| Tuesday,
October 11, 2005
For what it's worth:
Zithromax 600 mg Consumer price (100 tablets):
$1,482.19
Cost of general active ingredients: $18.78
Percent markup: 7,892%
Zocor 40 mg Consumer price (100 tablets): $350.27
Cost of general active ingredients: $8.63
Percent markup: 4,059%
Zoloft 50 mg Consumer price: $206.87
Cost of general active ingredients: $1.75
Percent markup: 11,821%
Since the cost of prescription drugs is so outrageous,
I thought everyone I knew should know about this. Please read the following
and pass it on. It pays to shop around. This helps to solve the mystery as
to why they can afford to put a Walgreen's on every corner.
On Monday night, Steve Wilson, an investigative
reporter for Channel 7 News in Detroit, did a story on generic drug price
gouging by pharmacies. He found in his investigation, that some of these
generic drugs were marked up as much as 3,000% or more. Yes, that's not a
typo .. three thousand percent! So often, we blame the drug companies for
the high cost of drugs, and usually rightfully so. But in this case, the
fault clearly lies with the pharmacies themselves For example, if you had to
buy a prescription drug, and bought the name brand, you might pay $100 for
100 pills. The pharmacist might tell you that if you get the generic
equivalent, they would only cost $80, making you think you are "saving" $20.
What the pharmacist is not telling you is that those 100 generic pills may
have only cost him $10!
At the end of the report, one of the anchors asked Mr.
Wilson whether or not there were any pharmacies that did not adhere to this
practice, and he said that Costco, Sam's Club and other discount volume
stores consistently charged little over their cost for the generic drugs. I
went to the discount store's website, where you can look up any drug, and
get its online price. It says that the in-store prices are consistent with
the online prices. I was appalled. Just to give you one example from my own
experience, I had to use the drug, Comparing, which helps prevent nausea in
chemo patients. I used the generic equivalent, which cost $54.99 for 60
pills at CVS. I checked the price at Costco, and I could have bought 100
pills for $19.89. For 145 of my pain pills, I paid $72.57. I could have got
150 at another discount store for $28.08. I would like to mention, that
although these are a "membership" type store, you do NOT have to be a member
to buy prescriptions there, as it is a federally regulated substance. You
just tell them at the door that you wish to use the pharmacy, and they will
let you in.
I am asking each of you to please help me by copying
this letter, and passing it into your own email, and send it to everyone you
know with an email address.
Sharon L. Davis, Budget Analyst, US Department of
Commerce Room 6839 Office Ph: 202-482-4458; Office Fax: 202-482-5480 Email
Address: sdavis@docgov
Mary Palmer, Budget Analyst, Bureau of Economic
Analysis Office of Budget &Finance; Voice: (202) 606-9295
This was forwarded to me by a well meaning
but often incredulous reader. Comments welcomed. I am aware that if drug
companies don't make money they can't do research, and that the cost of any
drug is driven not by the cost of manufacture, nor even of distribution, nor
yet of marketing and advertising, but by government regulations, the costs
of which have to be recovered somehow. The government exists to hire and pay
government workers including budget analysts, and that is a first charge
before anything else gets done.
Oliver Cromwell's Commonwealth put payment
of the New Model Army and its Major Generals as the first charge against the
government, and collecting enough taxes to do that was the first duty of the
Commonwealth; at least they were honest about it. And in the Restoration,
although it wasn't legal and open, the first charge of the Stuart government
was support of the King's Mistresses, and our "modern" budget system was
devised, according to C. Northcote Parkinson, as a means for preventing the
Navy Vote from going to the aptly named Duchess of Portsmouth. It wasn't
spectacularly successful even for that. We adopted the English accounting
system, and although starting with Budget Acts in Woodrow Wilson's time we
have attempted to modify and modernize our accounting, it remains impossible
to determine where the money goes, and how much of it simply goes to monkey
motions with a zero vectorial sum. The existence of the posts of
"budget analyst" add substantially to our tax burdens, but then the purpose
of government is to hire and pay money to government workers, all of whom
are certain they work hard and deserve every cent their Public Service
Unions can get for them.
