為什么美國藥品價(jià)格越來越高?（一）

Rick VonderBrink
Why does the US let drug makers set their own drug prices? Does this lead to higher drug prices here in the US?
We let drug makers set their own prices because this is a free market economy.
Tonight you will be hungry. There are three restaurants close to your house: Morton’s of Chicago steakhouse, Outback Steakhouse, and McDonald’s.
At Morton’s you will get a prime cut of meat, aged for 30 days, cooked to order by a highly trained cook, paired with a fine wine, and served with delicious side dishes by highly attentive wait staff. You will also pay over $100 for your meal.
At Outback, you will get a distinctly lower quality cut of meat, aged since this morning, served with Coors Light . You will pay around $30.
At McDonald’s, you will get the world’s most generic hamburger, fries, and a Coke, served by a teenager who’d rather be checking his phone than listening to you. You will pay $5, maybe less if you order from the value menu.
Not that in each case, when you walk away, you will not be hungry and your body will have obtained nourishment. But the experience was vastly better when you spent more.

為什么美國讓制藥商自行制定藥品價(jià)格？這會(huì)導(dǎo)致美國藥品價(jià)格上漲嗎？
我們讓制藥商自行定價(jià)，因?yàn)檫@是自由市場(chǎng)經(jīng)濟(jì)。
今晚你會(huì)餓的。你家附近有三家餐廳：芝加哥莫頓牛排館、澳洲鄉(xiāng)村牛排館和麥當(dāng)勞。
在芝加哥莫頓牛排店，你會(huì)得到一塊上等的肉，陳化30天，由訓(xùn)練有素的廚師烹制，配以美酒，并由細(xì)心的服務(wù)員提供美味的配菜。你還將支付超過100美元的餐費(fèi)。
在澳洲鄉(xiāng)村牛排館，你會(huì)得到一塊質(zhì)量明顯較低的肉，從今天早上開始陳化，配上銀子彈啤酒。你將支付大約30美元。
在麥當(dāng)勞，你會(huì)得到世界上最普通的漢堡、薯?xiàng)l和一杯可樂，由一個(gè)寧愿看手機(jī)也不愿聽你說話的青少年提供。你將支付5美元，如果你點(diǎn)超值菜單，可能還會(huì)少點(diǎn)。
并非每個(gè)案例都是如此，當(dāng)你離開時(shí)，你都不會(huì)餓，你的身體也會(huì)得到營養(yǎng)。但如果你花的錢越多，體驗(yàn)就會(huì)好得多。

Maybe you can’t afford to eat at the high-end steakhouse, or maybe you’d like to do it more often. You think it isn’t fair that it is that expensive. You get your local congressman to agree, and a law is passed capping the price of a meal at a restaurant at $20. You triumphantly show up at Morton’s with your $20 bill and prepare yourself for bliss.
Guess what happens? You no longer get a 24 oz cut of aged prime New York strip, because that is too expensive. The steak you do get is no longer cooked to order, the wait staff is less attentive, and the wine list consists of Two Buck Chuck. It isn’t a great experience, and you might not go back. Or you might not get the chance to, as they are likely to go out of business, because they can no longer afford their rent.
You try Outback instead, but even their food is worse. The steak is smaller and the Bloomin’ Onion is gone.
McDonald’s is unaffected, because their meal never did cost more than $20.

也許你沒錢去高級(jí)牛排館吃飯，或者你想經(jīng)常去，你認(rèn)為這么貴是不公平的。你讓當(dāng)?shù)氐膰鴷?huì)議員同意，然后通過一項(xiàng)法律，將餐館一頓飯的價(jià)格限制在20美元。你得意洋洋地出現(xiàn)在莫頓餐廳，手里拿著20美元，準(zhǔn)備迎接幸福。
猜猜會(huì)發(fā)生什么？在紐約黃金地帶，你再也買不到一份24盎司的陳年干酪，因?yàn)槟翘F了。你吃到的牛排不再是隨叫隨到的，服務(wù)員也不那么細(xì)心了，酒單上只有廉價(jià)紅酒“兩元恰克”。這不是一次很好的經(jīng)歷，你可能再也不會(huì)去了。或者你可能沒有機(jī)會(huì)了，因?yàn)樗麄兒芸赡軙?huì)破產(chǎn)，因?yàn)樗麄冊(cè)僖哺恫黄鸱孔饬恕?br /> 你可以試試澳洲鄉(xiāng)村牛排館，但就連他們的食物也更糟糕。牛排變小了，洋蔥也沒了。
麥當(dāng)勞沒有受到影響，因?yàn)樗麄兊牟唾M(fèi)一直就沒有超過20美元。

