Coming to a Pharmacy Near You: One Size Fits All

You’ll never see Bill Gates using an iPhone or see General Motors CEO Richard Wagoner driving a Ford. So, naturally, when Novartis pharmaceuticals’ CEO Daniel Vasella revealed last year that he takes the Pfizer statin drug Lipitor to treat his high cholesterol instead of Novartis’s Lescol, it raised more than a few eyebrows.

It’s well known among doctors that people respond differently to different medications that treat the same condition. Vasella says he had some unpleasant side-effects when taking Lescol. And plenty of others have tried one or another statin without reaching their cholesterol reduction goals, only to find success with a different one.

Unfortunately, the pharmaceutical industry’s biggest critics just don’t get it. Marcia Angell, a former editor of the New England Journal of Medicine, argues that drug companies are little more than “marketing machines” that produce few innovations, just “me-too” drugs that are similar to but no better than others on the market to treat the same condition. Public Citizen’s Sidney Wolfe argues that “most new drugs [a]re ‘me-too’ or copycat drugs that have little or no therapeutic gain over existing drugs.

Unfortunately, former Senator and erstwhile health czar Tom Daschle and many other congressional Democrats have been listening. Tucked away in the stimulus bill is a provision providing $1.1 billion to fund a new government agency called the Federal Coordinating Council for Comparative Clinical Effectiveness Research. It’s goal, as Daschle wrote in his 2008 book, Critical: What We Can Do About the Health Care Crisis, will be to evaluate medicines an decide which ones are effective enough for government health care plans like Medicare and Medicaid to purchase. So, if the Council decides Lipitor is the most effective colesterol drug, Medicare recipients who, like Daniel Vasella, see better results with a different statin are out of luck.

Fortunately, critics of the proposal, like Arizona Republican John Shadegg, have been quick to blow the whistle on this outrage. While supporters claim the program is merely intended to supply doctors with better information about the drugs they prescribe, Shadegg and others have pointed out that the Council is modeled after the UK’s National Institute for Health and Clinical Excellence (which goes by the ironic acronym NICE), which has repeatedly denied citizens of that country access to breakthrough drugs for life-threatening conditions like cancer and multiple sclerosis. Shadegg notes the case of UK resident George Robinson, who died of lung cancer after NICE deemed the drug Tarceva not cost-effective.

Think that can’t happen here? Think again, because it already has. Last year, the state-run Oregon Health Plan refused to pay for the exact same drug to treat 64-year-old Barbara Wagner. Adding insult to injury, the private firm administering Wagner’s health benefits on behalf of the state informed her that Oregon would pay for a cheaper option. The state health plan would be happy to pay for Wagner to take advantage of Oregon’s legal doctor-assisted suicide, if she wished to hasten her death.

Dr. Walter Shaffer, medical director of the state Division of Medical Assistance Programs, defended the policy, telling the Eugene, Oregon Register-Guard that “[w]e can’t cover everything for everyone. Taxpayer dollars are limited for publicly funded programs.” Indeed.

As libertarians, we normally applaud government employees for trying to cut costs. But, when our government tries to herd us all into the same one-size-fits-all health care plan, I believe we should demand a bit more choice. Or, at the very least, options that provide just a bit of basic human dignity.