the year. if it does, one point 5 million households will lose content. live coverage of the markup c-span 3. >> tonight on c-span, q&a with ibis sanchez-serrano, followed by question time with david cameron and the house of commons, and rand paul on government surveillance. >> this week on q&a, business man and author ibis sanchez-serrano discusses his book from the laboratory bench to the patient's bedside, "the world's healthcare crisis."

>> ibis sanchez-serrano, what's the reason that you say that 90% of all online drugs, meaning prescription drugs, are fake? >> there has been a study of the pharmaceutical association here in the united states that has done some research about many of these drugs online, which have been fake or counterfeited drugs. so, people have to be careful when they purchase these drugs, because one of the things that could lead people to go ahead and buy these drugs is the price. but there is no question about the quality, so this is something people have to keep in mind all the time. >> who makes them? >> many come from south america, india, peru, and different regions of the world. >> they have no drugs in them at all, or they are not as good as the brand name? >> what happens with these fake drugs, is that some of them have no active ingredient at all. and in some cases, the ingredients are adulterated. so, if these drugs do not come with different certificates of manufacturing practices from the

world health organization, then they have no validity, because no one know what is inside them. that is one of the major issues that exists with them. >> you also said one of the biggest problems in africa is fake drugs. >> absolutely. one has to understand, many of the drugs being sold in africa are sold to countries where systems are not as stringent as the ones in the united states or europe. therefore, many people who are really suffering from devastating diseases do not know what is going on. price is an issue, then what happens is many people believe this price is good. well, that is not the reality. >> when did you first get interested in pharmaceuticals?

>> i am a geneticist by training. my background is a scientific background. when i was working at boston university with jim and charles, who was one of the pioneers of the human genome project, i saw there was a link between that and human problems. that is how i first went to the law of diplomacy, with a project with harvard university and the school of medicine. then i did an internship here in washington, d.c. in 2003, in international science and technology, working on healthcare, and then i saw the link between pharmaceuticals. my background is in genetics, and then healthcare, and that's how i decided to write a thesis through a project on the issue of pharmaceutical development. >> where did you grow up? >> i grew up in panama. i was in panama until i was 18 years old, then i received a

scholarship to the united states for international development, to study genetics. at that time, i was a student at the medical school in panama. but what i wanted to do was research. they gave me a scholarship to come to the united states. i came to iowa state university, and then harvard, and then i graduated and went to continue my studies in europe, and eventually came back to the u.s. >> what was life like in panama? >> it was very difficult, because i grew up through two different dictatorships. one was a general, the one who signed the panama canal treaty, and the other was -- noriega. >> so i, throughout my life, saw a lot of problems in my country

due to the lack of opportunities as well as the lack of freedom. and so it was for me, that the scholarship i received from the u.s. came as a godsend gift, because otherwise, without that opportunity, i would not have become the person that i am right now. and that serves an example that many of these programs that the united states have with other countries do bear fruit and allow people to train in the best places with access to the best technology, and be enabled to serve not only their countries, but also the world. >> what do your parents do? >> my mother -- it's a very interesting story because my mother grew up in a very rural area of panama. it was a difficult situation, so she did not go to school at all. she is a genius, i reserve the word genius for remarkable people, and my mother is one of them.

she has a remarkable memory and high intelligence. because of her limitations, and she was a single mother and had to raise us all alone, it was very difficult for her. she brought up seven children and all of us went through college, and we all became professionals. and herself, she was always learning and learning. so the love for learning, and the love for serving other people and to help them came from her. >> did you ever know your father? >> yes, i do know my father. >> are they both in panama? >> yes, they are in panama and they are alive. >> what about your siblings? >> they are in massachusetts. my sister is a professor by training. another is a librarian. and one is an electrical engineer, the other is a construction engineer. the other is a scientist and business man in public policy. >> where is your permanent

residence today? >> right now it is panama, but i travel back and forth between panama, the united states, and other latin american countries and europe on business and research purposes. >> what would be the difference if we were in panama and had a medical problem and went to an emergency room versus here in the united states? >> the differences are big. first of all, in panama we have a universal healthcare system. but there are many issues with that. having access to an emergency room costs very little. but the problem comes when one has to be taken care of, or more importantly, with medication. so even though we have a universal healthcare system, having access to the physicians, having access to the health insurance, is not a problem.