This is essentially the drug market. There is always McDonald’s. There are many conditions I can treat effectively with cheap generic drugs. I have many patients who are on half a dozen meds and don’t pay more than $10 per month for any of them. These are mostly older meds that are nevertheless still effective. If it works, great.
However, we like medical progress. There are things I can treat better and more effectively now than I could 20 years ago. Innovation is expensive. Developing a new drug can cost hundreds of millions of dollars and take 10 years. Sometimes that time and money go to waste because the drug is rejected by the FDA over safety concerns (most new drugs do not make it through this process). Drug companies are not going to take the risk of making new drugs unless there is a reward at the end of the tunnel, and that reward is the profits from the initially very high prices. They get those profits primarily from the US market. Congratulations America, you fund drug development for the whole world.
But if you limit those profits with price controls, there is less risk taking, less development, and less progress. A diabetic that I treat with nothing but generic drugs is going to do much worse and die sooner than one I treat with the fancy new stuff.
Yes, it sucks if you are the one spending $$$ on meds. The meal at Morton’s was expensive, but you wanted to go there, enjoyed the meal, and will remember it fondly. Absolutely no one wants to spend $100 on medications. But not dying or losing your vision or having crippling arthritis is good too.

這就是藥品市場(chǎng)。那里總是有麥當(dāng)勞。我可以用便宜的仿制藥有效地治療許多疾病。我有很多病人同時(shí)服用六種藥物，每個(gè)月的藥費(fèi)都不超過10美元。這些大多是老藥，但仍然有效。如果有效，那就太好了。
然而，我們喜歡醫(yī)學(xué)的進(jìn)步。與20年前相比，我現(xiàn)在可以更有效地治療一些疾病。創(chuàng)新是昂貴的，開發(fā)一種新藥可能要花費(fèi)數(shù)億美元，耗時(shí)10年。有時(shí)，這些時(shí)間和金錢會(huì)被浪費(fèi)，因?yàn)樵撍幬镆虬踩珕栴}被美國食品藥品監(jiān)督管理局拒絕（大多數(shù)新藥都無法通過這一過程）。制藥公司是不會(huì)冒險(xiǎn)研發(fā)新藥的，除非在研發(fā)過程的盡頭有回報(bào)，而這個(gè)回報(bào)就是從最初的高價(jià)格中獲得的利潤。他們的利潤主要來自美國市場(chǎng)。祝賀美國，你們資助了全世界的藥物研發(fā)。
但是，如果你用價(jià)格控制來限制這些利潤，就不會(huì)承擔(dān)那么多的風(fēng)險(xiǎn)，就會(huì)減少發(fā)展，也會(huì)減少進(jìn)步。我只用非專利藥物治療的糖尿病患者會(huì)比我用新奇的藥物治療的糖尿病患者更糟糕，死得更快。
是的，如果你是那個(gè)花錢買藥的人，那就太糟糕了。這就像在莫頓餐廳吃的飯很貴，但你想去那里吃，吃得很好，會(huì)留下美好的回憶。絕對(duì)沒有人愿意在藥物上花費(fèi)100美元，但不死亡、不失明、不患致殘性關(guān)節(jié)炎也是好事不是。

Maureen Boehm
Why are prescxtion drug prices so high in the U.S. compared to the rest of the world?
Because we let them.
Read that again.
Because WE let them.
Medicare Part D specifically PROHIBITS the negotiation of drug prices.
(Some Big Pharma lobbyist, somewhere, broke out the champagne and got a huge bonus for that one.)
Just about every other country in the world, where universal health care exists, negotiates their drug costs. Those countries know that saying that the system pays only X dollars for Y drug means that effectively, that drug won’t go anyone in that country, unless Big Pharma plays ball.
The same cancer drugs that cost thousands here can be purchased in Europe for one hundred dollars.

