A hundred days into the Trump administration, don't expect
the vaunted changes to drug prices after the corporate execs get to Trump.
After being caught up during the campaign by the media
fetish over shameful drug price hikes, President Trump promised to lower drug
prices. Given deep public outrage directed at high drug prices, this price
lowering would be quite popular with his base, as well as all other Americans.
Yet, such a task—similar to the “replacement” of Obamacare—is, in Trump’s word,
Taking on the Drug Industry
The nonspecifics in policy making that lingered from the campaign
into the first months of the Trump administration came to an abrupt end with
Trump’s proposed Budget and House Speaker Paul Ryan’s American Health Care Act
(AHCA). Both proposals unleashed torrents of criticism, and revealed that
neither Trump’s voter base, nor the public at large, were considered much in
current Republican policy-making. The
content of “replacement” in the AHCA, its subsequent turbulent political
process and its final defeat by the Republicans themselves, all became an
embarrassing blow to both Trump and Ryan (Stanage, 2017a; Cassidy, 2017).
Given the deficit hawks Freedom Caucus stand against “tax
credit entitlements,” Trump now may have to shift to his next bipartisan
approach to replace the Affordable Care Act (ACA). His “Art of the Deal”
superpowers had failed miserably in this first legislative attempt. His final
epitaph was “let Obamacare explode,” which may now be the province of Health
and Human Services Secretary Price (Davidson 2017; Weber 2017).
Trump’s claim that Obama “wiretapped’ Trump Tower, which he heard on Fox News that
he watches daily, Comedian Bill Maher rattled off a list of psychoactive drugs
in direct-to-consumer (DTC) drug ads regularly shown on the Fox morning show,
and quipped: “Don pick one!”
Pharmaceutical Industry: Complex and Powerful
The soaring use of very expensive specialty pharmaceuticals has
dearly cost patients and families, along with the federal and state
governments, and employers more and more each year. The number of outrageous price
hikes trumpeted in the mass media brought the issue to the forefront of public
debate, and in the Presidential campaign. While most pharma industry developments
have received little analysis in the medical literature, corporate drug news
(excepting recent notable price climbs and the $5.4+ billion spent on
direct-toconsumer (DT C) drug ads [Bulik 2016]) remains the province almost
exclusively inside industry corridors and a few select think tanks.
Beyond threats for drug price regulation, rolling back government
regulations caused anxiety among pharmaceutical executives (Garde 2017), who
feared that a less robust Food and Drug Administration (FDA) would lead to
possible loss of insurance coverage for pricey drugs. In particular, there have
been tensions with Pharmacy Benefit Managers (PB Ms) and insurance companies, who
seek added profits for their bottom lines on top of the manufacturers'
discounts. By the time drugs reach consumers, the system baffles nearly
everyone: "Who knew it was so complicated?"
Robust review processes
are critical to both convince and encourage physicians and insurers of the
value of these extremely high-cost new medicines (Beasby 2017). Outgoing FDA
chief under Obama, Dr. Robert Califf, maintains that faster drug approval does
not necessarily mean less expensive drugs: "There's not a direct relationship
between the cost of development and the price of drugs or devices" (Califf
quoted in Lupkin and Tribble 2017).
Trump seeks to radically change how the FDA vets new drugs
by speeding up the "slow and burdensome" process (Kaplan 2017).
Changing review standards may not be appreciated by FDA staffers and could
rattle the biopharmaceutical industry, as well as their stocks. The Public
Citizen's Health Research Group, among other health advocates and scientists,
believes the FDA already concedes too much to industry parties (Carmone 2017).
Should Trump and his FDA designee, Dr. Scott Gottlieb,
focus on speeding through new innovative medical products from the top
biopharma research firms, they need to enforce strengthened postmarketing surveillance.
When a drug reaches the larger patient population who experience many clinical conditions
and simultaneously take multiple drug entities, mishaps become more common and
problematic beyond the two company-chosen clinical trials reviewed by the FDA.
Under the “gold standard,” the new drug is passed based upon being better than
placebo—not head-to-head against any existing competitor on the market.
