I’m actually paying money to do this
My primary domain name is conradseitz.com and references to conradseitz.wordpress.com will redirect to here. This is because I paid eighteen dollars to wordpress to activate a simpler name. Everything else will remain the same. I’m paying fifteen dollars a month to read New York Times online ad libitum and I pay a hundred dollars a year to New Yorker for a subscription and access to their web site. Not to mention Science News, which has gone to $16 a year for online access.
The Internet may be “free” but the perks are extra.
Here is another example of pharmaceutical company price-gouging and opportunism: a drug company has patented a delayed-release preparation of doxylamine and vitamin B6, previously marketed under another name at much lower price in an immediate-release preparation. It is possible to obtain the exact same ingredients over the counter, and the price differences impressive: the OTC combination costs a little over $20 a month, while Decligis costs between $350 and $700 a month, depending on the needed dose. This is a price differential of twenty times in order to get a delayed-release preparation which has never been tested head to head against the OTC combination.
Who in his right mind would pay twenty times the price for an unproven “improvement” which makes it possible to take the drug twice a day as needed instead of four times a day as needed? Patients with mild-moderate nausea could probably get by with the OTC preparation two or three times a day. The funny thing about delayed-release preparations is that they are not reliably time-released. Sometimes the contents are all dumped into the blood stream at once; at other times, sometimes depending on food content in the stomach, the preparation will not fully dissolve by the time it exits the body in the fecal stream.
Insurance companies should refuse to authorize payment for prescriptions of this drug– it takes money away from higher health priorities (not that morning sickness is not a dreadfully unpleasant, and rarely, a life threatening illness). At the very least, the insurance companies should include the OTC preparation in the formulary that they WILL cover; and the Diclegis should only be available to patients who have failed the OTC version.
The fact that Kim Kardashian is pushing this drug indicates the market for which it was intended: the top 0.1% on the income ladder.
Here is a quote from an excellent blog post by Dr. Jen Gunter describing the outrages committed by this drug company (who will remain nameless for the moment):
Yes, while you can buy Diclegis as a prescription it is just a combination of two readily over-the counter (OTC) medications –vitamin B6 and doxylamine (an antihistamine) with slightly different dosing. When taken together doxylamine and vitamin B6 are mildly to moderately effective for nausea and vomiting in pregnancy. The difference between the prescription and the OTC is a minor variation in dose and the prescription is delayed-release so it is only taken once a day. However, there has been no head to head comparison between the OTC and prescription so we have no idea if the delayed-release offers any advantage beyond the convenience of one-daily dosing.The big difference between the OTC option and Diclegis is price. You can buy 100 doxylamine 25 mg tablets for $12.79 and 100 vitamin B6 tablets 25 mg for $7.29 (see below) and you can bet the manufacturers are still making a profit. Diclegis, if you have a coupon, is $345 for 60 tablets. The dose is two tablets a day, but some women need four tablets so the cost for could be $690 a month (with discount coupon!). Some may get it covered by insurance, but even then co payments are likely to be $20 or more. You will pay at most $25.20 a month for OTC (less if you don’t need four pills a day and/or take advantage of the buy one get the other 50% off at Walgreens). The other advantage of the OTC route is you can start with vitamin B6 and if that doesn’t work then add in the doxylamine. After all, we recommend a step wise approach to nausea and vomiting.Let’s compare OTC doxylamine/vitamin B6 with Diclegis. The OTC dosing is not identical but close enough and before 2013 (when Diclegis wasn’t available) we managed just fine using these slightly different doses. Check out this table:
Diclegis– if you have to ask the price you can’t afford it.
Those Attacks on Planned Parenthood
This is an old story but it bears repeating during the current attack on Planned Parenthood by the Republican Congress: the former Kansas Attorney General who filed 107 charges of performing illegal abortions against Planned Parenthood lost his law license over this behavior and other outrages. The Kansas Supreme Court took away his license indefinitely over 11 charges of misconduct in office as well as unprofessional conduct. Read this Raw Story report from 2013: http://www.rawstory.com/2013/10/kansas-supreme-court-indefinitely-suspends-license-of-former-attorney-general-who-speciously-prosecuted-planned-parenthood-and-george-tiller/
One of the most egregious (but typical) of the actions Phill Kline was disciplined for: he appeared on Fox News with a radical anti-abortion television news “commentator” whose show was called “Tiller the Baby Killer.”
