总体而言，医疗费用是美国人的一种致残性既存状况。但处方药的高价通常是最突出的痛点。虽然美国人比其他同类国家的人为药品支付更多（往往多得多）的原因有很多隐蔽的因素，但滥用美国专利制度是一个显而易见的原因。
The cost of healthcare in general is a debilitating, pre-existing condition for Americans. But the high prices of prescription drugs usually stand out as a pain point. While there are many insidious reasons why Americans pay more—often far more—for their medicines than people in peer countries, exploitation of the US patent system is an obvious one.
周一发表在《JAMA》上的一项研究凸显了自1990年以来专利滥用增长了多少。研究人员发现，在此期间，小分子药物的专利数量增加了两倍多，从1990年获批药物平均每个2.1项专利增至2019年获批药物平均每个6.9项专利。
A study published Monday in JAMA highlights just how much patent exploitation has grown since 1990. In that time, researchers found the number of patents on small-molecule drugs have more than tripled, going from an average of 2.1 patents per drug approved in 1990 to 6.9 for those approved in 2019.
大部分增长来自“非主要”专利——这些专利通常与药物的活性成分无关，而是针对非活性成分的微小调整、用法用量的更新，或特种给药装置（如自动注射器）的设计等。这些额外专利共同作用，在单个药物上形成所谓的“专利丛林”，延缓了平价仿制药上市，在没有实际临床进步的情况下让药价长期居高不下。
Most of the growth was in "nonprimary" patents—patents that generally aren't related to a drug's active ingredient, but are instead for things like minor tweaks to a drug's non-active ingredients, updates to the way the drug is used, or the design of specialty delivery devices, such as auto-injectors. Together, those extra patents on an individual drug can create what's called a "patent thicket," which delays the release of affordable generics on the market, keeping drug prices higher for longer without actual clinical advancements.