San Mateo County Physician

A publication of the SAN MATEO COUNTY MEDICAL ASSOCIATION

| July / August 2017

S A N M AT E O C O U N T Y

PHYSICIAN

Alexander Ding, MD 201 7-2018 SMCMA President

INSIDE: Annual Awards Gala | Payor Issues | Big Pharma

LEGENDARY

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Editorial Committee Uli Chettipally, MD, Chair; Judy Chang, MD; Russ Granich, MD; Sharon Clark, MD; D. Gurpreet Padam, MD Sue U. Malone, Executive Director

SMCMA Leadership

S A N M AT E O C O U N T Y

PHYSICIAN

Alexander Ding, MD | President Sara Whitehead, MD | President-Elect Richard Moore, MD | Secretary-Treasurer Russ Granich, MD | Immediate Past President

July/August 2017 • Volume 6, Issue 7

Janet Chaikind, MD Uli Chettipally, MD Aruna Chinnakotla, MD Mamatha Chivukula, MD

Columns

Paul Jemelian, MD

President’s Message: Standing Up For Our Most Vulnerable Patients . . . . . . 2

Alex Lakowsky, MD

Alexander Ding, MD

Joshua Parker, MD Xiushui (Mike) Ren, MD Brian Tang, MD Dirk Baumann, MD | AMA Alternate Delgate Scott A. Morrow, MD | Health Officer, County of San Mateo

Editorial/Advertising Inquiries San Mateo County Physician is published ten times per year by the San Mateo County Medical Association. Opinions expressed by authors are their own and not necessarily those of the SMCMA. San Mateo County Physician reserves the right to edit contributions for clarity and length, as well as to reject any material submitted.

Acceptance and publication of advertising does not constitute approval or endorsement by the San Mateo County Medical Association of products or services advertised.

For more information, contact the managing editor at (650) 312-1663 or smcma@smcma.org.

Visit our website at smcma.org, like us at facebook.com/smcma, and follow us at twitter.com/SMCMedAssoc.

Feature Articles Photo album from the 2017 SMCMA annual meeting . . . . . . . . . . . . . . . 4 Photos by Scott Bushman Photography

Dr. Alexander Ding, 2017-18 president of the San Mateo County Medical Association . . . . . . . . . . . . . . . . . . . . . . . . 8 Bronwyn Hogan

Payor Issues . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10 Barbara Weissman, MD

Guest Commentary: They’re Getting Away with Murder . . . . . . . . . . . . . . . . . . . . . . . . . . 12 Babak Nouhi, MSII

Of Interest New SMCMA Members . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 30- and 40-Year Honorees . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 Member updates . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7

Cover photo by Kate Kelly Photography

© 2017 San Mateo County Medical Association

President’s MESSAGE

Standing up for our most vulnerable patients

A

t the time of this writing, the Senate had just released its draft legislation to repeal and replace the Affordable Care Act, entitled “The Better Care Reconciliation Act of 2017” to follow the House’s

similarly structured version “The American Health Care Act of 2017.”

The Congressional Budget Office estimated that within 10 years, 22 million fewer people would have health insurance, up to $772 billion would be cut from Medicaid, and $408 billion would be reduced in tax credits and subsidies, somewhat attenuated compared with the House version. Due to significant pushback, a self-imposed deadline of the July 4th recess was delayed.

Some of the key policy items in the BCRA include:

Alexander Ding, MD President

This legislation goes counter to many of the principles laid out by various prominent medical organizations, including the CMA and AMA.”

Repeal of the individual mandate and employer mandate Phase-out of the federal match for Medicaid expansion Ending Medicaid funding entitlement for low-income children, pregnant women, the elderly, and disabled Limits to federal obligation by allowing states to choose a per-capita cap or a block grant Caps on Medicaid spending growth below medical inflation rate Reductions in tax credits Allowances in the individual market to increase charges to the elderly versus those younger Elimination of current ACA public health funding Ending multiple taxes, including on high-earners, Cadillac tax on high-end health benefits, and the medical device tax Elimination of enhanced essential health benefits provisions, mental health and substance use disorder treatments Marketplace stabilization fund to address coverage and access disruptions of $123 billion

The overall broad-brush framework of this legislation seeks to limit the federal government’s financial exposure to the safety-net infrastructure and devolves safety-net funding mechanisms to the state governments, while reducing the requirements for coverage guarantee and mitigating ACA taxes.

