Sawbones: A Marital Tour of Misguided Medicine - Sawbones: EpiPen

Episode Date: September 1, 2016

How did a journey that began with Prince Albert hunting for jellyfish on a cruise end with one of the biggest calamities in prescription drug history? Join Justin and Sydnee for the story of the EpiPen. Music: "Medicines" by The Taxpayers

Saubones is a show about medical history, and nothing the hosts say should be taken as medical advice or opinion. It's for fun. Can't you just have fun for an hour and not try to diagnose your mystery boil? We think you've earned it. Just sit back, relax, and enjoy a moment of distraction from that weird growth. You're worth it. that weird growth. You're worth it. Alright, what's wrong with these about? Some books! One, two, one, two, three, four! I'm a little

little little little little little little little little

little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little little For the mouth! Hello, baby. Welcome to Saul Bones, a metal tour of Miscite and Medicine. I'm your co-host, Justin McAroy. And I'm Sydney McAroy. Sydney, there's been, um, the medicine has been the news once again, which is usually about a 50-50 split as to whether or not that's good or bad. Most of the time I feel like when medicine's in the news, it's just somebody on TV who's telling you like not to eat eggs, or it's time to eat eggs or that coffee is bad for you or isn't. Eggs are back.

I feel like it's made, it's either eggs or coffee, isn't that pretty much all they're talking about, like medically, wine. Wine for a while is like, drinks six glasses of wine every night, go to town, you'll be out of your liver. And then like forget that, eggs are in, it finds out, nope, forget the eggs again, and also, sausage is bad. That's usually the medical stuff that's on TV. Yeah, but recently it's been a lot of discussion

about the EpiPin, which I always really liked the EpiPin as an idea because it seemed to, I really like medical devices that are easy enough for everybody to use, you know what I mean? The ones that really love the playing field. Well, I'm, yes, it's created specifically. By leveling the playing field, do you mean keeping everyone alive?

Is that kind of what you're saying? No, I mean like anybody can speak. Leveling the life playing field, like the being alive, continuing to breathe. No, I mean like everybody gets to be a doctor. You know what I mean? Like anybody can be a doctor with a neppy pin. Well, I mean, I don't know that makes it.

It's like in, it's like in, I don't know, it makes you a doctor. It's like that one scene in pulp fiction where um, um, um, um, thermon gets stung by a B really bad. I'm assuming and she was like dying and then, right. And then John should bolt the jams of EpiPin

into her heart, saves her life. Yeah. It's beautiful in her life. That's the best thing by that awful bee, that awful. The awful several bees. They don't show the bees, but like... I think it was a horse fly. Yeah, link.

Did you get it? Was that a good drug joke? That's a good drug joke. So Sid, what does it do with Epi pins? Why is everybody so hot to try about those bad boys? Well, I want to tell you about Epi pins, Justin. But before I get there, I want to take you back. We got to go back.

We got to go back. Oh, yeah. We got too far back in the grand scheme of this show, not too far back. Let's just go back to 1901. All right. Hold on, let me set the dials here. Okay, we're here.

Whoa, all the clues are so different. All right. Nobody has electricity. This is wild. Whoa, all the clothes are so different. All right. Nobody has electricity. As well. Wait, really? Some people might have electricity. We're a time clear. We are a medical history show.

There are lights. So what we know here. There are lights, but they might be candles. It's hard to say from this distance. We're staying out of the, because our future clothing. People are here, and clothes, though. They're definitely clothing and buildings. We don't want to. Fire is is here and the wheel as well.

We don't want to alter the past and create a paradox or stay out of their way. Let's, it's 1901 and we are aboard a yacht on a lovely cruise with Prince Albert of Monaco. Oh, so he's in a boat, not a can. You know, I knew that was going to happen that that joke. We were talking about Prince Albert. It's because quarter point had just recorded in here and the

haze of dad joke is still thick in the air. So he set off on a cruise Prince Albert did in 1901 with two physiologists. This is not the beginning of a weird joke. Yeah, two physiologists in Prince Albert, where can? This is not the beginning of a joke and this sounds like a really weird thing for him to do, but actually Prince Albert was a big fan of scientific research.

He was really intrigued with marine biology and basically ocean ecology, all things to do with the ocean. And so he was, it was not uncommon for him to set forth on these sort of scientific voyages with various scientists on board his ship to study whatever the heck they want to study that's out in the ocean. Whatever science before doing out there. Exactly. So it's kind of a cool use, I think, of his money and yacht. Yeah. Yots plural. Go on these science cruises. Turn into a science yacht, I'm into that.

