PBS高端访谈:美国居高不下的药物价格

JUDY WOODRUFF: During the 2016 election campaign, President Trump¹ repeatedly pledged to bring down prescription² drug prices. And his administration has taken some steps in recent months, including trying to increase the number of generic³, or non-brand name products, available to substitute for high-cost drugs. They have also lowered the price Medicare pays initially⁴ for some medications. Feeling political pressure, some drugmakers have announced temporary price freezes. But a new analysis by the Associated Press finds there have been far more price hikes than cuts. While price increases did slow somewhat, the analysis found there have been 96 price hikes for every price cut in the first seven months of this year. Journalist Elisabeth Rosenthal watches health care costs. She's the author of a book on the subject called An American Sickness, and she's the editor in chief of Kaiser Health News. Elisabeth Rosenthal, welcome to the NewsHour.

ELISABETH ROSENTHAL, Editor in Chief, Kaiser Health News: Thank you.

JUDY WOODRUFF: So, in sum, what is this AP analysis telling us?

ELISABETH ROSENTHAL: Well, it's showing us how hard it is to bring down drug prices, and that the president, despite his narrative⁵ of saying these companies are getting away with murder, isn't making a whole lot of headway. I mean, that's pretty extraordinary, 96 up to one down.

JUDY WOODRUFF: But there, they do show there is some slowing in the rate of increase. Is that right?

ELISABETH ROSENTHAL: Well, they do. But when you're saying slowing in the rate of increase, that means they're still going up. And these prices are already for many drugs, for an extraordinary number of Americans, unaffordable. So they shouldn't just be going up at a slower pace. I think we really need them to come down.

JUDY WOODRUFF: Now, we know what, Elisabeth Rosenthal, we know what the drug companies say. They say, we need this additional money because we're doing experiments. We're trying to come up with new drugs to solve other problems, to cure other illnesses. And that costs money.

ELISABETH ROSENTHAL: Yes, they say that. And that is true. But I think what we see, which is extraordinary to me, is that, over time, the same exact drug, a vaccine⁶ for pneumococcal pneumonia⁷, a cancer drug, will go up, will double, will triple over time. Now, that isn't how any real market works, right? When things get older, the prices go down, because, hey, you have recouped your investment with this high price at the beginning. So why should it keep going up? That defies economic logic⁸. It defies health care logic, and, frankly⁹, it defies the drug companies' own logic.

JUDY WOODRUFF: So, when the president of the United States says, as President Trump said in May, he said he would be announcing massive voluntary drug price cuts within two weeks, what actually happened after that?

ELISABETH ROSENTHAL: Well, a bunch of companies started off just doing business as usual and announced price hikes. Then President Trump came back and said, shamed them. And shaming works a little bit. So there's a whole bunch of companies, probably half-a-dozen, that said, OK, we're not going to do price hikes this year. But, hey, we're going to pause. But what happens next year? No promises there. And, as I said, we're talking about price hikes of old drugs now. We're not talking about a new fabulous¹⁰ cancer treatment. We're talking about an annual 10 percent price hike on an old drug. And I don't think we have a good explanation for why that has occurred.

JUDY WOODRUFF: Is, as somebody who has studied this for a long time, what do you think it takes? I mean, is it, it's going to take? Are we talking political pressure from a president or somebody else? What does it take?

ELISABETH ROSENTHAL: Well, I don't think shaming enough is going to make it happen, right? So I think that the president proposed some ideas, like allowing greater generic competition, allowing biosimilars, which are complex molecules¹¹, to be done on a generic, basically, a generic basis. But that only affects a small number of drugs, maybe 10 to 15 right now. And the generics¹² we have seen in this country don't lower prices. Look, the EpiPen, there was a brouhaha. It was $700. A generic meant it was $350. P.S., an EpiPen in 2007 was $100. So we're starting with this crazy high price point. So what will it take? I can tell you what other countries have found, is that it takes some sort of price-setting, some kind of national price negotiation¹³.

JUDY WOODRUFF: Government action.