Trump has made other promises for sweeping deregulation amidst
the price pressures (Keshavan, 2017). With “value-added reimbursement” being
introduced and surveilled, clinicians might tend to side with their patients to
support Trump’s Medicare Part D price controls. Doctors spend more time with
patients explaining drug therapies and side effects to patients, and must deal
with DT C ad explanations, PB M tiers, prior authorisations, and co-payment
issues. Spending on pharmaceuticals has far outpaced that on physicians, hospitals,
and other parts of the medical care expenditure pie. Aggressive pricing by drug
firms produced a $324.6 billion dollars yield in 2015, up 9% from 2014; 2015
saw an additional 11.7% increase in drug outlays (Schumock 2016).
“Getting Away With Murder”
Trump picked up on the broad public resentment against drug
price increases from the campaign and as President has made trenchant attacks
on the drug industry. At his first news conference as residentelect Trump accused drug makers of
"getting away with murder" and pledged to "save billions of
dollars" for U.S. purchases in Medicare, Medicaid, the Defense Department and
Veterans Administration. His comment sent drug stock prices down dramatically,
but there was no follow-through with drug prices going down (Walker 2017).
After a meeting at the White House with pharmaceutical CEO
s, the rhetoric on price controls eased. Pharma executives still have many
concerns with a President who demonstrates little knowledge of their industry and
has given few specifics. Lax regulations, along with Trump's mentioning
"compassionate use of experimental drugs," are issues about which
Pharma retains strong opinions. Compassionate drug use refers to drug companies
expanding access to investigational drugs that are still in clinical trials.
Such a patient demand should be cautiously examined for provider and payer acceptance,
as well as clear safety issues. Multiple FDA - approved drugs have been removed
from the market when they cause severe mishaps in the larger patient population.
Wikipedia lists 178 “significant withdrawals from the market” since Thalidomide
in 1961 (2017).
After the FDA approved Tarceva, a $94,000 a year lung cancer
entity made by Genentech, it was later found to be wasted and ineffective on
about 90% or more of the patients using it. Only patients with a certain genemutation
benefited from Tarceva.
The story of Tarceva
shows the danger of approving experimental medicines before reliable scientific
data show they are effective -- which regulators are now doing more frequently.
Pressure by powerful pharmaceutical company lobbyists and often dramatic
testimony by patient groups looking for hope, Congress has repeatedly loosened
regulations to speed medicines to sale (Petersen, 2017, p.1).
While Pharma remains small capital compared to other
industries in the American economy, it has historically wielded
disproportionate political power. Multinational brand manufacturers (housed in
only seven advanced nations) discover new expensive novel therapies. A key
industry segment is the global generics market that chiefly supplies pharmacy
benefit managers in the U.S. and many developing nations with much lower cost
drugs, including APIs (approved pharmaceutical ingredients from mainly India
and China) that get poured into brand entities made in the U.S. A mass of
over-the-counter (OT C) products (including analgesics, digestive agents,
dietary substances, vitamins, minerals and herbals) are readily consumed by the
Inflation in U.S. drug expenditures has far outpaced other
medical costs for years despite quality efforts by managed care pharmacists to
keep cost contained (CVS Health 2017; Joszt 2106). Popularly used brand drugs for
the elderly, as well as most generic drugs, have seen regular double-digit
price climbs (Silverman 2016).
The First Hundred Days of the Administration
changes are usually expected to happen during the first hundred days of any new
administration (Adams, 2017), starting anew with fresh desired directives and
demonstrating technical expertise in full understanding of the Washington, DC,
and national landscape, which is a perquisite to passing policy. The public
usually allow for some novice miscalculations, but expect a give and take that
is devoid of unilateral decisions.
In the case of the Trump administration, it has been much
different (Stanage 2017). Trump showed he was a “man of action”, fulfilling
promises to his base with a long series of Executive Orders. There was much fanfare
on his repeal of the ACA. This has been so badly botched where Republicans did
not consider a “replacement”, let a lone think it out in legislative language.
The secret charade of “Hide the Bill”
in a basement Capitol room for select review of the so-called
“replacement” indicates deep splits within the Republican ranks. The jubilance
of the Republican election sweep has seen meagre gains on their bold legislative
to-do list (Steinhauer, 2017). Trump has yet to demonstrate understanding of
either the healthcare system, or the pharmaceutical industry.
