How drug companies make you buy more medicine than you need

How drug companies make you buy more medicine than you need

If you’ve ever tried to use eye drops…you
know it’s hard to do without some of it rolling down your cheek. I used to think that was because I missed. But turns out, I’m not actually so bad at
this. Well, most of the time anyway. Eye drops run down our faces because the typical
drop is larger than what the human eye can physically contain. Some are more than twice what the eye can
hold. That means using a single eye drop is like
pouring water into a glass that’s already full. Or like in those Clear Eyes commercials… It’s incredibly wasteful to make over-sized
drops. They cost a lot of money. The waste from each one is like a tiny snowflake. It’s easy to overlook, until they’ve piled
up into a billion dollar snowball. It’s wasted medicine, and all of us are paying
for it. The eye drops industry is huge. They’re sold by volume, and some can cost
hundreds of dollars for a small bottle that only lasts a month. The financial cost is a particular problem
for the millions of patients with chronic conditions that require expensive drops every
day. Last year US drug companies brought in about
$3.4 billion for dry eyes and glaucoma drops alone. Eye drops are far too big for our eyes. That’s Dr. Alan Robin, an ophthalmologist
and glaucoma expert who teaches at Johns Hopkins Medicine. It’s very wasteful. We see that patients are basically spending
twice as much money as they need to on drops. Everyone’s body is different, but experts
say almost every eye drop on the market is larger than the eye can hold. So the excess just washes out, and we end
up paying for a lot more medication than we can use. Wasted eye drops are part of a much bigger
problem. Experts estimate the U.S. health care system
wastes $765 billion a year. That’s about a quarter of our overall spending. And it’s actually more than the entire budget
of the Department of Defense. ProPublica has been investigating the kind
of wasted health care spending that exists right in front of our eyes. Literally. Cancer drugs are also a big ticket waste item. They can cost thousands of dollars per infusion
but are frequently wasted just because of the way they’re packaged. Most cancer drugs are infused based on body
size, so patients need different amounts. But most of them come in single-use vials
that can be much too large for an individual patient. So once a patient gets the needed dose, the
rest of the expensive drug in the vial is thrown out. Drug prices driving patients and their families
into bankruptcy. And on top of patients paying for expensive
cancer drugs to help them, they’re also paying for in some cases a lot of extra cancer drug
that’s just going in the trash. That’s Dr. Peter Bach, the director of the
Center for Health Policy and Outcomes at Memorial Sloan Kettering Cancer Center in New York. Waste hurts people because it costs money. If you waste half of a vial that costs $5,000,
somebody is paying that money, $2500 back to the drug company. And the drug company benefits, because they
count that as revenue or profit. Take the case of Herceptin, a popular, and
pricey drug that’s mostly used to treat breast cancer. The drug company used to make vials that patients
could share, so little of the drug would be wasted. But then it announced in May that the shareable
vials would be replaced by single-use vials. And the switch would mean throwing away any
medication left over from an infusion, and billing the patient for the waste. Genentech, the company that makes Herceptin,
told me that they had to make the change for supply chain reasons, to go to a size that’s
more common worldwide. Every milligram of Herceptin costs about $9,
so a cancer patient’s monthly infusion can run more than $3,000. One administrator at a California cancer treatment
center calculated her average patient would waste 110 milligrams per infusion with the
single-use vials. That’s an average of almost $1,000 of wasted
spending per infusion. The waste associated with over-sized cancer
drug vials is substantial. A study led by Dr. Bach in 2016 calculated
the waste associated with the top 20 cancer drugs packaged in single-use vials. It estimated that 10 percent of the medication
gets wasted, costing $1.8 billion in a single year. But here’s the thing: this is a waste problem
that’s fixable. For cancer drugs, manufacturing shareable
vials, or vials in varying sizes, are proven ways to reduce waste. For eye drops, why not just make the drops
smaller? Dr. Robin knows it can be done – because he
and a team of experts already did it in a study about 20 years ago. He consulted with global eye care leader,
Alcon, when its researchers developed what they called a microdrop for patients with
glaucoma. It was a 16 microliter drop — one that was
half to a third of the size of most drops on the market today. Then they studied the performance of the microdrop
compared to regular size drops. There was no significant difference between
the smaller and larger eye drops. Not only were the microdrops just as effective,
they also reduced some the uncomfortable side effects. And all the participants actually preferred
the microdrop bottle. But instead of being a breakthrough, the innovation became a case study in how profits can come before patients. I tried personally to get the microdrop accepted. And they looked at me as though I was a pariah. The pharmaceutical company would be losing
half the money that they could be making. Officials from Novartis, the drug company
that now owns Alcon, declined to discuss their microdrop study. They said eye drops are designed with a “margin
of safety” to help patients, but they wouldn’t go into specifics. You’d think that regulators would care about
all this wasted medicine. But the FDA regulates the safety and effectiveness
of a drug…not its price or the cost related to waste. Patients paying billions of dollars for wasted
medicine…is just one more reason America has the highest health care costs in the world. Hi guys, I’m Ranjani. A video fellow working at Vox and ProPublica. And this video is part of a new collaboration
between our newsrooms. For the full story at ProPublica, check out
the link down below and stay tuned for more stories coming this year.


