>> NOW, JUST BEFORE HIS TRIP TO THE MIDDLE EAST, PRESIDENT TRUMP ISSUED AN EXECUTIVE ORDER TO REDUCE THE COST OF PRESCRIPTION DRUGS FOR AMERICANS.

HE SAYS HE'S TAKING ACTION TO STOP BIG PHARMA CHARGING PEOPLE HIGH PRICES.

>> SOME PRESCRIPTION DRUG AND PHARMACEUTICAL PRICES WILL BE REDUCED ALMOST IMMEDIATELY, BY 50% TO 80% TO 90%.

BIG PHARMA WILL EITHER ABIDE BY THIS PRINCIPLE VOLUNTARILY, OR WE'LL USE THE POWER OF THE FEDERAL GOVERNMENT TO ENSURE THAT WE ARE PAYING THE SAME PRICES OTHER COUNTRIES.

>> BUT HOW WILL HE DO THAT AND CAN HE?

DR. JERRY AVORN FROM THE HARVARD MEDICAL SCHOOL JOINS HARI TO DISCUSS WHY THE COST OF MEDICATION IN AMERICA IS SO HIGH, AND WHAT CAN BE DONE TO FIX IT?

>> CHRISTIANE, THANK YOU.

DR. JERRY AVORN, THANK YOU FOR JOINING US.

JUST THIS PAST WEEK, THE PRESIDENT SIGNED AN EXECUTIVE ORDER, TITLED DELIVERING MOST FAVORED NATION PRESCRIPTION DRUG PRICING TO AMERICAN PATIENTS.

WHAT DID THE ORDER DIRECT?

>> WELL, THE ORDER WAS KIND OF ASPIRATIONAL IN THAT THE PRESIDENT, I THINK, DID US A FAVOR BY REMINDING EVERYONE THAT AMERICANS PAY TRICE PER CAPITA WHAT PEOPLE IN OTHER WEALTHY COUNTRIES PAY FOR THE VERY SAME DRUGS, OFTEN MADE BY THE SAME COMPANY IN THE SAME FACTORY.

BUT HIS SOLUTION WAS REALLY MORE ABOUT THINGS THAT HE HOPES COULD HAPPEN IN THE FUTURE, BUT THERE WAS NO CLEAR ROAD MAP TO EXACTLY HOW HE WAS GOING TO BE ABLE TO ACCOMPLISH THAT.

>> BACKING UP A STEP, FOR OUR AUDIENCE, WHY DO AMERICANS PAY MORE FOR THE SAME DRUG FROM THE SAME COMPANY THAN OTHER COUNTRIES?

>> THAT'S A GREAT QUESTION.

REALLY, ALONE AMONG THE WEALTHY COUNTRIES, THE UNITED STATES ALLOWS DRUG COMPANIES TO SET A PRICE AT ANY LEVEL THEY WANT, AND THEN WE ARE, AS CONSUMERS OR AS HEALTH CARE SYSTEMS OR AS PATIENTS, WE ARE OBLIGED TO PAY THAT.

VIRTUALLY EVERY OTHER WEALTHY COUNTRY IN THE WORLD HAS A PROCESS THROUGH WHICH THEY FIGURE OUT, HOW GOOD IS THIS NEW DRUG, IS IT BETTER THAN WHAT WE HAVE?

DOES IT HAVE SOIM ED ME ADVANTAGE IN EFFECTIVENESS OR SAFETY?

AND THEY DETERMINE A PRICE AS A START OF A NEGOTIATION WITH THE DRUG COMPANY AND SAY, WE THINK THIS DRUG OUGHT TO BE WORTH THAT, AND THE COMPANY COMES BACK, SAYS, IT SHOULD BE HIGHER, AND THERE'S A CONVERSATION THAT OCCURS BETWEEN THE HEALTH CARE SYSTEM AND THE MANUFACTURER, AND THAT DETERMINES WHAT THEY PAY FOR THE DRUG.

HERE, IT'S WHATEVER THE COMPANY WANTS TO CHARGE, PRETTY MUCH.

>> SO, LOOK, PART OF THIS ALMOST GETS INTO A PHILOSOPHICAL QUESTION, RIGHT?

I MEAN, IS THIS THE ROLE OF THE FREE MARKET TO SET THE PRICE?

