…

    A very interesting book online from economists Michele Boldrin and David K. Levine:
    http://levine.sscnet.ucla.edu/general/intellectual/against.htm

    Read chapter 9, long list natural experiments proving patents harmful...

    Report on the Cato Institure conference on IP:
    http://www.techdirt.com/articles/20060428/1516211.shtml

    More links (in French):
    http://guerby.org/blog/index.php/2006/04/30/71-les-brevets-suite

    I have many times posted on "liberal" economists blog (Greg Mankiw, Bernard Salanie, Cafe Hayek, The Case for Small Government, ...) asking why such a huge government intervention in the free market would do any good. I even had to recall Greg Mankiw the history of his own country:
    http://gregmankiw.blogspot.com/2006/04/intellectual-property-protection.html#114573874804295289

    See also about drugs here:
    http://gregmankiw.blogspot.com/2006/03/drug-reimportation.html#114410007829448517

    The only common point in all those "discussions" is that none of the econmist I asked ever responded to this kind of posts (even when citing Hayek on Cafe Hayek...).

    Talk about evidence of ideology trumping economics facts.

     
  • At 8:24 AM, Anonymous Erik L said…

    Colorless-

    Without patent protection the profits would not merely be lower, they would be negative. It costs a huge amount of money to develop a new drug and bring it to market. It costs very little for a generic maker to copy the average drug and bring it to production. The generic maker could make a profit at this market price. The company that paid to develop it cannot. No patents. No new drugs.

     
  • At 9:43 AM, Blogger Dean Baker said…

    A quick point:there are 2 separate issues here. The first is simply documenting the distortions created by patent protection. Here the textbooks on trade protection are useful -- it is the same picture, the government has imposed a barrier that allows the price of drugs to be far higher than the cost of manufacturing drugs. (in the abesence of patent protection, all drugs are essentially sold as generics.)

    The second issue concerns the best way to finance drug research. Patents are one way, there are alternatives. The question is which is the most efficient mechanism.

     
  • At 1:39 PM, Anonymous Anonymous said…

    As one who has worked in Big Pharma, now is trying to develop a product in Little Pharma, and has even sat on both sides of the bench in academia, the prescriptions to fix the industry are all wrong.

    1. The industry actually does need to be insanely profitable for anyone to want to invest in it. Very few VC people will even touch pharmaceutics because of the long time between investment and exit. (Admittedly, the industry does lie about development costs, but only by a factor of two) The low-lying fruit has mostly been picked. And, thanks to the controlled pricing in Europe, Japan, and segments of the US market, consumers pick up the tab.

    2. Pharmaceutics is still a small part of medical care costs. If the drugs did what they claim to do, they would be well worth the money. The real problem is that SSRIs (e.g. Prozac) are not cure-alls for depression, are widely overprescribed, and can have serious side effects that undercut the cost-benefit equation.

    3. The industry did great things and was not widely corrupt in the 1960s, 1970s, and even the early 1980s. As I wrote in my book on industrial science, high ethical standards meant that there were very few Thalidomide-style disasters thanks to scientists behaving responsibly and standing up to management pressures. Some time during the 1980s, *America* started to become corrupt, and since the industry is part of the nation, it suffered.

    4. Shamefully, much of the US industry is now foreign-owned. The pharmaceutical industry was once a crown jewel in our technological supremacy. But American managers screwed up. We need to make it a national priority to re-take the lead in this industry.

    5. The situation is actually bad for the industry. By raising prices, it ceases to compete with other medical technologies. That competition is great as a technology driver. Replacing (ineffectual) surgical removal of tumors with chemical treatment at a fraction of the cost is what free markets are supposed to do. High drug prices (as opposed to profits) discourages innovation.

    Here are my solutions: (1) ask the rest of the world to ease up on the price controls and crack down on counterfeiting, in exchange for which the US will do what it should have done all along in providing low cost medicine to the Third World. This will have the effect of reducing the monomaniacal focus of companies on the American market, (2) The real problem is competition. The industry is waaaaay too concentrated. I don't know whether trustbusting or encouraging entrants is economically preferable. As an entrant, I'm biased. The cost of capital we face is often 100% or even 200%, making it one of the primary barriers, (3) the problem behind, e.g. Vioxx is job insecurity. The SOBs in the economics industry (and I really can't be bitter enough here) encouraged Congress to flood the country with immigrants and to outsource what couldn't be done that way. What they didn't understand is that when you undercut the job security of people in regulated industries, you silence those relatively few inside of industry who keep things clean. The economics profession provided the intellectual cover for the policies that created a lot of the corruption that exists.