when it comes to purchasing of medicine, then it becomes a great difficulty. in the united states, prior to the obamacare, there were about 46 million people without health insurance. so many people would not go to the doctor fearing the high cost. so there are huge differences between these two systems. but the common denominators are two. one is the high level of inefficiency, and the other is the cost of having access to the medicines. >> what is the core model corporation? >> it is a think tank and consultantcy that works in two different areas. one of them is innovation. and that is taking ideas from university innovative centers through the hard process of

becoming drug products. and that is a collaborative project throughout the world. the other part is healthcare reform and the different policies that need to be implemented in order to make possible a better healthcare system. and the third part, which is closer related, is international economic development. because the issue of healthcare is a very complex problem that goes beyond health insurance. one has to take into consideration the economy and socioeconomic problem on how development plays a role in it. >> why did you start the company, and when and where is it based? >> it's now based in panama and it is a startup. it has been an ongoing process in the last year. the reason i wanted to, in panama, i could work in the whole area of latin america. eventually it would open a subsidiary in the united states. i'm working that process now. the goal of these companies is to bring a new perspective on healthcare. sometimes the difficulty is for scientists and business people

and policy makers to establish the relationship between research and development, and the delivery of good health care. >> you gave a speech at the new york library and i want to show a clip from that, and ask you about what you say about the future that you are predicting. >> and i personally believe and this is not just keep. i think the world is going to succumb sooner than later to a plague, and like the middle ages, in which large percentages of the population were killed. that is the situation because we don't have enough antibiotics right now, and this is the issue in which the developed world

should contribute to, to help other countries and to help themselves. >> what kind of a plague? >> i think it will be a bacterial infection that will spread all over the world. the reason for that is through different climate changes and the facility to mobilize from one place to another. many of the diseases travel through people and to other countries. and the problem is many of these bacteria or diseases are becoming resistant to the most potent antibiotics now. we have in panama for instance new strains of t.b. which are completely absolutely resistant

to the most potent antibiotics and medicines. the other problem is there is not enough interest on the part of the pharmaceutical industry to develop antibiotics. >> we need to make a global effort to work on this and develop collaboration between the developed world and developing world where many of these diseases are endemic. i think the case of hiv is an example in which people in many of the developed world, countries say why should we do research on that if that is not our problem. hiv proves that is not the case. this disease is spread very quickly and affects people all over the world. i think that the world is not ready for that. and also the experience we have to the h1n1 that we could have all over the world.

>> you tell audiencees that you spent six years on a study and credit a man named daniel in switzerland for backing you up on that. >> i will back up a little bit. daniel is a swiss man and he daniel is a swiss man and he financed the whole project of writing the book. in the year 2003 i was working on a theory that led to the core model or theory which i will explain later. and i found that there was a new way of thinking about dealing with the issue of productivity at the pharmaceutical industry level about healthcare. and i was very fearful about publishing that work.

i initially sent it to "science" here in the united states and they rejected it. i sent it to nature in the u.k. they got interested in this article and published it in the u.k. so daniel who say friend i met the first day i came to the united states in 1992 in the same bus going from iowa to aims iowa. he sat next to me. so we started a friendship for many years. daniel became a very well man of healthcare. he had an interest in this. he said this is something quite remarkable and i see what you are saying could have a great impact in how people develop drugs and also how the world could benefit from your research. so why don't you just write a book? i said that is a difficult task. and it would take considerable amount of money. but i think i could have the book in two years.

two years became six years. so it became a very expensive project. as i started researching about the pharmaceutical industry, about the academic industry about healthcare, i found out that it was a very extremely complex subject matter so i have to travel all over the world. i have to go to different places and interview. and the key people involved in making policies regarding drug development and healthcare. so daniel, who is from switzerland, funded to the end of the project. it was a project of $500,000 spent in order to write that book. and he supported it all. and something they wanted to mention, what we wanted to do was to create a work that was objective, that was not conditioned either by the pharmaceutical industry, nor by the university system in the united states.

but something that would be an independent and objective work that would contribute and say listen, these are the problems, these are the causes of the problems and these are the different solutions to deal with the global healthcare crisis. >> what's the biggest, most important prescription drug ever produced? >> it depends how you look at it. for instance lipitor has been one of the best sold drugs all over the world. it was about $9 billion before it became a generic. these have been very successful. there have been others too. these drugs are the one that sell $1 billion and above. we are talking about that range. >> you say when they spend $1 billion on research on the drug, they spend more money on marketing than they do the

creation of the drug. >> let us get into that. there is a study by the top center for drug development. and one of the findings is that on average it takes $1 billion and about 10 to 15 years to produce a new drug. but that is an average and that is for a handful of drugs. for instance, for cardiovascular diseases. but that is not for all drugs. if that were so no one would produce drugs. a few could go into that range or more but many others would never make that amount of money. >> if one looks into the buy technology based products, then it would be impossible for any capital group to fund such drugs so that is not the case.

