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There seems to be a pervasive view in the medical profession that most of their patients are lazy (probably correct ) and will not fix problems that could be addressed through diet and exercise, so the patient gets a cocktail of crap with nasty side effects to take for the rest of their lives.
The common reaction that runners get in a check up when the doc measures a resting pulse in the 50s, and fantastic numbers for cholesterol and blood pressure, is that the patient is some kind of freak and curiosity of what motivates people to be healthy like that. Was there a trauma experienced earlier in life?
Anyway, I don't think prescription drugs are what's causing out of control healthcare, but it contributes. And patients typically don't seem to be presented with the idea that taking all these drugs is really bad for them. It's better than doing nothing. But those aren't the only choices and often they are presented as such because the healthcare system rewards transactions, not patient health.
Before you get in your car to visit the drive-though for your super sized Big Mac and large fries, remember to take your cholesterol and blood pressure medication.
Last edited by Corcaigh; February-28th-2013 at 10:00 AM.
Things changed in those years.
The fact of the matter is that the CBO did understand that the drugs on the marker would see their exclusitivity expire, but they assumed as part of their calculation that new drugs would also be developed and the same costs would be associated with them.
They assumed that the net effect would be that as a percentage of the market the generic use would stay about the same. That this historical trends would hold.
They actually weren't already holding when Part D was passed, they weren't holding when the CBO did their estimate, and they've continued to not hold.
The CBO and others assumed that drugs going off of exclusitivity would be "replaced" by others that were not.
Everybody knew that Lipitor was going to go to generic, but the assumption was that the Pharma would create new drugs that other people would use at the same rate.
The assumption was that the percentage of the prescription drug market that was generics would resemble the historical norm and that the exclusitivity of the drugs being used would be essentially flat.
Neither of those two things have happened.
People discount because there is no evidence for it and there's no real reason it would happen, and we have plenty of data that pre-dates Part D that said it happened before Part D.
Before Part D, drugs came off their patent and generics were made that were cheaper. I don't need to invoke Part D for the same behavior that was happening before Part D to continue to happen.
And again, generics coming onto the drug market that are cheaper than the non-generic after the exclusitivity period pre-dates Part D.
I don't need to invoke a Part-D related mechanism to explain that.
There is no current viable economic theory that includes the ability to pass on costs.
(I'll point out that I used to make a similar argument here w/ respect to our Pharma costs and countries like Canada, but as I've gained a better understanding of economic (mostly by reading this board), I've come to appreciate that argument is badly flawed.)
"Department of Health and Human Services
OFFICE OF INSPECTOR GENERALGENERIC DRUG UTILIZATION IN THE MEDICARE PART D PROGRAM"
"For Part D, the overall generic drug substitution rate of 88 percent is similar to the median generic drug substitution rate of 89 percent for State Medicaid programs during 2004."
That is if people CAN use a generic they do so at an 88% for Part D. If they can in State Medicaid programs in 2004, they were at 89%.
(Please, note how they aren't just comparing the percentage of generics, but the subsititution rate. Comparing ONLY the percentage of generics is BADLY flawed because different populations will take different medicines that have differences in the availibility of generics (which is what the link you posted did).)
"Overall, Part D achieved a high level of generic drug use during the first two quarters of calendar year 2006 that was similar to the level of generic drug use achieved by State Medicaid programs in 2004."
I think that should pretty much kill your argument.
The shift to generics when things go off patent pre-dates Part D. Over the life time and even pre-dating the creation of Part D, the people that did the estimates predicted things based on historical norms. Those historical norms were wrong right off the bat and have been for the life time of the program, but they weren't just wrong for Part D, they've been wrong for the whole US population and can be tied to decreases in exclustivity being granted by the FDA, which has been tied to decreased drug development by Pharma
That tied to lower than expected enrollment in Part D are the best and clearest explanations of the reduced costs of Part D.
We don't have to go to unsupported things like maybe Part D caused there to be more generics or lowered the prices of the generics.
There were lower priced generics before Part D. Companies made generics and people used them.
---------- Post added February-28th-2013 at 11:52 AM ----------
---------- Post added February-28th-2013 at 12:23 PM ----------
That is the NIH is funding the basic reserach that then underlies the Pharma industry.
We should shift much of the focus of the NIH to finding affects of things we already know or basic life style things.
We should be doing more large scale and long term studies on diet and even the use of prescription drugs.
If we can figure out how to treat Alzheimer's by life style or existing moleulces, does it really matter if we understand Alzheimer's disease in detail?
(though I think we need to continue to do pretty active drug development research on infectious diseases and the risks of new technology because those things change, but I don't think we do enough of that now anyway.)
Last edited by PeterMP; February-28th-2013 at 04:43 PM.