    Please understand: I recognize that almost all Americans are here because of immigration. I like (most) immigrants, have served as faculty adviser supervisor, employer, or friend to more than I can count. But I like immigrants enough to not want to see them used as pawns in destroying the integrity necessary in a regulated industry.

    Immigrants damage national integrity in several ways. First, there's direct corruption. A couple of Chinese colleagues told me that $10,000 paid to the right judge would get them the green card. Second, there is ethical confusion. Ethical standards are different in other countries. I don't want to say our standards are better, because some of the crookedest foreign scientists I have known were British and some of the most ethical from China. But when you have many different standards, there's uncertainty, and uncertainty creates an opening for unethical managers to exploit. Third, the threat of deportation is used against non-permanent residents. A manager of my acquaintance specifically hired immigrants from a brutal totalitarian country because he would be able to have them deported if they didn't obey. Finally, there's resentment. Immigrants require huge investments of time to train, to assist them with writing reports and making presentations, etc. Who does that? Why, their American peers, who get no credit for providing this assistance. When one starts factoring in all of these externalities, immigration policy has been a disaster, costing the US far more than it gained from cheap postdocs and submissive scientific labor.

    It still takes 7-10 years to bring a typical drug to market.

    We need the patent protection.

    We need insanely high profits-- which can be consistent with moderate prices.

    We need good-faith exemptions in law to protect companies against lawsuits-- and universal healthcare so that people suffering a serious side effect don't need to reach for the deep pockets just to pay their bills-- while Americans need easier access to the courts to punish the bad actors.

    We need serious immigration and trade reform to protect American scientists from competition consciously designed to drive down wages and standards.

    There are other things, but this is already ridicolously long.

     
  • At 3:25 PM, Anonymous Anonymous said…

    anonymous wrote, We need insanely high profits-- which can be consistent with moderate prices.

    They're not really "profits." They're monopoly rents.

     
  • At 8:59 PM, Anonymous Anonymous said…

    If the only response to my long, detailed, and well-informed post is a quibble over words, we are in trouble.

    I've challenged the premise of this blog entry, namely that the "predictable result of the government granted monopoly known as a drug patent is that drug firms will lie about their test results, conceal evidence of harmful effects, [etc.]"

    It's not a predictable result. There are pressures to cheat whenever there's money to be had. There was no monopoly (or any other government intervention) involved when Prudential sold futures in speculative (read: highly doubtful) Louisiana oil properties to elderly people who relied on fixed income-- that was a HUGE scam.

    The difference in the pharmaceutical industry is that lives are directly involved. In a typical non-pharma company, small scandals get hushed up. Not so in pharmaeutics. We have to bury our mistakes, a situation which sobers the mind of anyone who is in a position of legal and moral responsibility.

    Developing a drug involves a measured-- one could even say a cold-blooded-- calculation of risk-benefit. For example, we can prevent 100,000 heart attacks, but also cause 500 strokes. All of the judgments have to be made at top velocity because time is, as it should be, so valuable. They're made with necessarily incomplete information. Work too fast, make an error, and you will kill people. Slow the process down so that a lifesaving medication makes it to market one day later and you will kill people. Working in the industry is both agonizingly difficult and deeply rewarding.

    What has been missing in the pharmaceutical industry recently is the impulse inhibiting corner-cutting. That impulse arises from having normal, decent, and well-trained people with basic employment security and a society that values ethical science.

    Remember that it was biochemist Jeffrey Weigand who brought the tobacco pirates to justice. An insider. The government would never have nailed them had it not been for him. Sure, it would have been wonderful if he had come forward 10 years earlier. But the society did not provide him any protection. We expect industry whistleblowers to throw themselves under the train to protect *our* lives and *our* health, even though it costs them *their* homes, *their* careers, *their* sanity.

    What the hell do we do to protect *them*?

    It may be that corruption starts at the top. But it can only endure and grow because the middle class-- which has the power to expose and heap opprobrium on top-level corruption-- is also in some way corrupt, selfish, unwilling to fulfill its political responsibility.

    The reason America increasingly dislikes George W. Bush is because they see themselves reflected in him. And those are the better Americans. The worse ones won't even look in the mirror.

    Well, I do have things to do, even if today I have pretended otherwise.

    (the previous anonymous)

     
  • At 10:45 PM, Blogger Dean Baker said…

    Anonymous,

    my point is precisely that if we took the money away, we would take away the incentive for corruption. The money is there because of patents. I don't think there are any disagreements here.

     
  • At 3:14 PM, Anonymous Anonymous said…

    arg.

    Take away the money and no one would invest!

    Trying to cure corruption by reducing the profitability of an industry is like trying to cure obesity by sewing a man's lips shut. It might work for a while, but sooner than you think, he'd be dead of thirst.