This legislation goes counter to many of the principles laid out by various prominent medical organizations, including the CMA and AMA. These include

2 SAN MATEO COUNTY PHYSICIAN | JULY–AUGUST 2017

Welcome NEW MEMBERS!

ensuring that people currently with health insurance not lose access to

Mark Albers, MD

William Babbitt, MD

Elizabeth Chang MD

Cynthia Cooper, MD

*Internal Medicine Redwood City

*Pediatrics Daly City

Internal Medicine Redwood City

* Obstetrics/Gynecology S. San Francisco

affordable, quality coverage; sufficient funding of Medicaid and other safety-net programs; and long-term stability of the individual market.

In California, greater than a quarter of residents are covered

by Medicaid with more than 3.5 million adults joining since the

Alfredo Dela Rosa, MD Meghan Hession, MD

Pragya Jain, MD

Roger Kao, MD

Oral Surgery Daly City

*Dermatology San Mateo

*Internal Medicine Belmont

*Gastroenterology San Carlos

Joann Laiprasert, MD

Joseph Marquis, MD

Theresa Nguyen, MD

Shaneen Oshtory, MD

* Obstetrics/Gynecology S. San Francisco

Internal Medicine San Mateo

Ophthalmology Redwood City

Dermatology San Mateo

Jeffrey Peterson, MD *Emergency Medicine Redwood City

Matthew Riley, MD

Carlos Rivas, MD

Dana Rosca, MD

Internal Medicine S. San Francisco

*Internal Medicine Redwood City

*Psychiatry Daly City

Jason Sun, MD

Hao Tran MD

*Oncology Redwood City

*Pediatrics Daly City

ACA expansion. Medi-Cal (California’s Medicaid program) patients are among our population’s most vulnerable, and include low-income families, and people with disabilities. Medi-Cal patients already have significant access challenges to a provider willing to see them, given the reimbursements rates are among the lowest in the country (48th in the nation). This legislation would not only jeopardize the health of this population with worsened access to care but also potentially worsen reimbursement due to lowering of rates or people falling back into uninsured status.

As a community of physicians, we should stand with our colleagues in the CMA and AMA in protecting the most vulnerable of our patients and oppose the Congress’s most recent attempt at health system reform.

Nisha Samdesara, MD Rebecca Schane, MD

*Internal Medicine Redwood City

*Internal Medicine S. San Francisco

*Board certified

JULY–AUGUST 2017 | SAN MATEO COUNTY PHYSICIAN 3

2017

P

Drs. Albert Wetter, Brenda Russell and Michael Norris

hysicians and influential stakeholders in the medical community joined in SMCMA’s Membership Gala festivities on June 16th, held at the Hillsborough Racquet Club. The event marked our 112th year as the only physician organization in San Mateo County that advocates for physicians across all specialties and their patients.

Attendees networked with colleagues, met SMCMA leaders, met with

California Senator Jerry Hill and legislative aide Brian Perkins, who was present on behalf of Congresswoman Jackie Speier, and our guest, Jan Wahl, San Francisco’s local movie critic.

The evening included the installation of Alex Ding, MD as the 2017-18

Drs. Christine Allen, Bruce Allen, Kimberly Dalal and Andrea Metkus

SMCMA President, acknowledgement of the contributions of Russ Granich, outgoing President for 2016-17, and a tribute to SMCMA members who have been members of the medical association for 40 and 30 years (photos on following page). We would also like to thank our members who attended the Gala, our sponsors, and special guests.

All photos courtesy of Scott Buschman Photography. All rights reserved. (http://www.buschmaphoto.com/)

Drs. Vincent Mason and Alex Ding

4 SAN MATEO COUNTY PHYSICIAN | JULY–AUGUST 2017

ANNUAL MEMBERSHIP

Gala Gala

Celebrating 112 Years of Physician Advocacy and Camaraderie

EVENT SPONSORS

Gold Sponsor Mills-Peninsula Medical Center

Silver Sponsors Dr. Brian Tang and Cheryl Pulanco

Drs. Bruce Allen and William Tatomer

NORCAL Mutual Insurance Company Gilead Sciences Kaiser Permanente South San Francisco Sequoia Hospital Stanford Healthcare

Bronze Sponsors Drs. Randolph Wong, Bruce Allen and Albert Wetter

Dr. Roy Deffenbach and Sharon Deffenbach

Cooperative of American Physicians First Republic Bank Mercer The Magnolia of Millbrae

Thank You! Drs.Vincent Mason and Alex Ding, Kimberly Ding, and Dr. George Prozan, seated in background

Drs. Russ Granich and Sara Whitehead JULY–AUGUST 2017

SAN MATEO COUNTY PHYSICIAN 5

ANNUAL MEMBERSHIP GALA

Honorees . .

