Recently, a graduate student majoring in pharmacy is going to take the "Introduction to Pharmaceutical Affairs Laws", and I worked overtime to watch the movie "I'm not the God of Medicine", which is going viral on the WeChat subscription account. It's really good. Even as a firm believer in the market economy, I have done research on drug prices, and I still shed tears several times. The pharmaceutical industry is a matter of human life. Does it need money or death ? This is the same question at home and abroad, except that countries like the United States are richer and we are poorer, so the question is more important.
In 1993, the American blockbuster "Desperate" was released, which tells the story of a pharmaceutical company hunting down a doctor in order to make a failed new drug pass the review. In this film, the doctor is a positive image. It is worth noting that in 1992, Clinton proposed the US health care reform plan.
In 2010, the American blockbuster "Love and Elixir" was released, which told the life of a medical representative, at the time of Obamacare reform. this is a true story.
The author himself is a medical representative, and he wrote his story into a book, "Small and Hard: The Growth History of a Viagra Salesman", because the author of this book was banned by the pharmaceutical company, and then he made a living by writing. It is estimated that he became a medical representative. Earn enough money to spend.
This book reveals the operating mechanism of a pharmaceutical representative of a pharmaceutical company in the United States. Things like seduction and bribery have occurred. For example, the book mentioned that a pharmaceutical company gave doctors a $500 red envelope, various party activities (to find a way to win the lottery for doctors who need a relationship), and lunches for doctors and nurses, etc.
In the U.S. system, the performance of a medical representative is mainly calculated by the drug company's purchase of pharmacy sales data collected by a third party. The government medical insurance plan has an important impact on the business model of the medical representative. The most interesting thing is that the author works lazily and has always been in the lower reaches of the sales force, most in the middle, but when he left a pharmaceutical company, he became the number one in the United States because of Viagra.
The introduction of Viagra in this book is very interesting: (1) The demand is so great that even the elderly over 70 years old are seeking a doctor’s prescription; (2) In order to prevent the medical representative from promoting too many drugs with large doses, a pharmaceutical company deliberately let 50mg and 100mg of medicines have the same price; (3) In order to prevent doctors and patients from cutting the tablets, they are designed in a diamond shape.” What this story actually tells us is that even if China has achieved the separation of medicines, the chain of interests between doctors and drug dealers is still cut.
In addition, in 2013, the American blockbuster "Dallas Buyers Club" told a story similar to "I am not a drug god", which shows that this theme is an enduring attraction. It also shows that the medical problem is a global problem.
"I'm Not the God of Medicine" seized this historical opportunity and became the first Chinese film to confront this problem head-on. This film was born in the tough stage of China's medical and health system reform. At the end of 2017, "The Past and Next Life of Medical Reform" written by Boss Dai aroused strong resonance in the society, and in February 2018, "Beijing Middle-aged under Influenza" went viral on WeChat to further spread the resonance to every common person. This film will further amplify that resonance.
Personally, I feel that this movie is related to the question of whether or not to be the bottom line in the market economy. 200 years ago, Adam Smith wrote The Wealth of Nations, a study of how self-interested people generate public goods. Its focus is on how to achieve public welfare through the market, rather than private interests. Because people are inherently self-interested, if what we want in the end is self-interest, then we can do without the market.
With the introduction of mathematics into economics, people pay more and more attention to the assumption of self-interest, because self-interest is easy to be mathematicalized, while altruism that is not easy to be mathematicalized is ignored. Professors teaching economics textbooks are also instilling self-interested human assumptions in students, and economics education is cultivating elites who cut leeks. A system in which everyone is self-interested and uses the market to harm others and cut leeks. This should not be the market system in the eyes of Adam Smith back then.
The film answers that question. It is understandable for pharmaceutical companies to make money, but it should be remembered that the founder of Merck taught that "the first is the patient, the second is the profit". The research and development of original drugs is getting more and more difficult, the cost is getting higher and higher, and the risk is getting bigger and bigger. Companies and hospitals involved in the pharmaceutical industry are increasingly considering money, not the health of patients.
However, if there is no money, how can enterprises develop research and development? This is a real problem. However, if the price is too high and patients cannot take the medicine, how will the value of this medicine be reflected? When a company sets the price of a drug so that no one in the world can afford it, then the drug can only be called an invention, because there is no industrialization, it cannot be called an innovation. Companies reduce drug prices, and gradually patients can afford them. When the company's profit is maximized, drug prices will not drop. And those who can't afford the medicine can only wait to die.
At this time, Indian generic drugs turned out, they infringed, but they also saved people. How should this account be calculated? Just as Cheng Yong, the hero of the movie, sold counterfeit medicines and saved a lot of leukemia patients, how is this account calculated? Although Cheng Yong's own subsidy to patients is rare in the real world, even if there is, it may not have a good effect in economics. As Zhang Changlin, another fake drug dealer in the movie, said that the most common disease is "poor disease", and "poor disease" cannot be cured, no matter how much money who subsidizes it, it can't solve the problem.
The two fake drug dealers in the movie, although they try their best to make money, they also have money that they don't make. Cheng Yong doesn't earn money for "killing people's lives", and Zhang Changlin doesn't earn money for "selling out friends". This is the bottom line of being a human being and is worthy of respect.
The reform of the pharmaceutical industry is a long way off, and the chain of interests between hospitals and drug dealers is like a diamond that is constantly being cut. The market economy is mutually beneficial and protects people's bottom line. It is hoped that the pharmaceutical market will gradually become a mutually beneficial market, rather than a market for harvesting leeks. I hope that pharmacoeconomics will not become a link in the chain of interests between hospitals and drug dealers. If so, it is very sad! It is also a phenomenon that reform will not allow to exist.
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