VICE (2013) s06e10 Episode Script

1 SHANE SMITH: This week on Vice America's soaring cost of prescription drugs.
JACKIE : A woman said I can't do it anymore.
I'm gonna go without my meds and die.
And it wasn't about the disease.
It was about the cost.
HAMILTON: I think it's important that people understand that the chemicals themselves, cost almost nothing.
SHANE: And then, the growing call for change in Puerto Rico.
ISOBEL: Were you surprised that this long after the hurricane hit that you guys still don't have electricity? (MAN SPEAKING SPANISH) CRUZ: We can no longer hide our poverty and our inequality behind beautiful palm trees, and pina coladas.
No.
It's there, raw for us to see.
(THEME MUSIC PLAYING) (CROWD SHOUTING) They're saying that right now, it's time for change.
(INDISTINCT SHOUTING) Pharmaceutical companies have made incredible advances in the field of medicine.
However, at the same time, prescription drug costs have been skyrocketing for years, dramatically outpacing other consumer products.
Recent scandals involving price gouging have led people to question whether the cost of some of our life-saving drugs should be determined by the market at all.
So we sent Hamilton Morris to investigate possible alternatives to this corporate system.
HAMILTON: I'm in a DIY, biohacker space in North America, and I'm going to be working with a chemist friend, who goes by the name, Dr.
N.
Butyl Lithium, and we're going to synthesize pyrimethamine, better known as Daraprim, better known as the drug that Martin Shkreli increased the price of in 2015.
NEWSMAN: From $18 a tablet, jumping to $750 a tablet, up 4,000% in just 24 hours.
Everybody's doing it.
In capitalism, you try to get the highest price that you can for a product.
HAMILTON: This is a drug that is accessible to really any chemist.
It's not something that only a pharmaceutical company can produce.
(VOICE DISTORTED) Should we make some sodium metal? Okay.
(DR.
N.
BUTYL SPEAKING) DR.
N.
BUTYL: There Ah, there, that's it.
There we go.
(DR.
N.
BUTYL SPEAKING) (LAUGHING) That's great.
HAMILTON: So this is the crude product, and then, this is what it looks like after recrystallization.
(DR.
N.
BUTYL SPEAKING) That's amazing.
How much does Daraprim cost as a pharmaceutical? And your pill would cost? HAMILTON: Price inflation is reaching into all corners of the drug market, even for some of the oldest treatments.
GAIL: I remember sitting in the lobby of the doctor's office.
And my parents were standing, talking with the doctor, and the doctor gave them the bad news that, "Your daughter has diabetes.
And she won't live to see 40.
" So, that's what I grew up with.
HAMILTON: Gail DeVore is one of 30 million Americans with diabetes.
Like many of them, she takes insulin every day to live.
Even though it's been around for a century, no modern generic form exists.
And the prices for some of today's most popular insulin treatments, have tripled in the last decade.
GAIL: Figuring out how to pay for it.
Figuring out what bill you're not gonna pay this month.
It's a horrible situation to have to be in.
And why we're forced to make those decisions is unacceptable.
HAMILTON: Multiple patent protections on a single drug can deter generic manufacturers from making cheaper options, leaving people like Gail virtually helpless.
This has empowered scientists working outside the pharmaceutical industry to devise alternative ways to produce insulin.
Counter Culture Labs is a biohacker space.
ANTHONY: As you can see, we have a pretty well-equipped molecular biology lab here.
India and China are doing pretty good jobs of of producing local alternatives.
And, shockingly, in America, because of the way the system works there are a lot of people in America who don't have insulin, and some of them have very tragically died, because of that.
Are there any diabetic people involved in this project? - Uh, there's me.
- You're diabetic? - Yeah.
Yeah, I have Type 1 diabetes.
- Oh, wow.
I would prefer a nice, like, artisanal insulin to, the like, mass-produced store-bought stuff.
- Soulless corporate insulin? - Yeah.
ANTHONY: In biotechnology, there are a few standard ways of making proteins.
We have a strain of yeast that has been engineered to produce proinsulin, which is a precursor protein to insulin.
The thing is, the insulin by itself is not patented.
The way you produce insulin, a lot of them are patented, so we have to find a strategy which is different enough that we don't infringe any patent.