AND THE COMPANIES WILL SAY, LOOK, I APPLIED MILLIONS OF DOLLARS INTO RESEARCH AND DEVELOPMENT, FOR EVERY DRUG THAT YOU SEE ON THE SHELF, THERE'S 15 THAT DIDN'T MAKE IT THROUGH THE TRIALS, AND THAT'S ALL SUNK COST, AND I HAVE TO GET IT BACK WITH ONE OF THESE BLOCKBUSTER DRUGS THAT MAKE IT.

WHAT'S WRONG WITH THAT THINKING?

>> WELL, THE TERM FREE MARKET IS THROWN AROUND A LOT IN THE CONTEXT OF DRUG PRICES, BUT IN FACT, IF WE REALLY DID HAVE A FREE MARKET, IT WOULD LOOK LIKE EVERY OTHER FREE MARKET THAT WE HAVE FOR ANYTHING ELSE, WHERE THERE'S A BUYER AND A SELLER, AND THE BUYER DETERMINES WHAT THEY'RE WILLING TO PAY, AND THE SELLER DETERMINES WHAT THEY'RE WILLING --WHAT THEY'RE INTERESTED IN CHARGING, AND THE TWO PARTIES KIND OF COME TOGETHER WITH A SOLUTION.

WE DO NOT HAVE A FREE MARKET IN DRUGS.

THE --IT'S NOT A FREE MARKET IF THE PERSON SELLING IT CAN DECIDE WHAT THE PRICE IS AND THE PERSON BUYING IT DOES NOT GET TO HAVE ANY SECOND THOUGHTS ABOUT THAT.

SO, YEAH, I WOULD KIND OF LIKE FOR THERE TO BE MORE OF A MARKETPLACE ENCOUNTER, NOT WHERE ONE SIDE GETS TO SAY WHAT SOMETHING COSTS AND THEN EVERYBODY HAS TO MEET THAT PRICE OR NOT GET THE DRUG.

>> THE PRESIDENT RECENTLY SAID THAT HE EXPECTS, BECAUSE OF THIS EXECUTIVE ORDER, THAT THE PRICES OF DRUGS SHOULD GO DOWN ANYWHERE FROM 50% TO 90%.

IS THAT POSSIBLE?

>> NO.

IT WOULD BE NICE IF THERE WAS A MASSIVE REDUCTION, I THINK 90% MIGHT BE UNREASONABLE.

BUT I THINK THESE ARE STATEMENTS OF GOALS.

BUT WITHOUT SOME MECHANISM FOR HOW YOU GET FROM A TO B TO C, THEY REALLY ARE JUST ASPIRATIONAL STATEMENTS RATHER THAN ANYTHING THAT LOOKS LIKE A REAL GOVERNMENTAL PLAN.

>> DOCTOR, PHARMACEUTICAL COMPANY STOCKS ACTUALLY WENT UP, AND I DON'T KNOW IF IT'S CONNECTED TO THE NEWS ABOUT THE EXECUTIVE ORDER ON DRUG PRICING, OR THE POSSIBILITY THAT TRADE RELATIONS WITH CHINA MIGHT IMPROVE, AS THESE TALKS PROGRESS, BUT A HUGE CHUNK OF OUR MEDICINES ACTUALLY COME FROM CHINA.

EXPLAIN THIS KIND OF RELATIONSHIP.

>> FOR ME, THE MOST TELLING THING WAS, AS YOU JUST SAID, BEFORE THE EXECUTIVE ORDER ABOUT DRUG PRICING, THE STOCKS OF DRUG COMPANIES WERE REALLY PRETTY LOW, AND AS SOON AS PEOPLE IN THE PHARMACEUTICAL INDUSTRY AND THEIR INVESTORS GOT TO READ WHAT THE ECUTIVE ORDER SAID, THE STOCKS SHOT UP BEYOND WHAT MOST OTHER COMPANIES DID THAT DAY.

AND I THINK WHAT THAT TELLS ME AND MOST OTHER OBSERVERS IS THAT WHEN THE RUBBER MET THE ROAD, THE INDUSTRY SAID, WHEW, THIS ACTUALLY IS SO VAGUE AND NONACTIONABLE THAT WE'RE NOT WORRIED, OUR PROFITS ARE GOING TO CONTINUE, AND THIS IS PROBABLY NOT GOING TO HAVE MUCH OF AN IMPACT.

