Taken from JRE #2037 w/Alex Berenson:
https://open.spotify.com/episode/0haulCcRb4r3qmQLYLQoPN?si=0ce69f18f0cd4426

When there's money, companies respond, doctors respond, everybody.

Yeah, I mean, I guess, unfortunately, I mean, look, it's why we have this, you know, all these great things in this country, too.

But yeah, I will, I will give you So an ophthalmologist called me a few weeks ago.

There's a drug, and the drug works, okay?

If something called wet macular degeneration, okay?

It's something older people get and it can blind you.

So there's a drug, there's a couple drugs that actually work for it.

They block the flow of, they block blood vessel formation at the back of the eye, they help you.

So these are administered, ophthalmologists administer them in their offices.

So a drug like that, the ophthalmologist actually buys and charges Medicare or the private insurer for.

Okay, what's happening, and I saw this with a different drug when I worked at the New York Times 15 years ago, so nothing ever changes, these companies all play the same games, is that the companies that make this drug are giving doctors a rebate on the purchase price.

And the more you use, the bigger the rebate.

And this is a drug that costs thousands of dollars per person per year.

Okay, it's dosed multiple times a year for a lot of these people.

So what all this adds up to is if you're an ophthalmologist who's using a lot of this, the company is cutting you a check for 5 or sometimes 6 figures, sometimes multiple times a year.

It may be legal, they may have found a way to do this, and he showed me, he showed me the check that his company, or that his ophthalmology practice had received, and it was huge.

And by the way, these doctors make a lot of money on their own just doing the procedure.

They don't need this, but it's a way for the drug company to get them to use this more.

There is corruption all over our medical system.

Is there a way at this point Or is it the system itself?

Is it just a function of that's how human beings behave when they have enough regulation where they can get away with some stuff and they just wanna make more and more money and it just becomes, that's what they're trying to do.

I mean, if you're that ophthalmologist in Florida, do you need another Ferrari?

But maybe you don't think that way, you don't think that way, you just think I can get

And I'm in this system, and the system is fucked already.

That's right, And I'm using this drug because I know it works and it's good for patients.

The problem is you're then you're then having incentives to ignore the problem if there is 1 later.

And so in this case, the guy actually said to me, he's like, this is a good drug.

But sometimes if we dose it too many times we can get there can be sort of a paradoxical effect where it stops working.

If you're 1 of those doctors who's on the tit and getting that check every quarter or every 6 months or you know however frequently you get it you're gonna it's gonna be harder for you to see the problem because all of a sudden, you have a financial incentive not to see it.

Except talk about it and make sure people know.

And you need senators that call this stuff out.

And we need people that run these companies to be, just to have their ethical boundaries.

The thing about pharmaceutical drug companies is like, I would never say we don't need them.

You know how many drugs the pharmaceutical companies that we currently demonize because of this thing, this for-profit aspect of it, But how many of them have brought drugs to the market that have fixed all sorts of problems that people have been suffering for forever?

You can't go crazy and force people to take your stuff.

A good relationship is a consumer and a provider.

And the provider develops these drugs that are very beneficial to people, and most of them are.

But they do have drugs that they've developed that are really beneficial for people They really do they're real and we can't fucking throw out the baby with the bathwater.

The problem is also the process right because to bring a drug to market costs so much fucking money It costs it crazy.

It's so prohibitive for most if you were like some pharmacologist or some biologist and you guys were working together and you developed something.

You had this idea about a pathway and you figured out something and maybe this could fix it.

Well, I mean, 1 of the great disappointments for me in the last 10 years is realizing that if you had to choose between a sewer system and a medical system, you'd choose a sewer system.

The great gains for human longevity in the last 200 years have been really simple things.

Clean water, try to get the air clean, don't bury, you know, don't have like meat packing plants in the middle of cities, don't have giant graveyards in the middle of cities.

Have you seen, or excuse me, have you read Dissolving Illusions?

and the beginning of it is they talk about the Conditions that people lived in because you never really think about it Like what would it be like to live in a city before there were cars?

You're not getting fresh vegetables in the winter.

There's massive malnutrition, starvation, extreme poverty, people living in squalor, terrible sanitation.

I mean open out houses for entire blocks of people and just crazy diseases.

And they all lived on top of each other and again malnutrition, no vitamin D, no sunlight exposure in the winter, etc.

And a lot of those people got horrible diseases because of that, just like they did in the olden times, like we know about when people dump shit in the streets.

the like, the like 18, the first, you know, The first few decades of the Industrial Revolution were terrible for human health.

People got crammed together, they got sicker, and then about 1850 they started to figure this stuff out.

For 100 years, we did great, but it wasn't really medicine.

The last 50, 60, 70 years we've spent more and more and more money on medicine trying to continue that growth in life expectancy.

And the problem is, in the US anyway, we're now spending so much money and having so many unnecessary medical procedures of marginal value.

I'm talking about like value to people that we've we seem to have topped out.


Speaker 0: The Jerogan Experience

Speaker 1: People respond to incentives. When there's money, companies respond, doctors respond, everybody. Yeah, I mean, I guess, unfortunately, I mean, look, it's why we have this, you know, all these great things in this country, too. But yeah, I will, I will give you So an ophthalmologist called me a few weeks ago. There's a drug, and the drug works, okay?

It's good for people. If something called wet macular degeneration, okay? It's something older people get and it can blind you. So there's a drug, there's a couple drugs that actually work for it. They block the flow of, they block blood vessel formation at the back of the eye, they help you.