為什么美國的處方藥價(jià)格比世界其他地方高?
因?yàn)槲覀冏屗麄冞@樣的。
再讀一遍。
因?yàn)椤拔覀儭弊屗麄冞@樣的。
醫(yī)療保險(xiǎn)D部分特別禁止就藥品價(jià)格進(jìn)行談判。
(在某個(gè)地方，一些大型制藥公司的說客打開了香檳，并因此獲得了巨額獎(jiǎng)金。)
世界上幾乎所有其他存在全民醫(yī)療保健的國家都在協(xié)商藥品成本。這些國家知道，說系統(tǒng)為Y種藥物只支付X美元的話，實(shí)際上意味著，除非大型制藥公司合作，否則這種藥物不會(huì)進(jìn)入該國的任何人手中。
同樣的抗癌藥物在美國要花幾千美元，在歐洲只要100美元就能買到。

I have a friend, with type 1 diabetes who rations her insulin because she can’t afford the five hundred dollar cost, each month. Without insulin, she will die.
I have another that can no longer pay for the rheumatoid arthritis drug, that keeps her functional, because her insurance company won’t pay the four thousand dollars a month for Enbril. It is an older drug. It used to cost seven hundred a month.
My son has severe allergies. He used to carry an Epi-pen with him everywhere. Again, a very old drug. Used to cost ninety buck for two. It went up to around eight hundred each.
Why?
Because WE let them.
Who is WE?
It’s YOU and ME.
If we don’t take action, we will continue to be like sheep going to the slaughter house.
The sheep aren’t doing anything about because, well, they’re sheep.
Don't be a sheep.

我有一個(gè)患有1型糖尿病的朋友，她需要定量使用胰島素，因?yàn)樗?fù)擔(dān)不起每月500美元的費(fèi)用。沒有胰島素，她會(huì)死的。
我還有一個(gè)無法再支付治療類風(fēng)濕性關(guān)節(jié)炎藥物的費(fèi)用，因?yàn)樗谋ｋU(xiǎn)公司不會(huì)支付每月4000美元的Enbril費(fèi)用。它是一種較老的藥物。過去一個(gè)月要花700美元。
我兒子有嚴(yán)重的過敏癥。他以前到哪都帶著腎上腺素注射器，這又是一種非常古老的藥物。以前兩支要90美元，如今每支價(jià)格漲到了800美元左右。
為什么？
因?yàn)槲覀冏屗麄冞@樣干的。
我們是誰？
是你和我。
如果我們不采取行動(dòng)，我們將繼續(xù)像羊一樣走向屠宰場(chǎng)。
綿羊什么也不做，因?yàn)?，它們是綿羊。
不要做綿羊了。

You have the power to vote. You have the power to protest.
There is currently drugs cost legislation being considered, in Washington.
If you are interested, and it’s cool if you are not (bah), go to FightPharma.org/senate.
There you can send a letter to the senators involved in this decision.
Tell your story. Add personal comments.
Let them know that this is an issue that will determine your vote, when they come up for re-election.

你有投票的權(quán)力、你有抗議的權(quán)力。
目前，華盛頓正在考慮就藥品成本立法。
如果你感興趣，如果你不感興趣也沒關(guān)系，請(qǐng)?jiān)L問FightPharma.org/senate。
在那里你可以寫信給參與這個(gè)決定的參議員。
講述你的故事，添加個(gè)人評(píng)論。
讓他們知道，當(dāng)他們競(jìng)選連任時(shí)，這個(gè)問題將決定是否獲得選票。

It took me fewer than five minutes.
As I uncover more practical steps that you can take, I’ll let all my wonderful Quora followers know.
Peace.
Edit——
Anyone that wants to throw blame around in the comments can stop right here.
The point of this answer was to empower and inform, not to bash each other’s political points of view or to throw blame around.
The house is burning down, arguing about who should put it out is a waste of time.

