DAVID GREENE, HOST:
And most of us have had this happen. You put eyedrops in, some of the medicine overflows, streams down your cheek, you wipe it away with a Kleenex. But did you ever think that maybe, just maybe, there was some way to prevent that medicine overflow in the first place? I mean, this stuff can be expensive.
Well, Marshall Allen from ProPublica did some digging, and he found that oversized eyedrops can actually cause patients to run out of their medicine way too soon, making it hard to get refills when you need them. It can actually mean going days without the eyedrops. And he joins me now.
MARSHALL ALLEN: Hey, good morning.
GREENE: So what did your investigation of eyedrops find?
ALLEN: Well, this all started because I'm doing a project on all of the wasted medicine that we have in this country.
GREENE: Yeah, we've talked to you about this on the show.
ALLEN: We've talked about it.
GREENE: So this is all part of the same thing.
ALLEN: Yeah, exactly. So this was kind of an ongoing thing, and I got a call from someone who talked to me about how drug manufacturers make eyedrops much larger than the human eye can hold. So when you put an eyedrop in your eye, it's really like pouring additional water into a glass that's already full. And a lot of drops are two times or even three times more than the eye can hold.
GREENE: Is there an innocent argument here? I mean, maybe they're making these drops really big to make sure that you're getting enough.
ALLEN: Yeah, so I talked to the drugmakers about this and the people who work as consultants in the industry. And what they would say is that the reason they make them big is because it's hard to put in an eyedrop, especially if you're elderly, if your hands are shaky. And so they would argue that a large drop is necessary because it helps hit the target. But...
GREENE: Sure. But people aren't buying that argument.
ALLEN: Well, where it's been studied, the microdrops - is what they call the smaller eyedrops - have been effective, and they've not been hard to administer. Alcon, the big eye care company, did a study in the early '90s because they were having too many side effects like irritation, and burning and itching.
And so they asked the research department at Alcon to come up with a solution. So they thought, well, we can make the drops smaller, and that way, they won't be as irritating to the eye. And they found that the small drop was just as effective as the big drop, and it caused less irritation.
ALLEN: But if the drugs last twice as long, then people are going to buy half as many, which then says, well, do you change the price on your drugs? Do you raise the price? But then if they raise the price, their competitors are going to accuse them of charging more for their eyedrops.
ALLEN: So there were too many concerns about whether or not this would be profitable, and so they killed the microdrop project.
GREENE: Huh, so it's not, like, something terribly sinister. The companies might just be deciding, if we made this change, it would mean a lot less money for us, and that's problematic.
ALLEN: You know, I don't know that that's sinister. I mean, that's capitalism, and we have a for-profit health care system in this country. And so it does help explain why some of these innovations and why what's better for patients don't ever come to pass.
And some of these bottles for glaucoma medication, they can cost hundreds of dollars for one small bottle of eyedrops. Now, most patients aren't paying that much, but your insurance payer might be paying it, Medicare might be paying it. So one way or another, we're paying for all of this waste.
GREENE: Did you figure out even some estimate for how much money people were spending on wasted medication here?
ALLEN: It's really hard to come up with an exact number on that. But the chronic eyedrop market for glaucoma and dry eyes alone brings in about $3.4 billion a year for drug companies. You could say that half of each drop is wasted or so. You could estimate that, you know, we're spending billions of dollars on drugs that we literally aren't even using.
GREENE: And I guess we should say - I mean, there have been some lawsuits filed over this that have been dismissed. And it seems to be the FDA who would have to do something, if anyone was going to crack down.
ALLEN: So you would think that regulators would care about this, but the FDA's mission is really to look at the safety and effectiveness of drugs, and this - that's not really the question here. The drugs that are being used are safe and effective. It's just that you're paying for a lot more of it than you need.
GREENE: Marshall Allen of ProPublica talking to us about his reporting on wasted eyedrops. Marhsall, thanks.
ALLEN: Thank you.