some drugs are cheaper than that, some are more, but on average that is the price. now i think that there is a big issue there, because when the pharmaceutical industry says drugs are expensive, it cost too much to produce them, that is not true. they spend at least twice as much marketing and promotion than they do on research and development. so that is a big problem. and eventually it is the consumer, the one who has to pay for all of this expenses regardless of the benefit -- cost benefit ratio. >> how long does a pharmaceutical company get to keep a drug solely in their company and sell it?

>> in the united states the intellectual property is for 20 years after filing. if one counts years of development, a company would in ten, nine, eight years would try to make as much money as it goes on generics. however it various because on some they get some extra time. and then the pharmaceutical industry know it's game. so what happens is they try as much as possible to extend the patent coverage by the formulation, by different type of use. by many tricks so that the products last as long as possible and continue making money for them. >> do you have any opinion about the doctor's relationship to the pharmaceutical company? >> absolutely. it varies from country to

country but in the united states this has been a scandalous situation. in countries like switzerland there are stringent laws. in the united states and it is very well documented that the pharmaceutical industry is very immersed in the universities in terms of talking to doctors and finding all sorts of strategies, lavish promotion, gifts. and although that has been regulated to some extent and it has improved, it is a big problem because it is an interference with the medical profession and also it is actually creating more harm than good. and that should be actually more stringent and stronger regulation for that. >> if you were in a doctor's office and a doctor said you have xyz problem and he or she said let me get some medicine, i'll give it to you and they

come in the sample boxes and all of that. >> that is called marketing. there is nothing free. these samples are also marketing. so the pharmaceutical companies give those to doctors. but that is not free. that is part of use it, we're giving a different product to other people. try this chocolate or try this candy and if you like, you buy more. it's very simple. >> in recent years if you watch television in this country, you often see ads for named drugs and they tell to you go to the doctor and ask for this drug and they tell you if you take this drug your right arm might fall off and go through a list of things. >> yes. right now the fda has become proactive about regulating that issue and all of that rambling at the end you will probably have diarrhea and vomiting and all of that. there is a problem about this in

the united states because the freedom of speech, the first amendment is that all of those tv advertisementa which is it is crazy my opinion and that is costly to the industry and to the patient. to regulate that is very difficult because as speech it is protected from my understanding. so i think there should come a system in which the internet should be used more than this advertisement because the budget they consume are huge. and probably it is not as effective as detailing the visit to the doctor. there is a lot of room for improvement and also for regulation and also for an understanding on the part of the pharmaceutical industry that people are tired and sick of that and it is necessary to put these things into perspective. >> put the american medical system into perspective with other countries you've visited. the american system is the most

-- >> the american system is the most privatized system in the entire world. yes, it is the most inefficient in the industrialized world not only in terms of the amount that is invested. it spends 18% of the g.d.p. which is the highest in the industrialized world. but also the outcomes in terms of mortality rate, the amount of money that is spent per capita, the amount of the life expectancy of the united states compared to other industrialized nations. by the age of 60, americans suffer significantly from chronic ailments. so they probably thrive average

-- live the average life expectancy 74 years. but it's with chronic ailments. >> i looked it up and we are listed as 34th in the world in infant mortality and listed at 35th in the world and in life expectancy. singapore is number one in infant morality. >> why is this? >> there are many different reasons. the united states, the system here is very stressful. money is always a big concern. work is a big concern. but also the habits of americans are very poor, the fast food and other issues that lead to a very unhealthy lifestyle compared to other countries where for instance people pay more

attention to what they eat, to healthy habits like exercising etc. so i think in that area the united states falls quite short of other nations. when it comes to also family life, i think that is also very important. many of the problems in the united states, the issue of depression. and people get depression and immediately go to the doctor to have a prescription of drugs like prozac or other medications related to that. that comes not from having a medical condition but i would say from having a very emotional and spiritual need in which people have lost many of the core values family in many ways face or see. so it has become very materialistic and that is having a ell toll on people's health as well. >> from your experience of living in panama and growing up in panama and living a lot in the united states. >> and in europe too.