I'm really jealous. I would love to be on the science cruise, by the way. With Prince Albert. Yeah, with Prince Albert on his yacht. And two physiologists named Paul Portier and Charles Rixet, which is kind of cool that they also rhyme. So that's how they got to be friends, actually. Paul, let me give you a little history of them.

Paul wanted to be a research scientist. He really didn't want to be a doctor. He liked more like bench research, meaning like in the lab research. Okay. That was really where his passions were. He liked the natural sciences a lot. He really loved physiology when he got into it,

but his parents made him go to medical school before it was a lab study, all that. Classic rebel wants to just do science and his parents are like, no, you're a man, you've got to be a doctor. And he's like, oh man, stop. You don't understand, I love it out there. In the lab.

In the lab. In the lab. In the lab. I'm afraid of not. You're like science bench. That's what you call the lab. Like in the lab bench on the lab. Lab bench is better than science bench, that's fun.

It is, what's a thing? A science bench is not a thing. Okay. What would you call bench on? What you did science? Lab bench. Okay, that's fine. Anyway, Charles.

He was active to me. Charles was more of a Renaissance man. He was indeed a surgeon and he did pursue medicine intentionally, not just because his parents made him,. He was indeed a surgeon and he did pursue medicine intentionally, not just because his parents made him, but he was also a poet. He was a pacifist. He was a philosopher.

He studied Latin. He loved sailing. He wrote books and plays. He liked physiology as well. And also, he was really into poisons. And this is where the two kind of cross paths. Paul was already going on some of these science cruises with Prince Albert.

Which is how they were advertising the brochure and he found science cruises with Prince Albert. One two day science cruises with Prince Albert. And so featuring baronigal ladies, smash them off, sugar ray. Prince Albert. Science. This is the most, is this a cool science cruise? I still don't think it's cool with the bands. It's like a flood. Throwback 90s. It's a throwback 90s science cruise. Tis yachting duty wants. Is that who Prince Albert's into? Sure.

It's his bands. So the, the, the the two cross paths because Paul was already kind of going on these science cruises and then Charles was really interested in the toxins from jellyfish, specifically Portuguese mannovers which could be found off the coast of France and in the deep waters. And so you kind of needed to like get way out there to find them. And so, and as a doctor, he was interested in, you know, they stung a lot of people, they caused a lot of damage.

What can we do about this? So they set forth on this cruise, these two physiologists and Prince Albert, and I'm sure there were some other people, but let's focus on them. People to like run the boat, probably. Probably some other like... Some boatsmen. some other sailors or whatnot

On a cruise to find them it was a two and a half month cruise and their plan was to try to collect some of these Buggers on July 5th. They departed from Toulon in search of what you can also call facelia Or Portuguese man of wars is probably what most people prefer. That sounds more intense. Yeah, it needs you to remember. It took them a while to find them. It took them about four or five weeks

before they found like a big, I don't know, like patch of them. Okay. I heard. Grove. A flock. Whatever of jellyfish. What do you call a group of jellyfish? What do you call a group of jellyfish?

Time for our segment, Justin's Google's the internet. A pride of jellyfish, a group of jellyfish? Time for our segment, Justin, Google's the internet. A pride of jellyfish, a murder of jellyfish. You got anything? You can't stop talking while I do the internet. I don't know. I only know so many names of... I think I got the next thing and I'll like, and then check back in with me, I'll be in the lab.

Okay, so this is not a particularly scientific point that I'll make then while you're looking that up. In the four to five weeks, it took him to find the jellyfish. Ryshe wrote a play, to your say, which was loved by Prince Albert, performed in 1905 in Monte Carlo,

starring the then very famous Sarah Bernhard French actress. Oh, right. Just an interesting little fact for you there. Here's another fact for you. A group of jellyfish is called a bloom. Oh. Yeah, and that nice.

Sometimes very rarely caught. Sometimes another case is called a swarm. That's scarier. Bloom. That is what I would call them. If they came at me, I would not think, oh, a bloom of jellyfish. I would think, ah, they're swarming.

Ah. They were swarming the summer. Oh, yeah. There's a bloom of jellyfish. I would think, ah, they're swarming. Ah, they were swarming the summer. Oh, yeah, there's a ton of them. Anyway, so they found their bloom of jellyfish. They caught them and they started taking various bits of goo from the jellyfish in various locations and injecting it into ducks and pigeons and giddy pigs and frogs until they figured out that the tentacle goo seemed to hurt them the most, made them kind of like sedated and quiet and sleepy, and they named that hypnotoxin.