In any event, 11,000% profit over costs of
manufacture do not greatly reflect the actual costs of doing business. It is
the official policy of the United States that both doctors and patients are
fools, incapable of deciding for themselves what is the best interest of the
patients, and that therefore all drug sales must be burdened with
"professional" oversight by government workers, who determine what drugs are
approved and what they are approved for, on penalty of criminal punishment
for violation. Violation of one or another drug law is responsible for about
half the incarcerations in the United States, and running the prison system
consumes a large chunk of both Federal and State budgets. The Prison Guard
Union has been one of the most powerful political forces in California and
other states, and it has as its primary interest the assurance of a supply
of prisoners to guard; it has done that very well, and most attempts to
devise alternate ways of dealing with non-violent drug offenders founder on
that political rock.
In other words, the high price of drugs
includes a very great number of hidden costs.
At the same time, you might do well to
look on line to see what you have to pay for brand name drugs from reliable
sources. There are also rumored to be quite reliable Mexican and Canadian
companies that will sell generic drugs at prices trivial in comparison to
those you will find in the United States. The problem here is determining
which firms are reliable.
My own view is that the FDA ought to have
the power and staff rigorously to enforce truth in labeling: if a bottle
says it contains "the freshest of snake biles" it must contain fresh snake
biles, not some artificial substitute. The bottle should also contain a
label such as "The FDA believes this stuff is worthless, and might very
likely be harmful. Take at your own risk." Perhaps the carton could contain
that warning in 12 languages, and even one of those tiny chip speaker
systems that will SAY that warning in 12 languages; I don't know what those
cost, but I get them as advertisements all the time so they can't be too
expensive. The cost of all this warning and enforcement should be about five
percent. of the hidden costs of drugs today, and would solve the problem of
choosing reliable sources of generic drugs, and for that matter greatly
reduce the costs of brand names.
Note that the whole FDA approval process
is pure cost with little benefit to the drug companies: if an "approved"
drug later turns out to cause unexpected side effects, or can be made to
look as if it cost unexpected side effects, the lawyers will sue the company
out of business, and the FDA does not go to bat to defend it. Thus the drug
companies must not only bear the costs of FDA regulation, but also have
enormous product insurance (or funds for self-insurance) against legal
extortion; this despite warnings, common sense, legality, or anything that
might assume even a tiny modicum of intelligent decision on the part of the
consumer.
If the US could export its regulatory and
legal system to China we would be in a better competitive position. Of
course our education system would still make us inferior to China and Japan
because the educated work force pool would still be small and shrinking, but
at least we'd have a slightly more level playing field.
Enough. If you are paying for expensive
drugs, it probably does make sense to look on line to see what major chains
including Wal-Mart, Costco, and Sam's Club charge. And
see below.
===
Interestingly, the next item in my email
was this:
National Association of Personal Injury Lawyers
<http://www.napil.com/>
How a Limited-Time Complimentary Membership
Could Bring You New Personal Injury Clients Without Any Risk or Cost to You
If you would like an easy, no- cost method to
get more personal injury clients then you will want to read this complete
email message right away.
As a fellow lawyer, maybe you're like me ---
tired of all the organizations that charge you hundreds or thousands of
dollars without providing you with a concrete way to grow your personal
injury practice. If so, you'll be pleasantly surprised by this new
opportunity to gain new clients with no upfront fees to you.
How Does This Work?
It's easy and simple. Join NAPIL <http://www.napil.com/>
(National Association of Personal Injury Lawyers) and you'll be listed on
our Personal Injury web site http://www.napil.com <http://www.napil.com/>
that personal injury clients search when looking for an attorney to
represent them.
And now, for a limited time, you can become a
member in NAPIL at zero cost to you --- but only if you're one of the first
1000 attorneys to do so, or if you join by Dec 31, 2005 ( whichever occurs
first) Since there are 212,384 attorneys in the US who handle personal
injury, these complimentary memberships could be snapped up very quickly.
You can't afford to wait to respond because your competition may very well
take your complimentary membership.Here's what a couple of lawyers have to
say about joining:
"I have been a member of NAPIL.com for several
months and have been impressed with the results it has gotten for me based
on the investment required. Within the first couple of weeks I signed up a
playground injury case with solid liability and significant injury to a
minor child. I would recommend NAPIL.com to any personal injury lawyer that
is looking to establish an internet presence or make their current internet
marketing more effective." ---- Benjamin J Sansone, Attorney Clayton
Missouri
"In today's every changing internet world it is
hard to figure out what works from what doesn't. From the first week we
started to get contacts. Results it makes the choice a lot easier." ---
Michael A Bryant, Attorney Waite Park Minnesota
How Can This Help Your Practice?