>> and in europe, how happy are people in america compared to people in panama? >> people in the united states are very unhappy. people are very friendly, because if there is a country where people are extremely friendly it's the united states. but when people smile it's quick. they become sad. i think on the surface level people are trained in their emotions and they try to keep all your problems, be strong, you are going to make it. and people do not allow themselves to expose their weakness and also to let it go. and just to depressure a little bit. i think eventually this is really affecting the psyche of people. for instance when people reach 18 years old.

they have to get out of the house and see what they can do. and in some cases even if the parents can afford tedge -- afford the education of their students in college, they say you get a loan and have to work for it. these things are different in other countries where the family values are strong. where religion is a strong force. it's about cultural values. it is about seeing beyond what is material, seeing about what we came to this life for. and this is in great contrast. >> i see you quoted saying people outside of the united states think we have it all. >> absolutely. everybody thinks this is a fairytale land and that is not true. boston has been the place where i have lived the most in my life. people think of boston as money

and wealthy people. that is not the case. even a place like beacon hill where i have lived a significant amount of time. people say this is a very wealthy area. not really. there are places as big as this room. outside of boston you see a great amount of poverty in many of the neighborhoods. this is the idea. when you see the united states tv programs, what are they about? they are about violence or they are about this beautiful perfect life. when you go out and see the hospitals that have four different doctors taking care of you when the reality is not like that at all.

so the united states, in many ways, and i would take this back to 100 years ago has created this aura of american dream and about happiness and this after the second world war it became stronger. and that has misled not only the united states to think of itself as a fairy land but the rest of the world to think that when the reality is quite different. >> who would hire you? >> right now i have my company but i think it would be the government or pharmaceutical. companies that are interested in different strategies. part of my work and the work that i'm focusing is to be a visionary, is to look at things other people are not looking at.

i am a scientists by training. things are always where you are not looking at. i think it would be important for them to see where would we be in five years from now, where we'll be in ten years from,000 -- 50 years from now and not only the united states but the entire world. because what happens in the united states and the problem of medicine is one case in point is the issue, since the united states is the leading country in invasion as well as in producing new medications and there are not price controls in this country, then the high prices are here based on a u.s. market. and even though there are price controls in other countries, the prices here are very expensive. these are being exported elsewhere. this is not good in the long run because what happens is eventually people over there are being effected.

but it always comes back to the united states and that is an issue. so i think that governments and national organizations, pharmaceutical companies, investors are the people interested in my work. >> how many other countries have price controls on their drugs? >> most countries have price controls in one way or another. there have been some experiments where they actually make a liberation of the price controls and that was the case in columbia. and remarkably colombia in the year 1993 adopted a similar program to the obama care. and then it also liberated price controls, in many ways, some were controls and others weren't. right now colombia is in a big mess because that was a failure. the pharmaceutical prices soared and then the problem is that now the health care system has become bankrupt.

>> you listed in your presentation the amount of money that is grossed revenue by the different pharmaceuticals and fires at $67 billion, johnson and johnson $65 billion. then you look at the c.e.o.'s of those company and a lot of them are making $25 million a year. >> absolutely. >> why can they put price controls in foreign lands but we pay three and four times as much for that? >> here there are no price controls. in the other countries what happens is that first of all, this is complex. we have to talk about the doctor salaries as well. those things are closely related and in other countries that is not the case. >> how much higher are the

salaries of doctors here than in overseas? >> in panama a very highly skilled specialist could earn $3,000, $5,000 a month. or $2,500 a month. here in the united states we're talking about hundreds of thousands of dollars a year. >> what about in france? >> in france it would be similar to the panama couple thousand dollars. >> why are medical schools so expensive to go to? >> here in the united states many people get loans. it's the way the university system is. they create a system people go to the medical school. many of those people have a vocation for being a doctor, some do not.