AND, YOU KNOW, THAT'S THE VIEW OF MILLIONS OF PEOPLE WHO INVEST IN THE DRUG COMPANIES, AND WHO ARE RUNNING THE DRUG COMPANIES, BREATHING A LOUD SIGH OF RELIEF, WHICH CONFIRMS THE SENSE OF, THIS IS PROBABLY NOT GOING TO BRING ABOUT WHAT THE PRESIDENT HAD SAID IT WOULD.

>> THE CEO OF THE LOBBYING GROUP FOR THE PHARMACEUTICAL INDUSTRY SAID, AT IMPORTING FOREIGN PRICES FROM SOCIALIST COUNTRIES WOULD BE A BAD DEAL FOR AMERICAN PATIENTS AND WORKERS.

IT WOULD MEAN LESS TREATMENTS AND CURES AND WOULD JEOPARDIZE THE HUNDREDS OF MILLIONS OUR MEMBER COMPANIES ARE PLANNING TO INVEST IN AMERICA.

WHAT'S YOUR TAKE ON THAT?

>> WELL, THIS IS A VERY STANDARD TALKING POINT FROM THE INDUSTRY TRADE GROUP.

CERTAINLY DRUG COMPANIES, WHEN THEY MAKE AN IMPORTANT INNOVATION, DESERVE TO BE REWARDED REWARD ED THAN SOME HANDSOMELY FOR IT.

AND THAT IS THE CASE.

HOWEVER, AND IT'S A BIG HOWEVER, AN AWFUL LOT OF THE DEVELOPMENT OF DRUGS IS FUNDED BY THE U. S. TAXPAYER.

THE NIH, AT LEAST UNTIL RECENT MONTHS, LAYS ENORMOUSLY IMPORTANT GROUNDWORK ON THE BASIC SCIENCE RESEARCH THAT A COMPANY CAN THEN TAKE AN TRANSFORM INTO A DRUG.

AND THAT COSTS THEM, AND THEY DO A LOT OF IMPORTANT WORK TO GET THERE, BUT IT IS NOT QUITE TRUE THAT THE STORY WE HEAR FROM THE INDUSTRY TRADE GROUP AND HAVE BEEN HEARING FOR YEARS, IS ALL NEW DRUGS ARE THE PRODUCT OF INVESTMENT BY PHARMACEUTICAL COMPANIES, AND IF WE EVER DARE TO HARM THEIR PROFITS, THEY WILL STOP INVESTING AND WE'RE NOT GOING TO HAVE ANY NEW DRUGS.

THAT IS SIMPLY NOT THE CASE, AND MY COLLEAGUES AND I HAVE LOOKED AND, WHERE DO A LOT OF NEW DRUGS COME FROM?

AND WHEN YOU TRACE BACK THE PATENTS AND THE GRANTS AND IS THE PAPERS, IT DOES TURN OUT THAT AN AWFUL LOT OF THEM HAVE THEIR MOST IMPORTANT HIGH RISK ORIGINS IN PUBLIC FUNDING THROUGH THE NIH, WHICH THE COMPANIES ARE THEN FREE TO BUILD TO THE NEXT STEP, WHICH IS NOT NOTHING, BUT IT'S ALSO NOT SPENDING BILLIONS OF DOLLARS OF THEIR OWN MONEY STARTING FROM SCRATCH, BECAUSE THAT'S OFTEN, OR USUALLY, NOT THE CASE.

>> YOU WROTE A BOOK ON THIS TOPIC, IT'S PART OF WHY WE'RE HAVING THIS CONVERSATION, IT'S RETITLED "RETHINKING MEDICATIONS. "

YOU ALSO BUILT A LEADING RESEARCH CENTER AT HARVARD TO STUDY MEDICATION USE, OUTCOMES, COSTS, SO, YOU ARE EMINENTLY QUALIFIED TO DISCUSS THIS.

ONE OF THE THINGS YOU WRITE ABOUT IN THE BOOK IS, WHEN YOU THINK ABOUT THE FACT THAT THAT RISK HAS BEEN PUSHED ONTO THE PUBLIC, AND THEN THE PROFITS HAVE BEEN PUSHED OBJECT THE PRIVATE SECTOR.

