美国国家公共电台 NPR Rural Hospitals Struggle To Stock Expensive Drugs That Could Save Lives

 

AILSA CHANG, HOST:

Deep in the Ozark Mountains of Arkansas, a 30-year-old drug saved Lulabelle Berry's life. But what if the drug hadn't been there? That question haunts hospital pharmacist Mandy Langston as the drug's price continues to climb for her hospital. Reporter Sarah Jane Tribble explains why.

SARAH JANE TRIBBLE, BYLINE¹: Lulabelle and Jimmy Berry live on 600 acres at the top of a crooked² and steep mountain road in northern Arkansas. Lulabelle remembers being on the computer just before lunchtime early last year. Then Jimmy felt the need to check on her.

LULABELLE BERRY: He was getting ready to go out, check on his cattle. And I didn't answer him when he called me.

JIMMY BERRY: I was just fixing to go out and get on my four-wheeler and go back on the place. And I saw her in there, and something got my attention. And I went in there. And she was out of her chair, down on the floor. She couldn't talk. She couldn't walk. She couldn't get up. And I just dialed 911 right quick.

TRIBBLE: It took nearly two hours to get Lulabelle Berry to Stone County Medical Center. Hospital pharmacist Mandy Langston was there when she arrived. Lulabelle's eyes wouldn't focus. One side of her face was drooping³. Langston says a quick brain scan and a telemedicine consultation⁴ with a neurologist confirmed severe stroke.

MANDY LANGSTON: She had not one minute to spare because the timing⁵ is three-hour window. If anything else had gone, you know, astray or, you know, they didn't get her here in time, then she wouldn't have been a candidate for the drug.

TRIBBLE: The life-saving drug is Activase, an old drug that's gotten a lot more expensive recently. A year ago, Langston bought it for about $2,000 a dose. Then Langston went to restock it this year. The drug cost $8,000 a dose. But just down the road in Batesville, Ark., another hospital is paying only about $1,600 for the same drug at the same dose.

And it turns out small hospitals across the country pay more for thousands of drugs than their bigger, more urban counterparts. Congressman⁶ Peter Welch is a Democrat⁷ from Vermont. He explains, smaller hospitals can't buy those drugs through a federal drug discount program.

PETER WELCH: PhRMA's charging the fat prices to our community hospitals. And then that is putting enormous pressure on their bottom line.

TRIBBLE: The federal program requires pharmaceutical⁸ companies to sell many drugs at a deep discount to hospitals that serve a lot of low-income patients. It used to be mostly for bigger hospitals, but the Affordable⁹ Care Act allowed rural hospitals to join. Then the pharmaceutical industry trade group PhRMA went to court to guarantee their members could charge full price to the rural hospitals for drugs that are designated to treat rare diseases. And there are lots of designated drugs, even common ones like Berry's Activase. That's because of complicated federal processes governing drug approval and research, says Bill von Oehsen, a lawyer who represents hospitals.

BILL VON OEHSEN: In most cases, these hospitals are not treating patients for those rare diseases, rare conditions. But the exclusion¹⁰ applies to any use, even the very common uses. And so most of your cancer drugs have to be bought at a much higher price.

TRIBBLE: Some pharmaceutical companies have voluntarily offered all of their drugs at a discount to rural hospitals. Activase's owner, Genentech, has refused. A company spokeswoman said the discount program had grown beyond its original intent. And it is following the laws. Back in Stone County, pharmacist Mandy Langston knew how important it was to get Activase to Lulabelle Berry. Her grandfather suffered a stroke when she was in high school. Stone County, like many rural hospitals at the time, didn't stock Activase.

LANGSTON: If we don't keep this drug, people will die. I mean there's no, you know, if, buts about it.

TRIBBLE: Langston's grandfather died two days after his stroke. When she graduated with her pharmacy¹¹ degree in 2008, Langston made it a point to get the certification needed to be in the ER.

LANGSTON: I've been in the room where these people have gotten the drug. And I've seen them, like, literally¹² go from a vegetable to living within, you know, 30 minutes of getting the drug. So I've seen that emotional connection. I've seen the fear in their eyes.

TRIBBLE: Lulabelle Berry was speaking within minutes of getting Activase. She still struggles to get her words out as easy as she once did but otherwise has fully¹³ recovered. The 78-year-old spends her days crocheting¹⁴, minding the cats and her tomato plants. And on a recent summer day, she had family photos out for sorting.

