React & Respond

How exciting to open the spring magazine and be greeted by Dean MacKenzie’s essay on public health 3.0 [“Public Health 3.0,” Spring 2018]. I had the privilege of serving at HHS in the Office of the Assistant Secretary for Health, alongside Karen DeSalvo [former Acting Assistant Secretary for Health], as this work was developed. The only addition I would suggest is that not only can JHU health professional schools collaborate to improve health, but leaders in these schools can reach across and leverage the University’s other schools and expertise—such as policy, engineering and education—to make 3.0 a reality.

Here are two ideas to reduce the high prices of drugs [“Open Source”, Fall 2017]. Congress should again ban drug companies from advertising prescription drugs directly to consumers on television. The FDA should also crack down. Drug companies routinely post two-year expiration dates on their drugs—even though most remain safe and effective for more than five years—just to increase revenues. It has caused health care providers and consumers to throw out billions of dollars’ worth of perfectly good drugs.

We should consider legislation requiring that drug companies price their drugs for Medicare/Medicaid patients at the lowest price those drugs are sold to the governments of [other] advanced economies. This “most favored nation pricing” would force pharmas to bring U.S. pricing more in line with worldwide pricing. The real question is whether [R&D] should be funded primarily by U.S. purchasers or more equitably by a worldwide consumer base.

As a former Osler house officer, and one with a major interest in public health and prevention, I read this article [“Lesson of the Goat’s Tail,” Spring 2018] and was intrigued by the graphic depicting an African community. There is an amazing amount of story there—old/new, traditional/progressive, healing in many forms, goats as medical diagnostic tools! I would love to hang this in my office as a reminder of the importance of listening to people and their stories.