Editorial: The Impending Health Care System Crisis and Pharmaceuticals

I have just completed reading an article entitled "Panel Fears Collapse of U.S. Health System", which was published in the Deseret News (Salt Lake City) on July 23 of this year and presented in the Pharmacist e-link, published by NCPA. It basically discusses what we all know, or at least we all should be aware of, and that is that we cannot continue to increase the rate of spending in healthcare, including pharmaceuticals.

With the growth in those "wanting" and "needing" healthcare and the mechanism in which it is delivered and paid for, something has got to give in the (near) future. With almost open borders and the ease in which non-citizens can tap into the healthcare system at tax payers expense, the aging population, and the mentality of "a pill for every ill", we have developed into the most medicated society in history; but, at what cost?

There is absolutely no question that many patients need the healthcare they seek. However, there are many that do not! I recall dispensing thousands of prescriptions over the years to patients who were "entitled" to 4 prescriptions or more per month and they came in and received them, whether they really needed them or not; and taxpayers paid, and still pay, for them. How many of these were needed, used, sold or just wasted? The article stated that health care makes up about 15% of federal spending and it's rising faster than inflation and economic growth; Germany and France are the only other countries in the world that spend more than 10% on health care. It is projected that by 2013, health expenditures will be 18.3% of the gross domestic product. However, looking at key health measures such as life expectancy and preventable deaths, the American health care system is performing below par, the article stated.

Where are all the costs going? Who or what is creating the demand for health care and medications? Are many seeking and receiving treatment because they feel they are entitled to it because they pay insurance premiums or on welfare/benefit programs? Who is profiting most from the high costs of health care today? Is there anything with which we should be concerned, as pharmacists? Should all medications be covered; both life-saving and life-style drugs? Why does the drug industry pay more for advertising than for research?

Obviously, one can pose dozens of questions about this topic. In reality, many of these questions will have to be addressed in the not-too-distant future. With physicians having limited time to spend with patients to do detailed diagnoses, etc, it seems that many tend to "write prescriptions to increase their patient throughput daily". This sometimes results in patients taking 5, 10 or even more prescriptions daily. In many cases, those patients may only need one, two or three prescriptions as some of them may be for the side effects resulting from other medications or their combinations. With the large number of prescriptions being written, what would happen if our health care system rewarded physicians who thoroughly diagnosed and treated patients with the possible result of a great decrease in the number of prescriptions written daily? Especially if some of those prescriptions were individualized for patients (compounded). We may see a decreased need for dispensing pharmacists, mail order, etc. and an increased need for compounding pharmacists in the future. Might this happen? In the future, I think it will as we progress more into the biotechnology and nanotechnology fields of healthcare. Many small molecule drugs we have used for years may not have the prominence they do now. The emphasis may be on the individual patient (pharmacogenomics) and individualized compounded prescriptions.

I often wonder what happened to the pharmaceutical industry I used to know; low prices, innovative and original research, commitment to patients, pricing based on the "cost" of developing and producing the product and an emphasis on the education of physicians and pharmacists on the merits of their specific products. It seems today that the NEW pharmaceutical industry is characterized by high prices, "me-too" research or buying products from other companies, a commitment to stockholders and profits, pricing based on "what the market can bear" and an education emphasis on educating the patient so they will put pressure on their physicians. Things have changed in the pharmaceutical industry and I don't think that the changes have all been positive.

One last topic on this soapbox is related to mergers in the industry. It seems that many companies "merge" to cut costs, increase efficiency and produce products at lower prices for their consumers. I don't see this happening. What I have seen in the mergers is that the upper echelon of management do quite well financially in the process. As the companies combine, some units are cut and others continue. Some facilities will close and others will continue. The product lines are combined and the lower-profit products are eliminated and become discontinued drugs. Many employees are uprooted to new locations and many lose their jobs. I do not generally see costs that are cut, increased efficiency or products at lower prices. One has to wonder why companies merge if not to benefit only the few at the top of the ladder that are making the merger decision. I think this merging of companies has resulted in several "mega-companies" that are quite powerful in setting drug costs high and influencing health insurers and the federal government in promoting pharmaceuticals as the way to treat illness and disease in the US; true, it is one way but there are many others also.

These comments in this editorial are shared by many; including many of those in the pharmaceutical industry. It seems that some companies are advertising that "we put patients first" while stuffing millions of dollars in their coffers from some drugs that should probably never have been approved and/or prescribed in the first place. I like to think that compounding pharmacists place the patient in much higher esteem than the pharmaceutical industry. True, we all must make a profit to stay in business; but ethics and the profession require us to uphold our standards as among the most trusted individuals. Think about it, many of our pharmaceutical companies were established by pharmacists and physicians and had a philosophy of serving patients; but it seems that has changed. However, serving patients is still the role that compounding pharmacists fill best.

Loyd V. Allen, Jr., Ph.D., R.Ph
Editor-in-Chief

Due to the large number of pharmacists and technicians now participating in the Compounders' Network Lists, the software has been updated to include not only the capacity to allow more pharmacists but a GREAT word searching feature of the past years' archives.

