One pill to rule them all.
The polypill, a combination of multiple medications packaged together as one pill, has recently sparked the interest of health policy makers. It has been around for some time, mostly for infectious diseases, but it now enjoys renewed interest in the preventive health space.
If recent studies are a sign, we may soon see combination medications packaged into one pill for chronic conditions and age-related diseases. It sounds idealistic enough, but the practical means to implement this are anything but.
In the coming years, if current trends hold and we see a push toward polypills, then we will witness how the pharmaceutical industry institutionalizes innovation and converts it into profit.
When we think of innovation, we think of novel inventions, tools, or widgets that improve on things from before. But innovation is also a process. And in healthcare, rife with complex processes, simply improving the way we do things is a form of innovation.
The technology to combine medications has been around for decades. In fact, it has its own cottage industry called compounding. Throughout the world, including the United States, compound pharmacies provide medications for pain relief and other herbal ointments by combining custom doses of various medications into one pill or cream.
But these formularies are generic and therefore not capable of sustaining the profit margins pharmaceutical conglomerates desire. For the pharmaceutical industry to get involved, and institutionalize polypills as standards of care – as only it can – polypills have to be in fixed dose combination. This means the combination of ingredients have to be set; unlike the many compound pharmacies that customize medications based on patient preference.
This may appear better for patients, but not for pharmaceutical companies’ profits – which means we will see fixed dose combination medications seeking patents for market protections as the calls for polypills grow louder. This opens Pandora’s box of regulatory approval, which then paves the way for FDA approval and Medicare oversight – effectively triggering the administrative machinations of the healthcare industrial complex.
As a result, the convenience of having a single pill transforms into the profit enjoyed from selling a fixed drug combination. Once the profit margins become publicly available, we will see waves of combination pharmaceuticals attain patent protection, undergo clinical trials, and seek market approval.
Instead of generic metformin, a medication used as first line treatment for diabetes, we will see metformin mixed with hypertension or hypercholesterolemia medications, clinical conditions commonly associated with diabetes, in a patented drug combination fully equipped with its own catchy name and go-to-market strategy.
Drug costs will increase and market shares for combinations of different clinical conditions will be carved out: All ostensibly in the name of patient convenience – the ease of a single polypill – but really, all in the name of pharmaceutical profits.
It makes for an interesting moral hazard and reveals how innovations are institutionalized into profits in the pharmaceutical industry.
What starts as a play for patient convenience contorts under the aegis of healthcare consumerism to become a tool to glean profits. Simply by leveraging the regulatory mechanisms of the federal government, pharmaceutical companies create a competitive advantage.
It improves patient compliance, they will argue. Already we are seeing studies that support that. We see scores of small-scale studies advocating improved compliance with polypills, as though it is not obvious enough that taking one pill is easier than taking multiple at a time. They read more like preliminary marketing materials than well designed clinical studies. But perhaps these researchers know something we do not.
Maybe they understand the price of convenience.