So these are administered, ophthalmologists administer them in their offices. So a drug like that, the ophthalmologist actually buys and charges Medicare or the private insurer for. Okay, what's happening, and I saw this with a different drug when I worked at the New York Times 15 years ago, so nothing ever changes, these companies all play the same games, is that the companies that make this drug are giving doctors a rebate on the purchase price. And the more you use, the bigger the rebate. And this is a drug that costs thousands of dollars per person per year.

Okay, it's dosed multiple times a year for a lot of these people. So what all this adds up to is if you're an ophthalmologist who's using a lot of this, the company is cutting you a check for 5 or sometimes 6 figures, sometimes multiple times a year. Don't tell me that's not a bribe. Okay, because that's a bribe. It may be legal, they may have found a way to do this, and he showed me, he showed me the check that his company, or that his ophthalmology practice had received, and it was huge.

And by the way, these doctors make a lot of money on their own just doing the procedure. They don't need this, but it's a way for the drug company to get them to use this more. There is corruption all over our medical system.

Speaker 0: And how does that get resolved? Is there a way at this point Or is it the system itself? Is it just a function of that's how human beings behave when they have enough regulation where they can get away with some stuff and they just wanna make more and more money and it just becomes, that's what they're trying to do. I mean, I don't know. It's just human beings?

Speaker 1: I mean, if you're that ophthalmologist in Florida, do you need another Ferrari?

Speaker 0: But maybe you don't think that way, you don't think that way, you just think I can get

Speaker 1: it. Right.

Speaker 0: And I'm in this system, and the system is fucked already.

Speaker 1: That's right, And I'm using this drug because I know it works and it's good for patients. The problem is you're then you're then having incentives to ignore the problem if there is 1 later. And so in this case, the guy actually said to me, he's like, this is a good drug. It does work, he said. But sometimes if we dose it too many times we can get there can be sort of a paradoxical effect where it stops working.

If you're 1 of those doctors who's on the tit and getting that check every quarter or every 6 months or you know however frequently you get it you're gonna it's gonna be harder for you to see the problem because all of a sudden, you have a financial incentive not to see it.

Speaker 0: Right. I don't know what

Speaker 1: we do about any of this. Except talk about it and make sure people know.

Speaker 0: Talk about it and make sure people know. And you need senators that call this stuff out. And we need people that run these companies to be, just to have their ethical boundaries. Because they make great stuff. The thing about pharmaceutical drug companies is like, I would never say we don't need them.

That's crazy. How many people they've helped? You know how many drugs the pharmaceutical companies that we currently demonize because of this thing, this for-profit aspect of it, But how many of them have brought drugs to the market that have fixed all sorts of problems that people have been suffering for forever? Yes. Yeah.

They just can't go ham. You can't go crazy and force people to take your stuff. Like, that's a bad relationship. A good relationship is a consumer and a provider. And the provider develops these drugs that are very beneficial to people, and most of them are.

A lot of them are, right?

Speaker 1: Some of them are.

Speaker 0: Some of them are. But they do have drugs that they've developed that are really beneficial for people They really do they're real and we can't fucking throw out the baby with the bathwater. I just think that It just happened. The problem is also the process right because to bring a drug to market costs so much fucking money It costs it crazy. It's so prohibitive for most if you were like some pharmacologist or some biologist and you guys were working together and you developed something.

You had this idea about a pathway and you figured out something and maybe this could fix it. And you really figured it out. You sure? Good fucking luck. Right.

Good luck getting that thing approved.

Speaker 1: Well, I mean, 1 of the great disappointments for me in the last 10 years is realizing that if you had to choose between a sewer system and a medical system, you'd choose a sewer system. Like, in other words,

Speaker 0: in other words, What's more efficient?

Speaker 1: What actually helps human health more? The great gains for human longevity in the last 200 years have been really simple things. Clean water, try to get the air clean, don't bury, you know, don't have like meat packing plants in the middle of cities, don't have giant graveyards in the middle of cities. Like that stuff.

Speaker 0: Have you seen, or excuse me, have you read Dissolving Illusions?

Speaker 1: I have not.

Speaker 0: It's a fantastic book about just that

Speaker 1: huh

Speaker 0: and the beginning of it is they talk about the Conditions that people lived in because you never really think about it Like what would it be like to live in a city before there were cars? Well, guess what? Horseshit. But nothing gets to you.

Speaker 1: That's right.

Speaker 0: You're not getting fresh vegetables in the winter. You're not getting vitamins. That's right. There's massive malnutrition, starvation, extreme poverty, people living in squalor, terrible sanitation. I mean open out houses for entire blocks of people and just crazy diseases.

And they all lived on top of each other and again malnutrition, no vitamin D, no sunlight exposure in the winter, etc. Etc. And a lot of those people got horrible diseases because of that, just like they did in the olden times, like we know about when people dump shit in the streets. So I mean,

Speaker 1: the like, the like 18, the first, you know, The first few decades of the Industrial Revolution were terrible for human health. People got crammed together, they got sicker, and then about 1850 they started to figure this stuff out. For 100 years, we did great, but it wasn't really medicine. It was really more basic than that. The last 50, 60, 70 years we've spent more and more and more money on medicine trying to continue that growth in life expectancy.

And it turns out there are limits to it. There are just limits. And we seem to be reaching them. And the problem is, in the US anyway, we're now spending so much money and having so many unnecessary medical procedures of marginal value. I'm not even talking about the cost.

I'm talking about like value to people that we've we seem to have topped out.

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Journalist Alex Berenson on the Real Cost of Pharmaceutical Incentives