More, does the problem primarily rest with pharmaceutical companies marketing directly to the American public? Lazy doctors? Lazy patients? All of the above? One more than the other? Etc.
Furthermore, how does one propose solving what they see is the problem?
Don't just tell me fat and lazy Americans. That's a very easy solution and more than obvious. How is that problem solved?
Just interested in people's thoughts on that.
Last edited by Special K; February-28th-2013 at 03:56 PM.
Formerly known as Nunya Bidness per arrangement with ES staff
And this includes advertisements/commercials.
This is what worked for smoking (lack of ability of cigerette companies to advertise (e.g. no tv commercials) and anti-smoking advertising) and what hasn't worked in terms of obesity (e.g. people know that being overly obese, especially when you are young is bad, but numbers for childhood obesity keep going up because of the difference in advertisement of that information vs. the advertisements to eat (especially eat things that can contribute easily to being obese)).
Last edited by PeterMP; February-28th-2013 at 04:44 PM.
I think that restrictions need to be placed on pharmaceutical marketing, in magazines, newspapers, tv commercials and a million other media venues. The same restrictions placed on tobacco products should be placed on pharmaceutical drugs, IMO. Observations made during my time interfacing with patients in the medical setting absolutely makes me think restrictions on pharmaceutical advertising would go a long ways in helping reduce patient "need" for Rx's. I can't count how many times patients entered the clinical setting where I worked asking directly for Rx's they had read about online or seen on TV. The infiltration of these advertisements into our everyday lives is out of control and this type of marketing needs to be addressed by our legislators.
I would also agree with positive PSA commercials regarding healthy living, facts about obesity and chronic disease, etc. would be helpful.
I'm also in support of taxing "junk food" items similar to the way we tax tobacco products. I'm not sure what exact type of metric should be used to determine what constitutes "junk food" and falls under the tax umbrella, but I'm sure health experts could come up with an appropriate definition.
Finally, I think incentives for healthy behavior (weight loss, healthy eating choices, preventive care checkups, etc.) should be more widespread among the insurance, employer, public and private sectors. When I lived in Colorado, a health incentive program called LiveWell Colorado experienced success with its' incentive program for registrants engaging in healthy behavior activities.
Anyway, I'm sure there are many more ways to approach this probem, I'm just sick of hearing people say "we rely too much on prescriptions" and "we're fat and unhealthy" without really outwardly verbalizing their thoughts regarding the causes of these health issues and potential solutions for them. Clearly these diseases place an immense burden on our health care system and I agree with others who say expanding efforts in the preventive realm can very likely help some of the problems we are experiencing with our health care system.
Formerly known as Nunya Bidness per arrangement with ES staff
On my phone, so I'll try to be brief.
1. On GDR vs GSR, I remember the issue but can't recall the details. I will try to look it up tomorrow, mostly because I think the distinction doesn't actually favor Medicaid.
2. The law was passed in December 2003. Plans had to hire staff, negotiate pharmacy networks, negotiate rebates and formulary design. Write and submit bids to CMS in June of 2005. That's like 20 months, max, and plan bids all came in under projections. The pipeline didn't dry up in 20 months. Prices were lower because of competition.
I don't think I'd have a problem with even an outright ban on advertising prescription medication.
Maybe I wouldn't have a problem with something along the lines of "if you have <condition>, theres a new drug out that might help. See your doctor to see if its right for you". Not so much advertising, as letting the public know that there's a new option on the table.
But my reasoning is that, supposedly, the reason why a drug requires a prescription, is because its been determined that nobody but a doctor can decide if this drug is right for you.
And yeah, I remember when mom went through a phase where she'd call me into her room every time an ad for a drug came on tv, and tell me that she wanted it. (And she watched shows like Matlock. Where ALL of the commercials were for drugs, scooters you could get if you had Medicare, and lawyers wanting to sue drug companies).
We're all here because
we're not all there
Are folks lazy to some extent? Sure. I wouldn't disagree, but I also think the population are being "poisoned" by some of the big food manufacturers.
It's also high questionable when you have board members hopping back and forth from the committees who regulate the food to the ones who regulate the medicine and back, then back again.
I think technology by nature has probably made us a less active society as far as "exercise" goes, but when I use the term exercise, I am not talking about taking an extra 2-3 hours out of the day to do it. I'd say 30-50 years ago, people were more active out of necessity, it wasn't necessarily because they were better or smarter about their health, it was because that is how it had to be done back then. As technology advances and more things become automated, it's just a matter of fact that many things that required an active lifestyle 50 years ago, don't anymore.
The problem is so complex.
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Formerly known as Nunya Bidness per arrangement with ES staff
I see a lot of taxes proposed for things like sugary junk food and sodas. If we are going to go this route, and I don't think it's a bad idea, I would prefer a tax on salt content. If you go after salt content, you go after processed foods. If you take on that portion of our diets, I suspect the rest is taken care of as a by product.