If you haven't subscribed to the CNL this is a great time to do so. You can peruse the archives to get caught up on the activity of the last several years and keep current with the latest trends, techniques and information about compounding. Click here to join the Compounders' Network today!

Thanks to the CNL advertisers, who help to keep this a free service for pharmacists worldwide! Next time you order from our advertisers or see them out at various CE's and trade shows, please take the time to say "Thank You."

It is a Great Day for Pharmaceutical Compounding!

Here is what was discussed on the CNL this week:

• Aluminum Chloride Solution
• Creams for Poison Ivy Treatment
• How to Treat Hiccups

A sampling of the 31 articles added to the CT.com literature search database related to chronic fatigue syndrome, fibromyalgia, myofascial pain is below:

• Afari N, Buchwald D. Chronic fatigue syndrome: A review. Am J Psychiatry 2003; 160(2): 221-236.\
• Blacker CV, Greenwood DT, Wesnes KA et al. Effect of galantamine hydrobromide in chronic fatigue syndrome: A randomized controlled trial. JAMA 2004; 292(10): 1195-1204.
• Crofford LJ. Pharmaceutical treatment options for fibromyalgia. Curr Rheumatol Rep 2004; 6(4): 274-280.
• Fishbain DA, Cutler RB, Lewis J et al. Modafinil for the treatment of pain-associated fatigue: Review and case report. J Pain Palliat Care Pharmacother 2004; 18(2): 39-47.
• Rimes KA, Chalder T. Treatments for chronic fatigue syndrome. Occup Med (Lond) 2005; 55(1): 32-39.

Practical Application of General Chapter <797> by USP
Featuring comprehensive review of compounding General Chapter <797> Pharmaceutical Compounding Sterile Preparation and more...

A USP Pharmacy Continuing Education Program,
Co-sponsored by the University of Wisconsin
15 Continuing Education credit hours

August 4 - 6, 2005
Hyatt Regency Fisherman's Wharf
San Francisco, CA
Cost is $495.00 per registrant for this 2-day workshop.

Featured Presenters include:
Loyd V. Allen, PhD, RPh: Editor-in-Chief, International Journal of Pharmaceutical Compounding, Chair, USP Expert Committee on Compounding
Eric Kastango, RPh, MBA, FASHP: Principal, Clinical IQ, LLC
David Newton, PhD, David Newton, Ph.D., FAPhA: Professor and Chair, Department of Biopharmaceutical Sciences, Shenandoah University, Winchester, VA, Chair, USP Expert Committee on Sterile Compounding
Jim Wagner, President: Controlled Environment Consulting
Darryl Rich, Pharm.D., M.B.A., FASHP: Part-time JCAHO Surveyor

To register, or for more information, see: http://www.usp.org/eventsEducation/education/pe/pharmacy.html

The Baker Company Introduces SterilSHIELD� Barrier Isolator Designed To Help Pharmacies Comply With USP<797> When Working With Non-Hazardous Pharmaceuticals

SANFORD, Maine -- The Baker Company has introduced a smaller, two-glove position model of the SterilSHIELD� Barrier Isolator that offers a contained, positive-pressure work area for pharmacy applications. Designed specifically for aseptic compounding of non-hazardous drugs in compliance with USP<797>, the SterilSHIELD� Model SS500 creates a HEPA-filtered unidirectional airflow of better than ISO Class 5 (Class 100) air cleanliness conditions within the chamber to eliminate cross-contamination on the work surface while preventing outside contaminants from entering the chamber.

The SterilSHIELD� Model SS500 (5 ft. wide) offers a two-glove position, while the original Model SS600 (6 ft. wide) and offers a three-glove position in the main chamber.

SterilSHIELD� SS500 Features

• Ergonomic design includes a slanted viewscreen angled at 10� with top hinge to allow full opening for loading and unloading of pharmacy equipment, oval gloveports (with two glove positions) offer easy reach to all interior surfaces for users of different heights, positive-pressure interchange (pass-thru chamber) permits safe and easy transfer of materials in or out of the chamber.
• Product protection is assured through a main chamber pressure that is positive to the room. The main chamber is slightly more positive than the pass-thru interchange to maintain aseptic conditions in the main chamber.
• A unique plenum design employs a high-performance airflow system that provides optimum protection from particulates, extends filter life and reduces cost of ownership.
• The SterilSHIELD microprocessor controller with touchpad membrane control offers simple operation without relays or switches. The Baker StediVOLT� motor speed controller reduces the risk of performance degradation due to line voltage fluctuations.

The Baker Company, a world leader in the design and manufacture of biological safety cabinets, clean benches, fume hoods, powder weighing stations, animal research products and barrier isolator, has been building equipment to protect personnel, animals, product and the environment for more than 50 years.

For questions about the SterilSHIELD� SS500, contact Phil Lang at plang@bakerco.com

Contacts:
Public Relations:
Offenberger & White
Bill White
USA
Phone: 740-373-9010
FAX: 740-373-9125

General Information:
Phil Lang
USA
Phone: 800-992-2537
FAX: 207-324-3869
plang@bakerco.com