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Tuesday, February 14, 2012

Drug Shortages Highlight Failures of For-Profit Health Care

Rick Ungar (via @Captain Clarion and @AggressiveProgresive) has a great catch and analysis at Forbes, "Proof of the Failure of Free Markets in Medicine." He discusses the shortage of the cancer drug methotrexate, which has an 80-90% success rate in treating the most common (and once always fatal) form of leukemia, acute lymphoblastic leukemia (ALL). The medication, now off patent, is apparently no longer profitable enough for the five U.S. makers of this drug, and methotrexate is one of a number of life-saving medicines in short supply. There are approximately 3000 new cases of ALL each year diagnosed in young children.

As Ungar argues, it is implausible that all five current manufacturers of methotrexate are simultaneously having production delays:
What are the odds that 100 percent of these companies are, somehow, each experiencing manufacturing delays?  Does anyone imagine that these manufacturing delays were occurring back when these companies were making big bucks on the product, achieved by the huge mark-ups that accompany receipt of the patent protection that bars others from competing?
The Huffington Post's Linda A. Johnson reports that the five companies are Ben Venue Laboratories Inc., APP Pharmaceuticals LLC, Hospira Inc., Sandoz Inc., and Mylan Inc. She also notes that Ben Venue was the sole U.S. producer of the breast cancer drug doxil, which with methotrexate was affected by a November shutdown of a company plant in Ohio after regulators found recurrent drug safety problems.

When production of these drugs falters, people die. As Ungar puts it, "This means that kids are dying —and will continue dying— because the money just isn’t what it used to be for the five manufacturers who have long supplied the critical medicine."

If we think that's wrong, it's necessary to address the problems of the patent system, which leads to high profits (and medicines unaffordable in developing countries, according to Susan Sell) during the patent's life but abandonment of vital medications after the end of the patent. Instead, we are at present having to fight off attempts to expand protection of patents and other intellectual property: the for-now neutralized SOPA and PIPA, as well as the Anti Counterfeiting Trade Agreement and the Trans-Pacific Partnership. Ungar suggests that the patent system be modified to take into account whether companies stopped making needed drugs after previous patents expired. This could be helpful, but the deeper question is whether patent protections are too strong already and need to reduced.

Basics: U.S. Students Score About Average in OECD Testing Program

Every three years, the Organization for Economic Cooperation and Development carries out its Program for International Student Assessment, PISA. The 2009 edition covered 65 countries and focused on reading, but included test results for math and science as well. PISA tests students who are 15 years, 3 months old to 16 years, two months old to
assess the extent to which students near the end of compulsory education have acquired some of the knowledge and skills that are essential for full participation in modern societies (PISA Results, Volume I, p. 19)
 In addition to the 34 OECD member nations, a further 31 "partner countries" take part. Some of these partners, such as Shanghai, were among the top performers, despite lower education budgets than in the OECD and wide socioeconomic disparities within them. In fact, Shanghai topped the list in all three categories (see below).

The U.S. scores on the high end of average in reading and science, and just below average in math. As the table below shows, America scores better than a few countries often thought of as more "socially advanced," such as Sweden. Though there is obviously room for improvement (and the PISA report discusses improved scores in countries as diverse as South Korea, Poland, Germany, and Brazil), the sky is not falling on U.S. education just yet.

In future posts, I plan to take up more education-related issues. Here, I wanted to show that the U.S. is not starting from as bad a baseline as it does, for example, in health care. Without further ado, here are the PISA scores for the top 50 countries:

Reading Math Science

556 600 575
539 546 538
536 541 554
Hong Kong-China
533 555 549
526 562 542
524 527 529
New Zealand
521 519 532
520 529 539
515 514 527
508 526 522
506 515 507
503 498 500
501 512 528
501 534 517
500 495 508
500 507 496
United States
500 487 502
499 536 520
497 494 495
497 513 520
496 487 508
496 497 498
Chinese Taipei
495 543 520
495 503 499
United Kingdom
494 492 514
494 490 503
489 487 493
487 525 511
486 483 489
484 482 494
483 501 512
483 466 470
481 483 488
Czech Republic
478 493 500
Slovak Republic
477 497 490
476 460 486
474 447 455
472 489 484
470 496 494
468 477 491
464 445 454
Dubai (UAE)
459 453 466
Russian Federation
459 468 478
449 421 447
442 442 443
429 428 439
426 427 427
425 419 416
424 427 428
421 419 425

Source: OECD, PISA 2009 Database