EXPLAIN WHAT HAPPENS.

>> YEAH, WE HAD A POLICY FOR MANY YEARS, WHICH IS IN MANY WAYS A GOOD POLICY, THAT THE PUBLIC WOULD, THROUGH THE NIH AND OTHER KINDS OF PUBLIC PHILANTHROPY, DO MOST OF THE HIGH RISK EARLY STAGE INVESTMENT IN DEVELOPING NEW CONCEPTS FOR DRUGS.

AND, IN FACT, IT WAS INTENTIONALLY DESCRIBED AS DERISKING THE DEVELOPMENT PROCESS FOR THE DRUG COMPANIES.

AND IN NEARLY EVERY OTHER SECTOR OF THE ECONOMY, IF AN INVESTOR COMES IN EARLY FOR ANY PRODUCT, WHEN IT IS JUST A GLEAM IN SOMEONE'S EYE OR IT HAS NO CLEAR MARKET, AND THEY PUT MONEY INTO A NEW COMPANY TO GET IT OFF THE GROUND, THOSE PEOPLE ARE REWARDED HANDSOMELY IN TERMS OF SHARES OF THE COMPANY AND THE PROFITS DOWN THE ROAD.

WE HAVE EXACTLY THE OPPOSITE WITH DRUG DEVELOPMENT, WHERE THE PUBLIC HAS FOR DECADES PUT IN A LOT OF MONEY, MANY TENS OF BILLIONS OF DOLLARS A YEAR, TO DO THE HIGH RISK SO-CALLED PRECOMPETITIVE RESEARCH THAT IS REQUIRED TO DISCOVER NEW DRUGS, AND THEN AS SOON AS THERE IS SOMETHING THAT LOOKS MARKETABLE, WE SET UP A SERIES OF LAWS THAT ENABLE A COMPANY TO BUY ALL THE RIGHTS TO THESE PUBLICLY DEVELOPED PRODUCTS AND THEN OWN THEM OUTRIGHT, AND THEN BECAUSE OF OUR STRANGE WAY THAT A COMPANY CAN DETERMINE JUST WHAT IT WANTS TO CHARGE WITH NO PUSH-BACK TO SPEAK OF, THEY THEN GET TO PROFIT FROM THAT AND, IN A SENSE, THE PUBLIC GETS TO PAY TWICE.

ONCE, WHEN WE AS TAXPAYERS ARE FUNDING THE NIH, AND THEN, THE OTHER IS WHEN WE HAVE A DRUG DEVELOPED WITH THAT KIND OF FUNDING, THAT IS CHARGED TO US AS AMERICANS AT A RATE THAT IS 2 TO 4 TO 6 TIMES WHAT THE SAME COMPANY CHARGES FOR THAT SAME DRUG IN OTHER COUNTRIES.

>> SO, YOU'RE SAYING THAT --LET'S SAY THE PRIMARY RESEARCH MIGHT BE HAPPENING AT A LABORATORY THAT --AT A STATE UNIVERSITY, SAY UNIVERSITY OF INDIANA, AND THEY COME UP WITH SOME AMAZING COMBINATION OF CHEMICALS THAT MAKE SENSE, AND COULD BE A BLOCKBUSTER DRUG.

WHAT CAN THE DRUG COMPANY DO WITH, I MEAN, DOES THE PATENT SIT IN THE UNIVERSITY'S LAB?

DO THEY JUST BUY THE LAB OUT, DO THEY BUY THE RESEARCHERS?

WHAT HAPPENS?

>> THEY BUY THE LICENSE TO MAKE THE DRUG.

AND AN ACT IN 1980 MADE IT POSSIBLE AND EVEN ENCOURAGED UNIVERSITIES TO SELL OFF THE RIGHTS TO PRODUCTS, PARTICULARLY IN THIS CASE, DRUGS, THAT WERE DEVELOPED WITH PUBLIC FUNDING, AND THEN SELL IT TO THE HIGHEST BIDDER, WHO THEN OWN EXCLUSIVE RIGHTS TO PRODUCE THE DRUG.