Ryan’s American Health Care Act bill turned out as a huge
tax break for the rich, while throwing 24 million Americans out of coverage.
Medicaid covering some 70 million Americans was to be more than decimated through
block grants to ease federal payments to the states over time. The proposed
$334 billion federal cut was intended to cover forthcoming corporate and personal
tax cuts under the next round of tax reform.
developments and their adverse impact across the world are evident on several
fronts: global access to essential medicines, particularly for the most
vulnerable; drug safety problems; controversial marketing issues; promotion expenses
exceeding R&D outlays; patent protection losses; bio similars coming to
market, and the outsourcing of manufacturing and conduct of clinical trials
abroad, among many others. The megamerger and acquisition fervour continues to
rapidly reshape the players; this trend is predicted to heighten under the
Trump administration to further consolidate their economic, and political power
both nationally and internationally.
Business leaders depend upon government in crucial ways and
prefer predictability for both near and longer term planning. Outright
disruption in healthcare is the best way to describe what faces, not just most
Americans in health care these days, but also the pharmaceutical industry,
given the commentary on sweeping deregulation, price controls for Medicare Part
D, and other appeals that Trump has made to his supporter base.
Pharmaceutical executives have identified a number of
precarious issues that may be forthcoming from a Trump administration,
- Corporate Tax reform clearly will affect the drug industry
with his proposed export/import levy; reform will definitely create winners and
losers among multinational drug manufacturers with international investments.
- Orphan drugs have proven to be very profitable for rare
diseases; they are publicly subsidised when the numbers of patients are small,
so any new policies might alter this.
- Solving the opioid epidemic involves steps to bring drug
companies and practising physicians more into the spotlight of Governor Chris
Christie’s new Commission.
- Trump's views on vaccines causing autism, along with the
potential of unleashing Robert Kennedy, Jr. on a Commission to investigate
vaccine use is frightening to this industry segment that has blossomed wildly
over the last eight years.
- Examining false claims for various complementary and
alternative medicines that may also extend to direct-to-consumer (DT C)
advertising of major brands.
- Super “bugs”, antibiotic resistance, and new social epidemics
where firms have lagged.
- Medical devices have evidenced a number of problems in their
functioning, necessitating new regulations.
- The recently passed 21st Century Cures Act with bipartisan
support that favoured cancer pharmaceutical firms could be redirected in
- Clinicians’ and scientists’ reactions to the Trump budget
and its $40 billion cut to the National Institutes of Health. Many now are wary
of Trump’s administration’s support for science in general.
- Other problematic tax issues may affect the many tax breaks
firms get for R&D, plant and equipment, and a host of other areas.
- In developing the AH CA proposal, industry sources were not
consulted; hearings were not held where they could offer their voice; and it
appeared from newsletters, that none of the parties who had vested interests
established under the ACA were givien consideration.
- Industry R&D expenditures have lagged behind promotion
expenditures for many companies; future incentives for innovative drugs could
be more closely examined in terms of what truly affects the public's health.
- The generic industry has blossomed with its own set of price
increases. While these lower cost entities are preferred by pharmacy benefit managers,
brand manufacturers have concerns over the number of brand entities going off patent.
A Trump administration attempting to keep expenditures low, which employers
would favour, might stimulate the FDA for more generic approvals, a record of
more than 800 last year, with many "first-time generic drugs."
- Issues of biosimilars (complex biological entities) being
imported from manufacturers abroad, or U.S. generic firms, threaten the huge
profit streams of major manufacturers, which have sought delaying regulations.
- Tax policy may affect the tremendous amount of outsourcing
that major manufacturers do in their drug production; these much cheaper-paying
jobs are again what the Trump administration expects to tackle and bring home.
- Trump’s immigration ban and visa programme affects
biomedical manufacturers as well as medical student recruitment, residency
placements and scientific exchanges; pharma leaders have spoken out about it.
The Trump administration has not shown great interest in
using the common political process for formulating legislation. When Cabinet
appointees finally get their staffing to work, will specifics in policy ideas receive
full input from the corporate sector—a worry of business interests.