If you get just one case, using a conservative
average of $25,000 for a personal injury settlement, with you receiving 1/3
--- that would mean $8,333 to you from this complimentary membership. So why
WOULDN'T you want to join?
Plus, you'll also have access to our discussion
forum to get help and discuss personal injury issues with your peers.
Furthermore, you'll be part of an elite group
of personal injury lawyers dedicated to fighting the big insurance companies
that want to take the rights away from victims
What's the Catch - What Do You Have to Do? OK,
you're thinking, "What's the Catch? Why are we willing to offer all these
benefits without charge for this limited time? And what do you need to do to
take advantage of it?
Well, you see, we're a relatively new
association and want to gain a significant presence and attain high rankings
in the search engines in a short period of time. This will, in turn, provide
the most benefit to you as a member. And so, we're seeking 1000 qualified
attorneys to join us. You need to practice personal injury law, have a
personal injury related web site, and also put a link to us on your web
site, which will help boost our rankings in the search engines.
Just click on the following link to register
and become a member, http://www.napil.com/reigister.aspx <http://www.napil.com/register.aspx>
while this complimentary offer is still available.
The way I see it this is a No-Brainer. Instead
of writing more checks that yield you nothing, why not become a member in an
association that can help your phone ring with personal injury leads at zero
cost to you.
The only risk is that you'll fail to act soon
enough to get one of the complimentary slots available.
To visit the site, click www.NAPIL.com <http://www.napil.com/>
To view our membership ranks, click http://www.napil.com/DisplayMembers.aspx/
<http://www.napil.com/DisplayMembers.aspx>
To register and become a member, click http://www.napil.com/register.aspx
<http://www.napil.com/register.aspx>
David Sheehan, Attorney National Association of
Personal Injury Lawyers 23945 Calabasas Road, Suite 106 Calabasas, CA 91302
P.S. Go register now at www.napil.com/register.aspx
to get your complimentary membership before Dec 31, 2005 (or until the 1000
are gone --- With at least 212,384 personal injury attorneys in the US this
could happen quickly).and start getting more personal injury clients calling
you without investing a dime.
To unsubscribe, please click here
I am unaware of subscribing to this. But I
find the spam rather interesting.
====
Now a different view of the
future:
Subject: Manufacturing In America
Dear Jerry,
I am not one of those sunk in depression thinking it's
impossible to beat foreign competition. Here's a superb contra example, in
which I have no personal interest, other than a heart warming cheer for the
old hometown team.
Steel Dynamics, Inc. (NASDAQ STLD). SDI is an Indiana
based steel 'mini-mill' operator. They were founded in the mid-90s by three
ex-Nucor executives. SDI now accounts for roughly 4% of America's steel
capacity at 4.2 million tons/year. They have just 1,700 employees and a man
hour/ton rate of 0.3, compared to an industry average of 1.0. Very forward
looking in all respects. And their CEO is not a Harvard MBA type. He went to
a local Catholic community business college in Fort Wayne, Indiana. Their
Board of Directors is also Midwest 'hometown' apart from one German and one
Japanese gentleman from Sumitomo. Non-union workforce and the company claims
an average non-executive employee pay rate of 84k/yr. What they do have in
common is deep experience in steel manufacturing and a complete focus on
what they're about, which is running quality steel.
Then we have 'Detroit'. The crisis du jour is Delphi.
This is GM's old parts division which was spun-off five years ago by GM's
Harvard Business School educated management. Ford did the same thing at the
same time with its parts operations, too. This includes ex-Ford entity Tower
Automotive, which preceded Delphi into U.S. Bankruptcy Court earlier this
year. Same story, different day. Tower Automotive's last pre-bankruptcy CEO,
and still CEO for reasons known only to God, is Ms. Kathleen Ligocki. Let
Ms. Ligocki speak for herself:
http://www.womenworking2000.com/feature/index.php?id=29
"My career path was not a result of brilliant
strategic planning," jokes Kathleen Ligocki." "Studying Chinese history and
Renaissance art in college, she "bummed around" in Spain and Mexico after
graduation, and worked on archaeological digs and community development."
"Then she made the transition into business, working
in strategy, mergers and acquisitions, sales, engineering, manufacturing,
purchasing, finance and general management for a range of corporations."