HAMILTON: How far away do you think you are from being at a point where you could use it to treat your diabetes? Optimistically, that could be in like, three to six months.
HAMILTON: So you're in the homestretch.
ANTHONY: Yeah, we're we're getting down to it now.
HAMILTON: The open insulin project isn't alone.
There's been a long fight to democratize medicine through alternative solutions.
But the pharmaceutical landscape is vast, leaving patients with rare diseases particularly vulnerable to pharmaceutical price gouging.
Without generic competition or regulations on prices, patients have few options, but to pay if they want to survive.
Jackie Trapp has multiple myeloma, a rare form of blood cancer.
When she was diagnosed three years ago, a doctor estimated that she wouldn't live for more than five years.
As part of her treatment, she takes a drug called REVLIMID, which is shown to double the life expectancies of multiple myeloma patients, but the price of which has skyrocketed in recent years.
What is this? This is all of the things that are related to my cancer.
All of my hospital visits, the bone surveys.
I've got the meds that I take in here, and what happens with them, so that I've got all the side effects.
These are the insurance papers, the grants, the you know, all the things that I need to cobble together to get those co-pays taken care of.
And that's just the new stuff.
The first giant punch in the gut was, "You've got cancer and it's terminal.
" The second one was, um, "You're gonna go through this bone marrow transplant, and it's gonna be a horror.
" And it was, but I could get through that.
And then, the third was, "You're gonna be on REVLIMID, your maintenance therapy.
" HAMILTON: The sticker price for REVLIMID has more than doubled in the last decade.
Today, a single month's supply of 28 pills can cost as much as $22,000.
What else has gone up in that kind of dramatic increase, in that short amount of time? My income certainly hasn't.
You're gonna let me drive today? I know.
It's gonna be scary.
(JACKIE LAUGHS) JACKIE: I've always been overinsured.
Uh, we've always had a pretty big safety net.
Um, we've blown through that.
We we've blown through the bank accounts.
They're they're pretty much empty.
We had to refinance our house.
We took a home equity line of credit.
These are these are not small things to me.
I was reading a thread in my Smart Patients support group, where a woman said, "I can't do it anymore.
I'm gonna go without my meds and die.
" And it wasn't about the disease.
It was about the cost, and all of the things that she had to do to get that get that medication.
Is there any alternative? No.
(CHUCKLES) Death.
There's only one producer of REVLIMID in the United States allowed, and that's Celgene.
Some patients have toyed with the idea of getting REVLIMID from India.
There were some questions over whether or not it's as effective.
And if you were sure that you could get it from India or China, and that it was pure, would you break the law to do that? I would.
I would.
HAMILTON: Most active pharmaceutical ingredients, or APIs, aren't actually produced in the United States, but in places with cheaper manufacturing.
These APIs typically cost a small fraction of the brand-name products, and a gray market has emerged, where consumers can subvert the pharmaceutical establishment, buying unapproved generics, and pure APIs.
And the center of drug manufacturing is in China, where 20% of the world's supply of APIs are made.
I am at an API convention in Shanghai, China.
These are active pharmaceutical ingredients.
They're the drug inside the drug.
And this is where all of the different factories convene to find buyers.
Someone wrote this song before And I could tell you where it's from HAMILTON: Wow.
This is so cool.
Whoa.
- Very good.
- Just have a laugh with me Cause you know I'm borrowing By now These sounds Have already Behind each of these technical names, there is a well-known pharmaceutical product.
So, Sildenafil Citrate is Viagra.
Diazepam is the API in Valium.
Lorazepam, brand name Ativan.
This conference is full of these sorts of products.
They don't seem like much, but they're the basis of the medications that are responsible for people staying alive in the 21st century.
HAMILTON: To find the true cost of Jackie's drug, REVLIMID, we needed to find a manufacturer of its API: lenalidomide.
So I enlisted the help of an API buyer, named Keoni.
Let's say somebody wanted to purchase a kilogram of lenalidomide.
I could locate the factory for them, run third-party, independent testing, facilitate logistics.
I think I could find any chemical that is currently produced in China without an issue.
Wow.
HAMILTON: Within minutes of our asking, Keoni was able to track down a bulk supplier of lenalidomide.
- Hello? - (MAN ON PHONE SPEAKING) Yes.
Yes, I know it's patented.
How much would it be per kilogram? (MAN ON PHONE SPEAKING) KEONI: Okay.