100 thoughts on “How drug companies make you buy more medicine than you need”

  • Lmao Americans.
    But but but our freedom but but but our economy… blah blah so many amazing countries with much better governments are out there America open your eyes for once.

  • Kathryn Harris says:

    Yup—IV medications indeed come in vials that are a higher dose than what is typically given. Then, most hospitals don’t allow reuse (even on the same patient) because of contamination risk. Therefore, what’s left in the vial (which could still be half to three quarters full) is wasted. And yes; the cost is passed on to the patient. Even during the multi-drug shortage due to Hurricane Maria hitting Puerto Rico (the only place in the whole world that certain meds and supplies are manufactured); when doses were being rationed, there was no effort; in my hospital anyway, to address the fact that more than half of the dwindling supply of critical medications were being thrown away…not helping anyone. Bacteriostatic vials, authorizing reuse for the same patient, and a process for documenting and the tracking and storing opioid medications (a BIG one for throwaways) in particular could make an enormous difference in such a scenario. Many vials are bacteriostatic now, but the medications still get wasted.

    Even without drug shortages, the millions we waste in our healthcare system is expensive and untenable. Addressing the impact of waste on the cost of care is critical, because if we could reduce that cost, then the millions of dollars saved could be used to treat people who right now are falling through the cracks. A public coverage option could facilitate the incentivization of reducing waste, as well as pressuring drug companies to do their part in reducing medication waste.

    My eyes were really opened to the wastefulness in our system when I travelled to the Dominican Republic and ended up being hospitalized for two days. For example, in the ER I was given an ECG. Instead of using disposable electrodes, they used these entirely reusable (after cleaning) suction cup and limb clamp electrodes. They also didn’t use individual prepackaged alcohol swabs—just cotton and a rubbing alcohol dispenser. They didn’t even use those prepackaged IV flushes most of the time. They would simple clamp the IV line of the saline drip attached to the patient, allow it to back up a little, and then release it…tada! Same difference; no trash. There were constant examples of common sense approaches that were far less costly.

    Just because we have the money to spend (and I’d argue that we don’t; so long as people are going without even basic care here), doesn’t mean that we should do so. None of the things they did; like the examples above, changed the quality of care one iota. But it DID mean that there were more resources available to help the next patient to walk into those hospital doors.

    Another example of wastefulness here in the US are the countless tests and monitoring that are done; not because they have any great clinical justification, but are done to just CYA. They are done because hospitals don’t want to get sued, on the one in a million chance that they miss something. Protocols get put in place; not because it is likely to change outcomes for patients, but because doctors are risk averse. There is nothing wrong with being thorough, but there needs to be a fine line drawn.

    There are two forces at work here. First of course is fear of malpractice suits and the need for tort reform. The second is an inconvenient truth in a for-profit system, which is that doctors and hospitals are incentivized to do more because they make a lot of money doing so. Yes, insurance companies can and do reject claims deemed unnecessary, but most of these things are not black and white. They fall under the heading of judgement call. The hospital or doctor does these things knowing they will likely get paid to do so. It isn’t an insurance issue, but an overkill mentality from the ground up. Such a system also doesn’t prioritize preventive care. That is not where the big money is. In single payer systems (and hybrids), keeping costs down is baked in, and the superior overall outcomes in just about every measure speak for themselves.

