Thread by @ASlavitt

COVID provides a look at something Americans don’t often get to see: the influence of drug companies & money on things that don’t reflect the patient’s best interest.

Good chance you’ve heard of remdesivir.

It’s the expensive drug from Gillead that Trump just procured (he bought 500,000 units). Gilead has had a shortage & says their several thousand dollar price is humanitarian.

Remdesivir has shown it reduces time in the hospital but didn’t show a clear reduction in the deaths. At least yet.

It costs $4300 for governments & $5700 for private insurers.

Fewer people have heard about 2 other things: one called dexamethasone and the other called proning.

Dexy has shown it REDUCES deaths by 1/3. Dexy doesn’t attack the virus; it dampens the immune system reaction.

Proning (pitting a patient on their stomach) significantly REDUCES the need for a ventilator in most patient. Vents can create complications & more importantly don’t always work.

These treatments— one new & expensive, 2 very low tech— work in different ways & different circumstances. They are not substitutes in all cases.

But as often happens, the low tech often wins.

As a low tech aside, low cost masks will likely save more lives around the globe than anything.

Despite these differences, patients & families are insisting their loved ones be prescribed Rem and typically haven’t heard much about the other 2, which so far have proven much more important.

Why have you heard the buzz about the more expensive & so far clearly inferior drug?

Because steroids are cheap & proning is free.

No one markets the better stuff.

The raw materials for Rem are very low cost and India already has approved generics selling for much less.

So the several thousand dollar price is meant to pay for other costs like R&D. But there’s also marketing.

What of that R&D cost? Gilead didn’t pay that R&D cost alone. Who else did? You did.

Tens of millions of taxpayer dollars including the help of 3 federal agencies. Without us, there would likely be no Rem (which had been a castaway anti-viral).

There are more cool tricks. Pharma pays a sliding scale fee to the doctors or administer them. Paying MORE the higher the price of the drug.

Docs will do the best thing for the patient. But these legal kickbacks go along with a lot of education & marketing.

And how much marketing do you need when the government buys a large amount in bulk.

And as you may see in the tweet responses, drug companies often hire social media people to hype their products or defend against stories they don’t like.

And even though Dexy is a better drug, manufactured primarily in India, there really is no big force to go out & market a low cost steroid. To build hype. To go on CNBC. To get media coverage. And patients hear it less. And demand it less.

And no one makes money off of proning. Still the media should be talking about it.

(Although I swear a patent has been filed. Check it out. Yes putting a patient on their stomach has a patent pending. Maybe more than one.)

Drug companies who read this will rightfully say “So? This is how it always works. What’s the big deal?”

They’re right. This is exactly how it works. All the time.

We get more expensive drugs. Drugs we subsidize. Drugs we can’t negotiate for. And newer more expensive drugs & treatments have big advantages even when they don’t work as well.

Lawmakers who get a lot of support for big pharma have been afraid to touch this system. Trump who crusaded against high drug prices hasn’t backed up his words. We in the Obama Administration tried but failed to change this as well facing an onslaught of opposition from Congress.

The public will need to remember these lessons we are being exposed to.

PS. Clinicians or patients with different views or experiences with these drugs or treatments should absolutely list them here. It’s early & we are still learning.