First, do no harm. Have we forgotten?

While cleaning out my garage yesterday, Dennis, who lives across the street, stopped by to drop off an extra jasmine plant he didn’t need. Since I moved in here over 20 years ago, his family and their revolving door of feisty little dogs, their renewing fleet of shiny new trucks and cars, including now a Model T, and their invitations to birthday parties and graduations have brought a strange calm to my existence. In my private mind, I think of Dennis as Wally Cleaver grown up. Everything about him says stability, except for his health.

Over the last fifteen years, Dennis has been a warrior, first battling two bouts of melanoma, then overcoming a dreaded intrusion of prostate cancer, and for at least seven years he’s been kicking back a persistent form of leukemia, likely triggered by RoundUp. I had just heard he was no longer in remission, so I asked him how he was doing.

“I’m feeling much better since starting the new drug—it’s the latest technology in fighting blood cancer,” he said proudly, gratefully. Then he leaned in and quietly added, “You know, it costs $16,000 a month.”

Mortified, I felt like my inner volcano just might erupt. Noting this, he said, “At least I have insurance, and they cover the whole thing—the whole enchilada.” Well, that was a relief to hear.

Although that brought me some peace, I felt angry and sad for all those who will never be able to afford such coverage or qualify for the cutting-edge, life-saving drug. What happens to them and their families? Do we shrug? Or say, who cares? Or say, oh well too bad for them? Or, there but for the grace of god go I? It’s no wonder more people are having trouble sleeping at night.

Earlier in the week, I read about an oncologist’s medical practice that pays over $350,000 a year on employees who spend all day battling with insurance companies over denials for patients’s prescribed procedures, tests, and medications. That’s all they do—argue. I wonder how well they sleep at night churning over the latest rejection and the related sick patient caught in the middle.

I learned that as a standard cost-cutting and delay tactic, insurance companies routinely deny each request right off the bat for one of countless bogus reasons. It’s up to the medical practice to fight the denials until the insurance company eventually relents. But often doctors in poor communities can’t afford to have someone doing that job. It’s up to the sick patient to fight his own battle.

There’s profit in delays and denials, and potentially a death sentence when it comes to cancer and other life-threatening diseases. As one doctor put it, for an insurer it’s cheaper to delay than pay.

So is anything being done to reel in the cost of drugs? Last week the Biden administration announced the first 10 of 50 medicare drugs to undergo cost reduction negotiations with the drug manufacturers over the next several years. The Drug Price Negotiation Program is part of the Inflation Reduction Act of 2022 (IRA), and the first group of drugs will reduce costs on treatments for diabetes, chronic heart failure, Crohn’s disease, and cancer. An overwhelming majority of Americans, both Republicans and Democrats, support the program, but it nevertheless faces legal challenges from Big Pharma. Big surprise.

There once was a widely accepted ethic in medicine: First, do no harm. But pharmaceutical companies are not required to take the Hippocratic Oath. Nor do they have any incentive to think outside the “make more profits” box. So anything goes, including the endless, frightening, potential side effects embedded in most of today’s latest drugs. Should they do better? Sure. But that would be less profitable.

Dennis is a very lucky man. He’s fortunate to have good insurance that covers him fully. Without it, he might not be with us today. The drugs have given him many precious extra years, and I expect will continue to do so. But for millions of less fortunate Americans, drug companies and insurers are knowingly doing harm by slamming their doors in their face, and that is an injustice no one should abide. I wish things were very different.

What then can we do? We can learn which of our legislators are focused on helping all Americans and which are sailing on yachts with babes, martinis, and profiteers. By learning who’s helping who, we can keep the good guys in office and boot the others to the curb. One quick way to learn who’s behind you and who’s not is to discover who supported the Inflation Reduction Act and who did not. Hint: All Democrats and Independents supported it, but not one Republican did.

If you’d like to learn more about the IRA that became law one year ago, check out this summary— https://www.mckinsey.com/industries/public-sector/our-insights/the-infla...