AND IN RETHINKING MEDICATIONS, I TALK ABOUT A FANTASTIC DRUG FOR PROSTATE CANCER, IT WAS DEVELOPED 100% ON THE BASIS OF FEDERAL FUNDING TO RESEARCHERS AT UCLA, WHO DID BRILLIANT WORK, AND CAME UP WITH A WAY OF TREATING THIS CONDITION WE DIDN'T HAVE BEFORE, AND THEN THE UNIVERSITY WAS ABLE TO SELL THE RIGHTS TO MAKE THAT DRUG EXCLUSIVELY TO A SERIES OF INTERMEDIARIES FOR OVER A BILLION DOLLARS, AND NOW THOSE INTERMEDIARIES HAVE SOLD IT OFF TO PFIZER AND ANOTHER COMPANY CALLED ASTELLUS, WHICH IS A JAPANESE COMPANY, AND NOW THEY OWN THE RIGHTS TO MAKE THE DRUG, EVEN THOUGH IT WAS DISCOVERED IN A PUBLIC UNIVERSITY WITH NIH FUNDING.

AND FOR OUR --FOR OUR TROUBLE, WE GET TO PAY 2 TO 4 4 TIMES WHAT OTHER PEOPLE IN OTHER COUNTRIES PAY FOR THE SAME DRUG.

>> WHEN WE TALK ABOUT THIS PRIMARY RESEARCH THAT'S HAPPENING AT UNIVERSITIES, I'D BE REMISS IN NOT ASKING, WHAT IS THE IMPACT OF THE CUTS THAT ARE HAPPENING ACROSS THE HEALTH SECTOR THAT WE'VE SEEN OVER THE PAST FEW WEEKS?

WE HAVE HEARD UNIVERSITY LABORATORIES HAVING TO STOP SOME OF THEIR WORK, EVEN AT SCHOOLS SUCH AS YOURS AT HARVARD.

I'M ASSUMING THAT THIS ISN'T JUST HARVARD, THIS IS OTHER SCHOOLS, IF IT'S NIH FUNDING, IF IT'S FDA-RELATED FUNDING.

>> IT IS A MASSIVE DISASTER THAT IS UNFOLDING BEFORE OUR EYES.

AND HARVARD, AS YOU KNOW, HAS BEEN HIT PARTICULARLY HARD, BUT IT'S HAPPENING AT MANY RESEARCH UNIVERSITIES ALL ACROSS THE COUNTRY.

AND THE PUBLIC IS NOT GOING TO NOTICE THE EFFECTS OF THIS IN THE NEXT COUPLE OF MONTHS.

YOU KNOW, IF THERE'S CUT- BACKS AT THE FEDERAL AVIATION AGENCY AND PLANES HIT EACH OTHER, THEN THEY MAY NOTICE THAT RATHER QUICKLY.

BUT CUT-BACKS IN BIO MEDICAL RESEARCH, BECAUSE IT TAKES YEARS FOR THESE TO TURN INTO MEDICATIONS, ARE GOING TO BE NOTICED BY THE PUBLIC FOR THE FIRST TIME IN A YEAR, TWO YEARS, THREE YEARS, BECAUSE RESEARCH PROJECTS ARE LITERALLY BEING STOPPED DEAD IN THEIR TRACKS AT HARVARD MEDICAL SCHOOL.

WE'VE GOTTEN STOP WORK ORDERS.

AND THESE ARE PROJECTS ABOUT CANCER, ABOUT MENTAL ILLNESS, ABOUT ALZHEIMER'S DISEASE.

THAT HAVE NOTHING WHATEVER TO DO WITH ANYTHING THAT THE ADMINISTRATION IS CONCERNED ABOUT IN RELATION TO WHAT HAPPENED LAST YEAR, FIVE MILES AWAY, ON OUR UNDERGRAD AND GRAD CAMPUS.

THE MEDICAL SCHOOL IS IN A DIFFERENT CITY, THESE FOLKS HAVE HAD HARDLY ANYTHING TO DO WITH THE PROTESTS.

MANY OF US BELIEVE THIS IS REALLY NOT AT ALL ABOUT ANTI-SEMITISM, AND IT IS DEVASTATING A LOT OF RESEARCH, WHICH WILL NEVER COME BACK THE WAY IT WOULD HAVE BEFORE.