Trump campaigned on "huge tax cuts," but the
prospects for quick tax reform according to Fortune Magazine are not looking
good. It will likely be a contentious process to appease Congress where Pharma
money now goes to both political parties.
Part 2 of this article will address the increasing role of
specialty pharmaceuticals in the cost explosion and will detail several
specific drug entities and their outrageous price increases that have been
heralded in the popular press. More of what Trump and Congress may have in mind
for healthcare reform may emerge over the next month.
My sincere thanks to Naimah Malik for preparation of the
manuscript and especially to Agatha Gallo, PhD for research assistance.
- The Trump administration is enduring multiple serious
problems in its first 100 days
- Republicans face a bleak future to overcome their promise to
“repeal and replace” the Affordable Care Act under Obama
- Taking on the pharmaceutical industry proves to be a most
difficult endeavour for Trump
- The climbing cost of pharmaceuticals will likely continue to
cause a burden to patients, employers, and government
Alexander R (2017) Trump needs to do the math. U.S. News & World Report, 1 March. [Accessed: 15 March 2017] Available from usnews.com/opinion/economic-intelligence/articles/2017-03-01/donald-trumps-budget-plans-dont-add-up
Alvarez SL, Salmon JW, Swartzman D (2011) The Colombian health insurance system and its effect on access to health care. Int J Health Serv, 41(2): 355-70.
Ballhaus R (2016) Wealth of Trump nominees complicates their approval. Wall Street Journal, 27 December, pp. 1-2.
Barkholz D (2017) Hospital stocks rally as ACA replacements fails. Modern Healthcare, 24 March. [Accessed: 27 March 2017] Available from modernhealthcare.com/article/20170324/NEWS/170329943
Beasley D (2017) Pharma industry shuns Trump push for radical shift at FDA. Reuters, 15 February. [Accessed: 15 February 2017] Available from reuters.com/article/us-usa-trump-healthcare-regulation-analy-idUSKBN15U0GP
Begley S (2016) Fearful of a Trump administration, many in research call for a 'tutorial' for the presidentelect. STAT, 9 November. [Accessed: 18 February 2017] Available from: statnews.com/2016/11/09/scientists-trump-new-reality
Berk B (2017) FDA sets record for generic drug approvals. Drug Store News, 27 February. [Accessed: 1 March 2017] Available from drugstorenews.com/article/fda-sets-record-generic-drug-approvals
Blau M (2017) At a resurrected climate conference, concerns loom that CDC scientists may be silent. PBS Newshour, 16 February. [Accessed 20 February 2017] Available from pbs.org/newshour/rundown/climate-conference-concerns-cdc-silenced
Branswell H (2016) Should researchers study bunk science: Among respected scientists, a debate ensues. STAT, 10 October. [Accessed 27 February 2017] Available from statnews.com/2016/10/10/homeopathy-nosodes-vaccines.
Bulik BS (2017) FDA proposes studies on deceptive ads to gauge doc and patient perceptiveness. FiercePharma, 18 January. [Accessed: 27 February 2017] Available from fiercepharma.com/marketing/fda-proposes-studies-deceptive-ads-to-gauge-physician-and-consumer-perception
Carmone M (2016) Pharma, medical device industries got an early Christmas present, but not everything on their list. Public Citizen Health Research Group, 7 December. [Accessed: 27 February 2017] Available from citizen.org/media/press-releases/pharma-medical-device-industries-got-early-christmas-present-not-everything
Cassidy J (2017) The health-care debacle was a failure of conservatism. The New Yorker, 24 March. [Accessed: 30 March 2-17] Available from newyorker.com/news/john-cassidy/the-health-care-debacle-was-a-failure-of-conservatism
Crow D (2017) Biotech industry leaders lambast Trump travel ban. Financial Times, 7 February. [Accessed: 8 February 2017]. Available from ft.com/content/13b62f88-ed3f-11e6-930f-061b01e23655
CVS Health (2017) 2016 drug trend: PBM clients achieved lowest prescription drug trend in four years, despite rising drug prices. [Accessed: 20 March 2017] Available from
Davidson A (2017) How Trump could still undermine Obamacare. The New Yorker, 29 March. [Accessed: 4 April 2017] Available from newyorker.com/business/adam-davidson/how-trump-could-still-undermine-obamacare
Davies A, Harrigan R (2017) The U.S. is running out of sources for borrowing money. US News & World Report, 4 January.