They got back to the lab to study this simore, they were still paired up at this point, and it was really hard to get this Portuguese man of war toxin, so they had figured out by now that the toxin was fairly similar to one from a sea anemone that was pretty abundant in the coastal areas so they could go gather these pretty easily. So they started working with this sea anemone, anemone, anemone toxin. And injecting it into dogs, their thought process, this was not intended to be mean. Their thought was if they did teeny little amounts that maybe they could build up tolerance, and so then there was some belief, like maybe we could figure out a way to make humans tolerant to the toxin. Okay, yeah, like eye-ocaine powder,

to have a little bit. Exactly, exactly like eye-ocaine powder. So they started injecting it into the dogs, and they had a very unexpected and unpleasant result. Some of the dogs who they were injecting teeny, teeny little way lower than lethal dose amounts of this toxin into got very sick and died very quickly one day, like eight of them all at once within a half an hour. And they got and very sick dramatically ill. This is like a long time after they got the toxin or they got the toxin

about three weeks later they got another injection of the toxin and they died almost instantly. Oh my gosh. And so they began to to posit that instead of building up a tolerance that there is some sort of counter protection that can occur when you're exposed to certain toxins as in you've been sensitized to it. You got it once, you got a little sick when you're exposed to certain toxins. As in, you've been sensitized to it. You got it once, you got a little sick, you get exposed to it a few weeks later, you get super sick. Okay.

And they called that aphylaxis, which from the Greek for Contrary to Protection, aphylaxis. Now, aphylaxis didn't sound as nice, so they changed it to anaphylaxis. That is literally why it was changed. So basically your body gets hit by something that hurts it and your body like freaks out about it. It's like, oh holy crap, did you guys see that? Everybody get out here. We have to build like crazy defenses and walls and turrets and lasers and everything. So if that

mother grabber comes back, we are going to be ready for it. We're just going to, yeah, we're going to smash it to bits. Right. Except for then your whole body goes nuts. It's filled with a IGE is the antibody that attacks everything, which is the thing that's always in operation with allergic reactions. The thing that makes you release a bunch of histamine and everything gets inflamed and swollen, and you get this whole inflammatory response everywhere That's what happens so it's dramatically quickly. So it's more like a bunch of bats flying in your town and everybody's like that

Sopped right. I'll tell you how bad that sucked if those bats ever come back here. So help me God I'm gonna burn the whole city. I'm gonna blow the whole town up. Okay. Exactly. That's a good analogy for it, Justin. That's about people who hate bats that much. So that's anaphylaxis. It's a fatal systemic reaction. And when I say fatal, I mean, if you don't do something about it, obviously there are things we can do about it. But if you don't do anything about it, it can very well be fatal to a normally well tolerated substance. So something that not necessarily kills everybody or always kills. And it can involve obviously cardiac symptoms, you know, heart symptoms, lung symptoms, respiratory problems, classically, you can't breathe, skin symptoms, you can

get horrible rashes, GI symptoms, you can get very sick to your stomach, start throwing up, blood can be involved. And then ultimately, basically everything just collapses. And you die. Or hopefully you don't because we do something about it. So they published the whole thing. This was a very important breakthrough that they made. And they went their separate ways. An interesting footnote, Risha would go on to be famous for this.

And about 10 years later, when a Nobel Prize, Portier was not mentioned at all in that. I mean, we know he did it. Like, obviously, I'm telling you this. This isn't a secret. But by all accounts, he was totally cool with that. Because I guess it was just like, at the time, it was normal for a younger scientist to just like do all the work for an older scientist

and then never get any credit for it. So he was cool with it. He was just happy to get back to his bench. There's a stamp that you can see from 1953, from Monaco, Monaco Stamp. Yeah, maybe. From 1953, that commemorates the discovery of anaphylaxis. It says something like that on it, the discovery of anaphylaxis. And it's got a picture of Prince Albert and these two dudes, 48 and Riche, a jellyfish and a yacht. Oh, that sounds awesome.

It's a pretty cool stamp. Oh, blow that up as a poster. If you don't know what this stamp is about, that is the weirdest stamp you could ever collect. But I do wanna collect stamps, but just that one. I just wanna frame that one and hang that on me. I do want that stamp on our wall. So Sydney, how do we obviously identifying it as always the first step? How do we treat it?

