Will SCOTUS Cure Big Pharma’s Anxiety?

On Tuesdays the New York Times still runs a “Science” section in the print edition. It never attracts advertisers but Big Pharma supports it with online ads. (The Times has more than 8 million online subscribers. They outnumber the print-edition diehards by about 20-to-1 and account for 70% of the paper’s revenue. Online ads make the overall operation profitable. Last year the owners netted about $350 million. Average Times readers are in their early 40s and earn about $80,000/year.)

The Science section includes a two-page spread called “Well” that is filled with faddish advice about exercise and diet, plus Big Pharma propaganda. On June 27 “Well” was pushing treatment for “Anxiety Disorder,” which, according to “medical experts” afflicts one in five US Americans. The print headline invited readers to “Spot Anxiety Disorders With a Few Questions.” The online hed asked, “When Does Anxiety Become a Problem?” The article consisted of questions lobbed to the president of the American Psychiatric Association, Dr. Petros Levounis, who explained why everybody under 65 needs to be screened for Anxiety. In response to one of the lobs, the Levounis said that people over 65 should also ask their doctor about treatment for “Anxiety.” 

There’s nothing new about this pitch. Soon after scoring big with Prozac as a treatment for “Clinical Depression” at the start of the ‘90s, Eli Lilly got FDA approval to sell it for “Anxiety,” too. Other drug companies making SSRIs followed suit, and soon US Americans could elevate their mood with Paxil, Zoloft, Luvox, Lexapro, and Celexa. When SSRIs fail to resolve the problem (which is almost always caused by loneliness and/or insecurity, not a chemical imbalance in the brain), doctors can prescribe benzodiazepines such as Xanax, Librium, Valium and Ativan.

Just as the Prozac pushers made a big show of distinguishing between normal “situational depression” and the more serious “Clinical Depression” that requires treatment, the current crew emphasizes the difference between ordinary “protective anxiety” and the more problematic “Anxiety” with a capital A that calls for medication. 

Other “Well” stories June 27 included “From Walk to Workout,” “Advice for Soothing a Bad Sunburn,” “Tai Chi is Exercise for the Brain and Body,” “Let Children get Bored, It’s Good for Them,” and “FDA Approves Gel for Erectile Dysfunction.” The gel, I kid you not, is called Eroxon.

Surely the 2023 award for best name of a new pharmaceutical product will go to Futura Medical, whose Eroxon contains the first the first and last two letters of erection, the last two of hard-on, and in between the rox that the customer intends to get off as he rocks on. Eroxon will be sold over-the-counter, no prescription needed. The package claims that it “Treats erectile dysfunction,” is “clinically proven,” and “helps you get an erection within 10 minutes.”

The Times story announcing this blessed event was written by “Well” staffers Dani Blum and Alisha Haridasani Gupta. They reported, “The gel has a cooling and warming effect that stimulates the nerves of the penis, prompting blood to engorge the tissue, said Dr. Arthur Burnett, a professor of urology at Johns Hopkins Medicine who was involved with Futura’s trial of the gel. He called the gel safe and ‘quite appealing’.”

Dr. Burnett may be in the great tradition of physicians who test innovative treatment on themselves.

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But Seriously, Folks

The triviality and pseudo-medical nature of many problems that Big Pharma’s products are designed to treat should be borne in mind in the months ahead as Medicare finally tries to use its bargaining power on behalf of US Americans. ”The Inflation Reduction Act” that President Biden signed into law last year will lower insurance premiums and out-of-pocket costs for older and disabled US Americans if and when it gets implemented. But, as the Times headline said July 23, ”Drugmakers Are ‘Throwing the Kitchen Sink’ to Halt Medicare Price Negotiations.”

According to the story by Sheryl Gay Stolberg and Rebecca Robbins, negotiating prices with the drug companies will also save the government $98.5 billion over the next 10 years. But last week “Johnson & Johnson became the latest drugmaker to take the Biden administration to federal court in an attempt to put a halt to the drug pricing program. Three other drug companies — Merck, Bristol Myers Squibb and Astellas Pharma — have filed their own lawsuits, as have the industry’s main trade group and the U.S. Chamber of Commerce.

“The suits make similar and overlapping claims that the drug pricing provisions are unconstitutional. They are scattered in federal courts around the country — a tactic that experts say gives the industry a better chance of obtaining conflicting rulings that will put the legal challenges on a fast track to a business-friendly Supreme Court.”

The drug companies contend that being forced to negotiate (or pay stiff fines) violates the Fifth Amendment, which says “…nor shall private property be taken for public use, without just compensation.”

The Times quotes a Georgetown professor, Lawrence Gostin: “It would not surprise me at all to see these cases go up to the Supreme Court and have them strike it down.”

The Congressional Republicans are in a bind because very few voters favor high drug prices. So it’s up to the courts to do the wrong thing.

“For drugmakers,” Stolberg and Robbins point out, “the stakes of the legal challenges are bigger than just their business with Medicare, their biggest customer. The industry fears that Medicare will, in effect, set the bar for all payers, and that once the government’s lower prices are made public, pharmacy benefit managers negotiating on behalf of the privately insured will have more leverage to demand deeper discounts...

“Industry executives are publicly arguing that the drug pricing provisions will lead to fewer cures... ‘You can’t take hundreds of billions of dollars out of the pharmaceutical industry and not expect that it’s going to have a real impact on the industry’s ability to develop new treatments and cures for patients,’ said Robert Zirkelbach, an executive vice president at PhRMA. He cited an analysis funded by the drugmaker Gilead Sciences that asserted the industry would lose $455 billion over seven years if companies negotiated with Medicare…

“A study released last month that was funded by the Biotechnology Innovation Organization, another trade group, warned that the pricing provisions would discourage innovation, resulting in as many as 139 fewer drug approvals over the next 10 years.” (A federal government study projects that only 13 fewer drug approvals will ensue.)

“This is not a ‘negotiation,” Merck said in its complaint. “It is tantamount to extortion.”

“If the government can impose price controls in this fashion on drug companies,” said Jennifer Dickey, a top Chamber of Commerce lawyer, “it could do the same thing to any sector of our economy.”

Price controls? Perish the thought!

The Times piece ends with a quote from Professor Gostin: “To me, Medicare is doing what it should do. It’s a huge buyer of a product, and it’s basically using that clout, that bargaining power, to get the best price... The drug industry is throwing the kitchen sink at the government. They’re looking for what sticks, and their arguments are directly targeted at the Supreme Court.”

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“The Western concept of romantic marriage doesn’t really allow for much middle ground between undying love and outright hostility.” — Ring Lardner, Jr.