Senator Jerry Hill presents to outgoing President, Dr. Russ Granich, a commendation from the California Legislature recognizing his significant contribution to SMCMA and his service to the members and community during his tenure.

Dr. Russ Granich and Senator Jerry Hill

SMCMA President Russ Granich presented gifts to thirty- and forty-year members of SMCMA:

40 years Thomas Hoffman, MD (not pictured)

30 years Allan Bernstein, MD Michelle Caughey, MD Robert Gamburd, MD John Hoff, MD (pictured at right) Sherna Madan, MD (pictured at right) Felix Millhouse, MD Chris Mochizuki, MD Michael Norris, MD (pictured below) Dale Ritzo, MD Joel Saal, MD Mark Sontag, MD (pictured below) James Torosis, MD (pictured below) Richard Young, MD

Dr. Michael Norris

Dr. John Hoff

Dr. Sherna Maden

Dr. Mark Sontag

Dr. James Torosis

6 SAN MATEO COUNTY PHYSICIAN | JULY–AUGUST 2017

...........

SMCMA’s highest honor, the Distinguished Service Award, was presented to Bruce Allen, MD, a general surgeon with Palo Alto Medical Foundation. A graduate of Stanford in 1974, he has more than 43 years of diverse experiences in general surgery. Dr. Allen received the award for his devotion to patient care and the medical needs of the community. The award was presented by Dirk Baumann, MD, a vascular surgeon who was recruited by Dr. Allen to practice in San Mateo and served as his mentor. A profile on Dr. Allen’s career will appear in the September issue of the San Mateo County Physician.

Retirement

Drs. Bruce Allen and Dirk Baumann

The following members have recently retired from practice: Cameron Emmott, MD

Adil Jadallah, MD

Irving Katz, MD

John Meharg, MD

Sturart Viess, MD

Michael Wick, MD

In Memoriam

Michael Cowan, MD • February 5, 2017 Lisa Dyer, MD • March 25, 2017

Morris Kace, MD • April 9, 2017 Raymond Kauffman, MD • January 16, 2017 Gerald Olson, MD • December 28, 2016 Virginia Shahrok, MD • April 27, 2017 E. James Young, MD • March 8, 2017

JULY–AUGUST 2017 | SAN MATEO COUNTY PHYSICIAN 7

Dr. Alex Ding 2017–2018 President of the San Mateo County Medical Association Dr. Ding and his wife, Kimberly Ding

Bronwyn Hogan

D

r. Alex Ding did

some wonderful physicians whom I

not come to medi-

deeply respected as professionals and

cine through the

as people. I enjoyed the thought of

traditional route.

combining science and a reliance on

He majored in

facts upon which medical treatments

economics at the

and protocols are based, along with

University of California at Berkeley

the wonderful humanitarian char-

and worked at Goldman Sachs and

acteristics that medicine offers; an

with The Economist prior to medical

opportunity to touch someone’s life at

school.

a profound and challenging time.”

“During my undergraduate work, I

Ding was born in Germany. He

kept medical studies in the back of my

immigrated to the US with his family

mind, as I was pre­-med,” explains Ding.

as an elementary school-aged child.

“I was attracted to medicine thanks to

His family came to California with

8 SAN MATEO COUNTY PHYSICIAN | JULY–AUGUST 2017

the classic yearning for the American

“I wanted in,” he added.

health care resources are used, things

Dream and for better opportunity for

Ding is currently in private practice

beyond just our traditional clinical

their children. He tells his parents to

with California Advanced Imaging

knowledge and skill. These are tough

this day that this was the best decision

as a diagnostic and interventional

decisions that cannot be left to regu-

that they have ever made. His deep

radiologist and cares for patients

lators, legislators, and stockholders.”

appreciation for this country led him

at Mills-Peninsula and San Mateo

to serve in the US Navy, and he still

medical centers. He also serves on

the lives of the physician-members

serves as a Lieutenant Commander in

the clinical faculty at UCSF and most

of the SMCMA. He warns that physi-

the Reserves.

recently served as the Vice Chief of

cian burnout is real, as is the sense of

Staff at San Mateo Medical Center.

simply being a “cog in the wheel.”