Well Justin, I want to tell you about how we treat anaphylaxis, but first why don't you follow me to the billing department? Let's go. Get my cards for the mouse! BEE-EE-EE-EE-EE-EE-EE-EE-EE-EE-EE-EE-EE-EE-EE-EE-EE-EE-EE-EE-EE-EE-EE-EE-EE-EE-EE-EE-EE-EE-EE-EE-EE-EE-EE-EE-EE-EE-EE-EE-EE-EE-EE-EE-EE-EE-EE-EE-EE-EE-EE-EE-EE-EE-EE-EE-EE-EE-EE-EE-EE-EE-EE-EE-EE-EE-EE-EE-EE-EE-EE-EE-EE-EE-EE-EE-EE-EE-EE-EE-EE-EE-EE-EE-EE-EE-EE-EE-EE-EE-EE-EE-EE-EE-EE-EE-EE-EE-EE-EE-EE-EE-EE-EE-EE-EE-EE-EE-EE-EE-EE-EE-EE-EE-EE-EE-EE-EE-EE-EE-EE-EE-EE-EE-EE-EE-EE-EE-EE-EE-EE-EE-EE-EE-EE-EE-EE-EE-EE-EE-EE-EE-EE-EE-EE-EE-EE-EE-EE-EE-EE-EE-EE-EE-EE-EE-EE-EE-EE-EE-EE-EE-EE-EE-EE-EE-EE-EE-EE-EE-EE-EE-EE-EE-EE-EE-EE-EE-EE-EE-EE-EE-EE-EE-EE-EE-EE-EE-EE-EE-EE-EE-EE-EE-EE-EE-EE-EE-EE-EE-EE-EE-EE-EE-EE-EE-EE-EE-EE-EE-EE-EE-EE-EE-EE-EE-EE- Three friends talk about bad movies and make each other and you laugh. Rated R. The flop house is playing at your ears. If you download it right now or whenever. Rated R. To purchase tickets to the flop house, you don't need to do that just download it. The flop house rated R form nudity, I guess. So sitting, we were talking just before the break

about how to treat NFlaxis. So you may already have a hint that epinephrine, the substance that is in the so-called epipin is the number one treatment for antiflaxis. Now epipinephrine, or you also may call it adrenaline, we're talking about the same thing, by the way. I actually fully think that's what, kidding aside, I think it was adrenaline

that he pumped in the immunothermative. That's epinephrine,'s happen effort. That's adrenaline. That's it's the same thing. It depends on where and who you are as to what you might call it, but it's the same thing. Obviously, this is something our bodies already make. We have this. If you if you call it adrenaline, you might know it's from your adrenal glands. Either way, we make a lot of it already. An easy way to think about what it does in your body is that you've probably heard of the fight and fight or flight response. Sure. So when we encounter a predator, we either want to fight it or...

Flight it. More run away. Right, flight it. Put it on an airplane. Sure. Give it a nice flight. That means that it's an issue. They never talk about that one.

Fight or run or put it on an airplane. Watch it fly away. Well, you're safe. The things that it does in order to help you fight or and or fly flight is it raises your heart rate. It raises your blood pressure. It will actually direct the flow of blood to your skin and your skeletal muscle. Now, why would your and skeletal muscle by that? I mean, like legs and arms and those kinds of muscles. Why would you need that? Think about it. Why would you need more blood flow there? Because you're going to fight or flight. Oh, that makes sense. Yeah. Because you're going to run away. You're going to fight somebody. It will make your

pupils bigger. Your pupils dilate. It will dilate your bronchi, your airways. So that's why it helps you breathe because it's opening up your airways. It's gonna increase your oxygenation, so you get more oxygen everywhere. You get more blood to your brain, and it'll also raise your glucose. All of these things to prepare you for some big, intense event that your body's about to undertake.

So if you can't find an Epipin, one thing you can do is tell somebody about like, how you're gonna go wakeboarding with them later, or hang gliding, or any other sort of extreme sport that really gets the adrenaline pumping. And we're gonna do some base jumping or whatever and now we'll actually do the same thing. Watch a suspenseful movie. Watch screen three, for example. Listen to our podcast.

