How drug companies make you buy more medicine than you need

If you’ve ever tried to use eye drops…you
know it’s hard to do without some of it rolling down your cheek. I used to think that was because I missed. But turns out, I’m not actually so bad at
this. Well, most of the time anyway. Eye drops run down our faces because the typical
drop is larger than what the human eye can physically contain. Some are more than twice what the eye can
hold. That means using a single eye drop is like
pouring water into a glass that’s already full. Or like in those Clear Eyes commercials… It’s incredibly wasteful to make over-sized
drops. They cost a lot of money. The waste from each one is like a tiny snowflake. It’s easy to overlook, until they’ve piled
up into a billion dollar snowball. It’s wasted medicine, and all of us are paying
for it. The eye drops industry is huge. They’re sold by volume, and some can cost
hundreds of dollars for a small bottle that only lasts a month. The financial cost is a particular problem
for the millions of patients with chronic conditions that require expensive drops every
day. Last year US drug companies brought in about
$3.4 billion for dry eyes and glaucoma drops alone. Eye drops are far too big for our eyes. That’s Dr. Alan Robin, an ophthalmologist
and glaucoma expert who teaches at Johns Hopkins Medicine. It’s very wasteful. We see that patients are basically spending
twice as much money as they need to on drops. Everyone’s body is different, but experts
say almost every eye drop on the market is larger than the eye can hold. So the excess just washes out, and we end
up paying for a lot more medication than we can use. Wasted eye drops are part of a much bigger
problem. Experts estimate the U.S. health care system
wastes $765 billion a year. That’s about a quarter of our overall spending. And it’s actually more than the entire budget
of the Department of Defense. ProPublica has been investigating the kind
of wasted health care spending that exists right in front of our eyes. Literally. Cancer drugs are also a big ticket waste item. They can cost thousands of dollars per infusion
but are frequently wasted just because of the way they’re packaged. Most cancer drugs are infused based on body
size, so patients need different amounts. But most of them come in single-use vials
that can be much too large for an individual patient. So once a patient gets the needed dose, the
rest of the expensive drug in the vial is thrown out. Drug prices driving patients and their families
into bankruptcy. And on top of patients paying for expensive
cancer drugs to help them, they’re also paying for in some cases a lot of extra cancer drug
that’s just going in the trash. That’s Dr. Peter Bach, the director of the
Center for Health Policy and Outcomes at Memorial Sloan Kettering Cancer Center in New York. Waste hurts people because it costs money. If you waste half of a vial that costs $5,000,
somebody is paying that money, $2500 back to the drug company. And the drug company benefits, because they
count that as revenue or profit. Take the case of Herceptin, a popular, and
pricey drug that’s mostly used to treat breast cancer. The drug company used to make vials that patients
could share, so little of the drug would be wasted. But then it announced in May that the shareable
vials would be replaced by single-use vials. And the switch would mean throwing away any
medication left over from an infusion, and billing the patient for the waste. Genentech, the company that makes Herceptin,
told me that they had to make the change for supply chain reasons, to go to a size that’s
more common worldwide. Every milligram of Herceptin costs about $9,
so a cancer patient’s monthly infusion can run more than $3,000. One administrator at a California cancer treatment
center calculated her average patient would waste 110 milligrams per infusion with the
single-use vials. That’s an average of almost $1,000 of wasted
spending per infusion. The waste associated with over-sized cancer
drug vials is substantial. A study led by Dr. Bach in 2016 calculated
the waste associated with the top 20 cancer drugs packaged in single-use vials. It estimated that 10 percent of the medication
gets wasted, costing $1.8 billion in a single year. But here’s the thing: this is a waste problem
that’s fixable. For cancer drugs, manufacturing shareable
vials, or vials in varying sizes, are proven ways to reduce waste. For eye drops, why not just make the drops
smaller? Dr. Robin knows it can be done – because he
and a team of experts already did it in a study about 20 years ago. He consulted with global eye care leader,
Alcon, when its researchers developed what they called a microdrop for patients with
glaucoma. It was a 16 microliter drop — one that was
half to a third of the size of most drops on the market today. Then they studied the performance of the microdrop
compared to regular size drops. There was no significant difference between
the smaller and larger eye drops. Not only were the microdrops just as effective,
they also reduced some the uncomfortable side effects. And all the participants actually preferred
the microdrop bottle. But instead of being a breakthrough, the innovation became a case study in how profits can come before patients. I tried personally to get the microdrop accepted. And they looked at me as though I was a pariah. The pharmaceutical company would be losing
half the money that they could be making. Officials from Novartis, the drug company
that now owns Alcon, declined to discuss their microdrop study. They said eye drops are designed with a “margin
of safety” to help patients, but they wouldn’t go into specifics. You’d think that regulators would care about
all this wasted medicine. But the FDA regulates the safety and effectiveness
of a drug…not its price or the cost related to waste. Patients paying billions of dollars for wasted
medicine…is just one more reason America has the highest health care costs in the world. Hi guys, I’m Ranjani. A video fellow working at Vox and ProPublica. And this video is part of a new collaboration
between our newsrooms. For the full story at ProPublica, check out
the link down below and stay tuned for more stories coming this year.


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