they are going after money or prestige. when people see that, they are working on investment. if you invest certain amount of money, you buy the title and then after that you go into practice and then there are the issues of the lawsuits here in the united states and the insurance and all that kind of stuff. so for people to be able to afford that kind of stuff. when i talk about health care reform, i talk about tort reform. it's necessary for this country to lower the cost. just having access to a doctor is costly. so these are remarkable differences in the other countries where the education is free or subsidized by the government. and the doctors are not going to have huge loans after they graduate and they are not going to have huge salary but they have a vocation and have to deal with whatever the problems are. >> if something happened to you and you had a major heart

problem and had to have a heart valve replaced, where would you go? >> in panama there are good doctors. >> i would do it in the private sector. i wouldn't do it in the public sector. it is terrible. the corruption that exist in panama which has become to frightening levels and despite the fact we are one of the fastest growing committees in --economies in the world and number one in the entire continent. then you see that problem. but in the case of a lot of -- but even in the public you get that because my aunt had open heart surgery recently and she had great complications and the public system took care of it and it was paid by her insurance. public insurance. >> if you had cancer, lung cancer, where would you go? >> it depends.

if i thought it was terminal, i would just go home. i wouldn't waste my time using all the money i have to try to live three or five months more and writing a check for the pharmaceutical industry. i think i would just go home and try different types of drugs try different types of drugs which are already off patent and be close to my family. i think that would be my strategy because i don't think i have to say that not only because i'm latin but i'm a catholic in the sense for me catholicism is a culture. one is not going to last forever. there are things one cannot control. i as a scientist, i as a person who is highly educated think my intelligence and the possibilities for me to change things are very limited. there are things i cannot control and there are things i'm not able to understand.

such is the case and so it be, i am convinced there would be a different reality from here. i am not that attached to this -- to this life in that regard. >> you say that you went to med school for one year. >> yes. >> but i saw a quote that said, "i went there because i wanted to make money off of medicine." >> that is not what i say. i went to school to study to make money out of medicine. i tack part of my education at the harvard business school and at the school of management where focus on the area of pharmaceutical development and how to make money out of that. i come from that background in the sense that after my training in genetics and then my other trainings, i went to study that, business management in the pharmaceutical sector and how to make money out of that situation.

>> recently, dr. collins at the national institute of health convened ten pharmaceutical companies to study the future of medicine. do you think it will work? >> this is an important step because in 2006 i published an article where i created a model which is called the core model. and that core models a method. it's an economic theory and organizational model of research and development. and it is the exchange of assets and collaboration taking advantage of different synergies and things already available in society to lower cost. so, i proved that using that model, one could develop drugs in a very economic manner and in a very short time and that was the case of a drug for the treatment of multiple myeloma which is a cancer.

so it is interesting when i read actually this initiative by collins because although they haven't called at this time core model, it is the core model. it is exactly what i proposed in 2006 for pharmaceutical companies and the governments all over the world, not only the united states but all over the world to try to do. to make this a collaborative effort. because healthcare is a huge problem that not only involves the pharmaceutical but government, investors, universities. so we need to be able to unite efforts in order to make sense of all the information and all the data that exist there. and with all of these findings what happens is now for the first time in history we have a huge amount of invasion, we have

-- huge amount of innovation, a huge amount of knowledge and data there. but what we are not seeing is significant better treatment. what we need to do is make it convert gent. all of that data should converge to one point about the understanding of disease, the causes of disease and how to treat them. this initiative by the n.i.d. which is part of what i created this model for in 2006. it is being implemented by the n.i.h. and i am thrilled about that. >> why do you think you can get pharmaceutical companies to change their habits if you look at the amount of money spent? >> one has to take into consideration that everything is in the mind. so what we need to look for is a mind change. we need to look for a different mentality. but the pharmaceutical industry know their image is not good at all. and there are many problems in

the developing world and also the united states and they have a bad reputation. so they have implemented problems such as social responsibility and many companies have seen a decline, so many of them have programs but there is much more to do. also what they have to understand is the pharmaceutical industry is seeing double digit return on investment. we are talking about one of the most profitable industries in the world year after year after year. so this is an issue here because when i talk about mentalities, why should that be so? why would car industry, telecommunication industry, other industry make single-digit return and the pharmaceutical industry make double-digit

returns? this is a real aberration of what the use of science should be about. because first of all, healthcare is a fundamental right of man. and even though those rights get violated all the time, in my opinion, coming from the scientific area, i don't see that there is no excuse for those high prices especially when they are not related to the >> you say the big winner in obamacare was the pharmaceutical companies. >> of course it is. there is a huge market out there. when it comes to the obamacare reform, one has to understand this is similar to the failed reform that has been implemented in columbia in 1993. it was a long time ago. and what happens is the pharmaceutical industry was not touched. because the worst that happens to the pharmaceutical industry