Yeah, that's thrilling. You think? I don't know. I don't think it's like a adrenaline pumping. It is a history show, but maybe in certain areas or dreams. Speak for yourself. Yeah, I mean, okay, I will, and I'm saying it's really thrilling. We knew for many years that there was something in the adrenal glands of animals that we

could inject into people and make things happen. This is how we figured out what epinephrine was where it came from. There's a lot of stories of people isolating like various animals, adrenal glands, and grinding them up, and turning them into bits, and figuring out what's in them. One of my favorite is George Oliver back in the late 1800s, who was a doctor who, either this is a famous story

or an apocryphal story. It could be best. There's no records of it actually written down by him. He didn't write it down, but everybody else said this happens. So who knows? He injected his son with ground up adrenal glands from a sheep and then measured the size of his son's radial artery, which is in your wrist.

And he could tell that it was getting smaller, it was constricting because he invented the instrument that measured that. He was like a tinker or a tinker or a doctor who did that. And so he got all excited. And he was one of the first ones to write about this. Like, hey, if you use these adrenal glands, it'll make your artery smaller.

He uses his son. Yeah, but he uses son. Okay, I'm assuming you didn't know a lot of friends. No, no, or at least maybe they'd learn their lesson. Sun. Yeah, but he uses sun. Okay. I'm assuming you didn't know a lot of friends. No, or maybe maybe they'd learn their lesson. Why stop? Don't hang out with George. In the early 1900s, we actually isolated adrenaline or epinephrine and figured out what it was. Most of the time, we talk about Jokichi Takamine as the one who finally did this and gets the credit for the discovery. There were several scientists just in case there was anyone who's into this topic and debating

it. There were multiple scientists involved. We usually cite him with the discovery. We synthesized it in like 1904 and so then we could make it ourselves. Initially it was mainly used for asthma because it could open airways. You're always right. Right. So for people with asthma, this was kind of an emergency treatment.

But we figured out eventually that I'll butural, which is now the mainstay for asthma, worked better. So it fell out of favor when it came to asthma. But we were still studying it because we knew this thing did a lot of stuff. And so there are like over 12,000 studies in this time period on epinephrine, well throughout the years. What can we do with it? What can it help?

What is it most useful for? Through that, we found that it was good for some breathing issues, even though it is not the main treatment for asthma. It was good for stopping bleeding. So you'll see us add it to like a local anesthetic if we're going to like inject you with a little bit of something to numb you before we stitch something up or something or cut something off you. We will put some epinephrine in there so that there's not a lot of bleeding.

Okay. We use it a lot a lot of the time alongside anesthetics in the OR. It's good for code blues. We use epinephrine commonly as part of our protocol for running a code if someone's heart stops. And code blues is a bad one, you don't want that. That's a bad one, yep. Not code red. There's no code that's a good one. Okay, that's fair.

Yeah, you never hear like code yellow. I was like, why I need some millowafers. It's not called a code yellow. I mean code blues is a bad one, but like code black means the computers are down. Code red means there's a fire. So, I mean, code blue is a bow, but like, code black means the computers are down. Code red means there's a fire. So I mean, none of them are green. No fun codes, right?

And because it was good for raising blood pressure and heart rate and opening airways and improving your oxygenation, we figured out that it was really good for severe allergic reactions, specifically, and a phhylaxis. Okay. And then because some of the things I mentioned, I didn't clarify this, in anaphylaxis,

your blood pressure can plummet. And so something that would raise your blood pressure is really important. So that you keep getting blood to all of your organs. It's very important. In the 1960s, we realized that epinephrine was good to have on hand. It was good to have a round for emergency situations because we were figuring out more and more that people are severely allergic to some foods, like peanuts, for instance. Some insects, like bees, for instance.

And then some drug reactions like penicillin could be very severe and people could stop breathing. And so having epinephrine kind of in your emergency kit became standard. It was so good that it became the World Health Organization listed it as an essential drug. Meaning you've got to have, this is just something you have to have. Like it is an accepted worldwide standard. If you're going to be an emergency medical care facility,

you've got to have this stuff. In the 1970s, Sheldon Kaplan made something called a combo pin. And this was actually initially just for the military in the event of chemical warfare. And it was something that would quickly auto-inject epinephrine into you. So you could click it yourself and shoot yourself full of epinephrine. So many advances there, military and space program. Absolutely. Absolutely. Yeah. Yeah. Thanks to the military

definitely for this one. Because what followed was in 1987, the Epipin was born. Now for those of you keeping track, the Epipin has been around since 1987. Okay. Come on up on 30 years. Always a big milestone. Yeah, it's pretty old drug. One thing to note about drugs is that the older they get, traditionally, the cheaper they get. So just so that we're aware, the EpiPim was born in 1987. I was born in 1983, so just a little bit after me.

