It's a device that injects you with adrenaline if you're having a possibly deadly allergic reaction.

當你發生可能致命的過敏反應時，這個裝置可以讓你注射腎上腺素。

If you have severe allergies, you basically need it.

如果你有非常嚴重的過敏，基本上就需要它。

And if you live in the UK, an EpiPen will cost you the equivalent of 38 US dollars.

如果你住在英國，一支 EpiPen 大約會花你 38 美金。

But if you live in the US, it'll cost you $300.

但如果你住在美國，它會花你 300 美金。

And it's not just the EpiPen.

不只是 EpiPen。

Let's look at five of the top selling prescription drugs in the world.

我們來看看全球銷量前五名的處方藥。

Advair, a brand-name asthma inhaler: more expensive in the US.

Advair，一種氣喘吸入劑的品牌：在美國比較貴。

Lantus, a type of Insulin: more expensive in the US.

Lantus，一種胰島素：在美國比較貴。

Sovaldi for hepatitis C?

C 型肝炎用的 Sovaldi？

Yup. Costs more in the US.

沒錯。在美國比較貴。

Humira for arthritis?

關節炎用的 Humira？

Crestor for cholesterol: more expensive in the US.

控制膽固醇的 Crestor：在美國比較貴。

So here's an unsurprising chart.

這是一張不令人意外的圖表。

Americans spend more on prescription drugs than anyone else in the world.

美國人在處方藥上花的錢比世界上其他國家都多。

Why?

為什麼？

The first thing you have to understand is that in the US, drugs get to patients differently than almost everywhere else.

首先你要了解，在美國，藥物抵達病人手中的方式幾乎與所有地方都不同。

Let's look at that popular hepatitis C drug, Sovaldi.

我們來看一下 C 型肝炎常用的藥物，Sovaldi。

In 2014 Sovaldi became the first drug to completely cure hepatitis C.

2014 年，Sovaldi 成為世界上第一種能夠徹底治療 C 型肝炎的藥物。

Here's how it got to market in, for example, the UK.

以下是它如何進入市場，以英國為例。

First a government agency had to decide that Sovaldi was safe and that it actually worked.

首先一個政府專門機構必須確認 Sovaldi 是安全且有效的。

Then it was evaluated by a regulatory agency to see if was worthwhile.

接著經由一個監管機構評估它是否值得進口。

Are there too many side effects?

是否有太多副作用？

Is there already a similar drug?

是否已經有類似的藥物？

Is there a cheaper option?

是否有更便宜的選項？

Sovaldi was deemed worthwhile.

Sovaldi 被認為是有價值的。

Next, they negotiated the price.

然後，他們針對價格進行談判。

In the UK, the government buys the stock of medicine for the country.

在英國，政府會替國家購入藥物的庫存。

That means they're usually able to get a lower rate, kind of like a bulk discount.

這表示他們通常可以拿到比較低的價格，有點像是量販折扣。

Which keeps prescription drugs cheaper for UK citizens.

因此讓英國公民可以取得較便宜的處方藥。

In almost every developed country besides the US, this is what the system looks like.

幾乎所有除了美國的已開發國家都是這樣的制度。

Safety evaluation, assessment of whether the country needs it, price negotiations, sold to patients.

安全評估、國家需求評估、價格談判、賣給病患。

Now let's look at the system in the United States.

現在我們來看一下美國的制度。

First, the drug is evaluated for safety, but that's it.

首先，藥品會先經過安全評估，就沒了。

If it's safe, they can sell it, end of story.

如果它夠安全，就可以販售，就這樣。

Drugs are sold by the drug companies to patients, usually through insurance.

藥品通常是透過保險，由藥品公司賣給病患。

And since the US system lets them sell it for any price, Gilead, the company that makes Sovaldi, charged Americans more for it.

既然美國制度讓他們能夠以任何價格販售，製造 Sovaldi 的公司，吉利德，跟美國人收取較高的費用。

When it first came to market, the entire treatment cost $84,000 in the US.

當它剛進入市場時，整個療程在美國要價 8.4 萬美金。

In the UK?

在英國呢？

Just about $58,000 US dollars.