L. BERRY: Some of these are older pictures because I was doing a - we just had our reunion for the Berry family, and I was getting pictures to take to them last weekend when we had this. Now I've got to put them back together (laughter).

TRIBBLE: She is grateful to have the time to do that. For NPR News, I'm Sarah Jane Tribble.

CHANG: Sarah Jane Tribble is with our partner Kaiser Health News.

(SOUNDBITE OF TEEN DAZE SONG, "ALONG")

1 byline   

n.署名；v.署名

参考例句：

• His byline was absent as well.他的署名也不见了。
• We wish to thank the author of this article which carries no byline.我们要感谢这篇文章的那位没有署名的作者。

2 crooked   

adj.弯曲的；不诚实的，狡猾的，不正当的

参考例句：

• He crooked a finger to tell us to go over to him.他弯了弯手指，示意我们到他那儿去。
• You have to drive slowly on these crooked country roads.在这些弯弯曲曲的乡间小路上你得慢慢开车。

3 drooping   

adj. 下垂的，无力的 动词droop的现在分词

参考例句：

• The drooping willows are waving gently in the morning breeze. 晨风中垂柳袅袅。
• The branches of the drooping willows were swaying lightly. 垂柳轻飘飘地摆动。

4 consultation   

n.咨询；商量；商议；会议

参考例句：

• The company has promised wide consultation on its expansion plans.该公司允诺就其扩展计划广泛征求意见。
• The scheme was developed in close consultation with the local community.该计划是在同当地社区密切磋商中逐渐形成的。

5 timing   

n.时间安排，时间选择

参考例句：

• The timing of the meeting is not convenient.会议的时间安排不合适。
• The timing of our statement is very opportune.我们发表声明选择的时机很恰当。

6 Congressman   

n.（美）国会议员

参考例句：

• He related several anecdotes about his first years as a congressman.他讲述自己初任议员那几年的几则轶事。
• The congressman is meditating a reply to his critics.这位国会议员正在考虑给他的批评者一个答复。

7 democrat   

n.民主主义者，民主人士；民主党党员

参考例句：

• The Democrat and the Public criticized each other.民主党人和共和党人互相攻击。
• About two years later,he was defeated by Democrat Jimmy Carter.大约两年后，他被民主党人杰米卡特击败。

8 pharmaceutical   

adj.药学的，药物的；药用的，药剂师的

参考例句：

• She has donated money to establish a pharmaceutical laboratory.她捐款成立了一个药剂实验室。
• We are engaged in a legal tussle with a large pharmaceutical company.我们正同一家大制药公司闹法律纠纷。

9 affordable   

adj.支付得起的，不太昂贵的

参考例句：

• The rent for the four-roomed house is affordable.四居室房屋的房租付得起。
• There are few affordable apartments in big cities.在大城市中没有几所公寓是便宜的。

10 exclusion   

n.拒绝，排除，排斥，远足，远途旅行

参考例句：

• Don't revise a few topics to the exclusion of all others.不要修改少数论题以致排除所有其他的。
• He plays golf to the exclusion of all other sports.他专打高尔夫球，其他运动一概不参加。

11 pharmacy   

n.药房，药剂学，制药业，配药业，一批备用药品

参考例句：

• She works at the pharmacy.她在药房工作。
• Modern pharmacy has solved the problem of sleeplessness.现代制药学已经解决了失眠问题。

12 literally   

adv.照字面意义，逐字地；确实

参考例句：

• He translated the passage literally.他逐字逐句地翻译这段文字。
• Sometimes she would not sit down till she was literally faint.有时候，她不走到真正要昏厥了，决不肯坐下来。

13 fully   

adv.完全地，全部地，彻底地；充分地

参考例句：

• The doctor asked me to breathe in,then to breathe out fully.医生让我先吸气，然后全部呼出。
• They soon became fully integrated into the local community.他们很快就完全融入了当地人的圈子。

14 crocheting   

v.用钩针编织( crochet的现在分词 )；钩编

参考例句：

• She sat there crocheting all day. 她整天坐在那里用钩针编织东西。 来自互联网
• The crafts teacher is skillful in knitting,crocheting,embroidery,and the use of the hand loom. 手工艺教师善于纺织、钩编、刺绣和使用手摇织布机。 来自互联网