Okay. The drug passed hands a few times, as these older drugs often do, as far as like what company owns them, who gets the patent on them. It was bought as part of a generic package from Merck. So Merck is a big drug company you may have heard of. And it was, there's a, there a common theme where smaller pharmaceutical companies will buy up old generic drugs from big pharmaceutical companies. will buy up old generic drugs from big pharmaceutical companies.

So a generic drug, meaning like it has been around so long that the brand is gone and it can be generic. Right. So it was bought as part of some other generics by myelin pharmaceuticals in 2007. Okay, but why, if it's a generic, why can't I ever make them? Well, the fact is that just not many people do. There are just some drugs that not a lot of people

are making and the EpiPen and Epinephrine in general is one of them. There are only a couple other drugs similar to the EpiPen. One, the AVQ, which was released just a couple years ago, got recalled almost, I mean, within two years of it coming out. So that one's not around anymore. There's also a one called the AdrinaClick,

which you may have heard of. It's been around since 2003. It just doesn't have nearly the market share that EpiPen did. EpiPen is, and why that's important is not just because you've heard of it. Well, although that is important, what's really important is who what formulary You have so like your insurance company has a list of drugs that it wants me as your doctor to prescribe you Okay, and if I'm going to go off that list I have to justify why I'm gonna do it. Well the fact is if two drugs are the same and I know they would work the same It's gonna be really hard for me to argue why you should have one instead of the other. So that can trip you up a lot of times.

You know, if you want a certain drug but another one's on your formulary, it can be really hard for you to get the one that you think might be better for you or cheaper maybe. So when myand got the EpiPen, it was making about $200 million a year. The EpiPen was, okay, in profits. Right. Now it is making $1.1 billion a year. Okay. That's a lot more money. Miland's been pretty clever in a couple of areas.

One has been getting it out as an essential drug in schools. They actually, a lot of that was done through the United States government to mandate that schools have an Epipin, which is, that's not a bad idea. I'm not saying that that's a bad idea, but it certainly was beneficial for Milen to get to sell the U.S. schools to ston- Right, insert a word out, great for everybody. Lots of Epipins. The other thing is they have a lot of commercials.

There are a lot of very dramatic commercials for the epipen where you see people having these severe allergic reactions. And these are direct to consumer commercials to remind you that you need an epipen and to terrify parents. Now their drug, which initially was about 90 bucks for two, is $600 for two pens. Now, obviously a pen is a single use thing. You use it, it's done. So two uses. Now, the bigger deal is you're probably not going to need these very often. So what tends to happen is you have to have them on hand because if you or your child or someone in your family has an anaphylactic response to something and you don't have this on hand, we, I mean, you can figure out the consequences. Sure.

But they often expire before people ever get to use them. Thank goodness. Right. But they gotta still get them. It's not like you can just hold on to an expired one. You've still got it when that one runs out. You gotta go get a new one. Right.

So that you always have one that would work on hand. Now, obviously, there's been a lot of us about how much this cost and how this is prohibitive. Myelin's response to this has been, they'll give you a half off coupon. I heard also they're doing a half off, this may be the same thing, but they're doing a generic version that's half, half as much. Right. that's half as much. Right, just $300 is a lot easier than $600, I guess for some people. Why did drugs cost so much?

I was about to ask you, Sydney. That's a good question. Some of this goes back to, you know, huh? Thank you. No, you're welcome. A lot of this, you know, we started making drugs prescription really only

in like the 50s. That's not really, that's kind of a newer concept if you think about it. What can be over the counter, what can be prescription. And along with in the 50s, when we started regulating what was only prescribable.bydoctors, we started holding them up to all these new standards. And so all these drugs had to go through all these protocols to be approved, which increased the cost of making drugs. Because now you had to do a lot of studies to prove that they work, right? Right.

It proved that they're safe. So the cost of making drugs definitely has gone up, but that is a small part, because that's what a drug company will tell you is that it is just because of all the research and development that goes into making the drug. However, it's more complicated than that. When we go back to AZT, which is a medication for HIV, when it was first introduced to the market, it was costing people between like $8,000-$10,000 a year

to treat themselves with AZT. Now, at the time, that was a crazy amount for a medication. Today, with some cancer drugs, that'd be a drop in the bucket. But at the time, that was a crazy amount. The reasoning was just, look, we're the only ones making it, and people really need it, and we don't have any competition,

and it was really hard to make. So... Capitalism. Deal with it. Capitalism. Since then, we've seen, and by the way, act up, protested on Wall Street and got the price reduced.

