Inchoate

I am the master of the inchoate thought.  Today at an otherwise routine staff meeting in our clinic,  someone mentioned the need for a closet in which to store coupons left by drug salesmen  for the unconscionably overpriced drugs they push. 


I hadn't thought this out, but something about our taking the little coupons from those pretty, smiling,  drug reps and handing them out, smiling, to our patients felt, on some gut level really obscene. 


Something just boiled over in me, and, sitting next to one of my favorite colleagues, who is a wonderful doctor but a deeply conservative Republican, I could not restrain myself, although a better angel kept dancing around my shoulders whispering, "Shut up." Couldn't do it. Couldn't restrain myself. 


And I blurted out, "I don't think we should have any closet for any coupons. I think we should not be in the business of playing shill for the drug companies. We should not be handing out coupons for the drug companies in our clinic."


Cries arose around the room, "But it's for the patients."  And, "I have a little old lady who needs them." And another of my colleagues, a woman,  said, "We are going to write for Androgel anyway, and the rep leaves the coupons, so why not make it easier on the patient who needs to fill that prescription?"


My favorite colleague said, "Well, I'm going to hand out those coupons and I'm glad to do it."


And all I could say, not having thought out my position in sufficient detail,  was it felt wrong: We are participating in a deception. 


Drugs in this country are shamefully overpriced and the company, having charged ten times what it ought to, comes by and plays the hero by offering a few coupons to reduce the price for some lucky few patients who are our patients. So we seduce the patient to pay our fees and come to our office by handing out coupons to reduce the price of an overpriced drug and we become complicit in the drug company's crime. 


Whenever I'm looking through the window at the drug rep in the waiting room, that well scrubbed, perfectly groomed saleswoman, who offers me coupons, I say in a loud and clear voice, so everyone in the waiting room can hear, "No. I do not want your coupons. I want you to go back to your bosses and tell them we do not want coupons. We want your company to lower the price on this drug for everyone . We want you to charge a reasonable price, which you are currently not doing. Don't play all magnanimous with a handful of coupons."


European drug companies spend more on Research and Development than American drug companies and yet they sell their drugs for about 60% of what American drug companies charge for the same drugs.


A drug with costs the company 50 cents to produce is sold for $10 a pill, and the company claims that's to cover the cost of "Research and Development." Somehow, European drug companies seem to do more R&D without over burdening their customers with outlandish prices at the pharmacy.


Drug companies lobby Congress for complete protection from foreign competition, from Indian companies which can make bio identical drugs for a quarter of the price our companies charge,  under the guise of "intellectual property rights."  American government agencies, like the National Institutes of Health develop and supervise testing of drugs for which American companies then claim patents. Congress passes laws to outlaw Canadian pharmacies from selling the same high quality but lower cost drugs to American consumers. American pharmacies, like Express Scripts require doctors to choose a brand like Humulin insulin and refuse to fill prescriptions unless a brand is specified. 


One filthy hand grasps another. Vulture capitalism has become predator capitalism. 


The oil companies don't hold a candle to the drug companies when it comes to raping the system.


And we participate, in our small way, in the office, by saying, "Oh, what's wrong with that?"


What was that great line from Apocalypse Now? We cut them in half with  machine gun fire, and then we throw a Band Aide at them and feel all virtuous.


I felt today the way I used to feel in suburban Maryland in the fifties when everyone around me, all those nice people, were saying, "But those Negroes don't want to go to school with white kids. They are more comfortable with their own kind." Everyone was so earnest and well meaning and part of the problem of simply not wanting to see the evil, and convinced the system is benign and good for everyone, so what is the basis for the protest?