Davis JH, Lafraniere S (2017) Trump lets key offices gather dust amid ‘Slowest transition in decades’. New York Times, 12 March. [Accessed: 13 March 2017] Available from nytimes.com/2017/03/12/us/politics/trump-administration.html
Delaney A, Scheller A (2016) Hmm, there may be a link between vaccines and political pandering. Huffington Post, 20 September. [Accessed: 21 February 2017] Available from huffingtonpost.com/entry/donald-trump-vaccines_us_57e1666ce4b04a1497b6e725
Facher L (2017) Senators on key panel reject Donald Trump's skepticism about vaccines. STAT, 18 January. [Accessed: 22 February 2017] Available from statnews.com/2017/01/18/donald-trump-vaccines-senators
Ferris W (2017) Possible Trump science advisor says global warming is a 'non-problem' not worth investing in. CNBC, 16 February. [Accessed: 20 February 2017] Available from cnbc.com/2017/02/16/possible-trump-science-advisor-global-warming-is-not-worth-investing-in.html
Garde D (2017) Trump wants to blow up the FDA. The drug industry? Not so much. STAT, 1 February. [Accessed: 1 February 2017] Available from statnews.com/2017/02/01/trump-blow-up-fda
Graham DA (2017) How Trump can fix his troubled White House. Yahoo News, 21 March. [Accessed: 25 March 2017] Available from yahoo.com/news/trump-fix-troubled-white-house-090000463.html
Gulfo JV (2016) How Donald Trump can benefit patients, by reducing red tape at the FDA. The Hill, 27 December. [Accessed: 30 December 2016] Available from thehill.com/blogs/pundits-blog/healthcare/311921-how-donald-trump-can-benefit-patients-by-reducing-red-tape-at
Harmon A, Fountain H (2017) In age of Trump, scientists show sign of a political pulse. New York Times, 6 February. [Accessed: 9 February 2017] Available from nytimes.com/2017/02/06/science/donald-trump-scientists-politics.html?_r=0
Helderman RS (2017) Despite early denials, growing list of Trump camp contacts with Russians haunts White House. Washington Post, 4 March. [Accessed: 6 March 2017]
Available from washingtonpost.com/politics/despite-early-denials-growing-list-of-trump-camp-contacts-with-russians-haunts-white-house/2017/03/03/a5b196d8-002d-11e7-8f41-ea6ed597e4ca_story.html?utm_term=.41856bdf6c50
Hogan A (2017) Week 3 with Trump: Hints of what's coming. STAT, 6 February. [Accessed: 7 February 2017] Available from statnews.com/2017/02/06/trump-biopharma
Hohmann J (2017) The daily 202: What Trump didn't want you to see him signing. Washington Post, 3 March. [Accessed: 6 March 2017] Available from washingtonpost.com/news/powerpost/paloma/daily-202/2017/03/03/daily-202-what-trump-didn-t-want-you-to-see-him-signing/58b923fae9b69b1406c75d33/?utm_term=.8d624843df61
Jopson B (2017) Drug stocks tumble as Trump singles our pharma companies. Financial Times, 11 February. [Accessed: 12 February 2017] Available from ft.com/content/087c8a06-d820-11e6-944b-e7eb37a6aa8e
Joseph A, Joseph DQ, Broodman E (2017) Trump's immigration order 'causing havoc' for medical students awaiting Match Day. STAT, 2 February. [Accessed: 2 February 2017] Available from statnews.com/2017/02/02/match-day-trump-medical-students
Kang C, Shear MD (2017) Trump leaves science jobs vacant, troubling critics. New York Times, 30 March. [Accessed: 30 March 2017] Available from: mobile.nytimes.com/2017/03/30/us/politics/science-technology-white-house-trump.html
Kaplan S (2017) 'Kids don't get a second chance': EPA staff fear cuts to health programs under Trump. STAT, 8 February. [Accessed: 9 February 2017] Available from statnews.com/2017/02/08/environmental-health-trump-epa