O

nce Ding made the choice

Ding has a long history of service

Ding hopes to focus on impacting

“Re-establishing relationships is

to pursue medicine, he

with medical organizations, and

key to overcoming burnout,” Ding

earned his medical degree

his involvement with the California

explains. “Establishing a community is

from UCSF, while also completing a

Medical Association (CMA) dates

one of the fundamental value prop-

masters at Berkeley’s School of Public

back to his first year in medical school.

ositions that SMCMA can and must

Health in health policy and manage-

He has served in numerous leader-

provide.”

ment. An internship at Santa Clara

ship capacities including tenure on

Valley Medical Center kept him in the

the Board of Trustees of the Massa-

Bay Area before he completed his

chusetts Medical Society and on the

residency and fellowship work at the

Board of Trustees of the American

Massachusetts General Hospital, the

Medical Association (AMA).

original and largest teaching hospital of Harvard Medical School.

For an Econ major, studying medicine was a little like uncharted territory, and choosing a specialty was by

A

D

ing lives on the Peninsula with his wife of eight years, Kimberly, a nursing school

instructor, and their two sons, Lucas, 3, and Liam, 4 months. Ding recognizes

s Ding sees it, medical

that his “down time” is anything but,

associations must ensure,

as he spends his time chasing his two

through leadership and

lively boys.

advocacy, that physicians are free to

“Before kids, my wife and I loved

no means a given. Ding’s background

practice their profession as they see

traveling to exotic places,” Ding

initially inclined him toward health

fit for the benefit of their patients. He

laughs. “We even explored and

policy work. But surgery also inter-

urges colleagues not to hide behind

camped in the Amazon. That was

ested him, particularly its “hands-on”

their masks and gowns, but to broadly

wild!”

aspect. But it was late in his medical

explore what it means to be a physi-

school career, during a rotation in

cian, as leaders in our communities

Ireland,” he added. “I won’t be kissing

interventional radiology, that Ding had

and social advocates.

the Blarney Stone.”

his “aha!” moment.

“Our next (tamer) planned trip is to

“Physicians must drive the conver-

“I thought, Wow! This combines

sation.” says Ding. “This means physi-

surgical procedural aspects with really

cians must define what quality care is,

Ms Hogan is a freelance writer living in

cool technology and toys.”

how to control costs, and how scarce

San Mateo.

JULY–AUGUST 2017 | SAN MATEO COUNTY PHYSICIAN 9

Payor Issues Barbara Weissman, MD

CMA Trustee for the Specialty Delegation

After extensive amendments to [AB 72] were adopted that made it much less onerous, CMA withdrew its opposition, although many physicians remained opposed to the bill. “

10 SAN MATEO COUNTY PHYSICIAN

A

t the last CMA Board of Trustees meeting at the end of April, the board members reviewed more than 700 pages of material and so the overall pace of the meeting was quite rapid. However, a couple of the items around payor issues received more intensive examination and discussion. One of these was the Governor’s proposed budget and his attempt to use the Tobacco Tax Initiative monies to backfill cuts to the state’s general fund contributions instead of increasing Medi-Cal reimbursement rates. With extensive lobbying from CMA including a focus on this issue at its Legislative Day, the legislature rejected the Governor’s proposal, and now a substantial amount of that money is earmarked to increase access to care by increasing provider payments.

The other payor issue that received extensive attention was last year’s bill on “surprise billing” (AB 72), which becomes active in July of 2017. The problem being addressed involves billing a patient who goes to their in-network facility

JULY–AUGUST 2017

but ends up getting care from an out-of-network provider without prior consent and then gets billed for those services.

Two years ago AB 533, which was on this same issue, was defeated — but the issue remained urgent in the eyes of the legislature, who pushed CMA to work for a solution to this problem. CMA initially opposed AB 72, stating that it would interfere with physicians’ ability to negotiate fair rates with health insurance plans, as a statutory default rate would incentivize the plans to drive down contracting rates and make them less willing to sign fair contracts; this would in turn lead to increasingly narrow networks. After extensive amendments to the bill were adopted that made it much less onerous, CMA withdrew its opposition, although many physicians remained opposed to the bill.

The current law states that the payor has to pay either their average contracted rate or 125% of the Medicare rate, whichever is higher, and that either party can engage in an independent dispute resolution process (IDRP). CMA is working on many aspects of this legislation including making sure that the average contracted rate is based on weighted averages of payments, pushing that the Medicare rate used be the noncontracted rate (which is 9.2% higher), and that network adequacy must be insured — so that plans have to continue to contract with physicians. They are working to get “baseball arbitration” for the independent reviews (where the reviewer is just given two numbers and has to pick one; this has been shown to favor the doctors in other states like New York).