ELISABETH ROSENTHAL: Yes, basically, large-scale government action. I mean, maybe when Amazon and J.P. Morgan Chase and Berkshire Hathaway get together, they will have that kind of clout¹⁴. But whether the market and these market manipulations can do it, I think Secretary Azar today said you need to give it time. I mean, my feeling is, yes, maybe some of them would work over time. But we're running out of time here. People are hurting right now. And these prices are extreme ordinarily high right now.

JUDY WOODRUFF: The other thing we see about drug pricing is, frankly, a lack of transparency. We don't see what it is inside these companies that is leading to these price increases, do we?

ELISABETH ROSENTHAL: No. And I think a number of politicians have called for that. A number of states are calling for that, which is interesting.

There's a lot of action at the state level right now, where a state is saying, if you want to raise prices, OK, explain why you need to do this.

We want a justification¹⁵. So far, at a federal level, it's been kind of willy-nilly. Why do we raise prices? Well, I mean, economists¹⁶ would say because they can.

JUDY WOODRUFF: But it sounds like you're saying, in the near term, we're not going to see much change?

ELISABETH ROSENTHAL: Well, slow change. But we find in Kaiser Family Foundation surveys 80 percent of people want the government to do something; 40 percent say they're worried that they can't afford their medicines. We see young people dying because they can't afford insulin now. I think this is an acute problem, so a long-term solution is not going to really be enough right now. And I hope voters realize that and start putting on the political pressure, because I think we do need a solution.

JUDY WOODRUFF: Well, we're paying attention now. And let's hope a lot more people pay attention.

ELISABETH ROSENTHAL: I hope so. Thanks.

JUDY WOODRUFF: Elisabeth Rosenthal, thank you very much, Kaiser Health News.

ELISABETH ROSENTHAL: Thanks.

朱迪·伍德拉夫：2016年竞选总统期间，特朗普总统曾多次承诺会降低处方药的价格。最近几个月，特朗普政府确实采取了一些措施，比如竭力给非专利药物以及非品牌类药物增产，从而替代成本高昂的药物。此外，特朗普政府还降低了美国老年人医疗保险制度支付一些类型药物的开价。在感受到了政治层面的压力后，一些制药商宣布会暂时进行价格冻结。但美联社的一项最新研究表明，提价比降价要多的多。虽然提价的速度有所减缓，但这项分析发现，在今年的前7个月里，每降价一次，就对应着提价96次。记者伊丽莎白·罗森塔尔跟进了医疗成本一事。作家伊丽莎白写了一本书，名为《美国病》，她同时也是凯撒健康新闻的主编。伊丽莎白·罗森塔尔，欢迎您参加本期的《新闻一小时》。

伊丽莎白·罗森塔尔，主编，凯撒健康新闻：谢谢您。

朱迪·伍德拉夫：那么，您能否谈谈，从美联社的这项分析中，我们能了解到什么吗？

伊丽莎白·罗森塔尔：这项分析告诉我们降低药物价格并非易事，而特朗普总统虽然说制药公司已经不再干谋财害命的事儿，但事情并没有多少进展。准确的说，是每降价一次，就要涨价96次。

朱迪·伍德拉夫：但该分析确实也表明一件事，那就是涨价的速率降低了，对吗？

伊丽莎白·罗森塔尔：这倒是没错，但是当我们提到涨价速率这种字眼的时候，就意味着药物的价格还是在不断上涨的。很多药物的价格对于很多美国人来说已经是天价了。光是放慢涨价速率是不够的。我认为，我们依然需要价格切切实实地下降。

朱迪·伍德拉夫：伊丽莎白女士，我们都知道制药公司的说法。制药公司都说，我们需要加价的那笔资金，因为我们要做实验。我们要竭力研制新的药物来解决其他的很多问题并治疗其他类型的疾病，这些都是成本。

伊丽莎白·罗森塔尔：没错，他们确实是这样说的，所言也不假。但我认为，我们都有目共睹的一件事，也是我本人触目惊心的一件事，就是不管过了多久，同样一种药，比如肺炎球菌性肺炎的疫苗或者抗癌药物，其价格一直都在上涨，甚至翻番，乃至三倍。这就不对了吧，因为没有哪个市场是这样运作的，对吧？按理来说，旧事物价格应该下降，因为一开始就已经通过高价弥补了研制和实验上的投资了呀。那么，凭什么还要继续涨价呢？这是违背经济逻辑吗？这违背了医疗逻辑，而且，坦白讲，也违背了制药公司自己的运作逻辑。