is price controls. which i fear because first of all, price control would have a big impact on invasion because -- impact on innovation, obviously one of the reasons why many people think they are coming up with new drugs or findings is because of the economic returns. but again, the system is such it's going overboard. it's going way beyond what people and what the world could tolerate. i don't think these prices are sustainable and what is happening now is people like in india are breaking the patents. in other countries people are breaking the patents. it is sad what happened recently where the c.e.o. said cancer drugs were produced for western people who cannot afford it but

not for indians. there is something quite immoral about that issue. >> what do you mean by breaking the patents? >> basically bringing up a genetic drug which is already covered by the pat tents. -- by the patents. a brand name drug. so they say we have people who are dying. our population is sick. we cannot afford your huge prices so we are going to copycat it. we are going to use the medication. >> how do they know what is in the medicine? >> there are many ways. the active ingredient is known.

a generic is a copy of that ingredient. they synthesize and produce a generic. >> what would be your reaction if you were at a doctor's office and lipitor for instance all of a sudden the generic was available, what would you do? >> i know it's generic now. >> if they said you can have the brand name or generic, would it matter? >> fits a quality generic i would go for that. >> the fda was guiding them and talking to them and helping train the people especially in the area of regulation and in compliance with international regulation this. is one of the issues in which many of these drugs come from india and china and then go elsewhere and people don't know what is in there. there are many ways to find that out and many other things.

but the point is it is necessary, more compliance for individual lens. it is the follow up of a medication and what is the effect on a population over a period of time. i think that is secondary effect. i think this is very important. so the united states is doing well in the sense of making sure that other countries on whatever product is imported into the united states is compliant with those regulations and that is something that should be implemented more and more all over the world, in african countries, all over. >> what should we think as americans about obamacare? >> i think that people should be realistic this. is not a solution to the problem. the healthcare problem in the united states is going to continue and not go anywhere. if we do not deal with the issue of innovation. if we do not translate all of

those findings that occur at the pharmaceutical level at the university level into healthcare products which are affordable and that treat disease and that curious them and as long as we do not understand disease and their causes and how to treat or cure them, there is no point really in talking about the solution of healthcare problem. because health insurance coverage is going to provide health insurance. but when it comes to drugs, when it comes to the premiums and subsidies where are these subsidies going to come from? from taxpayer money. it's not people are going to get the dollars out of the trees. people have to pay for that. and there is a limit. economy is the science of limitations. so we don't deal with a better system of working on prevention and working on understanding, how we could take care of our own health, then there is no point in having health insurance. what is going to happen is what happens in columbia now. everything can have access to healthcare. what happens in europe too, in which people are covered but when it comes to the medications and when it comes to access to drugs, then governments are

having problems affording them. >> we were talking about that drugs are said to cost as much as a billion dollars to create. >> even more in some cases. >> how does that break down? >> well, it depends. some part could be in research and development. other parts could be what is considered some cost. other would be part of the marketing. but actually it is interesting because the price of a drug is not necessarily related to the expense in research and development. it is related to what the market can bear. so there is not really a consideration of the cost benefit. if people can swallow the drug, then obviously i'm going to sell it. that's what i was talking about the problem being export and the rest of the world.

if a medication for the treatment of a blood disease is about $400,000 a year. people in columbia are having a debate, in mexico and brazil, how are we going to afford this. we are going to give you a discount. it's like 5% discount. this is something which is hard to understand. when people price a drug they see numbers. we are going to have tens of thousands of people take this drug. they don't think a mother with three or four or five or seven children, dies and it's the main bringer of the food to the home. and she has cancer or whatever and she dies.

the disaster this would create in this family and the disaster this would create at the sociological and economic level, those things are not taken into consideration when these drugs are priced. what is taken into consideration this is a niche market where not many people investing in this disease. this is i could have market exclusivity therefore i could charge as much as possible. it's like any other product, like a luxury car. i want the latest bmw, well you have to pay a premium for that. i think that mentality has to change. when i say the mentality, that has to change. >> all these companies, they are not all american but they are all stock companies and people are making lots of money, both the stock holders and the people running the company, why would they change?