Kaplan S (2017) Trump derides 'slow and burdensome' approval process at FDA. STAT, 28 February. [Accessed: 3 March 2017] Available from statnews.com/2017/02/28/trump-address-rare-disease-drugs
Keshavan M (2017) Trump's pledge to 'slash restraints' at FDA draws cheers and jeers. STAT, 28 February. [Accessed: 1 March 2017] Available from statnews.com/2017/02/28/trump-fda-reaction
Khazan O (2016) How Trump could slow medical progress. The Atlantic, 28 December. [Accessed 30 December 2016] Available from theatlantic.com/health/archive/2016/12/what-trump-might-mean-for-medical-breakthroughs/511574
Krauss LM (2017) Donald Trump's war on science. The New Yorker, 13 December. [Accessed 17 December 2016] Available from: http://www.newyorker.com/tech/elements/donald-trumps-war-on-science
Leonhardt D (2017) Why Trumpcare failed. New York Times, 27 March. [Accessed: 27 March 2017] Available from nytimes.com/ 2017/03/27/opinion/why-trumpcare-failed
Levin J et al. (2017) US immigration order strikes against biotech, 7 February. [Accessed: 9 February 2017] Available from blogs.nature.com/tradesecrets/2017/02/07/us-immigration-order-strikes-against-biotech
Lupkin S, Tribble SJ (2017) Former FDA chief cites five things to watch for on drug approvals and keeping medications safe. Modern Healthcare, 11 February. [Accessed: 13 February 2017] Available from modernhealthcare.com/article/20170211/MAGAZINE/302119972
Lynch DJ (2017) Trump attacks fellow Republicans for wrecking healthcare plans. Money Watch, 27 March. [Accessed: 27 March 2017] Available from moneywatch.us/trump-attacks-republicans-for-wrecking-health-plans
Meyer H (2017) Vital signs: Who won and lost in the battle to repeal Obamacare? Modern Healthcare, 26 March. [Accessed: 27 March 2017] Available from modernhealthcare.com/article/20170326/BLOG/170329933
Miller ZJ (2017) Can the GOP govern? Time, 27 March. [Accessed: 27 March 2017] Available from time.com/4713620/can-the-gop-govern
Miller ZJ (2017) High stakes week from Trump. Time, 20 March. [Accessed: 20 March 2017] Available from time.com/4706412/high-stakes-week-for-president-trump
Neergaard L, Woodward C (2017) AP Fact Check: Trump's iffy grasp of autism research. The Salt Lake Tribune, 16 February. [Accessed: 20 February 2017] Available from sltrib.com/home/4950195-156/ap-fact-check-trumps-iffy-grasp
Oransky I (2016) Keep politics out of science? Fugghedabout it. STAT, 21 October. [Accessed: 25 February 2017] Available from statnews.com/2016/10//politics-science
Peterson M (2017) Trump and Congress may make it easier to get drugs approved-even if they don't work. One News Page, 3 February. [Accessed: 6 February 2017]
Available from onenewspage.com/n/Americas/75e3pcpwo/Trump-and-Congress-may-make-it-easier-to.htm
Pianin E (2017) Clock starts ticking on possible treasury debt ceiling crisis. The Fiscal Times, 10 March. [Accessed: 12 March 2017] Available from thefiscaltimes.com/2017/03/10/Clock-Starts-Ticking-Possible-Treasury-Debt-Ceiling-Crisis
Rappleye E (2017) House scraps AHCA: 5 things to know. Beckers Hospital Review, 24 March. [Accessed: 26 March 2017] Available from beckershospitalreview.com/hospital-management-administration/house-scraps-ahca-5-things-to-know.html
Robbins R (2017) Vaccine advocates scramble to mobilize against threats to public health. STAT, 31 January. [Accessed: 1 February 2017] Available from statnews.com/2017/01/31/vaccine-advocates-speak-up
Rogan J (2017) Trump could cause 'the death of think tanks as we know them”. Washington Post, 15 January. [Accessed: 3 March 2017] Available from washingtonpost.com/opinions/global-opinions/trump-could-cause-the-death-of-think-tanks-as-we-know-them/2017/01/15/8ec3734e-d9c5-11e6-9a36-1d296534b31e_story.html?utm_term=.3e94788cfd30
