A breast cancer drug in South Africa costs $38,000 per year. The average household income? $7,500. That's five times what an entire family makes annually.

In the U.S., Gilead's hepatitis C cure hit the market at $84,000 per treatment course. Production costs? Estimated in the hundreds of dollars.

This isn't a story about greedy corporations or evil pharma executives. It's about incentive structures—and how they shape who gets access to life-saving medications and who doesn't.

In this solo episode, host Noah Volz zooms out from Southern Oregon to examine the global pharmaceutical pricing system that determines what medications are available locally—and what they cost. Even the most innovative community healthcare models hit a ceiling when drug prices consume entire budgets.

You'll discover:

• How pharmaceutical companies shift $112 million annually in profits to tax havens (while governments lose funding for clinics and vaccination programs)
• Why profit margins exceeding 20% are common in pharma when most industries operate at 5-10%
• What TRIPS patent protections actually do (hint: they create legal monopolies that prevent generic competition for years)
• Why the 2001 Doha Declaration said public health should override patents—but countries still can't access affordable generics
• How the Health Impact Fund would flip incentives from "charge maximum price" to "create maximum health outcomes"
• Why drug pricing affects gender equity (unpaid caregiving falls overwhelmingly on women when healthcare becomes unaffordable)
• The ceiling community healthcare innovations hit when upstream pharmaceutical pricing extracts all available resources

This episode is for you if:

• You've seen medication costs wipe out family budgets and wondered why prices are so disconnected from production costs
• You care about healthcare innovation but question whether current incentives serve public health
• You've followed this podcast's focus on Southern Oregon and want to understand the global forces limiting local solutions
• You believe structure shapes outcomes and want to see how that principle applies to pharmaceutical pricing
• You're tired of "pharma is evil" takes and want actual analysis of how incentive systems work

Why this matters for Southern Oregon: Jackson Care Connect, AllCare, and La Clinica are doing remarkable work—investing in prevention, housing, social determinants. But when medication costs consume disproportionate budgets, those preventive investments get overwhelmed. You can optimize local healthcare delivery all you want, but if upstream incentives extract value rather than create health, there's a ceiling on what local innovation can achieve.

The core insight: Pharmaceutical companies aren't irrational or evil—they're responding to incentives the system creates. Patent monopolies reward high prices. Tax structures enable profit shifting. Research focuses on profitable conditions in wealthy markets. Change the incentives, change the outcomes.

No prescriptions. No easy answers. Just clarity about how the system actually works—and why understanding incentives matters more than assigning blame.