As I See It

The Deal of the Year

How a compromise between Genentech, AAO and ASRS saved a beautiful relationship.

By Paul S. Koch, M.D. Editor Emeritus

Suppose you and your wife went shopping for a new automobile and found one that suited your purposes for about $20,000. Now, suppose the dealer also was showing a car that cost $800,000. Can you imagine how much more wonderful that car would be? Every feature, every stitch, every purr from its exotic engine would be perfect.

Suppose you took your wife diamond shopping and found a beautiful one for about $50,000. Then you saw one that cost $2 million. Wouldn't you assume that the second one would be much larger, clearer, more radiant and sparkling?

After shopping, you took your wife out to dinner and spent about a hundred bucks. You could have gone to a different restaurant and paid $4,000 instead. What foods could you eat, what fabulous wines could you drink to generate a bill like that?

Then, driving home to your $300,000 house, you pass the home worth $12 million next door. What could you get for $12 million? I suppose you'd have lots of land with a beautiful view, gold-plated fixtures and maybe a discothèque.

The next day you go to your office and give some injections. The first patient gets some $50 Avastin. The next patient comes in and you consider injecting something else that costs 40 times as much. What would she get for that $2,000? Would she get a guaranteed cure? Maybe super 20/5 acuity? Perhaps Superman's X-ray vision? Would you feel ripped off if the results were about the same? Would your patient?

Trouble Brewing

When you spend 40 times more for one product than the other you expect a breathtaking difference in what you get. The difference should be so qualitatively dramatic that it would be impossible to quantify. How do you compare those cars, those diamonds, the pricey dinner or the enormous house? Are they 40 times better? At the very least, they should be obviously and tremendously different.

Suppose, however, that the second car was just the LX version of the first car. The diamond was identical but mounted in a different setting. The expensive meal was the same food but served on china plates, and the houses were different only in that one had a three-car garage instead of two. Would you feel you got a value worth spending 40 times more?

Which brings us to the recent stand by the American Academy of Ophthalmology (AAO) and the American Society of Retina Specialists (ASRS), their members fed up to the ears by the announcement that the company that makes Avastin and a more expensive product was going to stop shipping Avastin to compounding pharmacies, and try to shift us into using a different product that cost 40 times as much.

"Enough!" the AAO and ASRS declared and sent out letters and press releases to criticize this action. They invited a beleaguered company representative to the AAO annual meeting to face a hostile crowd of physicians.

"But, this one is formulated for the eye," the representative told the group, all of whom knew that Avastin worked pretty darned well in the eye, too.

"But, this one is approved by the FDA," said the representative.

"Then go get Avastin approved, too!" screamed some.

"Who cares?" yelled others.

This crowd was not going to be pushed around. The mob wanted its Avastin.

Something for You, Something for Me

After some time, the company thought it over. "How about each of you buy the Avastin from your own distributors and have them ship it directly to the pharmacies? That way you can still get it but we're out of the loop."

Smiles all around. Yes, that would work.

Props to the AAO and ASRS for stepping up to the plate to broker a deal. Props also to the company for doing the deal. Good job. OM