“The pusher don’t care, ah, if you live or if you die.”
(Steppenwolf, 1968)
OPINION
Political debate about what drugs are or should be available does not often focus on the fact prescription drugs are part of a commercial market, a very big and powerful market.
There are fewer differences in this respect between prescription and other drugs than some might like to think (if you do not see that, try watching Painkiller on Netflix).
The prescription drug market is vast and profitable. It has brought many great benefits to the treatment of ill health. The makers of prescription drugs are driven by commercial imperatives, not altruism, not any more than Steppenwolf’s pusher. They identify commercial demand and deliver product which will make a commercial return, prioritising the products which are the most attractive commercially. Subject to appropriate safety regulations and scientific rigour, the availability of prescription drugs has been a significant factor in longer, better lives for vast numbers of people.
One big and often unappreciated aspect of the prescription drug market is that it is vastly profitable because of regulation.
Without the regulation of monopoly rights of production, most such drugs can be relatively cheaply replicated. The big costs of identifying and developing and gaining these monopoly rights would almost certainly prevent most such drugs from ever becoming available without protection. The “big pharma” companies would not bother purely out of concern for your health.
So the drugs do not, mostly at least, exist without government protection, or for that matter - in many cases - without government subsidisation of one kind or another in early-stage development. In our case, dependent on governments elsewhere, reinforced by our own regulation.
This does not need to be scary, and doesn’t make the companies evil. But we should be at least realistic about it. I’m not arguing here about morality, just the hard economics of it.
So we have these monopoly producers distributing their product, which is recognised as valuable by medical practitioners here and elsewhere.
Our response to this is to try to get the best deals we can through Pharmac.
You can argue about how well they conduct that, how much they are funded, and no doubt about other aspects of their work, but using a local monopoly buyer to handle the trade with a monopoly seller/s makes sound economic sense in principle. From most accounts, the system has worked well for many drugs in terms of both cost and availability.
It is clear there are exceptions to this.
I’m not competent to judge the medical efficacy questions, but neither are politicians who espouse choices different to those of Pharmac.
We must all accept there are drugs which would help patients available elsewhere which are not available here. It is the nature of the market for prescription drugs - we can ration by price or by some form of control and queue. I know we do not like to think of it as rationing, but that is what it is, whether by price or regulation.
There is not a lot which I like to hand over to experts, but medication does fall into that category. Someone has to make price and availability choices, and unless you want a free market where individuals or firms buy wholesale off monopolies for retail sale, that’s how it is. That is a recipe for inequity and exploitation on a big scale.
This is a different argument than whether Pharmac is adequately funded. This is a legitimate political debate. So is the broad categorisation of their purchasing strategy and priorities. It is legitimate for those concerned about any specific condition to call for their concern to be met. But there has to be an orderly process of some kind to ration availability.
But it is very dangerous for politicians to start picking preferred medications. Every choice is a preference. Each preference on finite funding is necessarily a choice for at the expense of another choice. “I can get you this” means “I will not get you that”.
This choice is not about prescription charges being made to pay for specified drugs. Whether there are general prescription charges or not, any populist choice carries with it a denial to some other condition.
It’s a very dangerous place for election promises. Anyone employing it is not really much better than the pusher Steppenwolf damned. Any experienced politician really knows this, so to pretend otherwise is deeply cynical.
In the midst of a deep health services crisis, where equity of access and outcomes, staffing, facilities and other aspects are all stressed to the max, throwing this into the mix is irresponsible too.
Rob Campbell is a professional director and investor. He is chancellor at AUT, chairman of Ara Ake, chairman of New Zealand Rural Land and an adviser for Dave Letele’s BBM charity. He is also the former chairman of Te Whatu Ora - Health New Zealand.
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