Do you remember the movie, “The Perfect Storm?” If you do, then you will know what Mark Dendy is going through. He is caught between worlds, the world of medical insurance and its constant denial and “dictation” of how to treat and what to treat it with, and the ever escalation of pharmaceutical pricing. The perfect storm of unethical medicine.
A Slow Decline
According to the website of the Mayo Clinic, Wilson’s disease is, “A rare inherited disorder that causes copper to accumulate in your liver, brain and other vital organs.” Mark Dendy has Wilson’s disease, and it can be treated with medications so patients can lead normal lives. When he was first diagnosed at 27, physicians felt he had maybe three years to live. Thanks to a breakthrough drug, he is well at 64. However, it could potentially change. 
Dendy is a collegiate biology tutor and teacher. He knows what he is dealing with in terms of the disease (that has the potential to kill him), what he can’t process is why insurance companies are denying more and drug companies are increasing their pricing to unreasonable levels. If the medication is withheld, the copper will again begin to accumulate and will destroy his vital organs and threaten his life.
As medical science has advanced, Dendy’s physicians found a “cocktail” of drugs that have kept him in good health. For the past 12 years, one of the drugs in the cocktail has been a pharmaceutical made by Bausch and Lomb called Syprine.
Since 2015, the cost for one month’s supply of Syprine has risen exponentially, from $600 to $21,000. Another way of putting it is that in about 3 years the cost has risen about 3,400%
The medical insurance company has recently sent Dendy a letter of denial telling him the drug is not necessary to treat his illness. Begging the insurance company’s pardon, but when I did a bit of lay person’s research on Syprine, it is a drug exactly used for Wilson’s disease.
To make matters worse (according to the New York Times, February 23, 2018), a long anticipated generic drug has been developed however, a 100-pill supply is about $18, 400! The Times shows that on a dosage basis, the generic drug is 28 times higher than what Syprine cost in 2010.
It was interesting to note that in 2014, the price of Syprine in Canada for 100 pills was about $823. Pills were offered by the health care system at no cost. Canada has since stopped the program.
What has happened?
Wilson’s Disease is a rare genetic disorder. The pharmaceutical companies understand that. If his insurance company keeps denying the benefits he has no idea of what he will do.
Mark Dendy recently said: “We’re left with not many options if Sutter (his insurance provider) continues to deny. Where is humanity? Is it all about profits for these big corporations?”
It is a “rare ethical case” where two, major (and seemingly opposed) forces are both seizing the opportunity to profit off of a vulnerable individual. Yet, I can’t help but think there are thousands of Mark Dendy’s as I write this post.
The drug companies are making as much as they can because patients such as Dendy have no choice. The insurance company (presumably companies) are willing to take anything they can get in terms of premiums and then invest the billions in premiums into higher yield financial instruments. They are reluctant to give back any of it.
The drug companies and insurance providers are wonderful at rationalization. They raise prices because their shareholders like it, and they will keep raising prices until they are confronted with strong regulatory intervention and ethical training for their executives. The insurance companies rationalize on the basis of actuarial tables and the re-investment of premiums. In other words, the limited number of patients with Wilson’s disease do not matter as much as the premiums they can collect for doing relatively little.
It is a perfect storm, and Mark Dendy is caught in it, but the storm is artificial and people-made, and the glue that holds it together is bad ethics. The perfect storm of unethical medicine.
