As an American doctor, I think you deserve to hear the truth about our health care system.

Every year, US taxpayers spend more than $ 39 billion through the National Institutes of Health fund medical research to discover new treatments and medicines that save lives. US patients risk their health and sometimes even put their lives in danger to see if these new drugs are safe and effective in clinical trials.

However, when the time comes to reap the benefits, Americans pay much higher prices for the same drugs that patients in universal health care systems abroad can obtain at a much lower cost. This is despite the fact that Americans are sacrificing much more to help put these drugs on the market.

This is largely because large pharmaceutical companies are leveraging both the US private health system and our patent laws to perpetuatenot injustice on the American people.

Take, for example, California-based pharmaceutical company Gilead Sciences, which markets Truvada, a formulation of two antiretroviral drugs, tenofovir and emtricitabine, that inhibit the ability of the HIV virus to take our cells and replicate. Truvada is so effective in pre-exposure prophylaxis (PrEP) to prevent HIV infection that it is on the Essential Medicines List of the World Health Organization as an absolutely critical part of any basic health system.

While the generic version of Truvada is available in many countries other than the United States for about $ 840 a year, Gilead is using its patent on the drug to make Americans pay nearly $ 24,000 a year per patient. It is for the exact fixed dose combination of tenofovir and emtricitabine that produce about $ 60 a year per patient.

Unfortunately, the consequences in terms of health are serious. According to the CDC, about one million patients are at high risk of contracting HIV in the United States – but only 160,000 patients take Truvada because of its high cost. With proper daily use, Truvada is 99% effective, but more than 40,000 people are infected with HIV in America every year. If the generic Truvada was available and all 40,000 patients followed this treatment before becoming infected, the number of people would be closer to around 400. The endemic spread of HIV in the United States could then be significantly reduced or even eliminated.

What is maddening is that US taxpayers have funded much of the research and development for Truvada. So, in fact, that according to the Yale Global Health Justice partnership, it is the CDC that holds the patent for the drug. Thus, Gilead earns essentially $ 3 billion a year by selling a drug that belongs to the Americans themselves.

And that's not all. Gilead recently partnered with Health and Social Services Secretary Alex Azar and President Donald Trump to set up a public relations program to deceive the public. During this, Gilead said that it would give enough Truvada to treat 200,000 patients each year until 2030. Although it sounds good on the surface, it basically means that it will donate about $ 12 million a year while making billions profits. and get a tax break.

I'm not surprisere Alex Azar would promote such an agreement for large pharmaceutical companies at the expense of vulnerable patients. After all, before joining the Trump administration, Azar was vice president of Eli Lilly, where Novo Nordisk and Sanofi – two other major pharmaceutical companies – more than tripled the price of insulin.

Just like Truvada, insulin is on the WHO list of essential medicines, but there is no effective generic in the United States. Because of loophole In patent law, called "evergreening", major pharmaceutical companies such as Eli Lilly, Novo Nordisk and Sanofi are gradually improving the same basic insulin discovered by Charles Best and Frederick Banting in 1921. While Best and Banting were selling their patent to a dollar that they could help save as many lives as possible, the pharmaceutical companies have increased since the price of insulin is so high because of the persistence of persistence that many patients resort to rationing their insulin to survive.

I will never forget the first time I had to amputate a patient's leg because of poorly controlled diabetes. It was my internship year as a resident in surgery and the man entered the clinic with a nauseating open wound on the heel of his foot, which probed to the bone and lay down until he at the ankle. After we prepared and draped it in the operating room and scarred our incision, I could not believe that I was cutting off all his arteries, bones, nerves and muscles and that I was removing his leg just to save his life because he had to choose between food, shelter and insulin. We are the richest and most technologically advanced country in the world and we can not provide the most basic care for our own people.

It is time for us Americans to realize that our lack of a universal health care system makes us vulnerable to pharmaceutical companies that, in my opinion, take our taxpayer funded research, use our body for clinical trials and sell us the drugs that we have helped develop at exorbitant prices simply because we do not have the combined power of buying and selling bargaining that benefits people in other countries with universal health systems. From insulin to Truvada to almost every essential medicine on the WHO list, we often pay literally with an arm or a leg – or even with our lives.

Eugene Gu is a surgeon and scientist whose medical research focuses on the development of a cure for babies with conbad heart and kidney disorders.