我只用了不到五分鐘的時(shí)間。
當(dāng)我發(fā)現(xiàn)更多你可以采取的實(shí)際步驟時(shí)，我會(huì)讓我所有優(yōu)秀的Quora粉絲知道。
和平
編輯----
任何想在評(píng)論中指責(zé)別人的人都可以在這里停下來。
這個(gè)回答的重點(diǎn)是賦予權(quán)力和信息，而不是抨擊彼此的政治觀點(diǎn)或相互指責(zé)。
房子著火了，爭(zhēng)論誰來滅火是浪費(fèi)時(shí)間的行為。

Drew Smith
Why are pharmaceuticals less expensive everywhere outside the U.S.?
There are two main drivers: strict enforcement of liberal intellectual property laws, and political restriction of bargaining power.
The grant of a patent on a drug compound gives its owner a monopoly for the lifetime of the patent, which is now 20 years. During this time the patent holder is free to charge as much as they believe the market will bear without the threat of being undercut by competition.
This is not quite as bad as it sounds - drugs are patented before they receive FDA clearance for marketing, so the effective life of the monopoly is usually on the order of 10–16 years, not 20.
Some countries - India and South Africa are prime examples - are not particularly respectful of intellectual property rights. They have refused to enforce patents when homegrown competitors make generic versions of on-patent drugs, or they threaten to do so in exchange for country-specific reduced pricing.
But pharma companies have gotten very creative about extending their monopolies. One strategy is to pay generic drug manufacturers not to compete[1] . Another is to make very minor - and in my opinion, obvious - changes in formulation that result in new patents and a brand-new patent clock.
The most notorious example of this practice is Prilosec/Nexium for acid reflux disease[2] . The active ingredient in both drugs is precisely the same. However in the original formulation (Prilosec), the drug is a 50:50 mixture of two mirror-image versions of the same molecule. One version is active, the other is inactive.

為什么美國以外的地方的藥品都便宜。
主要有兩個(gè)驅(qū)動(dòng)因素：嚴(yán)格執(zhí)行自由的知識(shí)產(chǎn)權(quán)法，以及政治上對(duì)議價(jià)能力的限制。
一種藥物化合物的專利被授予后，其所有者在專利有效期內(nèi)擁有壟斷權(quán)，現(xiàn)在是20年。在此期間，專利持有人可以自由地收取他們認(rèn)為市場(chǎng)可以承受的價(jià)格，而不會(huì)受到競(jìng)爭(zhēng)削弱的威脅。
這并不像聽起來那么糟糕——藥物在獲得FDA批準(zhǔn)上市之前就獲得了專利，所以壟斷的有效期限通常是10-16年，而不是20年。
一些國家——印度和南非就是最好的例子——并不特別尊重知識(shí)產(chǎn)權(quán)。當(dāng)本土競(jìng)爭(zhēng)對(duì)手生產(chǎn)專利期內(nèi)的仿制藥時(shí)，他們拒絕強(qiáng)制執(zhí)行專利，或者他們就此要挾對(duì)在特定國家的藥品降價(jià)銷售。
但制藥公司在擴(kuò)大壟斷方面變得非常有創(chuàng)意。一種策略付錢給非專利藥制造商，讓他們不要競(jìng)爭(zhēng)。另一種是在配方上做出非常微小的（這很顯然是我的觀點(diǎn)）改變，從而產(chǎn)生新的專利和全新的專利有效期。
這種做法最臭名昭著的例子是用于胃酸反流疾病的奧美拉唑/埃索美拉唑。這兩種藥的有效成分完全相同。然而，在原始配方(奧美拉唑)中，該藥物是同一分子的兩個(gè)鏡像版本的50:50混合物。一個(gè)版本是有化學(xué)活性的，另一個(gè)是無化學(xué)活性的。

AstraZeneca, Prilosec’s owner, figured out how to purify the active version away from the inactive one. This was challenging but not any kind of a breakthrough. Patents are supposed to be granted only for inventions that are non-obvious, but the patent office sets a very low bar for non-obviousness, and granted AZ a patent for the purified form, known as Nexium.
Nexium’s clinical benefits over Prilosec are very modest, and mostly result from comparing the two drugs at equal doses, even though Prilosec is only 50% active. But AZ has marketed the hell out of Nexium, and global sales are around $4B[3] .
The other driver of high US drug prices is a lack of bargaining power. Other countries have centralized/universal health care organizations that can and do negotiate with pharma companies on price.
Except that they are specifically prohibited by law from bargaining. Medicare and Medicaid must pay for nearly all FDA-approved drugs prescribed by a physician. But the Republican Congress, when it set up Medicare Part D in 2003, forbade Medicare from negotiating drug prices. Since Medicare must cover all drugs, and cannot bargain, pharma companies are free to charge as much as they like, knowing that Medicare simply has to pay up. This is a legally mandated transfer of funds from taxpayers to pharma companies.
And don’t expect this to change with a Republican Congress and President. US taxpayers will continue to be raped in this way for the foreseeable future.