Which is a cool story, yeah. Act up, actual reality. Yeah. Fight AIDS. Cheers. Cancer's a cool story, yeah. Act up actual reality, fight AIDS. Cancer drugs have followed suit as well. You remember when I came home, my whole rent past each there, I was doing for everybody, all the rent has been. I was enjoying, I was enjoying.

Thanks, sir. Cancer drugs have followed suit because they hold a similar place and that people really need them. People are, you know, they're scared and they're desperate for them and they're often hard to develop in the only one in a certain class.

Since 2000, the price to develop in the only one in a certain class. Since 2000, the price of drugs in the US is going up at a crazy rate. Part of that is that there are a lot of new drugs and it costs a lot to make them. But there's also a lot of the profits that pharmaceutical companies make go to administration and marketing. When the government allowed the drug companies to start marketing drugs to you, the consumer, that greatly increased the price of drugs. Which also, side note, is just here in the US and Australia. I think that's the only other country that allows that. It's a crazy thing. Why are they marketing a drug to you? Why, I mean, think about that.

Really think about that. In addition, greed. Greed is a big part of why drugs are so expensive. What happens a lot is that large companies, large pharmaceutical companies, may not even do all the research and development to make the drug. They will be watching a smaller company that has done that

and has made this drug that they're gonna start selling. Now that's really important and they know is gonna be a revolutionary breakthrough drug. The large company will buy that company and then start selling it at a crazy markup and their excuses, well it costs so much to develop it. Well, they didn't, none of that cost was on them. None of that cost burden was ever on them.

It was on the smaller company that probably would have never sold it for that amount. They also, by generics, there's another thing in drug companies, they'll buy generics that might hold a singular place in a treatment market and then mark them up crazily, which is what they've done with the Epipin, which is what, that jerk Martin the EpiPin, which is what that jerk Martin

sure, lecky, yeah. That same jerk did with the other HIV medication. Yeah, but the language. Sorry, it's a jerk. It's the same idea. Buy up a generic and make it super expensive because it's the only thing that works and people have to have it. The length of patents has gotten longer, so a drug can stay brand name much longer than

it used to, so that then they can charge that a brand name price for it. Which free market capitalists would tell you is way to incentivize people to create new drugs. Right, because it's a really easy marketplace to get into. Do you have several million dollars with which to do the research and development for a new drug? I don't't on hand. And we have really trouble breaking the patents.

You know, in Brazil, when HIV drugs got so expensive that the citizens couldn't afford them, the Minister of Health basically said, forget your patents. We're charging generic prices because you can do that when human lives are at stake. Now Brazil's got its own problems. Okay. Now Brazil's got its own problems. Okay, now Brazil has the weather. It's not like they didn't get it, they didn't get it gray on everything. I'm just saying, there are ways around this.

There are also orphan drugs, which are drugs where like maybe only a small. Only for orphan. No, only a small subset of the population really needs them because maybe it's for a rare disease. Right. So the drug companies feel justified marking them up at crazy rates because I mean we're

making them isn't that enough. Here's the other point. We fund up to 85% of the basic research that goes into these drugs through our taxes. Up to 85% of the research that they are so overwhelmed with paying for is funded by taxpayers, the basic research. Not the final clinical trials. That doesn't seem quite fair, Sydney. So we are all invested in these drugs that we can't afford.

And you can't negotiate because this isn't a free market. You don't choose the disease you have. You didn't get to go negotiate for which illness you wanted to get. You don't get to pick the treatment that was already created, that it's appropriate for the illness that you just got. Capitalism does not apply to disease. It really is where capitalism as a model, one of the many ways in which it breaks down is when you apply it to medicine, it just doesn't make any sense anymore. No, it doesn't make any sense at all. I mean, you need or you do not need, there is no want in there. It's...

No, you didn't go by diabetes, so it doesn't make sense that there's some way for us to just compete to see which diabetes treatment you get. Vicki, I don't know. Listen, she said in Christmas, she wanted this diabetes, and so we scrimmed and we saved and we got her diabetes. Chad never plays with it. All she does is complain about it. And we have to keep hard candies in your purse constantly.