    Here’s another quick example to illustrate this problem. Continuous telemetry ECG monitoring is a great tool that allows clinicians to monitor patients in real time for cardiac events in the hospital (and sometimes even at home). It’s wonderful for patients experiencing cardiac symptoms because it means that they can be seen as they happen and are addressed immediately. However, this tool is shown in studies to be FAR overused now in US hospitals, with almost no real benefit. Patients are put in telemetry while in the hospital simply as a matter of course; even when they have no history of heart problems and are admitted for completely unrelated issues. This is astronomically expensive; both in terms of the actual cost of monitoring (people are hired to do nothing more than stare at those screens 24/7), but also due to over-testing and treatment when something is found. The reality is that; if we slapped telemetry on the entire US population for 24 hours, a lot of perfectly healthy people would end up alarmed because some fleeting abnormality would be identified. This would lead to a lot of further testing; and at the end of the day, the majority of those people would be given a clean bill of health (this is the concern with new devices like an Apple Watch that is equipped with mini-telemetry—a marvelous thing if you have a heart condition, but likely to induce unnecessary anxiety and unneeded testing in the average person). The heart can be affected by any number of things, such as exercise, caffeine, or even a mild sleeping pill. We have all felt a little flutter in our chest at one time or another. If it doesn’t persist, we don’t think much of it. Even people who do have more persistent flutters and who go to the doctor for it usually won’t require much in the way of treatment (BTW, that isn’t always the case, so if you are concerned, you ABSOLUTELY should get checked out. You know what is normal for you, and you should absolutely follow your gut if you think something might not be right). Healthy hearts skip beats once in awhile; and it is usually clinically benign. When someone is sick from an infection or something, these things can happen even more often. Telemetry will pick these things up. If it does, it will lead to a big diagnostic workup; and even among hospitalized patients it’s usually nothing.

    Aside from the risk of overtesting; which is often not considered, are the risks associated with telemetry itself. To quote from the article linked below:

    "The wires get tangled all the time, people trip over them, and in elderly patients their center of balance is disturbed by the box, [onto] which they roll over in their sleep and endure a big metal thing crushing their chest," says Andrew Doorey, MD, a cardiologist at Christiana Care Health System, in Newark, DE.”

    There is significant risk of liability due to patient falls. I have personally fallen due to telemetry monitoring before. The leads of the telemetry also cause significant skin irritation for many patients. This is a huge issue for me. I have scars on my chest from being on telemetry. I’ve had two full cardiac workups; including at the Cleveland Clinic (top in the US for cardiac care). Both were completely clear, and yet I’m told that I require telemetry because of “protocol.” I have left the hospital multiple times with my chest bleeding as a result. This presents an infection risk to patients who already may be (like myself) immunocompromised. It is unconscionable, unnecessary, and extremely expensive, which the article also addresses:

    “The one-year cost of avoidable complications and potential injuries due to telemetry overuse in the 1,100-bed hospital system were estimated by researchers to be $4.8 million.”

    $4.8 million annually for every 1100 hospital beds across the country is mind-boggling. No wonder we pay so much for healthcare! Contrary to the thinking of many doctors, things like this (telemetry is just one example among many—don’t even get me started on the cost of having a baby and the risks of how we do birth in our system) don’t decrease liability. It doesn’t lead to better outcomes. It actually INCREASES liability and leads to consistently WORSE outcomes. It is mind-blowing in its wasteful expense, and serves as a barrier to care for millions of people because we are spending money on the exact wrong things. Our system needs a complete paradigm shift that only begins with how we pay for it.

  • If its bigger than your eye one drop should cover the whole eye so you dont have to keep squirting it out and risking a reaction.. right?

  • So shouldn’t there be something for medicine specifically like the better business bureau? Something that regulates this so that much medicine isn’t being wasted ? ?

