More Healthcare Crap

      I have a tongue in cheek saying around the office ( I work part time for my brother in law who is a family practitioner with over 30 years experience) that " It's all crap"- meaning all the bureaucracy and spin that accompanies the modern age. At any rate, in addition to their numerous TV commercials, drug companies also buy time and influence from doctors by purchasing lunch for them and their staff in return for the 'privilege' of talking to the doctor for 20 minutes while everyone eats. So for $70 or $80 per lunch, drug reps come into the office once or twice a week to promote their latest medicine. Some doctors enjoy more free lunches per week and some less, depending on how much they want to be bothered, but my brother in law does it twice for the benefit of his staff. This practice happens thousands of time per day around the country, and one can imagine the unseen perks that politicians are offered to peddle influence.
      Last Tuesday a rep dropped off this paper for the drug Belsomra, a sleeping aid for insomnia. It shows that the PA State employees negotiated a co pay of $18 from the Merck company, and also shows the low tier copay rates that various other entities have negotiated. Below that is an assessment of Belsomra by Consumer Reports, which is one of the few remaining news outlets that has any semblance of objectivity in this day and age.

 

    Consumer Reports> "We commissioned two drug safety experts—Steven Woloshin, M.D., and Lisa M. Schwartz, M.D., both at the Geisel School of Medicine at Dartmouth—to review the research and prepare a Drug Facts Box for Belsomra. Schwartz served on an FDA advisory committee of experts that looked at Belsomra in 2013.
Their analysis shows that people who took a 15 mg or 20 mg dose of Belsomra every night for 3 months fell asleep just 6 minutes faster on average than those who got a placebo pill. And the Belsomra group slept only 16 minutes longer—6 hours and 12 minutes total vs. 5 hours and 56 minutes for the placebo group.
Those small improvements in sleep didn’t translate to people feeling more refreshed. Instead, more people who took Belsomra felt drowsy the next day compared with those who took a placebo.
In fact, two people who took the 20 mg dose the night before were so drowsy the next day they had to stop a driving test. Slightly more people in the Belsomra group were involved in driving accidents or got traffic tickets and reported hallucinations or sleep paralysis—a feeling that you can’t move or talk while falling asleep or awakening.
The 10 mg dose was only studied in 62 people, and it’s unclear whether it improves sleep. Even Merck, the manufacturer of Belsomra, doubts whether it’s better than a placebo. “The overall picture is that 10 milligrams is not an effective dose,” said W. Joseph Herring, M.D., Merck’s executive director of clinical research, neuroscience, and ophthalmology, at the 2013 FDA advisory committee meeting. Yet, the FDA’s internal reviewers said the 10 mg dose improved sleep more than placebo. The bottom line is that the 10 mg dose is probably less effective than the 15 or 20 mg dose and it might not be much better than a placebo pill.
And it’s unknown if the 5 mg dose will help you sleep: It’s not been studied at all.
“The FDA has set a disturbing precedent by approving an untested dose of a drug,” Schwartz says. “For a deadly cancer with limited treatment this gamble might make sense, but not for a condition like insomnia and where Belsomra doesn't appear to work any better, or more safely, than available treatments."
Also, Schwartz and Woloshin worry that if people don’t sleep better with the 5 mg or 10 mg dose, they may take additional doses, increasing the risk of side effects.
If Belsomra’s slight benefit and potential side effects aren’t enough to make you think twice before trying it, consider it’s high price tag: about $70 for 7 pills. That’s more than four times the cost of the same amount of our Best Buy pick, zolpidem, the generic version of Ambien. Our Best Buy Drugs report found that people who took zolpidem fell asleep 20 minutes faster and slept 34 minutes longer on average than those who took a placebo&lt."<<
      .... So, as the information indicates, the price of medicines follows a flexible scale depending on what the Healthcare companies or corporations or governments are willing to pay, and the drug companies negotiate because they want to have their drug accessible to the millions of people in a particular insurance plan, corporation, or government entity  . If they don't negotiate, a rival drug maker will do so and that drug will become the drug of choice. This is capitalism behind the scenes-nothing illegal- but then again not exactly on the evening news or out front in political healthcare discussions. What is unethical-but again perfectly legal-occurs when drug companies whose brand name medication patent is about to expire, file frivolous new patents by changing a minor ingredient or a minor step in the manufacturing procedure. This effectively shuts out and delays generic drug makers from introducing a cheaper version of the drug. Happens all the time and explains some of the high cost of drugs and the decades long absence of some generics.
      ...and I hope everyone saw the October 15th episode of 60 minutes in which Republicans Marsha Blackburn of Tennessee and Tom Marino of Pennsylvania were exposed for the blood they have on their hands for their support of a bill that stripped the DEA of the legal power to stop drug distributors-primarily Mckesson, Cardinal Health and AmerisourceBergen-from oversupplying opioids to bogus pharmacies. Your government and capitalism at their worst...What does all the scheming and double dealing mean?...besides the consumer being screwed and people dying?...... 'It's all crap...'

Camping in Luxury

  Beth and I bought our used 'B' size motor home this summer and have gone out a couple of times to test things out. We really have not used the systems much so far, although it is nice to have a secure roof and a toilet when necessary.  The main purpose of this vehicle will be to travel for weeks at at time with the freedom to stop anywhere and sleep without the expense of hotel rooms. A larger motor home cannot be parked in a normal size parking space, and a trailer or tent would mean the hassle of finding a campground- restrictions on both freedom and expense. This vehicle(a 1997 Leisure Travel) has a toilet, stove, sink, heater, air conditioner, fridge, shower, microwave, generator, lights and one of the best sound systems I have ever heard in a vehicle. The Dodge 318 motor and other mechanical systems seem to have been well maintained. I cannot understand the "tiny house' phenomenon in which people spend tens of thousands of dollars for a static home when used motor homes or trailers can be had for less than $10,000-$20,000. At any rate, we look forward to many pleasurable miles exploring the country in the coming years and count our blessings that we may have the health and wealth to do so.

Song Lyrics

    In the 70's, when the songs first came out, Steve Millers 'Jet Airliner' had the lyric: "I don't want to get caught up in any of that funky shit going down in the city". The Pink Floyd song ' Money' had the line "goody good bullshit"  and in 'Life in the Fast Lane' the Eagles sang "haven't seen a goddamn thing"... all lyrics that I have heard changed ( 'funky kicks') or censored in today's airplay. With all the blatant sexuality and cursing on TV, the internet and in other forms of media, this seems like unnecessary puritanism to me. Of course in those days some radio stations blacklisted "Sympathy for the Devil" by the Stones and other songs, so I guess every era has sensitive things that both earlier and later generations question. In the late 60's a radio station would play the entire 17 minute version of Iron Butterfly's 'In-A-Gadda-Da-Vida.' as well, which would never happen in the corporate controlled homogeneity that passes for music these days.