CMA has been going on Listening Tours and developing a Grassroots Campaign — again with the initial goals to make sure that the Average Contracted Rate is not “gamed” by the insurance companies and that they maintain network adequacy. They are listening and responding to physician concerns, but also hearing from a few physicians that the bill will have a positive impact on them. They have developed a webinar and will have an online research tool where members can submit their stories. They have a dedicated team for this issue that involves staff from multiple areas of CMA, and have budgeted for a new staff person to be dedicated to it. They plan to assist members in filing for greater reimbursement through the regulators’ mandatory IDRP, as well as to develop a template for physicians to use to opt out.

AB 72 was also discussed in the context of the year around resolution 206-17, which asked CMA to be involved in a lawsuit against AB 72. Although CMA did not believe the lawsuit against AB 72 would be successful, an amended version of resolution 206-17 was passed that noted that CMA plans to “aggressively advocate for physicians affected by the law — using all appropriate regulatory, legislative, public relations and legal resources including unfair contracting and inadequate networks, and will develop resources for physicians to challenge any unfair practices that may result from the law, and will report to the board quarterly.”

A

nother payor issue that CMA has on the top of their priority list is looking at retroactive Medi-Cal recoupments. Currently there is no limit on how far back the Department of Health Care Services can go to recoup funds it feels were overpaid. CMA will be pushing to limit Medi-Cal recoupments to 365 days from the date of payment.

Finally, CMA will be looking at Quality Rating Programs through its newly formed CMA Quality TAC. A recent study shows that physicians and their staff can spend more than 15 hours per week dealing with quality measures that come from different payors. CMA has existing policy that payors should just have one set of quality reporting requirements, and CMA will be looking to support any legislation that arises in this regard.

CMA is involved in advancing medicine in California in many different areas. It has been a privilege to serve on the Board and learn more about all their efforts. Although I can’t possibly cover all the actions and activities that pass through the Board each quarter, I will continue to focus on separate areas and update you on items of interest and look forward to communicating again after its upcoming July Board meeting.

Dr. Weissman is a psychiatrist in San Mateo County.

JULY–AUGUST 2017 | SAN MATEO COUNTY PHYSICIAN 11

They’re Getting Away with

GUEST COMMENTARY

Murder

By Babak Nouhi, MS II

H

OW DID ONE

ophthalmologist in South Florida bill Medicare over $11 million for injections of a single drug in 2012? How is it that pharmaceutical companies are able to spend more money on lunch buffets than on research and development? And, why has Big Pharma’s main lobbying group, PhRMA, outpaced any other in total spending devoted to lobbying?

The answer is simple: The rules and regulations put in place by our elected officials have completely set the board in the drug companies’ favor.

Market exclusivity and an inability for national health programs and government entities to negotiate drug prices are the two biggest reasons why the pharmaceutical industry has outperformed other major sectors for the better part of the past decade. Unfortunately, unlike the financial fiddlers on Wall Street, Big Oil, and the tobacco industry, Big Pharma has advertised to the American people a mission statement as altruistic as the ones placarded by medical schools around the country: “We’re doing it for you.”

In September 2015, Martin Shkreli became the “The Most Hated Man in the Country” when he obtained the manufacturing license for

This article is reprinted from the May/June issue of Sierra Sacramento Valley Medicine.

the anti-parasitic drug, Daraprim, and raised its price from $13.50 to a whopping $750 per pill. His reasoning? “Research and Development.” R&D, as it’s been referred to, has long been used by pharmaceutical companies to justify hiking drug prices. Though these companies do pay enormous sums of money to pass a drug through the FDA, a number of factors weigh against this rationale for the high prices.

For one, the proportion of revenue made by these large companies that is actually invested back into R&D is just 10–20 percent. Secondly, the most important innovation for these new drugs is often performed at academic institutions and supported by grants from public entities, such as the National Institutes of Health (NIH). In fact, more than half of the 26 most transformative drugs of the past 25 years have had origins in publicly-funded research. Furthermore, in 9 out of the 10 largest pharmaceutical companies, more money is spent on advertisement than actual R&D. Pharma companies explain that non-negotiated prices are essentially a mechanism put in place to subsidize their research and development. What seems truer is that taxpayers are subsidizing the $24 billion they spend on physician advertisement every year instead.