奧美拉唑的所有者阿斯利康（AstraZeneca）想出了如何從不具備化學(xué)活性的分子中分離出化學(xué)活性分子的方法。這很有挑戰(zhàn)性，但并不是什么突破。這樣做是一個(gè)非常明顯的步驟——當(dāng)然，你希望配方由其活性成分組成。專利應(yīng)該只授予那些非顯而易見的發(fā)明，但專利局對(duì)非顯而易見性設(shè)定的標(biāo)準(zhǔn)很低，并授予阿斯利康一項(xiàng)純化形式的專利，該專利被稱為埃索美拉唑。
埃索美拉唑相對(duì)于奧美拉唑，增加的臨床益處非常小，主要是在同等劑量下比較兩種藥物的結(jié)果，盡管奧美拉唑只有50%的活性。但AZ已經(jīng)將埃索美拉唑推向了市場(chǎng)，全球銷售額約為40億美元。
美國藥品價(jià)格高企的另一個(gè)驅(qū)動(dòng)因素是缺乏議價(jià)能力。其他國家有集中/普遍的醫(yī)療保健組織，可以而且確實(shí)可以與制藥公司就價(jià)格進(jìn)行談判。
除非法律明確禁止他們討價(jià)還價(jià)。醫(yī)療保險(xiǎn)和醫(yī)療補(bǔ)助必須為醫(yī)生開出的幾乎所有fda批準(zhǔn)的藥物買單。但是，共和黨控制的國會(huì)在2003年設(shè)立醫(yī)療保險(xiǎn)D部分時(shí)，禁止醫(yī)療保險(xiǎn)參與藥品價(jià)格談判。由于醫(yī)療保險(xiǎn)必須覆蓋所有藥品，而且不能討價(jià)還價(jià)，制藥公司可以隨心所欲地收取費(fèi)用，因?yàn)樗麄冎泪t(yī)療保險(xiǎn)必須支付全部費(fèi)用，這是法律強(qiáng)制將資金從納稅人向制藥公司進(jìn)行轉(zhuǎn)移。
不要指望共和黨國會(huì)和總統(tǒng)會(huì)改變這種情況，在可預(yù)見的未來，美國納稅人將繼續(xù)被這種方式蹂躪。

Cyrille Serdon
Why are drug prices so much higher in the US than in France?
I’m no expert on this one but the explanation I’ve been given in the past is that it comes from a difference in bargaining power between the different actors in the two markets.
As you may be aware of, France has a very socialized health system and, among other things, most drugs prescribed by a doctor will be paid for by our public health insurance system and not by the patient himself.
Now, if you are a pharmaceutical company willing to commercialize a new drug in France, you have two options :
you simply go through the process of getting your product approved for the French market. In this case, if you do get the authorization from the French authorities, you will be allowed to sell your drug in France at the price you wish but it won’t be part of our insurance system either (meaning that your customers will actually have to pay for the drug themselves)
in addition of having your product approved, you make an application to the French administration for it to be registered by our insurance system. In addition of checking that your molecule is in line with all the regular medical requirements, this process will involve a negotiation with the French administration on a fixed commercialization price… but it also means that your prospective customers will not have to pay themself for your product if it is accepted