"Her entry into Ford was also the result of writing her own rules"
This personifies everything that has made Detroit what
it is today. GM and the rest of the collapsing domestic auto industry is
full of these Harvard MBA Wall Street numbers spin-meisters. Study their
corporate websites. And on the other side we have 'Labor', personified by
the UAW. Study their senior leadership. Their biggest concern from their
website bios is to show their 'solidarity' by listing their many NAACP and
ACLU memberships. Plus all the other Democratic Party - Washington politics
we're so familiar with.
If one wants to truly help the American workers and
their communities, then send all these barnacle encrusted capital structures
to U.S. Bankruptcy Court today and chase every last one of these useless
pc-minded bureaucrats out of their executive suites. There are still plenty
of engineers and plant managers with Flyover Country Moo-U educations who
know what the hell to do. Provided they're not crippled by the geniuses of
the Harvard and Yale Schools of Business. Just look at Steel Dynamics for an
example.
This dysfunctional Ivy League Art Department MBA style
of non-leadership of industrial enterprises is the entire problem. It is not
any part of the solution whether as 'management' or as UAW style 'labor'.
Just think NASA every time manufacturing doomsday scenarios are drawn about
what will happen if we don't 'save' GM & Ford in their current form, or
close to it. 'Save' being a code word for 'subsidize' in various artful ways
so they can continue their dysfunctional practices. This thinking is just
more Luddite-ism.
Think "Steel Dynamics" for an example of the brighter
future ahead once these older industrial dynosaurs are cast into the tar
pits where they belong.
Mark
Let me point out that Detroit refused a
private gift of $200 million to build charter schools. The Teacher's Union
couldn't stand that. The story is in the current issue of the Weekly
Standard (http://www.weeklystandard.com/Check.asp?idArticle=6130&r=fnzna)
and worth your attention if your stomach is up to the task. This makes for
an interesting segue to the next letter...
==================
Subject: Rebuild New Orleans -
Where?
Dr. Pournelle,
When considering where New Orleans should be
relocated, one should also consider the fact that the course of the
Mississippi River is unstable. As one can easily see from a map of
Louisiana, there are many shorter (and therefore steeper) ways for the
Mississippi to get to the Gulf then the one it currently follows.
The most likely new course for the Mississippi is into
the Atchafalaya River. The Atchafalaya and the Mississippi meet upstream of
Baton Rouge, and the distribution of water between the two is controlled by
the Old River Control Structure, which is operated by the Army Corps of
Engineers. Currently about 30% of the Mississippi's flow is diverted into
the Atchafalaya. Were the Old River Control Structure to fail in a large
flood (which has nearly happened in the past), it is likely that the
remainder of the Mississippi's flow would be captured by the Atchafalaya.
This would leave Baton Rouge and New Orleans landlocked, or at best
connected to the Gulf by canals. John McPhee's book "The Control of Nature"
includes an interesting chapter on this subject.
It seems to me like a bad idea to rebuild New Orleans
in its current location if its status as a port city is not secure. Rather,
I think this is a good opportunity to encourage the Mississippi to find new
and more stable route to the Gulf, and rebuild southern Louisiana based on
that.
Peter Schmalzer
I am not at all sure I know why it is the job of
Denver taxpayers, or New England insurance brokers, to pay for rebuilding
New Orleans to begin with. It is the most corrupt and least efficient city
in the nation, in a state that contends annually for honors in those
categories and often wins. If there are sound economic reasons to rebuild
New Orleans, they will prevail, and certainly the parts that remained above
water will attract new investment.
The new Imperial style in which all funding flows
to Washington and all blessing flow from Washington is quite alien to the
American tradition. It seems to be part of Big Government Compassionate
Conservatism. As once who simply wishes to conserve the American system
which has been demonstrably successful, I have no idea where to turn. The
Democratic Party seems to have gone swimming and found the Republicans stole
their clothes. Turning to the Democrats to relieve us of Big Government,
High Taxes, and Large Deficits does not seem intuitively to be a sound move.
Of course empowering the Republicans doesn't seem to have done any more
good. Perhaps less. I now actively wonder what a Gore presidency with a
Republican Congress might have done. Then I listen to Gore on global warming
and his fancied understanding of technology, and go back to writing novels.
Have I mentioned that Niven and I are writing INFERNO II: Escape from Hell?