You’ll recall that Dr George Tiller, one of three doctors in the US who provided rare late-term abortions, was shot to death by an anti-abortion assassin, in 2009, after a first attempt left him with bullet wounds in both arms in 1993. When Phill Kline, the Kansas attorney general, filed 19 counts of violating the law by using an employee to provide second opinions (required for late-term abortions), Tiller was acquitted on all counts. This was one of the charges Kline was disciplined for. The campaign of harassment and murder directed against Dr Tiller was not organized by Phill Kline, but he fed into the insanity of trying to prosecute a doctor for saving the lives of women who had nonviable late-term pregnancies (most with major developmental defects like hydrocephalus that were incompatible with life.)
Another of Kline’s unlawful actions was “speciously” filing 107 charges of illegally performing abortions on underage women; he somehow got his hands on the clinic records of a large number of women who had been treated by PP and picked up these 107 counts by combing through the charts. This was while he was Johnson County District Attorney (Johnson County is the most populous in Kansas.) The Court found that he repeatedly lied about how he had gotten access to all those charts. All of the charges were eventually dismissed but it took until 2012 to clear this up.
It seems that the radical Republicans were so charged up by their success in destroying ACORN, an organization dedicated to registering people to vote, by using doctored videos taken by hidden cameras, that they couldn’t wait to attack Planned Parenthood. PP is an organization that spends 97% of its time giving Pap smears and breast exams to poor women so that they can take birth control pills and thus avoid the need for abortions. In fact, when a PP clinic was shut down in one county, it was followed by an epidemic of HIV infections. PP is primarily a women’s health care provider for poor people, most of whom can’t get reasonable access to doctors even when they have Medicaid. A small proportion of its business, provided at a minority of its clinics, is providing abortions to women who pay cash for the procedure. Most of these women were using birth control and/or are financially unable to support another child (most already have children.)
The effort to destroy PP started with the creation of a sham organization that claimed to procure fetal organs for research; this allowed them to schedule meetings with PP administrators and invite them out to dinner. After secretly recording these meetings, filled with leading questions and wrong assertions by their spies, they selectively edited them and added words to the transcripts to make it appear as if the PP administrators were actively attempting to profit from the sale of fetal organs (“baby parts.”) Studies made of the videos after they were released showed that they were edited in such a way as to remove any denials by the administrators of the spies’ statements and make it appear that the administrators were agreeing with the outrageous lies told by the spies. In addition, they provided transcripts which were falsified; correct transcription showed that the administrators did not make the statements that the transcript attributed to them.
The saddest part of this scandal was that a major Republican Party candidate, Carly Fiorina, claimed that she saw things (“a baby with its heart beating and legs kicking”) that weren’t on the videos. She even claimed that she heard a PP technician say “we have to keep it alive so that we can harvest its brain.” (Does that statement make any sense? Why would someone say that about an aborted fetus (“baby”)?? As Star Trek fans would say, “He’s dead, Jim.”) When questioned about these claims, she “doubled down” and repeated her hallucinatory observations. That’s probably all I’m going to say about Carly Fiorina, despite my urge to mention all the candidates for President; she is so delusional that there is little else to say.
On CNN, a clip was shown of Congressional Republicans questioning an administrator for PP. The questioner claimed that PP used $22 million of federal dollars for lobbying. The administrator pointed out that none of that was federal money and all of it came from donations; when PP receives federal money, it is specifically reimbursement for expenses it incurs in providing health care and contraception to poor women. So Republicans are even attacking PP for lobbying to defend itself and are claiming that PP fraudulently uses the money it gets for health care for other purposes. This is absurd when we consider the minimal amounts of money that Medicaid pays for medical services, not even enough to fully reimburse a clinic for its expenses.
There is no logic or sense in destroying an organization that primarily provides birth control to poor women because the lack of birth control will lead to more pregnancies, all of them unintended and unwanted, and more abortions. This is the distorted and misogynistic thinking of radical Republicans.
Scientists have confirmed by observations from the Mars Orbiter, which has been taking close-up pictures of Mars for several years, that streaks of flowing water have been found in several places. Thousands of dark streaks that appear to lighten over periods of days have been seen. They are almost certainly water with high concentrations of perchlorates, which keep the water from freezing. It is very unlikely that anything could live in such salty water, but it appears that there is a great deal of underground water that is likely to be more pure and thus capable of supporting life. It looks as if there are large reserves of ice under the surface, which could easily melt under certain circumstances and provide a habitat for Earth-like micro-organisms.
