The villain of the piece may change from year to year or even month to month -– it may be a cancer drug that costs more than $120,000 a year, or Turing’s Daraprim, or Mylan MV’s EpiPen -– but drug companies have been excoriated in the media with increasing frequency these days. The Fall 2016 issue of Penn Medicine, which comes out in early November, considers the topic of drug costs from several angles. The cover article looks at the impact of those costs on both patients and health care institutions. At Penn Medicine, nurses, physicians, pharmacists, and financial counselors are working behind the scenes to ensure that patients can afford the spiraling costs of their lifesaving drugs. Last year, bankruptcies from unpaid medical bills were estimated to affect two million Americans. Those bills continue to be the most common reason people file for bankruptcy in this country. As Richard Demers, MS, RPh, director of Pharmacy Services at the Hospital of the University of Pennsylvania, put it, “We all need to take step back and work together to figure this out, so the person who is sick doesn’t have to go through these gyrations to get something that could save their lives.”
The article also describes another approach to lowering costs. A study by the recently established Penn Medicine Nudge Unit -– which focuses on testing ways in which “nudges” can be used to optimize medical decisions and improve the value of care delivered to patients –- sought to encourage physicians to prescribe more generic drugs instead of brand-name medications. In the study, when a physician prescribed a drug for a patient, the electronic medical record would default to an equivalent generic, if available. When warranted, the physician could still prescribe the brand name by selecting the “dispense as written” checkbox. In the long run, this seemingly small change could significantly cut costs for both patients and the health system.
In another piece, Ezekiel J. Emanuel, MSC, MD, PhD, the chair of the Perelman School of Medicine’s department of Medical Ethics and Health Policy, places the matter of high and rising drug costs within the larger context of high health care costs. Acknowledging the public outrage, he notes that “even drugs where there’s been no further research on them or changes of any kind, they are steadily raising the rates of those drugs.” Emanuel has described the drug market as a monopoly, but he also believes that there should be incentives in health care to save money -– and that doctors and the health care providers should be leading the way in the effort to cut costs.
Another article in the Fall issue takes a somewhat broader look at the high cost of health care. Richard “Buz” Cooper, MD, had two different stints at Penn: as a chief of Hematology and the first director of what is now the Abramson Cancer Center and, more recently, as a senior fellow in the Leonard Davis Institute of Health Economics. He delivered his manuscript to the Johns Hopkins University Press before he died in January. In Poverty and the Myths of Health Care Reform, Cooper contends that the leading cause of the nation’s high health care costs is not physician-induced demand, waste, and fraud, as many influential organizations assert. Instead, as shown in the excerpt in Penn Medicine, he argues that the cause is poverty. In its simplest terms, low-income people are sicker and sick people require more care.
Discoveries and Innovations
J. C. Lopez (left) and Alex Sotolongo
Another theme in the forthcoming issue is the role of invention and innovation within Penn Medicine. Inventing a device that could improve efficiency in a commonly performed surgery would be a mark of achievement for anyone -– but the achievement seems even more impressive if the inventors are 4th-year medical students in the Perelman School. J. C. Lopez and Alex Sotolongo, the two innovators, have had to learn as they go, becoming entrepreneurs as well. Penn’s innovation infrastructure, including the Penn Center for Innovation, and professional connections that come with such a globally plugged-in institution have helped them move their invention along.
The other innovators in this issue, Michael S. Brown, MD ’66, and Stanley B. Prusiner, MD ’68, are two alumni who have received the very highest levels of academic accolades. Both have won the Nobel Prize in Physiology or Medicine. This spring, they came to campus for different events to speak about their early years and to encourage future physician-scientists. Brown related how, during his fellowship at the National Institutes of Health, he and his research partner Joseph Goldstein were saddened that they were unable to help two siblings with very elevated cholesterol levels. When cholesterol accumulates in the wall of arteries, it can cause atherosclerosis and eventually a heart attack. But far from being discouraged, Brown and Goldstein went on to discover the low-density lipoprotein receptor, which controls cholesterol in blood and in cells. The work of Brown and Goldstein laid the groundwork for the development of statins, the cholesterol-busting drugs now taken by more than 25 million Americans, often when diet and exercise efforts fail to yield results.
Prusiner discovered “prions,” pathogens implicated in neurodegeneration, such as mad cow disease and, in humans, Creutzfeldt-Jakob disease. But he also had to withstand years of doubt and even ridicule before his work was accepted. Perhaps it was an instance of innovation before the world was ready for it. As a speaker at the department of Medicine’s “Celebration of Research,” Prusiner argued that there was “mounting evidence” that prions also cause most, if not all, neurodegenerative diseases, including Alzheimer’s disease.
We also profile a faculty member here on campus, Yvonne Paterson, PhD, a longtime professor of Microbiology. She recognized how a common bacterium could be developed into an immunotherapy to combat cancer. In April, the U.S. Food and Drug Administration gave Paterson’s vaccine to treat osteosarcoma the “fast-track” designation, which is designed to expedite the development and testing of new therapies that treat life-threatening conditions. The article also describes her as “a citizen of the University,” and Paterson certainly has fulfilled that role over her nearly three decades at Penn. She has been a teacher, a scientist, an administrator, and a mentor. In addition to her appointment in the medical school’s department of Microbiology, she has served as the school’s associate dean for Postdoctoral Research Training and as associate dean for Research at the School of Nursing. In her current research, she is collaborating with faculty members at the School of Veterinary Medicine. Paterson’s portfolio, in other words, is capacious.