By Elizabeth Cook
Salisbury Post
The problem with health care in the United States is not its management but its focus, according to pharmaceutical company executive Robert Ingram.
The country spends too much money treating people after they become sick, said Ingram, the vice chairman for pharmaceuticals of GlaxoSmithKline.
Speaking at Catawba College’s Distinguished CEO Series on Tuesday, Ingram said 45 percent of Americans have one or more chronic diseases. They account for 75 percent of the $2.4 trillion the nation spends on health care ó almost $7,200 per year for every person in the country.
“Perhaps we should be looking at preventing and better managing chronic disease before we talk about better management of health care,” he said.
Ingram, who said the McCain and Obama campaigns have invited him to speak about prevention, said the private sector should lead the way in emphasizing prevention. He gave the example of a CEO round table on cancer that he organized at the request of former President H.W. Bush.
With an eye toward disease prevention, the 17 to 18 CEOs decided first to examine their own companies’ employee benefit plans. “Frankly, we were embarrassed,” Ingram said. “We were not doing what we should.”
The group set five criteria companies could meet to reach what they called the “CEO Gold Standard” in employee benefits that could improve employee health: be tobacco-free, encourage healthy diet, encourage physical activity, pay for early diagnostic tests and help those who do become sick to get trial drugs.
All of those things cost a lot ó his company spent $3.5 million for early diagnostic testing for its U.S. employees and beneficiaries last year. “But all those things have a cost-benefit ratio that is positive,” Ingram said.
And when it comes to treating cancer, new drugs have revolutionized treatment. Five years ago, he said, doctors treated cancer by cutting in surgery, burning with radiation or poisoning with chemotherapy. New drugs attack cells and shrink tumors with minimal side effects, he said.
He emphasized prevention, intervention and innovation.
Once people are properly diagnosed with an illness, he said, they needed the right treatment or intervention.
“You’re probably saying, ‘Here comes the pitch for more drugs.’ No. The only business we should ever get, the only business we deserve, is right medicine, right patient, right time, right dose.”
He might also add “right pharmacist assistance.” Ingram touted the Asheville Project, which came about through a partnership between GlaxoSmithKline and the American Pharmacists Association. Focusing on diabetes treatment for employees of the city of Asheville, a self-insured entity, the project brought pharmacists out from behind the counter to act as therapy managers ó to counsel patients, coach them on treatment and discuss drug interactions and side effects. The city waived its workers’ copayments for diabetes medication. Asheville spent more on medication, but overall costs for diabetes treatment and lost time at work went down. So did the workers’ blood sugar levels, blood pressure and cholesterol.
Ingram said today’s pharmacy school grads are put behind bulletproof glass and given tasks any high school graduate could do ó “pour, count, lick and stick.” The days of compounding drugs are gone, he said.
“Anyone who can read, type and count can fill a prescription.”
Through innovation, Ingram said, companies have developed drugs that have turned AIDs from a death sentence to a chronic disease. And the industry has some 30 medicines in development for Alzheimer’s Disease, he said. Most will fail, but one or two will be successful.
Innovation is not limited to pharmaceuticals. It may also be needed in record-keeping and communications.
Ingram gave the example of traveling to Zurich. If he needs money, he can take his Wachovia card to a teller machine and get cash. But if he gets sick, he’ll be taken to an emergency room that will have no access to his medical records.
“That same technology that protects my financial records can do the same thing for my medical records. We should have that.”
Catawba officials said the CEO Lecture Series was being reinstituted after a 15-year hiatus, part of a revitalization of the Ketner School of Business. The presenting sponsor was Rockwell Farms.
Ingram touched on several issues during a question and answer session and in interviews.
– Advertising prescription drugs: Ingram said he was a leader in the first type of advertising the industry presented, which raised awareness of symptoms without recommending specific drugs. A better educated patient is a better educated consumer, he says. But that low-key advertising has morphed into selling drugs the same way other companies market soap. “I think we’ve gone too far.”
– Affordability: “We should never let price be a barrier to access.”
– Leadership: Corporate America should lead the shift in emphasis and show it is willing to invest shareholders’ interests in prevention. That would drive others in the same direction.
– Helping the uninsured and under-insured: Ingram said talk-show host Montel Williams is the industry’s spokesman in spreading the word that help is available. In some cases, drug companies might be willing to give a patient prescription drugs for free, he said. They would asks that physicians in those cases discount their services, too. “Never let price be a barrier.”
– Jobs: GlaxoSmithKline recently turned down at least $1.4 million in state incentives related to the expansion of its manufacturing plant in Zebulon, and has cut some jobs. Ingram said taking taxpayer money didn’t feel like the right thing to do.
– Cheaper drugs abroad: If patients can find the same drug for a cheaper price in another country than in the U.S. ó if it really is the same drug ó it’s usually because of government price controls in that country, Ingram said. “It speaks to the question, is the American patient shouldering more than their share of global R&D costs?” he said. The answer now is yes, but Ingram says price disparities will shrink as other countries such as China and India become more developed.
– Food and Drug Administration: The FDA, an underfunded and under-resourced agency, has to balance efficacy vs. safety in approving new drugs, Ingram said. The agency has no incentive to speed up the approval process, he said. The last thing FDA officials want, he said, is to be called to Congress to explain something like Vioxx, a Merck painkiller that was pulled off the market after being linked to serious heart problems. In the future, Ingram said, drugs likely will have to undergo another phase of study or surveillance after approval, a step he supports. “I think it’s the right thing to do.”