We dive into the pharmaceutical industry, so buckle up!

As a side note, we reference Karendia (finerinone) as an expensive drug (around $800 a month list price) with minimal benefits. It provides 3-4% reduction in people having decreases in their GFR (a measure of kidney function) over 4 years, but no benefits in death, kidney failure, hospitalizations, heart attacks, strokes or any of the other things they measured. This is one of the medications that is being pushed on everyone with kidney disease but really is far too expensive to make sense with that little benefit. It would cost over $1,000,000 over 4 years for 1 person in 30 to not have a 40% reduction in the GFR with no other appreciable benefits. Here's the trial - https://www.nejm.org/doi/full/10.1056/NEJMoa2025845

References:

https://repository.si.edu/bitstream/handle/10088/97768/Daemmrich%20PharmaMfg%20PharmHist%202017.pdf?sequence=1 - history of pharmaceutical manufacturing

https://pharmaphorum.com/r-d/a_history_of_the_pharmaceutical_industry - more history

https://jamanetwork.com/journals/jama-health-forum/fullarticle/2811344 - PBMs

https://www.help.senate.gov/imo/media/doc/big_pharmas_business_model_report.pdf - profits in Pharma

https://www.fda.gov/drugs/special-features/manufacturers-mouth-your-ears-direct-consumer-advertising - DTC advertising

https://www.propublica.org/article/doctors-prescribe-more-of-a-drug-if-they-receive-money-from-a-pharma-company-tied-to-it - Doctors’ prescribing patterns

https://lowninstitute.org/more-than-half-of-doctors-receive-industry-payments-with-some-making-millions/ - industry payments

https://jamanetwork.com/journals/jama-health-forum/fullarticle/2804378 - drug research money source

https://www.raps.org/news-and-articles/news-articles/2019/4/how-biopharma-companies-use-nih-and-vice-versa - NIH royalties

https://www.gao.gov/prescription-drug-spending - Govt prescription spending

https://oig.hhs.gov/reports-and-publications/featured-topics/drug-spending/ - Govt drug spending

https://www.aafp.org/pubs/afp/afp-community-blog/entry/will-the-high-price-of-gene-therapy-for-sickle-cell-disease-put-this-cure-out-of-reach.html#:~:text=The%20approval%20of%20Casgevy%2C%20which,distributional%20cost%2Deffectiveness%20analysis%20standards. - sickle cell example

https://www.fiercepharma.com/pharma/top-20-pharma-companies-2023-revenue - Pharma Revenue

https://www.npr.org/2024/04/12/1244509038/u-s-drug-makers-see-big-profits-but-many-pay-taxes-far-below-the-corporate-rate - drug company taxes

https://www.gao.gov/products/gao-18-40 - drug company profit margins

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2690298/ - History of drug advertising

https://www.pharmacytimes.com/view/are-pbms-downplaying-their-profits - PBM profits

https://www.nbcnews.com/health/health-news/gaming-us-patent-system-keeping-drug-prices-sky-high-report-says-rcna47507 - “Evergreening” and patent thickets