On the incentive side, I know BCBS has offered a pedometer to my wife and I every year. Seeing how much you walk or run is encouraging. Incentives for maintaining or improving a body fat percentage could also help.
I believe my job as a parent is to give my kids all the blocks they need to build a life in which they can attempt to reach everything they strive for and see anything they can imagine. In a world where everybody finds it easier to destroy than build, I wish for my kids to experience the joy of seeing something for the first time and the love of creating something new.
It is given in the link I've already posted:
"For Part D, the overall single-source drug-prescribing rate of 37 percent is similar to the median single-source drug-prescribing rate of 41 percent for State Medicaid programs during 2004."
"For Part D, the overall generic drug utilization rate of 56 percent is similar to the median generic drug utilization rate of 54 percent for State Medicaid programs during 2004."
The numbers are similar is what they concluded, but more importantly even if the numbers aren't similar its really irrelevant at the level of a prescription drug benefit.
It might suggest that there is something else in Medicare that is helping people not get diseases where they don't have the option of using a generic or possibly that Pharma is going out of there way to develope new drugs that are relevant to the Medicaid population more specifically (possibly not because they are on Medicaid, but because they are more likely to have characteristic X), or it might be a difference between the two populations that is simply inherent in them being different (e.g. environmental pollution issues related to differences in where they live based on their income.)
The most meaningful number is the substition rate, and they are very similar (1% a part) for the numbers we seem to have.
The initial CBO estimate was created in 2003 and so there are years in between where the estimate was done and people really started spending on drugs.
But it is even worse than that, in making its estimate the CBO didn't use 2003 data, they used older data for prescription drug use.
"The model contains detailed information about beneficiaries’ spending for prescription drugs and Medicare-covered services, their supplemental insurance coverage both public and private), their health status, and their income.2 CBO’s estimates of Medicare costs result from the operation of that model.3"
"The estimates are based on data from Medicare claims for 1999 and from the 2000 Medicare Current Beneficiary Survey,
projected forward using CBO’s March 2003 economic assumptions and baseline projections of Medicare spending.
3. For more general information about CBO’s prescription drug estimates, see Issues in Designing a Prescription Drug Benefit
for Medicare (CBO Study: October 2002).
They used data from the height of the patent protection of the commonly used drugs (1999 and 2000) associated prices and inflation of costs to do their estimate.
Now, it was clear in 2003 when they did their estimate that there was PROBABLY going to be down turn (from 2000 there is a clear trend of a decrease in FDA granted exclusitivity, but at that point in time, it was only a 3 year trend, but at that point in time it was pretty clear that the large scale combinatorial chemistry approach for discovering drugs had failed so the pipeline was going to be down for a while), but they used the older data (probably because that's what they had in terms of real numbers (It has also seems to me that they more regularly over estimate costs/under estimate savings by using older data that it appeared wouldn't hold true they ensured they didn't underestimate costs)).
And then in 2005, the CBO actually up-dated their estimate, but in terms of drug prices and usage, they still went back and used the older data.
If in 2006, you would have used 1999/2000 data to estimate the drug costs of the US, even excluding Part D participants, you would have been wrong.
And there was "competition" before Part D. People were making generics. People were using generics. There were drug stores and insurance companies trying to cut as good as deals as possible to make more money for themselves or to recruit customers.
It isn't like there was no or even low prescription drug use prior to Part D.
You don't get to conclude because X was lower it was lower because of Y reason. How was the estimate done, what year did the data come from, etc?
What did they anticipate that the generic substitution rate would be and why?
When you do the estimate is irrelevant if you are using old data to do the estimate.
Last edited by PeterMP; March-1st-2013 at 09:19 AM.
Artificial Sweeteners in Milk?
Got diet milk? In a highly controversial move, the dairy industry wants to market artificially sweetened milk—without any special label to alert consumers.
In a petition filed with the FDA, the International Dairy Foods Association (IDFA) and the National Milk Producers Federation (NMPF) seek to change the definition of “milk” so that chemical sweeteners like aspartame and sucralose can be used as optional ingredients not listed on the product label.
If the petition—originally filed in 2009 and now under consideration by the FDA—is successful, these hidden additives could also be included in 17 other dairy products—including whipping cream, low-fat and non-fat yogurt, eggnog, sweetened condensed milk, sour cream, and half-and-half—without requiring any special labeling.
The dairy industry contends that using artificial sweeteners like aspartame as optional ingredients in milk and other dairy foods without any special labeling would “promote more healthy eating” and boost kid appeal. Currently, milk consumption is dropping among both children and adults.
Click on the link for the full article
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