Unfortunately, while the Mars Rover is on the ground only a few miles from one of these sets of streaks, scientists are reluctant to approach it because the Rover was not completely sterilized before leaving Earth. Some have suggested that after several years on the surface of Mars, with its harsh ultraviolet illumination because of the thin atmosphere, the vehicle may be sterile enough to avoid contamination. The only question is whether the Rover can survive another two years, long enough to reach the streaks. If it can approach a streak, the laser photometer on it that is specifically designed to vaporize samples and measure their spectra can shine on the streaks and directly test their water content.
It is already established that running increases one’s blood levels of endorphins. The same is true of anandamide, the body’s analogue to cannabinoids; running for 30 minutes increases blood levels of anandamide. More recently, blood levels of leptin have been found to change in relation to exercise.
In humans and most mammals, leptin, a hormone produced in fat and circulated in the bloodstream, reduces the appetite and indicates to the body that there is sufficient energy available. Fasting and running are associated with reduced levels of leptin, and faster running is associated with even lower levels.
Most recent, though, is an experimental setup in which mice had their STAT3 receptors deleted genetically. These receptors, in dopamine neurons, are associated with the mediation of the the leptin response in these neurons, which are important for their association with rewarding stimulation. In the absence of these internal mediating receptors, the neurons are continually stimulated and the mice respond by running twice as much as normal.
Mice do normally run several kilometers a day voluntarily on treadmills. But in the absence of the STAT3 receptors, they ran as much as 11 kilometers a day. The researchers say that they gave leptin to normal mice (intra-tegmentally) and they stopped running. The mice with the genetic deletion of the leptin mediator didn’t respond to leptin injections and kept running. The odd thing was that the leptin deficient mice didn’t have any changes in eating behavior. This receptor deletion study was published this month, here.
The trend of research recently has been towards multiplying the known endohormonal systems that are associated with changes in the individual’s metabolism and activities. There has been, over the last fifty years, a plethora of discoveries of new hormones and receptors. First, there are the brain and gut receptors that correspond to specific drugs: opioids, known as endorphins, that are subdivided into mu1, mu2, mu3, k1, k2, k3, d1, d2, and ORL1; GABA-A and GABA-B; nicotinic receptors, subtypes composed of twelve different subunits, and muscarinic, five subtypes; serotonin 1A-1F, 2A-2C, 3-7; endocannabinoid 1, 2, and possibly 3-5; testosterone, estradiol, and progesterone, using four types of nuclear receptors, luteinizing hormone, chorionic gonadotropin and follicle stimulating hormone, using membrane receptors ; oxytocin; finally there are the metabolism-related hormones insulin (probably the first) and glucagon, leptin, and ghrelin. There may be numerous others. In addition, the five known types of endovascular nitric oxide should be mentioned. Some of these function as both neurotransmitters and hormones, such as oxytocin.
An article published in the Australian Geographer last week related the oral traditions of twenty-one locations around the coast of Australia that described sea-level rises, occurrences that are reliably dated to 7-13000 years ago. The oral histories are in the form of myths that describe magical people and animals who induce the water to rise, in some cases suddenly, inundating passages between islands, creating bays, and sometimes submerging entire islands. All of these things happened during the last Interglacial sea level rise, occurring after the end of the last Ice Age 20,000 years ago. Since that time, for the last 7000 years, the sea level has been relatively constant; yet all of the coastal cultures seem to have these myths that describe a sudden sea level rise.
The paper is long and carefully reasoned, and worth reading if you are interested in Aboriginal myths. The article also mentions myths of the Great Flood and of Gilgamesh in passing, but these myths are quite different and speak of a permanent rise in the sea level of a relatively moderate degree. In all, I rate the reasoning as credible, and that it is possible for some cultures to retain in oral traditions, memories of events as much as 7000 years ago.
On May 20, about 100 stock analysts gathered in the ballroom of the Hyatt Regency Hotel in New Brunswick, New Jersey, to hear good news from top executives at Johnson & Johnson: The company had 10 new drugs in the pipeline that might achieve more than a billion dollars in annual sales.