YOU DON'T JUST STOP A CLINICAL TRIAL OR AN ANIMAL STUDY OR A TISSUE CULTURE EXPERIMENT, AND LEAVE IT GO FOR A NUMBER OF WEEKS OR MONTHS OR MORE AND THEN JUST COME BACK AT SOME POINT IN THE INDEFINITE FUTURE AND PICK UP WHERE YOU LEFT OFF.

A LOT OF THAT WORK IS GOING TO BE LOST FOREVER.

>> IN YOUR BOOK, YOU TALK ABOUT A PHRASE, THE MEDICAL INDUSTRIAL COMPLEX.

THIS IS KIND OF HARKENING BACK TO EISENHOWER'S FAMOUS LAST SPEECH ABOUT THE MILITARY INDUSTRIAL COMPLEX.

FOR OUR AUDIENCE, EXPLAIN WHAT THIS IS, WHAT'S WRONG WITH IT?

>> SURE.

THE MEDICAL INDUSTRIAL COMPLEX WAS A TERM INVENTED BY MY LATE COLLEAGUE BUD RELMAN, THE EDITOR OF "THE NEW ENGLAND JOURNAL OF MEDICINE. "

AND HE POINTED OUT THAT JUST AS EISENHOWER WARNED US THAT WITH THE GROWTH OF THE DEFENSE INDUSTRY, THOSE PEOPLE MAY TEND TO SHAPE OUR FOREIGN POLICY IN WAYS THAT MAKE SENSE FOR THEIR OWN BENEFIT, AND THEIR COMPANY'S BENEFIT.

SIMILARLY, WE HAVE DEVELOPED OVER THE DECADES A VERY POWERFUL MEDICAL INDUSTRY, NOT JUST DRUG COMPANIES, BUT ALSO PRIVATE EQUITY FIRMS THAT ARE GETTING INTO THE BUSINESS, HOSPITALS, AND EVEN NONPROFIT HOSPITALS HAVE ENORMOUS POWER AND WEALTH AND CLOUT, AND THAT TENDS TO SHAPE OUR HEALTH POLICY, MUCH AS THE DEFENSE INDUSTRY HAS COME AND STILL, IN MY VIEW, DOES SHAPE OUR FOREIGN POLICY.

AND DR. RELMAN WARNED, AND THIS GOES BACK 20-PLUS YEARS, WARNED US ABOUT THE FACT THAT WE NEED TO HAVE POLICIES IN MEDICINE THAT ARE DRIVEN ONLY BY SCIENCE AND BY THE NEEDS OF PATIENTS, NOT BY THE NEEDS OF DRUG COMPANIES.

AGAIN, DRUG COMPANIES OR HOSPITAL COMPANIES OR MEDICAL CENTERS THAT MAY EVEN FLY UNDER THE NONPROFIT BANNER, THE BUSINESSES ARE SO IMPORTANT AND LUCRATIVE AND ENORMOUS THAT THEY TEND TO SHAPE HOW WE THINK ABOUT DELIVERING HEALTH CARE WAY MORE THAN THEY SHOULD.

>> YOU ALSO POINT OUT THAT THE REGULATOR THAT MOST AMERICANS THINK IS THEIR KIND OF LINE OF DEFENSE, THE FDA, HAS BEEN STRUCTURALLY CHANGED OVER TIME, AND MOST PEOPLE DON'T KNOW THAT THE PHARMACEUTICAL INDUSTRY IS PART OF, WELL, THE SALARY OF THE FDA INSPECTORS, THE FEW THAT ARE LEFT.

>> EXACTLY RIGHT.

I THINK A LOT OF PATIENTS AND MOST DOCTORS BELIEVE THAT THE FDA TESTS DRUGS AND IT DOES SO IN AN UNBIASED WAY AND IT'S IMPORTANT, I THINK, FOR VIEWERS TO UNDERSTAND, THE FDA DOESN'T REALLY TEST DRUGS TO SEE IF THEY WORK.

THOSE STUDIES ARE PRIMARILY DONE BY THE COMPANIES THAT MAKE THEM, AND OFTEN THEY WILL STRUCTURE THOSE STUDIES IN A WAY TO KIND OF WIN APPROVAL, YOU KNOW, THEY'RE ALLOWED TO TEST THEIR DRUG AGAINST A PLACEBO, AND MEASURE A LAB TEST OUTCOME INSTEAD OF A PATIENT BENEFIT OUTCOME, AND IF THEY'RE BETTER THAN NOTHING AT CHANGING A LAB TEST, THEN THEY GOT THEMSELVES AN FDA APPROVAL.

