down your cheek.

流到臉頰。

I used to think that was because I missed.

我以前認為是因為我沒有滴好。

But turns out, I'm not actually so bad at this.

但事實證明我其實沒有那麼糟糕。

Well, most of the time anyway.

至少大部分的時候。

Eye drops run down our faces because the typical drop is larger than what the human eye can

眼藥水之所以會滑到到臉上是因為一滴眼藥水比人的眼睛

physically contain.

可以容納的量還要大。

Some are more than twice what the eye can hold.

有些是我們眼睛可以容納的量的兩倍。

That means using a single eye drop is like pouring water into a glass that's already

這代表使用一滴眼藥水就像是往一杯已經滿的玻璃杯

full.

倒水。

Or like in those Clear Eyes commercials...

或像是那些 Clear Eyes 的廣告。

It's incredibly wasteful to make over-sized drops.

製造太大滴的眼藥水是十分的浪費的。

They cost a lot of money.

它們會花很多錢。

The waste from each one is like a tiny snowflake.

每一滴的浪費就像是微小的雪花。

It's easy to overlook, until they've piled up into a billion dollar snowball.

在它們累積成一個十億元的雪球之前，它們很容易被忽略。

It's wasted medicine, and all of us are paying for it.

它們是藥品廢棄物，而且我們都在為這些付錢。

The eye drops industry is huge.

眼藥水產業很龐大。

They're sold by volume, and some can cost hundreds of dollars for a small bottle that

它們是按體積銷售，有些用不到一個月的一小瓶就會花你

only lasts a month.

幾百塊。

The financial cost is a particular problem for the millions of patients with chronic

金錢對於每天都需要昂貴眼藥水的上百萬

conditions that require expensive drops every day.

慢性患者來說是一個負擔。

Last year US drug companies brought in about $3.4 billion for dry eyes and glaucoma

去年，光是乾眼症和青光眼的眼藥水就為美國藥廠

drops alone.

帶來大約三十四億的收入。

Eye drops are far too big for our eyes.

眼藥水對我們的眼睛來說實在太大了。

That's Dr. Alan Robin, an ophthalmologist and glaucoma expert who teaches at Johns Hopkins Medicine.

那是 Alan Robin 醫生，他是一位在 Johns Hopkins Medicine 教書的眼科醫師和青光眼專家。

It's very wasteful.

這非常浪費。

We see that patients are basically spending twice as much money as they need to on drops.

我們發現患者花費在眼藥水上的錢都是他們所需的兩倍。

Everyone's body is different, but experts say almost every eye drop on the market is

每個人的身體都不一樣，但專家指出市面上幾乎所有的眼藥水

larger than the eye can hold.

每滴都比我們眼睛可以容納的量還要大。

So the excess just washes out, and we end up paying for a lot more medication than we can use.

剩餘的都會被沖掉，所以我們最終所付的錢遠遠超過我們可以用的藥。

Wasted eye drops are part of a much bigger problem.

浪費掉的眼藥水只是一個更大的問題的一部分。

Experts estimate the U.S. health care system wastes $765 billion a year.

專家估計美國的醫療系統每年都浪費 7650 億。

That's about a quarter of our overall spending.

這大約是我們所有花費的四分之一。

And it's actually more than the entire budget of the Department of Defense.

而且這其實超過國防部的所有預算。

ProPublica has been investigating the kind of wasted health care spending that exists

ProPublica 已經在研究這些在我們眼前

right in front of our eyes.

所被浪費的醫療支出。

Literally.

確實地。

Cancer drugs are also a big ticket waste item.

癌症用藥也是一個巨大的浪費。

They can cost thousands of dollars per infusion but are frequently wasted just because of

一劑可以花你幾千塊，但因為包裝形式的關係

the way they're packaged.

它們常常也被浪費。

Most cancer drugs are infused based on body size, so patients need different amounts.

大多數的癌症用藥都是依照體格大小來注入，所以每一位患者所需要的量都不一樣。

But most of them come in single-use vials that can be much too large for an individual patient.

但是絕大多數的藥都是以一次性的藥瓶包裝，有時比一個患者所需的量還要大很多。

So once a patient gets the needed dose, the rest of the expensive drug in the vial is thrown out.

所以當患者使用它所需的藥量之後，瓶子裡所剩的昂貴的藥物都會被丟掉。

Drug prices driving patients and their families into bankruptcy.

藥品的價錢使患者和他們的家庭破產。

And on top of patients paying for expensive cancer drugs to help them, they're also paying

除了昂貴的抗癌藥之外，患者也支付了

for in some cases a lot of extra cancer drug that's just going in the trash.

很多多餘的抗癌藥，這些藥最後都會被丟掉。

That's Dr. Peter Bach, the director of the Center for Health Policy and Outcomes at Memorial

那是 Peter Bach 醫生，他是紐約紀念斯隆凱特琳癌症中心

Sloan Kettering Cancer Center in New York.

的醫療政策和成果中心董事。

Waste hurts people because it costs money.

浪費的藥品會給人們帶來傷害因為那些會花他們的錢。

If you waste half of a vial that costs $5,000, somebody is paying that money, $2500 back

如果你浪費半罐價值五千塊的藥，這表示有人在付那兩千五百元

to the drug company.

給藥廠。

And the drug company benefits, because they count that as revenue or profit.

而藥廠會因此而受益，因為它們把這些算作為收入或利潤。

Take the case of Herceptin, a popular, and pricey drug that's mostly used to treat breast cancer.