===========
Hi Jerry Pournelle, Ph.D.,
David K. M. Klaus stopped by Geek Culture thought it
was cool, and suggested that you visit the following URL:
http://www.geekculture.com/joyoftech/joyarchives/740.html
Here is their message.... The 'Verse...the Final
Frontier.
Geek Culture
I do not often copy these automated messages. I
wonder who invented this technique? I get so many I generally ignore them.
================
Subject: how to withdraw from
Iraq
Jerry, This is good. Very good. I happen to know
Luttwak (not well, i took a class from him when i went to Johns Hopkins).
He's a very clear thinker on strategic matters.
His opinion in the attached article is *the very first
one* I've heard that passes my smell test for why it might be a good idea to
withdraw from Iraq (a little quote here):
"IN REJECTING CALLS for a rapid withdrawal from Iraq,
President Bush rightly insists that the United States cannot abandon the
country to the insurgents — a murderous gathering of Arab Sunni
supremacists, Saddam Hussein nostalgics and Salafist terrorists. These last
fanatics would become even more dangerous if invigorated by victory in Iraq.
But in presenting the victory of the killers as the
only alternative to a failing military occupation, Bush is entirely wrong.
It is the least likely of all possible outcomes."
Full article here:
http://www.latimes.com/news/opinion/commentary/la-oe-
luttwak11oct11,0,2083693.story?coll=la-news-comment-opinions
This is good stuff. Someone in the White House should
call Luttwak up and pay attention to what he says.
-jcp-
-- Joseph C. Pistritto
"The U. S. Constitution doesn't guarantee happiness,
only the pursuit of it. You have to catch up with it yourself" - Benjamin
Franklin
Luttwak is always worth listening to, but this
is hardly startlingly new. I have pointed out for a long time that letting
Iraq have its civil war may be preferable to continuing occupation.
Luttwak says the US Army is protecting our
enemies from our friends. There is a real sense in which that is true, and
good imperial strategy would make use of our friends and allies in the
conquest of Iraq.
Luttwak's strategy would be the de facto
partition of Iraq. Perhaps a good thing, but it warrants thought; we started
with the objective of not partitioning Iraq.
Of course one problem, that
turning the Kurds loose to establish an independent state would irritate our
Turkish friends is no longer applicable. We don't have many Turkish friends
any longer, having managed to alienate our one powerful and at one time
constant ally in that area.
====
Dear Jerry:
A new dimension to military overstretch. The Army had
doubled recruitment bonuses and still can't fill all the slots. This is not
good news, either for the future of the war, or the US Military
Sincerely,
Francis Hamit
Airmen Fill the Gaps in Wartime - Yahoo! News
http://news.yahoo.com/s/latimests/20051011/ts_latimes/airmenfillthegapsinwartime
I saw that this morning. I agree, it's an
omen.
=================
Subject: more energy independence discussion
Jerry,
It looks like the country's conversation is slowly
moving towards your proposal of 4 years ago of energy independence:
the petroleum bomb by George P. Shultz and R. James
Woolsey
http://www.memagazine.org/contents/current/features/petrbomb/petrbomb.html
Sincerely, Jim Laheta
Eventually they catch up with me.
===========
Subject: Different Worlds, Different Americans.
Hello Jerry.
Here's an article I thought you might find
interesting.
http://www.jewishworldreview.com/0905/graham092805.php3
Reminds me of characters from some of my favorite
authors, Heinlein, Campbell, Piper, and of course Pournelle.
The competent man. Someone needs to get them onto the
endangered species list. They are disappearing fast in this country.
I may not envy those people their education levels or
poverty but I admire them as men.
Tom
===============
Dear Jerry,
An amusing, yet insightful piece from Opnion Journal
Letters to the Editor:
http://www.opinionjournal.com/extra/?id=110007385
--------------------------------------- How can you
tell if a conservative is pro- or anti-Miers? Based on my conversations with
conservative friends this week, here's a good rule of thumb. Ask the
conservative to define the following words or phrases and see what he says.
"Blackberry"
Anti-Miers: A handheld device that allows you to get
e-mail and access the Internet. The biggest problem is when the battery runs
low. You solve the problem by carrying a charger.
Pro-Miers: A delicious berry that you find in the
woods. The biggest problem is that bears love them too. You solve that
problem by carrying a .44 Magnum.