只要大約 5.8 萬美金。

That's still a lot of money, but it's a full 30% less.

這還是一筆不小的數目，但是整整少了百分之 30。

So it seems like the UK has the better system right?

所以這樣看來英國的制度比較好，對吧？

Well, it's complicated.

其實這很複雜。

These photos are from protests in the US against the high price of EpiPens.

這些照片來自於美國針對高價 EpiPen 的抗議活動。

And these are photos from protests in the UK, over the lack of access to a cystic fibrosis drug called Orkambi.

而這些照片則來自於英國的抗議活動，原因是缺乏取得治療囊腫性纖維化的藥物 Orkambi的管道。

That's because when there's a committee that determines whether a new drug is worthwhile, sometimes they say no.

這是因為當有一個委員會來決定一種藥品是否有價值的時候，有時答案會是否定的。

And when they negotiate the price, sometimes they don't come to an agreement and hit a standoff.

另外在協商價格的時候，有時他們無法達成協議，形成了僵局。

That's what's happening with Orkambi.

這就是 Orkambi 面臨的狀況。

Both systems require trade-offs.

這兩種制度都需要權衡。

Regulated drug markets tend to make drugs more affordable, but some drugs are completely unavailable.

受規範的藥品市場使得藥品較容易負擔，但是有些藥品則完全無法取得。

And while the US has more drugs technically available, they're often too expensive to actually afford.

而雖然嚴格上來說，在美國有更多種類的藥品可以取得，但是它們往往太貴，無法負擔。

Americans without insurance are the most likely to skip medication because of the cost.

沒有保險的美國人是最有可能因為價格而省略藥物治療的族群。

Even Americans with insurance, are second.

即便是有保險的美國人，依舊排名第二。

But the commonality between these two systems is the drug companies.

但是這兩種制度間的共通點是藥品公司。

Developing new drug products isn't cheap and they're for-profit businesses.

開發新藥品並不便宜，而且他們是盈利企業。

If Gilead didn't think that researching and developing a hepatitis C cure, would make them money in the end, they might not have.

如果 Gilead 覺得研究、開發 C 型肝炎的治療藥物最終無法使他們獲益的話，他們可能就不會開發。

And with these regulated markets keeping costs down, the only place drug companies can really make their money is, you guessed it, the US.

而由於這些受規範市場維持著一個低價，這些製藥公司唯一可以賺錢的地方就剩—你猜對了，美國。

Americans are essentially subsidizing the cost of drugs for the rest of the world.

美國人基本上在替全世界補貼藥品的價錢。

In other words, a big part of why prescription drugs are more expensive in the US is because they're cheaper everywhere else.

換句話說，處方藥在美國比較貴的一大主因，正是因為這些藥在其他地方都比較便宜。

If you'd like to continue exploring the importance of easier access to medicine and vaccines, then I highly recommend a documentary called "Viruses: Destruction and Creation".

如果你想繼續深入探討更加容易取得藥物及疫苗的重要性，那麼我非常推薦一部叫做《Viruses: Destruction and Creation》的紀錄片。

Available now on CuriosityStream.

現在可以在 CuriosityStream 收看。

CuriosityStream is a subscription service that offers more than 2,400 documentaries and non-fiction titles, from some of the world's best filmmakers.

CuriosityStream 是一個訂閱系統，提供超過 2400 部由一些全球最厲害的製片人所拍攝的紀錄片和紀實影片。

You can get unlimited access starting at $2.99 a month and because you're a Vox fan, the first 31 days are free if you sign up at curiositystream.com/vox and use the promo code "VOX".

你可以用每個月 2.99 美金的價錢獲得無上限的權限，而且，由於你是 Vox 的紛絲，如果你用促銷代碼 "VOX" 到 curiositystream.com/vox 註冊，你就可以獲得前 31 天免費的體驗。

CuriosityStream doesn't directly impact our editorial, but their support makes videos like this one possible.

CuriosityStream 並沒有直接地影響我們的頻道內容，但是他們的支持，讓類似這樣的影片得以拍攝。

So go check them out!

所以去瞧瞧吧！