朱迪·伍德拉夫：所以，当特朗普总统又翻出来5月的话重新说了一遍之后——他说他会在2周内宣布对进行大幅度自愿降低药物价格——情况会有实质性的改变吗？

伊丽莎白·罗森塔尔：有很多公司还是像往常一样运营，还宣布会抬高价格。然后特朗普总统又会回过头来说，这些人真可耻之类的话。但这种话一点作用都没有。所以有很多公司，大概有十几个公司都说，好的，我们今年不会涨价了。但这时候我们会愣住，心想：明年会有什么幺蛾子呢？我不想再听什么承诺了。而且，如我前面所述，我们现在讨论的老药的涨价问题啊。我们讨论的又不是什么治疗癌症的新型酷炫药物。我们讨论的是一种每年都会涨价10%的老药好吗？所以，我觉得，目前还没有任何人对已经发生的情况做出合理的解释。

朱迪·伍德拉夫：有些人研究这个问题已经很久了，您认为要改变这种情况需要付出什么努力呢？或者说，是否要付出什么代价呢？是否需要总统或者什么人施加政治压力呢？需要付出什么代价呢？

伊丽莎白·罗森塔尔：首先，我觉得羞不羞耻并不会产生什么效果，对吧？所以，我觉得特朗普提出了一些观点，比如让非专利药物市场有更激烈的竞争，允许分子更为复杂的生物仿制药进入市场，也就是从通用药上入手。但这只会让少数药物价格发生改变，大概10-15种吧。而美国的大多数通用药都不会降价的。比如，炒上天的肾上腺素是700美元，如果以通用药的出售，就是350美元。顺便补一句，2007年的时候，肾上腺素才100美元。所以，如果要从这种天价开始入手的话，代价自然是非常大了。我还想补充一下其他国家的发现成果，即需要定价，需要国家层面的价格谈判。

朱迪·伍德拉夫：也就是政府层面的举措咯。

伊丽莎白·罗森塔尔：没错，是大范围的政府举措，即亚马逊和摩根大通、伯克希尔·哈撒韦公司合力，才能有这样的影响力。但市场以及这些操纵市场的作用力是否能成事，我觉得现任卫生部部长阿扎尔说的有道理，即需要一段时间才可以完成。我想说，我的感觉是：没错，或许有些做法需要时间才能发挥效用。但我们现在没那么多时间了。人们备受药物价格居高不下之苦。而且价格现在已经奇高无比了。

朱迪·伍德拉夫：关于药品定价的问题，我们还发现一个现象，那就是缺乏透明度。我们从这些制药公司内部是探究出他们制定如此高价的原因，不是吗？

伊丽莎白·罗森塔尔：是的。而且我认为很多政客都要求过这一点。很多州也在要求，这就很有意思了。现在，在州的层面上已经采取了很多行动，比如有的州会说，想提价？可以啊，那解释一下原因吧。我们想要合理的解释。目前为止，联邦政府的层面还是有些犹豫不决。为什么要提价呢？我觉得，经济学家会说，因为他们有这个能力提价。

朱迪·伍德拉夫：但听您的意思，您觉得短期内是不会有很大改变的，是吗？

伊丽莎白·罗森塔尔：会有改变，但会很慢。不过，我们从凯泽家庭基金会的调查中得知，80%的受访者都希望政府能有所行动。40%的人表示他们很担心无法支付高昂的医药费。我们看到有年轻人因为付不起胰岛素的费用而死去。我觉得是这是一个紧迫的问题，所以长期的解决方案对于现在来说是不够的。我希望选民们能意识到从政治上施压的重要性，并开始行动，因为我觉得我们确实需要一个解决方案。

朱迪·伍德拉夫：我们现在正在重视这个问题，我们也希望有越来越多的人能关注这个问题。

伊丽莎白·罗森塔尔：我也希望如此。谢谢大家。

朱迪·伍德拉夫：伊丽莎白·罗森塔尔，非常感谢您的到来以及凯撒健康新闻。

伊丽莎白·罗森塔尔：谢谢。

1 trump   

n.王牌，法宝；v.打出王牌，吹喇叭

参考例句：

• He was never able to trump up the courage to have a showdown.他始终鼓不起勇气摊牌。
• The coach saved his star player for a trump card.教练保留他的明星选手，作为他的王牌。

