A Friendly, But [Slightly Less] Terse Reply — To Matt Herper, At Forbes [U]

Matt (writing for Forbes) has a good recap of the ENHANCE debacle up for review, this morning.

I generally agree with him — but perhaps he goes too easy on Mr. Hassan, in particular. Even so, he is right — when he writes this:

. . . . It’s a tiny benefit: with ezetimibe, 33 patients out of 100 would have a heart attack or stroke; without, there would be 35, a difference of one heart attack and one stroke for every hundred patients over the course of seven years. . . .

So. . . my reply: why did we all (insurers, patients, and the government) pay billions of extra dollars, to switch away, from statins alone? For two fewer strokes/MCIs over 700 per patient years? Really? That’s worth. . . perhaps tens of billions, over six years?

More generally, Matt’s narrative line is spot-on, and nuanced: we should not be too quick to demonize all of pharma for the mis-deeds of a few CEOs (think Fred Hassan here). And he’s right, the drugs themselves just either work — or they don’t. But when the marketeers squeeze billions out of a finite health care budget, for tiny incremental benefits, that leaves (by definition) less available money for a true breakthrough, like Solvaldi, on Hep C. In sum, it consumes a finite resource — for very scant incremental real world benefits.

[I’ll be back with more, tonight — massage time!]


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