Rogan J (2016) Inside the collapse of Trump's D.C. policy shop. Washington Post, 8 September. [Accessed: 4 February 2017] Available from washingtonpost.com/news/josh-rogin/wp/2016/09/08/inside-the-collapse-of-trumps-d-c-policy-shop/?utm_term=.40ce7cbbd6cc
Ross C (2017) Andrew Wakefield appearance at Trump inaugural ball triggers social media backlash. STAT, 21 January. [Accessed: 25 February 2017] Available from statnews.com/2017/01/21/andrew-wakefield-trump-inaugural-ball
Rubin J (2017) Conservative scholars shouldn't be in the tank for Trump. Washington Post, 17 January. [Accessed: 3 March 2017] Available from washingtonpost.com/blogs/right-turn/wp/2017/01/17/conservative-scholars-shouldnt-be-in-the-tank-for-trump/?utm_term=.1a23fac73a1d
Sagonowsky E (2017) Pharm alert: lawmakers win bipartisan support for tweaked price-gouging bill. FiercePharma, 2 February. [Accessed: 19 February 2017] Available from fiercepharma.com/pharma/congressmen-win-bipartisan-support-for-bill-to-fight-drug-price-gouging
Sagonowsky E (2017) Marathon halts launch of DMD drug as $89K price attracts congressional heat. FiercePharma 13 February. [Accessed: 19 February 2017] Available from fiercepharma.com/pharma/sanders-cummings-have-their-latest-pharma-target-it-s-marathon-s-89k-emflaza
Sagonowsky E (2017) Trump's 'not going to back down' from vaccine safety commission, RFK says after new White House talks. FiercePharma, 16 February. [Accessed: 19 February 2017] Available from fiercepharma.com/vaccines/vax-safety-commission-still-going-forward-rfk-says-after-new-trump-talks
Samuel L (2017) Vaccine exemptions are on the rise in a number of US states. STAT, 20 January. [Accessed: 16 February 2017] Available from statnews.com/2017/01/20/vaccine-exemptions-states
Schencker L (2017) Questions surround true cost of $89,000 drug. Chicago Tribune, 19 February. section 2, pp.1, 4.
Scott D (2017) Tom Price, Trump's nominee to lead HHS, rejects claim that vaccines cause autism. STAT, 24 January. [Accessed: 25 February 2017] Available from statnews.com/2017/01/24/tom-price-hhs-senate-finance
Scott D (2017)Tom Price, nominee to lead HHS, sidesteps questions on Medicare drug-pricing negotiations. STAT, 18 January. [Accessed: 25 February 2017] Available from statnews.com/2017/01/18/tom-price-drug-prices
Scott D (2017) Robert F. Kennedy Jr. says he expects Trump vaccine panel will move forward. STAT, 15 February. [Accessed: 15 February 2017] Available from statnews.com/2017/02/15/vaccines-trump-panel-kennedy
Scott D (2017) Trump has big plans to fix drug prices. Here's your reality check. STAT, 31 January. [Accessed: 1 February 2017] Available from statnews.com/2017/01/31/trump-pharma-reality-check
Scott D (2017) Trump promises reform on drug prices, saying companies 'getting away with murder’. STAT, 11 January. [Accessed: 25 January 2017] Available from statnews.com/2017/01/11/trump-drug-prices-news-conference
Scott D (2017) NIH supporters worry: Will research get a funding increase this year? STAT, 4 January. [Accessed: 11 January 2017] Available from statnews.com/2017/01/04/nih-supporters-worry-will-research-funding-increase-this-year
Shellock D, Chisholm J (2017) Wall St pares losses as equity bulls fight back. Financial Times,, 27 March. [Accessed: 27 March 2017] Available from ft.com/content/c4cde316-128c-11e7-80f4-13e067d5072c