I regret it. Honestly, I do. We should've gotten the puppy. I told you we should've gotten the puppy. What are some actual things that we could do to fix this? Because obviously, the system is broken, is indicated by the fact that a life-saving medication that has been around since 1987 is, I mean, unobtainable by many, many people in this country right now.

So, we need to be able to negotiate drug prices. For instance, the government should be able to negotiate the prices of drugs through Medicare, which is a government funded, well taxpayer government funded healthcare program. They should be able to go to the drug companies and negotiate the costs of the drugs that they're going to pay for. They can't do that right now. That's a really easy thing that is constantly introduced in the house and then killed. That would be a really easy thing for you to tell your representative that you would want to happen. We need price caps. That there's just no reason. These drugs are just so ex and there's no reason.

There's no justification. There is no research and development that justifies the price of some of these drugs. It's crazy. They're price capping in every other country works. It works. We need that. We need marching rights, which is sort of what I said when I mentioned Brazil broke the patents. We need that. We need that.

We need to be able to say, listen, we can't keep this on patent anymore. People are dying. We need to do something. We need that ability. We need faster generics. Right now, the process for getting generics approved, like to go from brand to generic through the FDA is crazy long. It takes them so long to get these generics approved and make sure that they're equivalent to the brand that they say they are.

We have to find a way to expedite that process to do it safely, to do it appropriately, but also to do it faster. Remove some of the red tapes so that we can get these drugs out there. We need to import drugs from other countries if we're not going to do it right. You need to be able to buy your drugs from Canada if you're not. I mean, buy USA, right? I don't buy anything that is American made. I certainly am not going to start drugs. If Charlie needed an EpiPen and you could get it from Canada and we couldn't afford it from here, you buy it in a heartbeat.

Yeah, that's true, but like, go USA. I'm just saying, either we do it right or we need to start letting people get, I mean, if it's, you know, if we're a global economy, let them buy drugs where they can afford them. Obviously, you can talk to your doctor about some things. Sometimes we can do things with like giving you 90 days instead of 30 days to help out with the cost. Sometimes we can figure out other like giving you 90 days instead of 30 days to help out with the cost.

Sometimes we can figure out other cheaper medications that might still work. Sometimes talking to your pharmacist or looking for other pharmacies can help. And then also, you can call your representatives because there are actual things that could be done, laws that could be passed that have done well all over the world that we could do to take money out of medicine and put drugs in the hands of people who need them. So it's not the same thing as buying a new car when you go to the doctor and get a medication prescribed. It's not the same thing and we have to stop treating it like it is in this country. All right, Sid.

You convinced me. I'm going to buy an epipin. You're gonna buy an epipin. Yeah, is that where we're working towards it? Did you want me to get an epip? If you're trying to sell me an epipin, it sound great. They're very hot right now. No, it's hot as thick as a town. You still need a prescription. That's a crazy thing. I want to sell it. Love the epipen. That's a crazy thing. How would you say? How would you say? How would you say? How would you say? How would you say? How would you say. How would you say.

How would you say. How would you say. How would you say. How would you say. How would you say. How would you say. How would you say. How would you say.

How would you say. How would you say. How would you say. How would you say. How would you say. How would you say. How would you say. How would you say.

How would you say. How would you say. How would you say. How would you say. How would you say. How would you say. How would you say. How would you say. How would you say. How would you say. How would you say. How would you say.. We wanna say a special thank you to the taxpayers for letting us use our song Medicines as the intro and outro of our program.

Right this second, if you go over to thetaxpares.bankamp.com, you are going to be able to listen to a different version of our theme song that is really cool. That's actually just, I'm gonna spoke just taxpayers our theme song that is really cool. That's actually just, I'm gonna spoke just taxpayers that bandcamp.com, not the taxpayers. So taxpayers.bankamp.com head over there and check all that out. And thank you the Maximum Fun Network for having us on.

There's a ton of great shows for you to enjoy. Might I recommend still buffering a show that Sydney hosts with her sisters Taylor and Riley for you to enjoy. Might I recommend still buffering, I show that Sydney hosts with her sister's Taylor and Riley, and they try to navigate the top of your water to teen life, is a fine program, and I think you would enjoy it. If you found it, this one, you can find that one where you found this one.

It's not hard. Thank you, Justin. Yeah, thanks, I love you. At least I can do, sister. Folks, that's gonna do it for us until next week. My name is Justin McRoy. I'm Sydney Mac. And as always, don't drill a hole in your head. Alright!

Maximumfund.org Comedy and culture, artist owned Listener supported.