>> they change because in the end it's becoming like a boomerang. it is coming back to the united states and it will create a lot of problems, a lot of pressure. in many ways the pharmaceutical industry origin are in europe and switzerland and germany. but they are based here because this is the largest pharmaceutical market in the world. they see that the profitable market. the problem is that if things continue this way then healthcare will become unaffordable because the health insurance has system. the more complicated it is the higher the price, the higher the premium, the higher the doctor bills etc. that is escalating at least twice as much as inflation.

obviously that is a problem effect in the economy as well. so people are going to say fine, now we have obama care, now we have these reforms. when they say fine, you are going to have to pay for this drug or more more this doctoring doctor and more for this and that. that is what happens in other countries. i'm working in columbia this process to see beyond the immediate what is going to come next. and when it comes to drugs, even though they say they are 10%. drugs are essential to the healthcare maintenance. even in prevention programs, drugs are necessary. so drugs then escalate, then the price escalate, then everything

else escalates. >> what's the status of the antibiotics? >> that is a problem. many pharmaceutical industries are not interested in this area because it does not make as much money. if you get infectious disease and once it is treated and cured, what is going to happen next. the issue is many of the antibiotics were created a long time ago. now with changes in vitamins. these strains are mutating and some are really changing fast. that is a big problem and there are not enough antibiotics there and not enough medicines to treat infection diseases. it is a huge problem. eventually they come back to the united states to create problems too. people have to see beyond what is the immediate problem and think about how the research that has been done in the united

states, how what is done in terms of the pharmaceutical development here not only helps the united states but also the rest of the world because helping those people also help people here. it's a different way of thinking about the fact that we are not isolated. this is a global problem. >> how big is the online business of prescription drugs? >> i cannot tell you right off the top of my head the number but it's fairly large. >> would you ever order anything online? >> no, i wouldn't. >> nobody? >> no, i would not. simply i would not. that would be my own personal.

i would not. >> are there any reputable companies? >> of course. ordering online could mean many things. it could be a genetics house in india. i have seen the whole range of spectrum but personally i would not order online. >> which countries have you experienced have done the best with medicine? >> it depends how you look at it in terms of the outcome and access to medicine. a doctor wrote a book on singapore. but that is a particular case. >> about 4 million people. >> wouldn't be accept to believe other countries. probably the european system like the swiss, the dutch. but the german even with those systems are having problems right now when it comes to access to medication even in the dutchland because it is a social conscious system they are having problems because of the economic recession and what is going on

in the new world. they cannot continue to afford these high health care expenses. there are other countries like a few years ago like france for instance. but the problem with france is people say i see a doctor whenever i want. i go to a specialist whenever i want. i consume these, this and that. then they say we have the best system because of that. yeah right. but when you see what you have to pay. all of that is subsidized by the government. it all comes from tax money or loans. what happens is many of these systems are financed with debt which eventually lead to a deficit in the long run. nothing is for free. you have to pay for it and eventually it creates a lot of problems because more and more money is being spent on sick people and a very inefficient system that then affects other areas such as education,

security, less policemen, less firefighters etc. >> you went to school at iowa state and got what degree? >> i got a b.s. in genetics and art history. >> then? >> at tufts, that was a matter in international affairs but with a focus on business. i also went to the university of paris in italy to study in molecular genetics. but in the end i decided to come back to the united states and i was working at b.u. then at harvard. then i decided i did not want to pursue the full phd and decided to switch to this area of healthcare. >> you told us your mother had no education? >> she was not sent to school at all. and she knows how to read and when she speaks she speaks like

a professional person. she educated herself learning and cultivating herself. >> what does she think about what you do? >> she feels very proud of what i do for many years. for her this was a success because as a mother she did what she could and then to change the life of her children through education, but also the fact that none of us followed a criminal path or none of us followed a different path but all became good citizens and working for the better meant of the world and making the world a better place. to realize her dreams through her kids has been a great satisfaction. >> how many of your siblings went to school in the united states? >> myself and my youngest brother studied naval engineering in columbia, i was the one who was able to study in the united states.

>> and if people want this book, the "world's healthcare crisis," where can they buy it? >> on amazon and order it online. also i have a website which is sanchez-serrano.com where people can ask questions about any of the issues related to the book. >> the publishing company is where? >> it's a dutch company. my understanding is largest publisher of medically related books. it is a dutch company with a long tradition and also based in the united states and elsewhere. it's a leading publisher in the field. sanchez-serrano, author of the world's health care crisis. thank you very much. >> thank you very much.

>> british prime minister david cameron taking questions from the members of the house of commons. after that, kentucky senator rand paul taking students -- taking questions from students of university of california at berkeley. >> on the next "washington .ournal," william golson then, fiscal times reporter brenda ely