"Friends"
Anti-Miers: A popular TV show that looked at cultural
and sexual mores.
Pro-Miers: People you invite over to your house
"$20 Snifter of Cognac"
Anti-Miers: Not a bad price for a great brandy at a
nice bar.
Pro-Miers: An outrageous price for a drink. Where we
people live, you can get a two-pound T-bone steak dinner and a drink for
$20.
"Meet the Press"
Anti-Miers: Must-see TV.
Pro-Miers: We are too busy going to church. Besides,
who really cares what they say?
"December"
Anti-Miers: A period of increased cultural sensitivity
when you have to wish people a "Happy Holiday" instead of "Merry Christmas"
for fear of offending them.
Pro-Miers: Merry Christmas!
"A List"
Anti-Miers: The type of party you want to be invited
to.
Pro-Miers: What you don't want to get from your wife
on Saturday morning.
"Assault Weapons"
Anti-Miers: A class of weapons that anti-Miers
conservatives use in their legal arguments concerning the meaning and extent
of the Second Amendment. Although anti Miers conservatives favor the
ownership of assault weapons, they probably have never touched or fired one.
Pro-Miers: A nice varmint gun, although it doesn't
have enough range or accuracy to shoot wary prairie dogs. They aren't as
good as Dad's old M1 Garand.
"Democracy"
Anti-Miers: A Broadway play.
Pro-Miers: One of the things that makes America great.
"Antonin Scalia"
Anti-Miers: A brilliant legal scholar with libertarian
tendencies. A good Supreme Court justice.
Pro-Miers: Who? Oh, the guy who hunts with the vice
president and belongs to a gun club in Virginia. A good Supreme Court
justice.
"The Buzz"
Anti-Miers: What "everybody who is anybody" is talking
about.
Pro-Miers: What hornets, bees, wasps and yellow
jackets do.
"Hunting"
Anti-Miers: A method for thinning wildlife populations
that allows a rural American tradition to continue.
Pro-Miers: A chance to get together with some friends
on a weekend and have a good time. We never let the hunting get in the way
of having fun, however.
"Cowboy"
Anti-Miers: A metaphor for the American tendency to
act aggressively. What makes America a great power.
Pro-Miers: The guy we see at the diner, who works on a
ranch or travels the rodeo circuit. A term that is rarely applied, and when
it is, is a compliment.
"John Deere"
Anti-Miers: A riding lawn mower.
Pro-Miers: A tractor.
"Paris Hilton"
Anti-Miers: A cultural icon.
Pro-Miers: A hotel in France. Although I wouldn't
know, because why would I want to go to Paris on vacation when I can go
camping?
"Big Bore"
Anti-Miers: A person who corners you at an A List
cocktail party.
Pro-Miers: A rifle that you need for hunting elephant
or cape buffalo.
This would have probably worked well at the NR 50th
bash.
-- Harold Hough
------------------------------------------------------------------------
I'd scoff at conservatives watching "Friends", but my
younger sister does.
Cheers, Rod Schaffter
-- "I find, for some odd psychological reason, that I
can deal better with a man's exercise of free will if I believe that he has
got it." --G.K. Chesterton
==============
Subject: Time to retire "egregious Frum "?
Dear Doctor Pournelle-
Since Chuck Boudin has compared your phrase to Larry
Niven's "flup" I cannot resist. Egregious Frum sounds like a magical plant
Terry Pratchett would invent for the Discworld.
Seriously yours,
Carl Zeichner
I will retire the phrase when the egregious
Frum makes some apologies, particularly to Stephen Tonsor.
==============
Dr. Pournelle,
Excellent list of the various reasons
why drugs cost so much and why the markup over the
materials cost is not a metric of profitability. As for the markup at the
pharmacy level, this anecdote may be of interest:
When I was an undergrad at Cal Poly I needed some
antibiotics to treat bronchitis. The price of the antibiotics (erythromycin
if I recall correctly) from the student health center was around $8, or
about a third of my insurance co-pay. I asked about it and was told by the
staff that the Cal State University system was required to sell
pharmaceuticals at cost. Since the retail price was around $60 the local
pharmacies must have been doing quite well I would imagine.
Also, you did leave out one important factor that
drives up prices, though perhaps the economics are so obvious that you did
not feel the need to bring it up.