以賀癌平為例，它是一個受歡迎但昂貴的藥，大多用於乳癌的治療。

The drug company used to make vials that patients could share, so little of the drug would be wasted.

這間藥廠以前都將藥裝在患者之間可以共用的瓶罐，所以只有一些藥會被浪費。

But then it announced in May that the shareable vials would be replaced by single-use vials.

但在五月的時候他們宣布藥品將會以一次性瓶罐包裝，取代以前的共用瓶罐。

And the switch would mean throwing away any medication left over from an infusion, and

這樣的改變代表一劑所剩下的藥品都會被丟掉，而

billing the patient for the waste.

患者會需要為這些廢棄物付錢。

Genentech, the company that makes Herceptin, told me that they had to make the change for

生產賀癌平的藥廠 Genentech 告訴我說他們必須要做這個改變基於

supply chain reasons, to go to a size that's more common worldwide.

供應鏈管理的考量，因為他們想要做成一個全世界比較普遍的尺寸。

Every milligram of Herceptin costs about $9, so a cancer patient's monthly infusion can

每毫克的賀癌平價值約九塊錢美元，所以一個癌症患者每個月所需的劑量

run more than $3,000.

可以達到三千塊美元以上。

One administrator at a California cancer treatment center calculated her average patient would

一位加州癌症治療中心的管理者計算了他的患者在使用一次性罐裝藥品的時候

waste 110 milligrams per infusion with the single-use vials.

每劑平均會浪費 110 毫克的藥。

That's an average of almost $1,000 of wasted spending per infusion.

這樣平均每劑都會浪費一千塊美金。

The waste associated with over-sized cancer drug vials is substantial.

用過大的藥瓶裝抗癌藥會浪費非常多的藥。

A study led by Dr. Bach in 2016 calculated the waste associated with the top 20 cancer

一個在 2016 年由 Bach 博士所帶領的研究計算了前二十大

drugs packaged in single-use vials.

以一次性藥罐包裝的抗癌藥所浪費的藥物。

It estimated that 10 percent of the medication gets wasted, costing $1.8 billion in a single year.

他們估計百分之十的藥物都會被浪費，每年花費十八億美元。

But here's the thing: this is a waste problem that's fixable.

但重點是這個浪費藥品的問題是可以被改善的。

For cancer drugs, manufacturing shareable vials, or vials in varying sizes, are proven

以抗癌藥來說，製造可以共用的瓶罐或是不同大小的藥罐已經被證實

ways to reduce waste.

可以減少浪費。

For eye drops, why not just make the drops smaller?

而眼藥水，為什麼不直接做成小滴一點？

Dr. Robin knows it can be done - because he and a team of experts already did it in a

Robin 博士已經知道這些事是可以被完成的，因為他和專家團隊已經在一個

study about 20 years ago.

二十年前的研究就已經達成了。

He consulted with global eye care leader, Alcon, when its researchers developed what

當他的研究者開發出了一個叫做微滴的青光眼眼藥水，

they called a microdrop for patients with glaucoma.

他向一位國際眼睛保健領導人 Alcon 諮詢了。

It was a 16 microliter drop -- one that was half to a third of the size of most drops

它一滴十六微升，大約是市面上大多數眼藥水的

on the market today.

二之一到三分之一。

Then they studied the performance of the microdrop compared to regular size drops.

他們之後研究了微滴和普通眼藥水的性能。

There was no significant difference between the smaller and larger eye drops.

大滴眼藥水和小滴眼藥水之間並沒有顯著的差異。

Not only were the microdrops just as effective, they also reduced some the uncomfortable side effects.

微滴不只有相同的效果，它還可以減少一些不舒服的副作用。

And all the participants actually preferred the microdrop bottle.

而且所有的受試者其實都比較喜歡微滴的瓶子。

But instead of being a breakthrough, the innovation

比起突破，這個創新

became a case study in how profits can come before patients.

反而變成一個利潤比病人重要的案例。

I tried personally to get the microdrop accepted.

我個人有嘗試著讓微滴被接受。

And they looked at me as though I was a pariah.

但他們看我就如同看一位賤民一樣。

The pharmaceutical company would be losing half the money that they could be making.

藥廠會因此而損失一半他們所賺的錢。

Officials from Novartis, the drug company that now owns Alcon,

Novartis，現在擁有 Alcon 的藥廠，他的官員

declined to discuss their microdrop study.

拒絕討論他們的微滴研究。

They said eye drops are designed with a "margin of safety" to help patients,

他們說為了幫助病患，在設計眼藥水的時候有考量安全邊際，

but they wouldn't go into specifics.

但他們拒絕討論細節。

You'd think that regulators would care about all this wasted medicine.

你會以為監管機構會在乎浪費的藥物。

But the FDA regulates the safety and effectiveness of a drug...not its price or the cost related to waste.

但是 FDA 只會監管藥物的安全性和有效性，並不會在乎它的價錢或是廢棄藥品所花費的金錢。

Patients paying billions of dollars for wasted medicine...is just one more reason

患者花幾十億在廢棄藥品上只是

America has the highest health care costs in the world.

美國醫療花費位居世界第一的原因之一。

Hi guys, I'm Ranjani.

大家好。我是 Ranjani。

A video fellow working at Vox and ProPublica.

我在 Vox 和 ProPublica 參與影片製作。

And this video is part of a new collaboration between our newsrooms.

而這影片是我們編輯部合作的其中一支影片。

For the full story at ProPublica, check out the link down below and

如果想要更了解 ProPublica 可以點下面的連結，

stay tuned for more stories coming this year.

可以繼續關注更多將會在今年推出的故事。