A recent JAMA report from Harvard Medical School concluded in a meta-analysis that “. . . there is no

12 SAN MATEO COUNTY PHYSICIAN | JULY–AUGUST 2017

evidence of an association between research and development costs and prices; rather, prescription drugs are priced in the United States primarily on the basis of what the market will bear.”

Think about it. As a taxpayer, not only are your dollars going towards researchoriented government initiatives such as the NIH, but they are going towards subsidizing the latest Xarelto commercial: you are essentially paying for a completely monopolized drug twice.

Hiking drug prices are only part of the story. The number of tricks and tactics that pharmaceutical companies have under their sleeves to maximize profit is unbelievable. For the treatment of Wet Age-Related Macular Degeneration (AMD), there are currently two drugs available.

Both have virtually the same mechanism of action, both cost about the same to manufacture, both have nearly identical clinical outcomes, and both are made by the same exact company. The difference?

One costs $50 for each injection (Avastin), the other costs $2,000 for each injection (Lucentis).

Both of these drugs are injectable antivascular endothelial growth factor (anti-VEGF) drugs. They are literally miracle workers for patients suffering from AMD, as they are known to restore vision in those destined for blindness. However, Avastin was originally manufactured by Genentech to treat various forms of cancer whereas Lucentis — which is basically

The number of tricks and tactics that pharmaceutical companies have under their sleeves to maximize profit is unbelievable.”

Avastin with a few cosmetic changes — was specifically rolled out by Genentech as a treatment for AMD. When ophthalmologists began realizing that Avastin had very similar clinical outcomes as Lucentis, Genentech’s alarm bells went off. They went through practically every measure possible to ensure doctors stopped using Avastin — a drug that they created — on patients with AMD. For one, Genentech began aggressively marketing Lucentis as the sole treatment option for AMD, stating that it lasted a few weeks longer in the body than did Avastin. Secondly, the company refused encouragement from the FDA to seek approval for using Avastin in eye ailments, according to unpublished internal FDA documents. Thirdly, and perhaps most disturbingly, the company packaged Avastin in doses far too big for use in ophthalmology, meaning that the drug needed to be repackaged by other companies for use in the eye.

Genentech then proceeded to argue that, because third parties were forced to repackage this medicine, there would be risk for contamination. For this reason and the fear of being sued for using off-label medication, there are still those ophthalmologists who administer Lucentis. John Thompson, a Baltimore ophthalmologist who is president of the American Society of Retinal Specialists, noted that, “If Genentech decided to get FDA approval and make Avastin available in small quantities for the eye . . . the American Society of Retinal Specialists would applaud.” Unfortunately, Avastin still hasn’t been FDA-approved for eye ailments, and Genentech is still soaking up the revenue from over the roughly 40 percent of ophthalmologists who still prescribe Lucentis.

Following my uncle, who is a physician, into pharmaceutical conferences was always fun for me.

Free all-you-can-eat buffets, cool bags

of goodies, and incredibly beautiful women in their twenties speaking to you about a drug that could save millions of lives. What’s not to love?

The truth is, these pharmaceutical companies are no different than a pooling company; they have only one agenda, and that’s to make as much money as humanly possible. They don’t care about you, your health, or even if their drug is better than the last iteration. Yet, when Martin Shkreli was pressed on the massive price hike on Daraprim, he said, “I can see how it looks greedy, but I think there’s a lot of altruistic properties to it.”

It’s funny — as medical students, we carry around a copy of First Aid as if it contained a higher being’s commands, treating each word like scripture. In it, “altruism” is defined as, “alleviating negative feelings via unsolicited generosity.” The example provided is that of a mafia boss making large donations to charity. So in a way, I suppose Martin Shkreli is right: the pharmaceutical companies are like a mafia, one that has been getting away with murder for much too long.

Email: Babak.Nouhi6995@cnsu.edu

NOTE: In an effort to lower the skyrocketing cost of prescription drugs, a drug importation amendment was advanced during the January budget resolution vote in the Senate. It was rejected because it contained no language guarding against unsafe drug importation from unknown sources. In late February, Senators Cory Booker (D–NJ), Bernie Sanders (I–VT), and Bob Casey (D–PA) introduced stand-alone legislation that would allow Americans to import safe medicine from Canada. Reps. Elijah E. Cummings (D–MD) and Lloyd Doggett (D– TX) introduced a companion bill in the House. It was voted down in March.

JULY–AUGUST 2017 | SAN MATEO COUNTY PHYSICIAN 13

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