  • This is why you need government regulation and government to step into stupid profit-making tactics like this. This is where the US falls far behind compared to other developed Nations where government isn't played like puppets by these large corporations.

  • Just avoid getting sick at all costs. Spend your money on organic foods and wholistic treatments. Remove potential toxins from your life as best you can and anything that is linked to cancer – makeup, microwaves, antiperspirants, nail polish, air fresheners, household cleaners, teflon, perfumes, pesticides, processed meats, etc. You can't be too cautious. Big Pharma and the FDA are not in business to help you. You have to help yourself.

  • You can't calculate waste that way. The actual cost of the content is never 100% of the price. Its usually more like 30% most of the price is to cover years of R&D + shipping advertising etc + profit. If you reduce the size of any product by 50% you'd usually save 10-25% of its value. So there is a waste there but its not as significant as this video claims. Thats why when drugs loose the patent the new generic drug that is produced with out the need in the RD is usually 25-30% of the price of original drug. The price has little to do with the actual content.

  • truly speaking, us drug companies can be evil because government let it, why government let it because they afraid if they too tough with them,they will stop innovation that needed by US citizen. so if that the case, so US people, what is your idea of solution ? let the government know to make change.

  • Anyone who thinks healthcare should be private is actually evil, can you imagine thinking that cancer patients should have to pay for medicine that gets thrown away. Capitalism needs to be stopped.

  • Another Startup idea: a company that allows patients who order cancer meds and have left over meds to sale (at a greatly reduced rate) their meds to other patients seeking the same meds. It would be an amazon type company: gets the remaining drug from the patients doctor store it and ship it to the other patients doctor for use. Kind of a medicine share club. Medshare! Sounds great to me but I’m sure some greedy fuc$ing billionaire would create the company and charge excess fees to use it. 😢😢

  • Ashley Blackwater says:

    Is this as big a problem in countries with socialised medicine? The NHS here in the UK is always trying to cut corners, so i can't see them standing by and letting this kind of waste eat into their budget?

  • Drink more water and eat better. May not fix everyone but I can fix people that have dry eyes from malnutrition. And that’s a lot more than we even know.

  • Marie Katherine says:

    Get a syringe. Put in the right amount for you. I NEVER buy eye drops otc. There's lots of diy natural solutions you can make yourself.

  • I never understand the medical industry/field. I've always known it to be wasteful but you cant really do anything about it cause you need to treatment or medicine. I dont see how people can claim they love helping people be healthy but then charge so much money to help them. Medical field us a big scam

  • As a Brit, the US is so mad! From what I hear, the US is the most third-world first-world country I've ever seen. I don't care if the US has the highest GDP or largest military; I think countries should put less effort into trying to be an empire and just make the citizens of your country be healthier, feel better and live comfortable.

    I'm sot saying the UK is perfect, but we have:
    – Universal free healthcare
    – No gun(s) allowed
    – No gerrymandering
    – No (biased) supreme court

  • Well the only way to solve the problem of eye drops is to pour it side ways in the corner of the eye. I always do that. Never goes waste. Basically when you do that it will eventually spread in the eyes. Since it's a liquid

  • Arved Ludwig says:

    Here in Germany I can buy eyedrops that come in a dispenser. Press the dispenser together and a small drop will be released. The drop is not oversized because I've never had a tear running down after using it.

  • I knew an elderly lady that had an issue producing tears so she wore swimming goggles all of the time and would purchase these enormous bottles of artificial tear solution

  • Watching these kind of videos makes me so more grateful that i live in a country where health care is as good as free 🙂

  • Mikkel Aaholm Bennetsen 2j says:

    C'mon America. Get it together, i'll bet that u are the only country thats having these issues. why? because y'all taxes is too low too support a free healthcare system. plz look at france, danmark etc. everybody should be intitled to free and effektive healthcare :-/

  • Debbie Nandalall says:

    765billion guys that's how much they are wasting. So much food that could have bought for persons in Africa. (EDITED) WELL NOT JUST AFRICA BUT MANY OTHER COUNTRY

  • Backinblack Bunny says:

    The problem with videos like this is that they get me SO ANGRY and bc I know I'm going to be infuriated for the rest of the day after I watch them, I end up never watching them. I used to catch myself screaming at my kids even hours afterwards for the slightest provocation. I wished I could be informed and not be going grey from the knowledge rage.

