Pharma Companies

How One Problem Becomes Five Prescriptions

The pharmaceutical industry isn't built to cure you. It's built to keep you coming back.

When I was going through residency 40 years ago, physicians had a reference book called the Physician's Desk Reference. It listed virtually every drug available for clinical use. The book was about an inch thick.

That same reference today is closer to six inches.

Think about what that means. The growth isn't because we've cured more diseases. It's because we've built thousands more ways to manage conditions that — in most cases — are driven by the same underlying problem we've never seriously addressed.

Where the Research Money Goes

Right now, a significant portion of pharmaceutical R&D is being poured into diabetes. GLP-1 medications like Wegovy and Ozempic. New insulin formulations. New delivery mechanisms. The investment is enormous.

You might expect that to be encouraging. The nation has a diabetes problem, so science is working on it.

Here's the part worth sitting with: the nation has a diabetes problem largely because it has a weight problem. And almost nothing in that R&D spending is aimed at the weight problem itself. The research follows the revenue — and the revenue is in treating the chronic condition, not resolving it.

The Cascade Nobody Warns You About

Here's how the road actually looks for a lot of patients who come through my door.

Carrying extra weight long enough leads to insulin resistance. Insulin resistance becomes Type 2 diabetes. Now you're on diabetes medication. Every day, for the rest of your life.

The weight puts pressure on your joints. Specifically your knees. Over time, they give out. So you take anti-inflammatory medications to manage the pain. But those medications irritate your stomach lining. Burn a hole in it, actually, over enough time. So now you need a proton pump inhibitor — something to protect the stomach from the medicine you're taking to protect the knees.

Every day, for the rest of your life.

Then you're managing blood pressure that's been elevated for years. You're stiff. You're in pain. You're taking four or five medications with their own side effects and interactions. And you're depressed. Not because something is chemically wrong with your brain — but because you feel terrible, your body is failing, and the medical system keeps handing you another prescription instead of a way out.

So there's an antidepressant. Every day, for the rest of your life.

I'm not describing a rare outcome. I'm describing a path that millions of Americans are on right now.

Why There Are 4,000 Blood Pressure Drugs

There are somewhere between three and four thousand medications listed for the treatment of high blood pressure in the current reference guides.

I cannot think of a blood pressure situation I've encountered — in decades of practice — that I couldn't manage with five generic medications that together cost roughly $12 a year.

So why do thousands of formulations exist? Because you're going to be on them indefinitely. A lifetime customer is worth significantly more than a patient who gets better and stops buying.

The pharmaceutical industry didn't create this situation out of malice. It's just how the incentives are structured. Chronic disease is more profitable than prevention. Treatment is more profitable than a cure.

The Extreme Version of This

For anyone who thinks I'm overstating the profit motive: there was a man — Martin Shkreli — who acquired the rights to Daraprim, an anti-malarial drug, and raised the price from $13.50 a pill to $750. Overnight.

The drug costs approximately two cents to manufacture.

He was eventually convicted and fined $60 million. He went to jail. In my personal view, the fine and sentence were both inadequate for what he did.

But his behavior wasn't an aberration from how pharmaceutical companies operate. It was an unfiltered version of it. The difference between him and a major pharmaceutical company is mainly that he didn't bother with the subtle methods: evergreening patents to delay generics, reformulating drugs slightly to restart patent clocks, creating restricted distribution arrangements to block competition. The industry does all of these things within the law. Shkreli just did it without the cover.

The Part That Actually Helps You

Here's what I want you to know about generics, because I think most patients don't understand this.

Generic drugs are not inferior versions of name-brand medications. By federal law, a generic manufacturer must demonstrate that their product produces an equivalent response at an equivalent dose to the name brand. The original manufacturer is required to provide their medication to the generic manufacturer for this testing. It is not optional. The law mandates it.

Generics are the same drug. They cost a fraction of the price. And for most of the conditions I treat, they work exactly as well — because they are exactly the same.

Ask your doctor which of your medications has a generic equivalent. Ask what it costs. The answer will often surprise you.

The Alternative the System Doesn't Sell

There's a way off the cascade. It's not complicated, but it requires deciding that the cascade is not acceptable.

Lose the weight. Lower the blood pressure through the absence of the cause, not through a daily pill. Reverse the insulin resistance. Take the load off your knees before they give out. Stay off the anti-inflammatories, the stomach medications, the antidepressants.

I've seen patients come off four or five medications inside of six months by addressing the one thing that was driving all of them.

That's what this practice is built around. Not adding to the list — reducing it.

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