2 prescription   

n.处方，开药；指示，规定

参考例句：

• The physician made a prescription against sea- sickness for him.医生给他开了个治晕船的药方。
• The drug is available on prescription only.这种药只能凭处方购买。

3 generic   

adj.一般的，普通的，共有的

参考例句：

• I usually buy generic clothes instead of name brands.我通常买普通的衣服，不买名牌。
• The generic woman appears to have an extraordinary faculty for swallowing the individual.一般妇女在婚后似乎有特别突出的抑制个性的能力。

4 initially   

adv.最初，开始

参考例句：

• The ban was initially opposed by the US.这一禁令首先遭到美国的反对。
• Feathers initially developed from insect scales.羽毛最初由昆虫的翅瓣演化而来。

5 narrative   

n.叙述，故事；adj.叙事的，故事体的

参考例句：

• He was a writer of great narrative power.他是一位颇有记述能力的作家。
• Neither author was very strong on narrative.两个作者都不是很善于讲故事。

6 vaccine   

n.牛痘苗，疫苗；adj.牛痘的，疫苗的

参考例句：

• The polio vaccine has saved millions of lives.脊髓灰质炎疫苗挽救了数以百万计的生命。
• She takes a vaccine against influenza every fall.她每年秋季接种流感疫苗。

7 pneumonia   

n.肺炎

参考例句：

• Cage was struck with pneumonia in her youth.凯奇年轻时得过肺炎。
• Pneumonia carried him off last week.肺炎上星期夺去了他的生命。

8 logic   

n.逻辑(学)；逻辑性

参考例句：

• What sort of logic is that?这是什么逻辑？
• I don't follow the logic of your argument.我不明白你的论点逻辑性何在。

9 frankly   

adv.坦白地，直率地；坦率地说

参考例句：

• To speak frankly, I don't like the idea at all.老实说，我一点也不赞成这个主意。
• Frankly speaking, I'm not opposed to reform.坦率地说，我不反对改革。

10 fabulous   

adj.极好的；极为巨大的；寓言中的，传说中的

参考例句：

• We had a fabulous time at the party.我们在晚会上玩得很痛快。
• This is a fabulous sum of money.这是一笔巨款。

11 molecules   

分子( molecule的名词复数 )

参考例句：

• The structure of molecules can be seen under an electron microscope. 分子的结构可在电子显微镜下观察到。
• Inside the reactor the large molecules are cracked into smaller molecules. 在反应堆里，大分子裂变为小分子。

12 generics   

n.（产品，尤指药物 ）无厂家商标的，无商标的( generic的名词复数 )

参考例句：

• Pfizer has set up an in-house division to handle such generics. Pfizer已经建立了一个内部机构来处理这些学名药。 来自互联网
• Payers are being more pushy about getting patients to take generics. 药物费用的支付者更倾向于让病人使用非专利药。 来自互联网

13 negotiation   

n.谈判，协商

参考例句：

• They closed the deal in sugar after a week of negotiation.经过一星期的谈判，他们的食糖生意成交了。
• The negotiation dragged on until July.谈判一直拖到7月份。

14 clout   

n.用手猛击；权力，影响力

参考例句：

• The queen may have privilege but she has no real political clout.女王有特权，但无真正的政治影响力。
• He gave the little boy a clout on the head.他在那小男孩的头部打了一下。

15 justification   

n.正当的理由；辩解的理由

参考例句：

• There's no justification for dividing the company into smaller units. 没有理由把公司划分成小单位。
• In the young there is a justification for this feeling. 在年轻人中有这种感觉是有理由的。

16 economists   

n.经济学家，经济专家( economist的名词复数 )

参考例句：

• The sudden rise in share prices has confounded economists. 股价的突然上涨使经济学家大惑不解。
• Foreign bankers and economists cautiously welcomed the minister's initiative. 外国银行家和经济学家对部长的倡议反应谨慎。 来自《简明英汉词典》