  • Peter Sorensen says:

    Wrong! eyedrops only run down if you use them incorrectly. But if only part of the drop goes in the drop will still work. THAT IS A FACT!

  • Rick Steegers says:

    buy your eyedrops then transfer them into a different container that makes drops of the right size? problem solved

  • it's like buying vegetables that are packaged in large sizes, if you can't eat them they will just go to waste

  • What about some of the bogus expiry dates on many medicines. People just throw a lot of them out because the label says they're not good anymore. But many medicine last like 5 to 6 years

  • Sarah Jackson says:

    Well then. Why don’t people just get their own smaller eye dropper thingy and save money because honestly the people selling the stuff aren’t going to change

  • Casper de With says:

    2:18 Makes me think of some video made by someone, about diagrams that are not to scale.
    Whom was it made by..?


  • I’m pretty handy with an eye dropper. I can typically get about a half a drop into my eye, and have little to no runoff by applying it to the inside corner and letting it release by touching the drop near the tear duct rather than dropping a whole drop from a distance. Seems to work alright.

  • Its the same thing done with toothpaste… If the hole is bigger, you put more on your toothbrush…and they sell more.

  • Jacque Johnson says:

    I’m gonna empty my eye drop bottle into a small glass bottle with a smaller dropper, and adopt this method where else necessary.

  • Guanqiao Wang says:

    Funny that I am just doing 4 kinds of eye drops for the 4th time today, after getting LASIK surgery. Every time there's wasted drops running down my cheeks.

  • DoctorChained says:

    This video makes the mistake of forgetting R&D is a huge factor into drug costs. Throwing away half the drug isn't so bad if it's cheap to make. I'm not saying it is, but without knowing R&D and drug manufacturing cost, we won't know how expensive throwing away half a vial really is.

  • The eye drops is a good example because you reuse the bottle. But the cancer treatment is a terrible one. The cost of the product does not come from its volume, almost all medicines are really cheap to produce. So half a bottle wasted is not equal to 2500€ wasted. It's 5000€ for a treatment, I guess it would not change much with different volumes.

  • I have a testosterone deficiency, so I have to give myself an injection once a week. The prescription comes in 1ml bottles and it is literally impossible to get more than about 80% of the liquid in the bottle into the syringe (even the nurses in the doctor's office conceded as much). The doctor has a 50ml bottle. I asked if I could just have one of those every few months instead of getting a half dozen impractical micro bottles per month – you don't have to guess what the response was.

  • Victoria Chuzhina says:

    and all this is happening because healthcare is seen as a business here rather than a basic human right

  • Hey they "forgot" to mention death rate of the suckers/patients and the $$$ the cancer doctors make. How many months do they Have? Humm

  • Keyboard Warrior says:

    i mean it takes 7 years minimum of testing and manufacturing before u even have a chance to be approved by the FDA millions and millions of dollars for research so think about that

  • Can't believe they're complaining about the size eye drops. Maybe because the size is larger than needed to make sure you get some in your eye. Alot of people aren't comfortable dropping something into their eye. Even if they made the drops smaller, I'm sure the cost would remain the same! You're not just paying for the physical product, but the research, testing, patents, employees, etc.

  • Squanchmaster Squanch says:

    U guys r doing it wrong. Not once have i missed a single eye drop ever since my doctor showed me the correct way back in 2012

  • Federico Olivares says:

    With vials there's a conondrum.
    Lets say you need 3ml. But only 5ml vials are available.
    So you waste 3ml.
    What if only 4 ml vials were availble? Then you waste 2ml too.
    What if they came in 3ml vials? Awesome, you dont waste!
    But when if you needes 4ml and vials held 3?
    Same stuff.
    Doesnt matter what size the packaging is, you will ALWAYS waste

  • heck the FDA should work with the EPA to look into wasteful packaging and procedures its not about lowering cost its about saving the environment from behaviors from the throwaway economy

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