為什么美國的藥品價(jià)格比法國高得多？
我不是這方面的專家，但我過去得到的解釋是，這源于兩個(gè)市場(chǎng)中不同參與者之間議價(jià)能力的差異。
正如你可能知道的，法國有一個(gè)非常社會(huì)化的衛(wèi)生系統(tǒng)，除其他外，醫(yī)生開的大多數(shù)藥物都將由我們的公共醫(yī)療保險(xiǎn)系統(tǒng)支付，而不是由患者自己支付。
現(xiàn)在，如果你是一家愿意在法國將新藥商業(yè)化的制藥公司，你有兩個(gè)選擇：
你只需通過讓你的產(chǎn)品進(jìn)入法國市場(chǎng)的程序。在這種情況下，如果你確實(shí)獲得了法國當(dāng)局的授權(quán)，你將被允許以你希望的價(jià)格在法國銷售你的藥物，但它也不會(huì)成為我們保險(xiǎn)系統(tǒng)的一部分(這意味著你的客戶實(shí)際上必須自己支付藥物費(fèi)用)。
除了讓你的產(chǎn)品獲得批準(zhǔn)，你向法國行政部門提出申請(qǐng)，在我們的保險(xiǎn)系統(tǒng)中登記。除了檢查你的藥品分子是否符合所有常規(guī)醫(yī)療要求外，這個(gè)過程還包括與法國政府就固定的商業(yè)化價(jià)格進(jìn)行談判，但這也意味著，如果你的產(chǎn)品被接受，你的潛在客戶將不必為你的產(chǎn)品付錢。

Practically, any drug would have to be part of this insurance system to get any significant market penetration in France (there may possibly be some cutting hedge treatments so attractive that they could still afford not to be part of it but that would really not be mainstream). Ultimatly, this means that pharmaceutical companies have to negociate with one single body controlling their access to the entire French market. This means that the French administration is in a very strong position in the negociation, thus allowing it to secure low drug prices.
On the other hand, in the US, where my understanding is that the whole health care system is privatized pharmaceutical companies enjoy much more bargaining power and do get to set higher prices.
I believe (though not 100% sure) that most of Western Europe works with more or less socialized health systems and that the price gap mentionned in the question is not limited to France.
At the end of the day, one thing that is sure is that, in this organization, the American customer probably ends up subsidizing the R&D programs (whose costs are massive in drug development) the French (and possibly European) one is ultimately enjoying the benefits of.

實(shí)際上，任何藥物都必須成為這一保險(xiǎn)體系的一部分，才能在法國獲得顯著的市場(chǎng)滲透（可能會(huì)有一些非常吸引人的對(duì)沖措施，他們?nèi)匀豢梢猿袚?dān)不參與其中的后果，但這真的不是主流）。最終，這意味著制藥公司必須與一個(gè)控制其進(jìn)入整個(gè)法國市場(chǎng)的單一機(jī)構(gòu)進(jìn)行談判。這意味著法國政府在談判中處于非常有利的地位，從而使其能夠確保低藥價(jià)。
另一方面，在美國，我的理解是，整個(gè)醫(yī)療保健系統(tǒng)都是私有化，制藥公司擁有更大的議價(jià)能力，可以設(shè)定更高的價(jià)格。
我相信（盡管不是100%確定）大多數(shù)西歐國家或多或少都有社會(huì)化的醫(yī)療體系，問題中提到的價(jià)格差距不僅限于法國。
歸根結(jié)底，有一點(diǎn)是肯定的，在這個(gè)組織中，美國客戶可能最終會(huì)資助研發(fā)項(xiàng)目（其在藥物開發(fā)方面的成本巨大），而法國（可能還有歐洲）客戶最終會(huì)享受到這些項(xiàng)目的好處。

Robert Smith
How has the "big pharmafia" impacted drug prices?
They game the patent system. For example they reformulate a medication in a more desirable package (like a longer acting version, or one with less side effects) and repatent it for another decade. I’m not sure why they can get away with this, it seems like a stupid loophole, but it apparently works.
They buy off potential generic makers. If you were a small company thinking of cloning say Ozempic in a few years. You could invest in a production line, buy raw materials, start advertising, fight against the “generics aren’t as good” thought process. Or you could just accept the $3 billion dollars that were offered to just bow out. Which is better for your stock holders? Interesting that Mark Cuban, of all people is trying to disrupt this. He’s buying and eventually going to be making, his own generics and selling them at 15% over his cost, with $5 shipping per order.
They do the absolute minimum research to get something approved. For example, they might use a surrogate endpoint, like blood sugar for diabetes or drop in blood pressure rather than the decrease in cardiac deaths we’re really concerned about. They leave the “does this stuff actually help people live longer or healthier” for the patients to sort out!