For 129 years, New Brunswick has served as the headquarters of J&J, America’s seventh most valuable public company. With consumer products from Band-Aids to baby powder, Neutrogena to Rogaine, Listerine to Visine, Aveeno to Tylenol and Sudafed to Splenda, Johnson & Johnson is the biggest and, according to multiple surveys, most admired corporation in the world’s most prosperous industry—healthcare.
But the real money—about 80 percent of its revenue and 91 percent of its profit—comes not from those consumer favorites, but from Johnson & Johnson’s high-margin medical devices: artificial hips and knees, heart stents, surgical tools and monitoring devices; and from still higher-margin prescription drugs targeting Crohn’s disease (Remicade), cancer (Zytiga, Velcade), schizophrenia (Risperdal), diabetes (Invokana), psoriasis (Stelara), migraines (Topamax), heart disease (Xarelto) and attention deficit disorder (Concerta).
via America’s Most Admired Lawbreaker – The Huffington Post.
This is the beginning of a 58,000 word document that lays bare Johnson and Johnson’s crooked doings.
Johnson and Johnson had sales of $30 billion dollars; compared to that, the fine of $2 billion levied by the federal government for misrepresenting the effects of Risperdal was manageable. Johnson and Johnson profits make the $100 million that will be made from jacking up the price of a drug that only gets 10,000 prescriptions a year seem like small time money.
The medical industry is enormous and enormously profitable. The medicines sold don’t always do what they are advertised to do. There is something ugly about the prime time television commercials for Johnson and Johnson’s drugs. What right does a pharmaceutical company have to advertise drugs that consumers can’t directly buy and thereby put pressure on practicing physicians to prescribe? How can a patient judge what medicine is best for her condition?
The solution to these problems is a vastly strengthened FDA, to regulate the drug companies and reduce the excessive profit-taking that occurs daily, not to mention the drugs that are known to be ineffective or unsafe. There is no private solution that can stand up to $30 billion in sales a year. Only the government can develop the power to regulate this vast industry, and only with a restriction on lobbying.
A perfect example of what is wrong with the present system is President Obama’s nominee for FDA chief, a cardiologist who is accustomed to working closely with the drug industry in the research laboratory as well as clinically. This nominee’s potential conflicts of interest ran to twenty pages on his last published paper. It would be hard to find someone more in bed with the drug industry than this man. That demonstrates Obama’s obligations to drug lobbyists; the ACA demonstrated his obligation to health insurance lobbyists. There is no politician, whether Democrat or Republican, who is not in the pockets of any number of lobbyists who have paid for the campaign and expect recompense.
A Dream of Dancing Version 2
A Dream of Dancing
In the movie, the actors are dancing, in period clothes, to period music, and then just weaving about the dance floor, clasped in one another’s arms; from time to time the tune changes, but the dancers are the same and wear the same outfits. The camera focuses on the dancer’s feet; they are close together, stepping back and forth in time to the music.
I am dancing with a rather tall, slender young woman wearing a soft wrinkled silk dress that I feel rather than see. We are dancing close together and I have one arm behind her waist and the other one in her hand.
I realize that I am dreaming.
The music is slow waltz time, soft and languorous. I concentrate on feeling my hand behind her waist, I move my hand up to her back… I feel her warm, living body with my fingers, I am feeling the skin and the muscles underneath… arteries, veins, and under it all her living skeleton… I feel her muscles are warm… I feel her muscles warming my fingers…
The dream is pleasant… I want it to go on… the dream goes on… I feel her body with my mind… the dress, her skin, the play of her muscles as she turns forward and back…
The dream ends.
There is a state of feeling in the dream, in which time seems to have stopped, but the dancing doesn’t stop; my hand touches the dancer’s shoulder torso opposite me, in fact behind her in a peculiar fashion which would be difficult to duplicate unless we are melded together, facing each other in one body… there is no awkwardness…
The dance continues, as if the dream had not ended.
The air is cool; it is early morning.
The New York Times (NYT) carried a story today that may shock you: Turing Pharmaceuticals has acquired the antibiotic Daraprim (pyrimethamine), the drug of choice for toxoplasmosis, and raised the price again. The drug, which was raised from $1 to $13.50 a tablet recently over the last few years, was further increased to $750 when it was acquired by Turing. This price increase is bad news, but only for the estimated 8,000 people who will receive prescriptions in the next year, down from 12,700 a couple of years ago.