- Do you want to go? - Yeah.
Okay.
(MAN ON PHONE SPEAKS) HAMILTON: Keoni's contact led us to a chemical plant south of Shanghai, where we were given a tour of the facility by representatives eager to sell inexpensive kilograms of pure lenalidomide.
(WOMAN SPEAKING CHINESE) Over tea, they offered me a ten-gram lenalidomide sample for analysis.
HAMILTON: I left the lenalidomide factory.
They gave me ten grams of the pure API as a gift.
HAMILTON: This quantity, offered as a free sample in China, would potentially cost cancer patients in the United States as much as $3 million at list price.
Chemical analysis showed that, not only was the sample lenalidomide, but its purity was comparable to the pharmaceutical product.
HAMILTON: It's not right to suggest that everybody get their drugs from China, but it's also not right to price gouge dying, desperate people.
It's a really complicated situation, and I don't know what the answer is, but I think it's important that people understand that the chemicals themselves, cost almost nothing.
When we reached out to Celgene for an explanation of REVLIMID's cost, they responded that the price was dictated by the value to patients, the health care system, and the overall cost of research and development.
They also sent us a study coauthored by a Celgene employee, stating that 90% of claims amount to $50 or less in out-of-pocket costs to patients.
A more recent study by the Kaiser Family Foundation could expect to pay a median annual out-of-pocket cost of $11,500 for the drug.
To better understand drug costs in general, I went straight to the industry's primary lobbying organization, known simply as Pharma.
And so, how does that happen? How does a drug become so expensive? Well, there's a lot of factors that go into developing a medicine, and ultimately, what its price is.
And I think the fact is that developing new treatments to fight diabetes, or cancer, or, you know, really tough diseases like Alzheimer's are really hard.
It takes a very long time, it's very costly, um, and the odds of success are very low.
Nine out of ten medicines that go into clinical trials never make it to the market.
Um, and yet, it's through that trial and error process that we're able to learn what it takes to ultimately develop a successful medicine to fight disease.
Right, but it's not just R&D.
If it were only R&D, I think most people could stomach that.
But then there's issues of marketing, advertising.
And maybe even just unfair price hiking out of greed, and I think that's what really makes people uncomfortable.
Well, yeah, you're right.
There's a number of factors that go into how, how medicine, you know, is ultimately priced.
Looking at how many patients does it help, um, what kind of other healthcare costs can it offset? Um, what types of how transformative is that medicine compared to other treatments on the marketplace? Ultimately, the price that's ultimately paid for a medicine is negotiated between very large powerful purchasers, and the company that made the medicine.
And as a result, medicine cost growth is actually at its lowest rate in years, which is surprising to a lot of people because it's much different than what you see in the news and read in the headlines every single day.
But if people are losing everything to pay for these treatments, it's putting a price on a human life, and no one's comfortable doing that, but that's what it is at the end of the day.
We absolutely agree that we need to do more to make sure that patients can access and afford the treatments that they need.
And unfortunately, what we've seen is a massive shift to ask the sickest patients to pay the greater share of their healthcare costs.
We've got the sick now subsidizing the healthy.
The reason you have health insurance is so that when you get sick, if you need a medical procedure or a medicine, then it's there for you.
You can get access to it.
And too often, that's not the case.
And we've got to address that.
I'm assuming buttered and panini'ed? JACKIE: Yes, please.
Okay.
JACKIE: You know, Doug and I are the kinda couple We've been together since high school.
This'll be our 30th anniversary this year.
We always thought we'd be that couple that would grow really old together, and now, we're just kind of old together.
When our friends were out spending, spending, spending, we were saving, saving, saving.
And it was all for later, and that's gone.
He's not bothering me.
'Cause he knows.
But you, softie He knows where the meat and cheese is.
(JACKIE CHUCKLES) JACKIE: To leave him bankrupt, on top of everything else, it's bad enough that we're not gonna get that 50th anniversary.
(CAT MEOWS) Hurricane Maria was one of the worst natural disasters in Puerto Rican history.
NEWSMAN: The storm is heading straight for the island.
The hurricane caused $90 billion in damage.
NEWSMAN: 4,600 people died, because of little access to power or medical care.
Now even though the island is part of the United States, the federal response was smaller, and slower than its response to mainland Hurricane Harvey barely a month earlier.
