I’m totally in agreement with you on this. Not just prescription drugs, but healthcare in general. A friend’s child broke his arm a couple of months back and the emergency room bill for x-rays, setting the bone, and a temporary cast were >$10,000.
However…
A few years ago I was at a pharma industry conference, and the head of the FDA gave a quite compelling keynote talk addressing this very issue. He went very deep into the subject with lots of data and slides, but the take home message was this: on the average, a new drug today takes 14 years to come to market and costs $800 million.
And from within the industry, one can see that no one is rolling in the dough; it is a business like any other. You can see the sheer number of scientists and the amount of testing involved in Drug Discovery, identifying potential new drug candidates from millions of existing compounds and combinatorial modifications of compounds. A telling statistic about this stage is that there are hundreds of thousands, if not millions, of compounds evaluated, but only tens or hundreds that have made it beyond this stage in any big pharma’s lifetime.
The equipment used in Discovery is not cheap. I recall hearing that an outage in a typical high throughput screening operation might cost a company hundreds of thousands per day of down time.
Once promising candidates have been found, a great quantity of preclinical work is done, analyzing the drug safety and toxicology, identifying its metabolites, performing preclinical studies in animals to generate the reams of data needed before the FDA will allow a drug to be tested in humans.
From this point on, all work is done in facilities that must meet very rigorous standards set down by the FDA in the Seventies after they found that the honor system just wasn’t working.
These studies are very costly, and many millions will have been invested in a compound before it is ever tried in humans.
Beyond this there are clinical trials. The first phase uses a small group (20-50) of healthy volunteers, only to prove the drug’s safety. Once proven relatively safe, phase two uses ~20-300 volunteers to assess the effectiveness of the drug. In phase three, the drug is tested on a much larger randomized controlled group (300-3000), to establish the definitive assessment of the drug.
For each clinical trial, there are patients, doctors, nurses, facilities, and many supporting people. The trials have to have proper controls and be properly randomized and blinded. The data needs to be collected and evaluated.
I once heard that the supporting documentation for a New Drug Application would fill a full-sized tractor trailer, at least before the digital age.
This doesn’t exactly make me not care about high drug prices, but it does explain where much of that expense goes.
One other thought: most pharmaceutical companies are living off of the profits of a few key blockbuster drugs, but they continue to research drugs that will never have the same large number of customers. Why should they research a drug that will address a condition that only a few thousand people have when they can research a drug that addresses a condition experienced by 20 million? Blockbuster drugs carry the load for the rest.
A positive note: the scientists I know and work with all are highly driven individuals, focused on their particular part in discovering a new drug. They studied many years to be able to piece together the right molecules, perform the intensive testing, identify the metabolites that have been generated, etcetera. In other words, the great majority of the individuals in the Pharma Industry seem to be doing the work because the want to make a difference—the pay is not stellar, especially considering the years of education needed.
I imagine the same can be said of most health care professionals: the bills may be outrageous, but the ER doctor who pieced together my friend’s kid’s arm was focused on that kid and nothing more.