Sheridan K (2017) US research and health care rely on international workers. Here are the visas that make it happen? STAT News, 31 January. [Accessed: 1 February 2017] Available from twitter.com/statnews/status/826437532770508800
Silverman E (2017) Marathon backpedals on launching pricey drug after rebuke from Sanders. STAT, 13 February. [Accessed: 14 February 2017] Available from statnews.com/pharmalot/2017/02/13/bernie-sanders-drug-prices-marathon
Silverman E (2017) Marathon CEO, who was praised by Martin Shkreli, causes a new stink over drug pricing. STAT, 10 February. [Accessed: 14 February 2017] Available from statnews.com/pharmalot/marathon-dmd-martin-shkreli-drug-pricing
Silverman E (2017) Bill to lower drug prices will get a boost from a House lawmaker. STAT, 2 February. [Accessed: 2 February 2017] Available from statnews.com/pharmalot/2017/02/02/drug-prices-generics-vouchers
Silverman E (2016) Trump is considering a radical to lead FDA. That's dangerous for public health. STAT, 12 December. [Accessed: 30 December 2016] Available from statnews.com/2016/12/12/donald-trump-fda-oneill
Silverman E (2016) Global meds to hit $1.7 trillion by 2021. STAT, 6 December. [Accessed: 1 February 2017] Available from statnews.com/pharmalot/2016/12/06/drug-prices-spending
Stanage M (2017) THE MEMO: Trump faces dangerous week. The Hill, 22 March. [Accessed: 22 March 2017] Available from thehill.com/homenews/administration/325108-trump-faces-dangerous-week
Staton T (2017) Novo CEO 'volatile' environment, U.S. politics in cut to 2017 growth prospects, 2 February. [Accessed: 19 February 2017]
Available from fiercepharma.com/pharma/novo-ceo-cites-volatile-environment-u-s-politics-cut-to-2017-growth-prospects
Staton T (2017) Trump's pharma CEO confab: Get prices 'way down' get 'better innovation' and get back to U.S.. FiercePharma, 31 January. [Accessed: 20 February 2017] Available from fiercepharma.com/pharma/novartis-phrma-ceos-to-face-trump-and-his-drug-pricing-vows-at-tuesday-meeting
Steinhauser J (2017) Meager gains for Republicans on bold legislative to-do list. New York Times, 17 February, p. 1.
Sullivan S, DeBonis M, Wagner J et al. (2017) Who is to blame for the failure of the health-care overhaul? The finger-pointing begins. Washington Post, 25 March. [Accessed: 26 March 2017] Available from washingtonpost.com/powerpost/who-is-to-blame-for-the-failure-of-the-health-care-overhaul-the-finger-pointing-begins/2017/03/25/d799fc94-115d-11e7-9d5a-a83e627dc120_story.html?utm_term=.e9d634e1866a
Tracer Z (2017) Trump volatility index takes pharma companies on a wild ride. Bloomberg, 2 February. [Accessed: 3 February 2017] Available from bloomberg.com/news/articles/2017-02-02/trump-volatility-index-has-taken-pharma-companies-on-a-wild-ride
Wagner J, Paletts D, Sullivan S (2017) Trump's path forward only gets tougher after health-care fiasco. Washington Post, 25 March. [Accessed: 26 March 2017] Available from washingtonpost.com/politics/trumps-path-forward-only-gets-tougher-after-health-care-fiasco/2017/03/25/eaf2f3b2-10be-11e7-9b0d-d27c98455440_story.html?utm_term=.37cbd52c2f9d
Walker J (2017) Trump assails drug industry. prices. The Wall Street Journal, 12 January. p. 4A.
Wasik Z (2017) What the wobble in US stocks tell us. Financial times, 27 March. [Accessed: 27 March 2017] Available from ft.com/content/d1fdeb96-10a5-11e7-b030-768954394623
Wikipedia (2017) List of withdrawn drugs. [Accessed: 1 April 2017] Available from en.wikipedia.org/wiki/List_of_withdrawn_drugs
Yen H (2017) President Trump wants Democrats help with health reform. Time, 26 March. [Accessed: 27 March 2017] Available from time.com/4713381/acha-trump-bipartisan-health-care-reform