Now, this lopsided relief effort has further strained the relationship between the US and its territory.
Coming to a head in the very public stand-off, between President Trump and the mayor of San Juan.
We have done an incredible job considering there's absolutely nothing to work with.
Mr.
Trump, do your job.
Lives are at stake.
This is not about politics.
So we sent Isobel Yeung to Puerto Rico to see the political fall out that Hurricane Maria has wrought there.
(DOG BARKING) CARMEN CRUZ: It's a very painstaking job, in the sense that you really there is no way of doing this except walking through the community.
ISOBEL: Months after Hurricane Maria hit, many communities in Puerto Rico still lay in ruins.
Official figures put Maria's death toll at 64, but a recent study says it was over 4,500.
We joined the mayor of San Juan, Camen Yulin Cruz, to see some of the hundreds of thousands effected.
CRUZ: Oh, shit.
Oh, lookit here! The mark! The water got up to here.
(CRUZ SPEAKS SPANISH) (SPEAKS SPANISH) (CRUZ SPEAKS SPANISH) They didn't give her any aid.
CRUZ: It took the federal government a long time for them to realize that this was a humanitarian crisis.
Mr.
Trump was giving himself a ten.
NEWSMAN: How would you grade the White House response so far? I'd say it was a ten.
Rather than walking out here, he didn't walk.
He threw paper towels at us, and he thought that was fine.
ISOBEL: President Trump did visit Puerto Rico two weeks after the storm, but not before launching a Twitter war.
NEWSWOMAN: "Such poor leadership ability by the mayor of San Juan, and others in Puerto Rico, who are not able to get their workers to help.
" While the American people have had a big heart, President Trump has had a big mouth.
I hate to tell you, Puerto Rico, but you've thrown our budget a little out of whack.
You know, he's sort of like miscommunicator-in-chief.
Obviously, you've been pretty vocal in terms of your criticisms of the federal government's response to the hurricane, but given the scale of the devastation here, how would you rate their response? - Overall.
- (SCOFFS) Really? Shitty.
It's not a good response.
ISOBEL: I mean, they have provided aid and support though.
CRUZ: That's their duty.
Just like people in Houston, just like people in California, just like people in Florida, just like people in New York.
You help, and you help to make sure that everybody's okay.
Haiti is a few miles from us.
And Haiti received a lot more help, and they have nothing to do with the United States.
Why is it that Puerto Ricans are owed particular support and help from the US? We got the US citizenship.
We were invaded in 1898.
We receded as a spoils of war of the Spanish-American war, and we were given in 1917, the American citizenship by birth.
Just in time to be drafted for World War I.
So ever since then, Puerto Ricans have died at every conflict.
So, we have paid the ultimate price.
How has the federal government's response highlighted to you the relationship between Puerto Rico and the mainland? We are a colony of the United States.
And in a situation like this, the knowledge that we are a colony has been hiding.
'Cause we can no longer hide our poverty and our inequality, and the discrimination that takes place in Puerto Rico behind beautiful palm trees and pina coladas.
No, it's there, raw for us to see.
ISOBEL: Puerto Rico is an unincorporated territory of the United States.
Meaning its residents are American citizens, but can't vote for the President, and don't have full representation in Congress.
The US government is responsible for emergency relief there.
But its reaction to Hurricane Maria paled in comparison to its recent responses on the mainland.
The aftermath has had three major consequences.
Firstly, Puerto Rico is facing a mass exodus.
And it's projected that nearly half a million residents will have left by the end of next year.
That's nearly 15% of the entire Puerto Rican population.
NEFTALY: After Maria, there was a boom.
An incredible boom that we've never experienced before.
We had lines of, maybe, 50 people at a time.
Waiting outside to be able to get serviced inside.
Wow.
NEFTALY: This container's being filled to Orlando.
- Right.
- And this was picked up yesterday going to Orlando.
ISOBEL: In the 51 years that you've had this family business for, have you ever seen it this busy? After the hurricane, no.
All our offices were affected.
Had lines running out the door.
We didn't have enough people to take care of everybody.
We extended our hours.
Because people were driving from far away to reach us.
So, truthfully, no.
Maria really affected us.
ISOBEL: In general, social services are affected, and that's one of the reasons people are moving? NEFTALY: Still a lot of areas without power.
