HEALTH CARE/Joan Retsinas

Dribbling Out Profits: Of Catsup and Eye Drops

Retrieve the empty catsup bottle you discarded. How much was left? Did you leave it upside down for a day to let the remains dribble down? Did you add water to loosen the dregs? Finally, did you care that you were not using an ounce or so of the 24 ounce bottle? Probably not. After all, catsup isn’t expensive; you don’t truly need it (the condiment, in spite of what children may think, is not a necessary food); and while you may think “what a waste,” the waste is ecologic, not financial. You are a consumer with choices.

Now turn to eye drops. They are packaged so that the patient – no longer a consumer but a patient – who dribbles out one drop often dribbles out more. The reason: the drop is too big for his/her eye. The drops are expensive. The drops are essential. Unlike catsup, the patient cannot forego them, or water them down, without consequences. One estimate holds that a patient with glaucoma using a popular medication spends as much as $1000 annually on wasted drops that dribble down his/her cheek.

Patients have banded together to sue the Big Pharma manufacturers of eye drops — a class action suit from patients of ophthalmologists.

From the vantage of Allergan, Bausch & Lomb, Merck and Pfizer, the suit must seem bizarre: a class action suit from patients with eye diseases who take the drops that ward off blindness. The companies argue that the dribble-down is akin to that of catsup left in a bottle, or toothpaste left in a tube. Unless you stamp on the tube, you will leave some paste inside. Also, they point out that the Food and Drug Administration (FDA) approved the eye-drop dispensers. If the manufacturers re-designed the dispensers to minimize drip, the FDA would need to approve that new design. The result: more bureaucratic costs, more time lost for the manufacturers.

The patients point to the expense of the waste. Patients translate wasted medication into money. A re-designed dispenser would save patients money and, conversely, cost manufacturers. (Perversely, the manufacturers hint that the re-design might ultimately boost costs for patients as the companies recoup the cost of the redesign.)

One federal court sided with the patients; one federal court sided with the manufacturers. The case wended its way to the Supreme Court, which recently opted not to rule: the suit returns to federal court. Some day law students may ponder 17-1337 Alcon Laboratories v Leonard Cottrell. For now, patients and manufacturers await a decision.

The bogey, though, is not so much the wasted dribbles, but the cost of those dribbles. As the cost of medications has risen, patients have grown desperate for relief. Mounting a class-action suit to prompt re-design of the eye-drop package marks that desperation. Indeed, the smaller drops may well remain too expensive for some patients’ budgets. But the intransigence of manufacturers who argue against re-designing their package marks their callous indifference to patients’ desperation.

Joan Retsinas is a sociologist who writes about health care in Providence, R.I. Email retsinas@verizon.net.

From The Progressive Populist, August 15, 2018

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