Pimpin’ Gladwell … again

I can’t help myself when it comes to pimpin’ Malcolm Gladwell. You see, I value people who can make the complicated uncomplicated and can forgo conventional thought for intellectual thought. And Gladwell does both.

Case in point … his take on the high prices of prescription drugs.

In a recent New Yorker article, High Prices -- How to Think about Prescription Drugs, Gladwell expertly dispels the myth that it’s the fault of the pharmaceutical drug companies for rising drug costs.

Instead, Gladwell argues, “... drug expenditures are rising rapidly in the United States not so much because we're being charged more for prescription drugs but because more people are taking more medications in more expensive combinations. It's not price that matters; it's volume."

In the article Gladwell goes on to point out we have become far more aggressive in the treatment of diseases. And because of the intensity to which we are treating illnesses with prescription drugs, the volume of drug use has increased precipitously. In essence, we are spending more on drugs because we are using more drugs.

Gladwell writes, “The fact that volume matters more than price also means that the emphasis of the prescription-drug debate is all wrong. We've been focused on the drug manufacturers. But decisions about prevalence, therapeutic mix, and intensity aren't made by the producers of drugs. They're made by the consumers of drugs.”

Gladwell continues … “The core problem in bringing drug spending under control, in other words, is persuading the users and buyers and prescribers of drugs to behave rationally, and the reason we're in the mess we're in is that, so far, we simply haven't done a very good job of that.”

Malcolm addresses other aspects in this complicated pharmaceutical drug game, made all the more relevant thanks to the recent Vioxx and Celebrex mishaps.

A worthy read for all.

******************************************************************* Other Brand Autopsy pimpin' Gladwell posts:

Brand Autopsy pimpin' Gladwell post #1 | Oct. 1, 2004

Brand Autopsy pimpin' Gladwell post #2 | Dec. 16, 2004

Comments

[Steve Portigal]

Gladwell is persuasive as usual in that article, but I really took note of the letters to the editor that appeared in a subsequent issue - they did a nice job of refuting some of the points that they glossed over.

But I honestly don't remember what they were, and I'm fairly certain I've recycled all the New Yorkers from December.

So this isn't much use at all, I guess, but maybe someone else has those letters (or would they acdtually be online? gasp?) and can share 'em here?

[johnmoore (from Brand Autopsy)]

Interesting insight Steve.

Hopefully someone can round up the letters to the editor with their counter-points.

FYI … after reading this article I shared it with two friends of mine in the pharmaceutical drug game and they both replied back that it was the best portrayal of the industry they have read in the major media. They also pointed out that Gladwell missed the rampant usage of free samples doctors give to patients which actually helps to reduce patient’s costs in some cases.

[Tom Asacker]

John,

You really don't believe Gladwells' nonsense, do you? It sounds to me like he's been bought and paid for by big Pharma. For example, Gladwell writes: “We've been focused on the drug manufacturers. But decisions about prevalence, therapeutic mix, and intensity aren't made by the producers of drugs. They're made by the consumers of drugs.” Complete horse hockey. Where do you think physicians receive their education on therapeutic mix, frequency of use, dosage, et al? From consumers? Right.

Oh, and when a consumer sees a little blue face in an ad next to a bright, smiling one labeled "Prozac," and storms into his or her doctor's office looking for a cure, that's exclusively their doing? And when physicians hand out Viagra samples like candy to recreational users, and then write scripts for the same, this is exclusively the consumer's doing.

Get real. "Plop plop. Fizz fizz." was contrived by a marketing person to double the use dosage of Alka Seltzer. And if you don't think that the same thing is going on today with prescription drugs, well . . . let's just say that you should stay out of the medical marketing profession. I have a feeeling that it would disillusion you in a big way.

Gladwell continues … “The core problem in bringing drug spending under control, in other words, is persuading the users and buyers and prescribers of drugs to behave rationally, and the reason we're in the mess we're in is that, so far, we simply haven't done a very good job of that.”

[johnmoore (from Brand Autopsy)]

Tom, it’s easy to point the finger at the pharmaceutical industry for rising drug costs. But it’s not so easy to make a compelling argument that it’s not all Big Pharma’s fault for high drug costs. And I found Gladwell’s argument of how we, as consumers, are taking more medications to more aggressively combat diseases to be an intellectual thought countering the conventional wisdom of it’s solely the pharmaceutical companies fault for higher drug prices.

We read story after story in the media that slams Big Pharma for higher drug prices. I found it refreshing to read a story from the media that didn’t buy into so-called conventional wisdom

Personally, I would not classify Gladwell’s position as nonsense. Instead, I would classify it as unconventional.

But if you re-read my post … you will notice I never officially took a side in this argument. I merely presented another side to the story. A story I found to be very thought-provoking.

[Dhrumil]

Dollar for Dollar, the United States is the lowest ranked nation when it comes to overall health.

Some 93-98% of all the money spent of health care is spent in the last 90 days of an individual's life.

I love this conversation, however I also want to add another dimension.

Are cheaper drugs really what we need?
Are more drugs making us healthier?

John thanks for putting out this conversation.

[Nittacci]

There's a reason conventional wisdon exists. Usually, it's correct. The reason drug costs are so high is because "Big Pharma" sets the prices so high. If this is NOT the case, as Gladwell seems to suggest, then why does the same drug cost 10 times more in one country, than in the one just next door? If it were so unprofitable for the drug companies to charge 10 cents on the dollar, then they just wouldn't sell their products in Canada. No. The profit margins in the prescription drug business are absolutely out of control. Perfectly effective good drugs are phased out for less effective ones just because generics become available. What does this tell you about "Big Pharma?" Gladwell is a whore.

[johnmoore (from Brand Autopsy)]

Nittacci ... please allow James Surowiecki, author of "Wisdom of Crowds," an opportunity to sway your opinion that conventional wisdom is more right than collective wisdom.

[Zane Safrit]

My intitial reaction was "yeah, I agree". But then I realized that people with health problems outside their domain are turning to doctors who are incentivized by the big drug companies to push the drug companies' latest cocktail solution on the trusting and unsuspecting patient. The doctors often have a vested interest in the sales of the drug or in churning patients through offering only drug prescriptions, not solutions.

If the public, along with their trusted experts known as their doctor, had access to other solutions than the convenient drug prescriptions and were incentivized to offer them then Malcolm would have a valid point.

In other words, the playing field ain't level Malcolm. And your insight overlooks that reality.