Pyrimethamine was first marketed 62 years ago and has long been considered a “generic” drug, although it is made by only one company currently. It is used in combination with sulfadiazine in severe cases of toxoplasmosis, a parasite infection that can invade the brain and cause abnormal behavior in addition to serious complications in the fetus. Toxoplasmosis is carried by cats and can be picked up by handling infected cat feces. It is considered most dangerous when it invades immunocompromised patients or pregnant women, causing fetal abnormalities or stillbirth.
Pyrimethamine was originally made by Glaxo Smith Kline, but they sold the rights to CorePharma in 2010, which is when the price went from $1 to $13.50. A year ago, Impax Laboratories bought CorePharma for $700 million, and in August of this year, Impax sold the rights to pyrimethamine to Turing for $55 million. Yearly sales of pyrimethamine went from $667,000 to $6.3 million even as the number of prescriptions stayed at about 12,700. In 2014, sales increased to $9.3 million, even as prescriptions shrank to about 8,800, again simply due to more price increases. If another 8,000 prescriptions are written over the next year, sales could easily exceed $100 million; recommended dosage for acute toxoplasmosis is two to three tablets a day for one to three weeks, followed by a reduced dosage of one tablet a day for four to five weeks– meaning a single treatment course could represent 50 to 100 tablets, or as much as $75,000. This is aside from the cost of the sulfadiazine used as an adjunct.
The drug can also be used, one tablet a week, as malaria prophylaxis. A rich traveler might spend several thousand dollars to use this drug for prophylaxis.
This price increase is part of a pattern: many, many generic drugs have seen enormous increases over the past few years, with few or no excuses given for the increases. The chief executive of Turing claims that he will use the money earned to develop better alternatives to pyrimethamine, but there is little chance of that actually happening and experts say there is little demand for a better drug despite the occasionally serious side effects. There is no priority to developing a better drug because pyrimethamine is so little used; as noted, there are perhaps ten thousand patients a year in the US who might need it.
In any case, the drug is now on a controlled distribution basis; many hospitals cannot afford to stock it, which will cause delays in beginning treatment. Controlled distribution makes it more difficult for other companies to produce generic copies, because they will have trouble getting samples to compare for the necessary equivalency tests. Medicaid and some public hospitals will be able to get the drug at a large discount, but Medicare will have to pay full price because of laws passed by Congress in creating Part D of Medicare that make it illegal for the government to bargain on price.
This price increase is part of a pattern: many, many generic drugs have seen enormous increases over the past few years, with few or no excuses given for the increases. The chief executive of Turing claims that he will use the money earned to develop better alternatives to pyrimethamine, but there is little chance of that actually happening and experts say there is little demand for a better drug despite the occasionally serious side effects. It is only rarely used, primarily in immunocompromised or gravely ill patients.
The chief executive of Turing was fired last year from another drug company he created in 2011, Retrophin, because the board complained that he was using it as his private piggy bank to reimburse customers of his hedge fund who had lost money. Retrophin had the same strategy of buying up neglected drugs and raising their prices. I won’t use the chief executive’s name because I don’t like his attitude or his behavior and I think he should be sent to prison for this. Unfortunately, there are no specific laws that make fleecing the vulnerable, sick public a crime.
The only solution to this problem is for Congress to pass laws that make this sort of behavior illegal and to create an agency that develops and produces “orphan drugs” as a public service.
Confession is Good
While looking at a cartoon, I noticed the apparent worldview depicted that led to the appearance of ruminations, that is repeated thoughts that occur during a time when one is not thinking of anything in particular. Certain kinds of ruminations, in particular thoughts about the past, predominate in predisposed individuals. In the cartoon, it was thoughts about the past wrongs done to him or that he imagined had been done when he said, on the phone: ““Oh, not much. Just sitting here sifting through an old scrapbook of past injustices and imagined slights.”” In my case, or the neurosurgeon’s case, it was thoughts about the failures one had had, the mistakes one had made. Why does one personality remember the wrongs done to him and another remember the wrongs that he himself had committed? Why does a third not think about the past at all? Yet a fourth thinks about the past but thinks about the good things that he has done or were done to him.
So how to think about the past? More relevant, how to write about the past? More in another post.
Conrad Theodore Seitz 