AND FDA HAS NOT REALLY BEEN AS ASTUTE IN FOLLOWING UP ON A LOT OF THOSE APPROVALS TO ASK THE QUESTION THAT THEY'RE LEGALLY MANDATED TO ASK, WHICH IS, IT'S NICE THAT YOU CHANGED THAT LAB TEST SLIGHTLY, BUT DID YOUR DRUG HELP THE PATIENTS?

AND WE'VE GOT EXAMPLES THAT I REFER TO IN THE BOOK, FROM MUSCULAR DISFREE IF I TO ALZHEIMER'S DDZ, WHERE COMPANIES HAVE MANAGED TO KIND OF USE THAT TECHNICALITY AND SAY, LOOK, WE MADE A LAB TEST BETTER, AND FAILED TO SHOW THAT THEY MADE THE PATIENTS BETTER.

THEY THEN NOT COME BACK AND DONE THE FOLLOWUP STUDIES THAT THEY ARE SUPPOSED TO BE REQUIRED TO DO, AND AS A RESULT, THE DRUGS ARE ON THE MARKET, CHARGING FULL FREIGHT, SOMETIMES HUNDREDS OF THOUSANDS OF DOLLARS A YEAR, IN THE CASE OF SOME OF THE MUSCULAR DYSTROPHY DRUGS THAT I WRITE ABOUT, AND THERE'S REALLY NO ACCOUNTABILITY.

AND WE NEED TO GET BETTER AT FIXING THAT.

>> SO, IN THE BOOK, YOU ALSO LAY OUT KIND OF PRESCRIPTIONS FOR SYSTEMIC OVERHAUL.

WHAT WOULD YOU BOIL THOSE DOWN TO?

>> YEAH, I TRIED NOT TO BE ALL CRITICISM AND DOOM AND GLOOM.

I THINK THERE ARE SOME VERY ACTIONABLE THINGS THAT I TRIED TO RELATE THAT WE CAN DO BOTH IN TERMS OF POLICY, BUT ALSO THAT PATIENTS CAN DO THEMSELVES WHEN THEY'RE WITH THEIR DOCTOR.

YOU KNOW, WHAT IS THIS DRUG FOR, WHY ARE WE USING IT, IS THERE A GENERIC?

WILL I BE ABLE TO AFFORD IT?

HOW DO I TAKE IT?

YOU KNOW, THINGS WHICH YOU CAN KIND OF TAKE WITH YOU TO THE DOCTOR, BUT MORE IMPORTANTLY, THERE'S ALSO PRETTY STRAIGHTFORWARD POLICY FIXES THAT WE CAN ENGAGE IN.

REFORMING OUR PATENT SYSTEM TO DEAL WITH THESE KIND OF MEANINGLESS THINGS.

DOING WHAT ALL THE OTHER COUNTRIES THAT PRESIDENT TRUMP THIS WEEK WAS SO MUCH IN AWE OF THAT GET SUCH BETTER DRUG PRICES, IT'S NOT BECAUSE THEY'RE SOCIALIST COUNTRIES, IT'S BECAUSE THEY HAVE THIS SYSTEMATIC EVALUATION OF, HOW GOOD IS THIS NEW DRUG, IS IT BETTER THAN WHAT WE'VE GOT?

WHAT ARE WE WILLING TO PAY MORE FOR IT?

EXACTLY THE WAY CONSUMERS AND GOVERNMENTS AND CORPORATIONS MAKE ALL OF THEIR OTHER PURCHASING DECISIONS, BECAUSE, YOU KNOW, WE CAN'T GO ON PAYING TWICE AS MUCH AS EVERY OTHER COUNTRY FOR OUR DRUGS.

>> DR. JERRY AVORN, A PROFESSOR AT HARVARD MEDICAL SCHOOL, AND AUTHOR OF "RETHINKING MEDICATION: TRUTH, POWER, AND THE DRUGS YOU CAN TAKE.

THANK YOU FOR HAVING ME.

I'VE ENJOYED IT.