    Here is why pharmaceutics needs high profits.

    1. Attrition: As the GSKW ad says, very few compounds make it through development. While most get shot down early on--i.e. cheaply-- some wash out only well down the pipeline-- i.e., after a lot of money gets spent on them. Drug prices reflect the cost of R&D of both successful and unsuccessful compounds.

    2. Time value of money, neglecting inflation but incorporating attrition and other risk factors. As anyone knows, if you deposit $1 in a bank for 10 years at 5% interest, you will have $1.63. But banks are safe and stocks are not, especially when their products are 10 years away from market. The risk premium raises the effective cost of capital.We talk about this in terms of the discount rate: how much interest do I have to pay to borrow money for development?

    In pharmaceutics, one of my students researched the cost of capital and concluded that 24% is a reasonable overall risk-adjusted discount rate for a well-established pharmaceutical company. (One can break this down further and produce estimates of the cost of capital at various stages of development; research might carry a 100-200% discount rate, for example while a product just approved by the FDA might carry a 15% discount rate) If your bank did that, after 10 years, $1 would become $8.59.

    Suppose you have $200M in net profit in years 10, 11, 12, 13, and 14-- a HUGE drug (back-of-the-envelope ballpark estimate: total sales of $5 BILLION). In net present value, this income stream is worth $23M, $19M, $15M, $12M, $10M, for a total present value of $79M.

    In plain language, when you go to an investor and say, "I can produce a drug with FIVE BILLION IN SALES," what the investor hears is "I have an idea worth $79 million."

    Sobering, isn't it?

    If government replaced all private investment, it might be possible to reduce the discount rate to 12% (not lower, because attrition still accounts for a major part of it). That would have a huge effect on drug prices. My back of the envelope says that if the drug industry were completely nationalized while miraculously not losing its vibrancy, drug costs could fall by up to 50%.

    But look at that "could" more closely. The government already funds almost all early-stage research, where the discount rates are highest-- but the total spending is relatively small. If the government funds late-stage pharmaceutical development, costs might be further reduced. But in fact, the government does some of this, too, through industrial development bonds. So, that "could" might actually, really represent a drop of drug costs of 25%.

    (Inter alia. IDBs are in my opinion the worst sort of corporate socialism, vulnerable to cronyism and self-dealing. While not opposed to government intervention in markets, it's often done badly.)

    In other words, that 24% discount rate already includes massive government subsidies. The low-lying fruit has been picked. And patents? They merely create the mechanism to induce private investment.

    There are ways to cut drug development costs, and ways to cut costs downstream of that. But they are all process-wonk stuff having little to do with economics or patents or even financial markets, and a lot to do with people: how academicians view research, how physicians view the disease process, eliminating improper offlabel- and over-prescribing, improving performance standards in clinical research, etc.

    If this doesn't clarify why I think there is exactly zero connection between patents and the high price of drugs, there's no more I can say that will help. There are some things one learns only by running a business.

    [Disclaimer: arithmetic comes without warranty.]

     
  • At 4:33 PM, Blogger Dean Baker said…

    Anonymous,

    My point was exactly that we may not want the drug industry to do the development precisely because they are so inefficient and corrupt. Drug prices would fall 70 percent or more if drugs were sold without patent protection. We know this, because that is the ratio of generic prices to the price of brand drugs.

    There are alternative ways of supporting drug research. The right question is which method is the most efficient.

     
  • At 4:35 PM, Blogger Dean Baker said…

    Anonymous,

    My point was exactly that we may not want the drug industry to do the development precisely because they are so inefficient and corrupt. Drug prices would fall 70 percent or more if drugs were sold without patent protection. We know this, because that is the ratio of generic prices to the price of brand drugs.

    There are alternative ways of supporting drug research. The right question is which method is the most efficient.

     
  • At 10:24 AM, Anonymous Udolpho said…

    I'm at a loss for words regarding Dean Baker's almost comical reading comprehension problems.

    "Drug prices would fall 70 percent or more if drugs were sold without patent protection. We know this, because that is the ratio of generic prices to the price of brand drugs."

    I'm dumbstruck that Baker thinks this is an intelligent and useful reply to anything. Is there a blog called "Beat the Economist"? There should be, and I vote for Baker, Gladwell, and Levitt (why do all economist dilettantes think of themselves as rogue?) for the first group of beatees. Get your fists conditioned, people, this first beating could take awhile to produce results.

     
  • At 11:09 AM, Anonymous Daniel Haszard said…

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    a patent is comparable to a tariff in that it is a government intervention that raises prices which are paid by the consumer, and are higher than what the market would allow under competitive conditions.

     
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