Most Americans don't pay for their own drugs directly,
we pay our standard insurance co-pay and never even think about (or even
see) the price, convenience is most likely the first thing on my mind. The
result is that we have isolated the end consumer from the cost thus removing
any real market pressure to bring down prices. We got into this insurance
mess in the first place because the government tax code makes it cheaper for
an employer to offer health insurance as a benefit than to pay an employee
enough to go out and buy his own insurance. And the Liberals lament that not
enough people have health insurance!
Now that the federal government has graciously allowed
us to have a Health Savings Account some of us may be able to break the
cycle, but I don't know enough about them yet. Last time I saw Mitchell
Burnside-Clapp he was waxing eloquently on the benefits, and I have always
taken him to be a man who knows what he is talking about. Maybe some of your
readers have some advice on the subject, i.e. cost/benefit analysis, best
way of setting these up, etc.
Best regards,
Mark E. Horning, Research Scientist
===================
The Doctor's World Nobel Came After Years of
Battling the System
By LAWRENCE K. ALTMAN, M.D. Published: October
11, 2005
When two Australian scientists set out in the
early 1980's to prove that a bacterium, Helicobacter pylori, caused stomach
inflammation and ulcers, they met opposition from a medical-industrial
complex entrenched in the belief that psychological stress was the cause.
Opposition to their radical thesis came from
doctors with vested interests in treating ulcers and other stomach disorders
as well as from drug companies that had come up with Tagamet, which blocked
production of gastric acid and was becoming the first drug with $1 billion
annual sales. Skip to next paragraph Related Two Win Nobel Prize for
Discovering Bacterium Tied to Stomach Ailments (October 4, 2005)
Ulcer surgery was lucrative for surgeons who
removed large portions of the stomach from patients with life-threatening
bleeding and chronic symptoms. Psychiatrists and psychologists treated ulcer
patients for stress.
The concept of curing ulcers with antibiotics
seemed preposterous to doctors who had long been taught that the stomach was
sterile and that no microbes could grow in the corrosive gastric juices.
A bacterial cause "was just too wild a theory
for most people" to accept, and something so ingrained as stress causing
ulcers was too difficult to dismiss, Dr. J. Robin Warren, one of two who won
the 2005 Nobel Prize for Physiology or Medicine on Oct. 3, said in a
telephone interview.
Blame focused on psychological stress in part
because many patients had stressful lives and scientists lacked another
explanation.
Also, Tagamet and similar drugs, known as H2
blockers, safely made ulcers and their symptoms disappear. But the H2
blockers were not one- shot cures. Ulcers often recurred, requiring repeated
courses of the drugs, providing a steady stream of profits.
"The opposition we got from the drug industry
was basically inertia," said Dr. Barry J. Marshall of the University of
Western Australia, the other Nobel winner, and "because the makers of H2
blockers funded much of the ulcer research at the time, all they had to do
was ignore the Helicobacter discovery."
"If the drug companies were truly into
discovery, they would have gone straight after the Helicobacter," Dr.
Marshall said, but they did not because of the success with H2 blockers.
"Had these drugs not existed, the drug
companies would have jumped on our findings," he added.
Then, too, the fresh thinking was coming from
what many doctors regarded as a medical outpost, Perth.
All the factors created a type of rigidity that
many doctors say still exists for better or worse.
Further, Dr. Marshall said, "The fact that the
big drug companies who were supporting the journal articles ignored H.
pylori was far more effective than actually saying that a bacterial cause
was not true because if they had said it was false, or not important, they
would have created a controversy and maybe media interest."
Right from the moment in 1979 when Dr. Warren,
a pathologist, first saw bacteria in stomach biopsies at the Royal Perth
Hospital, he said: "I met skepticism from my colleagues who mostly did not
want to know, or believe, what I was describing. Anyone could see the
bacteria through a microscope, but the clinicians did not want to see them."
Why was he the only one seeing the bacteria?
Why had others not described them earlier? He did not know, Dr. Warren said
in answer to the skeptics who asked. "Once I started looking for them, they
were obvious," he said, "but convincing other people was another matter."
Even doctors who peered down the barrel of a
microscope and did agree bacteria were present said they must be
opportunists, not the cause of stomach ailments.
Dr. Warren pointed out that the bacteria were
all the same, not the variety that would be expected of secondary invaders.
But, he said, "It was hard for me to prove them wrong. <snip>"
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