Generic drugs: good for the PBS

 

Since someone on Twitter has no idea about “chemo day”, and sees fit to tell me I don’t know, let me tell you what it’s like.

Today, Ms T didn’t get her usual chair in “siberia” – that part of the chemo suite reserved for people both on cytotoxins and with superbug-risk. Someone else was there first, so she had the chair next door.

He was an old gentleman who’d arrived, been given morphine, been sent off to get an MRI before his chemo (this sounds bad to me), returned, and waited. Then, before his chemo, he was visited by another doctor, given a butterfly for morphia, recommended for admission and assigned a bed, and sent off again for another MRI because they “wanted more information”. This sounds really bad to me.

On the other side was a teenager who nearly broke my heart: the beautiful-but-hairless that mostly I’d only seen in fundraiser ads (and in our adventures at RPA, we’ve met many cancered-and/or-transplant teenagers).

And there were the carers. On one side, a sixtyish woman fussing over her husband; on the other, a fortyish woman fussing over her daughter. In the middle, us: me arriving late, because I’d had other things to do today, Ms T waiting after some hours because the chemo suite is busy.

We were, remember, in a corner: sibera. The rest of the suite has maybe thirty chairs.

We got through with the small pleasantries that make tolerable being around so much grief. Everybody here is dying, and the carers are all cheerful. “Oh, I can’t stand to see the needle going in.” “I fainted once, so I must be worse than you.” From the teenager’s seat: “Pussies! I have to get the needle IN me, and my bags are bigger than yours!” (She was right. She had a line-up that looked like three liters).

Every single drug these three were receiving was an unbranded generic. There were two cyclophosphamide patients, one on something I didn’t recognise but didn’t come with a “big name” above the chemical name.

We all smiled and chatted. All of us thanked the nurses, whose job I wouldn’t take at two hundred thousand a year, who were invariably happy and gentle and solicitous. We chatted en-passant, wheeled our respective patients’ assemblies towards the toilets as required, tried not to invade each others’ privacy (funny thing: cram people in desperate circumstances into a tight space, and we’re all sensitive to each others’ privacy), and tried to smile.

In another corner of the world, the government has decided not to pay full-price for one cancer drug that’s now available as a generic. In essence the policy is this: “since the drug is available for $X, we will pay $X. If big pharma wants to supply at that price, fine. If not, we will buy it as a generic and pay $X.”

Whaddaya know? Within nanoseconds, the entire Big Pharma machine is in swing.

I know how the machine works. I once worked for the publisher of Australian Doctor, and not only did I get a close-up day-to-day of the machine, I had an internal training session on its practises.

The “desperate patient” is the poster-child of any pharmaceutical campaign, whether it’s for Viagra, the creation of a brand-new (medicable) psych complaint, or “protect this cancer treatment”.

The last one is the best. Who’s going to argue with a cancer patient’s needs?

Me. Someone inside the system. Someone who’s seen it at work. Someone who knows how it works, both as a journalist and carer.

The entire pharmaceutical campaign over the funding of one – just one – drug is based on a simple premise: most people don’t know.

The big thing they don’t know is this: most of the drugs you get in a hospital are generic. From the paracetamol up. Want an anti-emetic? It’ll be generic. Need morphia? Ditto. Artificial morphioid? Yep, generic. Cancer drug?

That’s the sensitive issue, but: most of the drugs used to fight cancers are out of patent, dispensed as generics. Not one person receiving those drugs wants them. They just need them – and don’t care about the brand name.

Some of those drugs are used for other things, like locking down the immune system. Cyclophosphamide, my wife’s drug of choice, came out of the 1950s: anyone arguing that the government must fund its branded versions, Cytoxan, Endoxan, Neosar, etcetera, merely to demonstrate its “commitment” to the health system?

Stupid.

When the premium for the brand could be spent somewhere else?

Stupid.

Should “paracetamol 500 mg” be replaced with a branded product at six times the price, in hospitals, merely as an icon of our “commitment to excellence” or some such shit?

Stupid.

Should the pharmacist insist that Ms T be dispensed with “Immuran” instead of Azathioprine, just so the government can pay more on the PBS to get the brand instead of the chemical compound?

Stupid.

There is no good argument for demanding that the government pay a brand-premium, when “brand” exists only as an emotional consumer artefact to get people to pay premiums that they don’t have to pay.

The idea that “extra spending” should happen as a symbol of “commitment” is childish and simplistic.