“大型制藥公司”是如何影響藥品價(jià)格的?
他們玩弄專利制度。例如，他們將一種藥物重新配制成更理想的包裝（如長效或副作用較小的版本），然后再使用十年。我不知道他們?yōu)槭裁茨芴用搼土P，這似乎是一個(gè)愚蠢的漏洞，但它顯然有效。
他們收購潛在的仿制藥商。如果你是一家考慮幾年后克隆的小公司，比如Ozempic。你可以投資一條生產(chǎn)線，購買原材料，開始做廣告，對(duì)抗“仿制藥沒有那么好”的思維過程?；蛘吣憧梢越邮?0億美元的報(bào)價(jià)，然后退出。哪一種對(duì)你的股票持有者更有利？有趣的是，在所有人中，馬克·庫班（馬克·庫班，是現(xiàn)任美國職業(yè)籃球聯(lián)賽達(dá)拉斯獨(dú)行俠的擁有者。庫班還擁有兩架波音商務(wù)噴射機(jī)）正試圖破壞這一局面。他購買并最終生產(chǎn)自己的仿制藥，并以比成本高出15%的價(jià)格出售，每筆訂單的運(yùn)費(fèi)為5美元。
他們只做最少的研究就能獲得批準(zhǔn)。例如，他們可能會(huì)使用一個(gè)替代終點(diǎn)，比如糖尿病的血糖或血壓下降，而不是我們真正關(guān)心的心臟病死亡人數(shù)的減少。他們把“這些東西真的能幫助人們活得更長或更健康嗎”留給病人來解決！

In the interests of the above, they’ll often lie to the FDA/CDC and doctors with statistics. They’ll start a clinical trial with a clear goal (does drug X reduce problem Y) and fail, but X reduces something ASSOCIATED with Y, so they’ll rewrite the research to emphasize that. Or they’ll start a project, discover that it only seems to help a certain sub-population, so they’ll find a way to exclude all the folks it doesn’t help. Or they’ll talk about trends, not significant results. Cook the books enough and you can prove almost anything helps almost anything. The new drugs related to Alzheimer’s are a great example-each introduced with great fanfare, despite having almost no positive effect and costing many thousands per month.
They market directly to consumers (you) and provide lecturers to sell their claims. Back in the 00s I treated a lot of diabetes, and I’d started using a fair amount of Avandia, because it was one way to reduce blood sugars when everything else didn’t work. Turn out that it doesn’t help diabetics health (surrogate marker) but we didn’t know that yet. The drug company offered to pay me $100s a night to lecture people on how wonderful Avandia was.

為了上述利益，他們經(jīng)常會(huì)用統(tǒng)計(jì)數(shù)據(jù)對(duì)FDA/CDC和醫(yī)生撒謊。他們會(huì)帶著一個(gè)明確的目標(biāo)(藥物X是否能減少問題Y)開始臨床試驗(yàn)，結(jié)果失敗了，但X減少了與問題Y相關(guān)的某些東西，所以他們會(huì)重寫研究來強(qiáng)調(diào)這一點(diǎn)。或者他們會(huì)啟動(dòng)一個(gè)項(xiàng)目，發(fā)現(xiàn)它似乎只對(duì)特定的亞群體有幫助，所以他們會(huì)找到一種方法來排除所有幫助不到的人群?；蛘咚麄儠?huì)談?wù)撢厔?shì)，而不是談?wù)撝匾慕Y(jié)果。做足假賬，你幾乎可以證明任何事情，幾乎可以證明能幫助所有人。治療阿爾茨海默氏癥的新藥就是一個(gè)很好的例子——每一種藥物都被大張旗鼓地推出，盡管幾乎沒有任何積極作用，而且每月要花費(fèi)數(shù)千美元。
他們直接向消費(fèi)者（你）推銷，并準(zhǔn)備好講師來推銷他們的主張。早在00年代，我就治療了很多糖尿病，我開始使用大量的文迪雅，因?yàn)楫?dāng)其他一切都不起作用時(shí)，這是降低血糖的一種方法。事實(shí)證明，它對(duì)糖尿病患者的健康沒有幫助（替代標(biāo)記），但我們還不知道。制藥公司愿意每晚付給我100美元，讓我向人們宣傳文迪雅有多棒。