Without public transportation, without proper hospitals.
Every everything's affected.
ISOBEL: More than 13,000 homes across Puerto Rico are still without basic services like electricity and water.
Leaving it to the residents to take matters into their own hands.
What's the work that your uncle's doing here now? (GIRL SPEAKING SPANISH) ISOBEL: Is this what you do for a living? You work in the electricity field? (SPEAKS SPANISH) Were you surprised that this long after the hurricane hit that you guys still don't have electricity in your village? (SPEAKS SPANISH) ISOBEL: The emergency continues.
With the Puerto Rican power outage, now the second-largest in world history.
The effects are clear across the island.
Miguel.
(YAMILETTE SPEAKS SPANISH) ISOBEL: It's really quite impressive how these teachers are making due with what they've got.
There's no electricity, their school days have been cut in half.
And somehow, they're struggling on.
It's quite dark in here.
I mean, it must be even hard for these kids to read, or do basic things.
(SPEAKS SPANISH) ISOBEL: Genesis, a student here, invited us home with her.
ISOBEL: Why is it that you're leaving school so early? (GENESIS SPEAKS SPANISH) - So, this is your home? - GENESIS: Yes.
(GENESIS SPEAKING SPANISH) (GENERATOR STARTS) How do you feel about President Trump's response to what happened here in Puerto Rico? (SPEAKING SPANISH) Do you think that your kids have a future here in Puerto Rico? (SPEAKS SPANISH) ISOBEL: Discontent and frustration among those who have stayed has led to another major consequence.
Rising momentum behind the idea that Puerto Rico doesn't need the US at all.
Independence activist, Jocelyn Velazquez, gets the word out at marches like this one.
Where residents are protesting the policies of their very pro-US governor.
ISOBEL: Do you think that Hurricane Maria has impacted the level of faith that people are putting in the government? (SPEAKS SPANISH) ISOBEL: Anger towards US interference has been growing for years since Puerto Rico declared bankruptcy and Washington imposed austerity measures.
Independence supporters call the un-elected physical control board "colonialists.
" And worry it will only worsen their already 44% poverty rate.
In terms of your group, what are you after? What do you want for Puerto Rico? (SPEAKING SPANISH) But do you really think that Puerto Rico can cope without any federal funding? (SPEAKS SPANISH) ISOBEL: But while some support this idea, a recent referendum suggested that far more Puerto Ricans favor the opposite approach.
The third major consequence of the hurricane has been a renewed push for Puerto Rican statehood.
The current governor, and his new progressive party, have spearheaded the effort.
But it hasn't yet found any traction in Congress.
We sat down with a key advocate, state Senator, Carmelo Rios.
Do you believe that Hurricane Maria has been a catalyst, in driven support for statehood? Yes.
We didn't have two senators, or five Congressmen or women, to represent us.
And we had to kinda rent democracy, that's what I call it.
When you have to go out and say, "Hey! "Can you be my Congressman for a day? Can you be my champion? Can you make this happen? And can you make sure that we get fair treatment?" Why do you believe that Puerto Rico becoming its own state is the only solution to this island's woes? Well, I didn't ask for it.
I'm a citizen of the United States.
My dad served in the military.
We fight the same wars.
We pay taxes, and no representation.
I went to school in the States.
I voted for the president of the United States as a citizen.
Full rights.
Something happened 33,000 feet up in the air, when I landed in my homeland, Puerto Rico, then I lost all those rights.
So, it comes to an issue of civil rights.
Isn't that what this country is all about? In theory, in an idealistic world, yes, however it would be a huge, financial burden on the US.
Why would they agree to it? We're no different from other states that are having budget issues.
Why haven't they kicked out Detroit out of the you know, of the Union? What's at stake here if the US continues to reject the idea of Puerto Rico statehood? Well, let's say, President Trump will say it's no.
And Congress, the Republican Congress, says no.
Well, maybe, we'll probably have to organize people like we are doing right now in all the states.
I'm telling Latinos to get out and vote, and change the perspective on what politics are all about.
We are an issue that the United States has to deal with.
They cannot go around saying that they cover the world, and you deny rights to 3.
2 million.
So, that's why it's so important to define ourselves.
After Maria, we are getting the attention that we deserve in order to fix what is broken.
And say, whether we're in or we're out.