We’ll be importing 4 million flu shots from Germany.
A cynical man might compare this to the four-plus years that drug importation legislation has failed to get past the White House. Such a man, jaded and bitter, might ask what happened to the President’s concern, expressed so clearly in the debates, that nefarious Indonesians were determined to dose Canadian Lipitor with LSD and turn Miami Beach into a geriatric Haight Ashbury (”Dear Grandma: Thanks for the socks. They’ll come in handy as soon as my legs grow to be nine feet long and sprout extra tentacles…”).
Let’s put aside for a moment the fun problem of these vaccines forcing flus to mutate into ever more deadly forms each year. That’s a more complicated topic, and one that I’m not really qualified to talk about. I mean, I’m anti-flu, sure, who isn’t? But I have a passing understanding of evolutionary pressures, so I’ve got the creeping feeling that by 2020 there will be ferret-sized flu viruses that forcibly pry your mouth open and leap into your lungs. A decade after that they’ll probably be hiring PR firms and launching sophisticated ad campaigns that convince you that you actually want them in your body.
Come to think of it, it wouldn’t be a much tougher sell than “Let’s invade Iraq while letting Osama bin Laden set up a chain of ‘Li’l Qaeda’ daycare centers in western Pakistan.”
Anyway, a cynical man might allege that an administration that steadfastly prevents the re-importation of American drugs and then turns around and allows a German company to send in vats upon vats of an experimental vaccine might not have a lot of credibly, might even be “in the back pocket” of the pharmaceutical companies that mark up drug prices for their fellow Americans while enjoying a bizarre form of protectionism.
A cynical man might say that. Me, I’m advising everyone to dress warmly, drink plenty of juice, and avoid french-kissing chickens for a couple of months. These common-sense precautions oughta get you through.





65 comments
bjd
December 7, 2004 at 7:37 pm
1Could be worse. We could be importing it from Japan today (our other Axis enemy).
&mdash Those who forget history are doomed to suck at Trivial Pursuit.
Scott
December 7, 2004 at 7:46 pm
2I’m no micro/molecular biologist or anything, but I ‘ve read that the flu virus mutates in a wacky recombinant fashion that requires almost no selective pressure. The DNA of flu viruses mingles in its host with other strains to create new mutant strains. I doubt that the use of vaccines would apply enough pressure to make them mutate any more than they already do. It’s this fundamental aspect of the flu that dictates a new and different flu vaccine every year.
On the larger point of calling bullshit on the adminstration’s pathetica attempts to justify the prevent the importation of cheap drugs from Canada, I wholeheartedly agree that it is indeed the stinky crock of shit you claim it to be.
God only knows what would have come to pass had the French been the only ones with a backup supply of vaccine. Freedom flu anyone?
CJ
December 7, 2004 at 8:02 pm
3Scott is generally correct - it’s different than the ‘antibiotics/bacteria’ effect. That was the product of overusing relatively few antibiotics over a long period of time resulting in the development of several resistant bacterial strains. Viruses will ‘mutate’ their protein coats in response to our normal immune response and do so quite readily. That’s why it’s difficult keeping up with vaccine demand because each season the prevalent viral strains have to be identified before vaccine can be produced -in essence ‘mutation’ of the vaccine is trying to keep pace with viral mutation.
adam
December 7, 2004 at 8:11 pm
4I stand corrected. Actually, I think I’d heard something about the difference between viral mutation abd the antibiotics dilemma…
… but I just couldn’t resist the chance to make those jokes.
My apologies to all, but let me say that I’m very impressed with the scientific acumen of my readership. Anyone care to explain quantum communication and why it will or won’t lead to actual teleportation?
Faisal N. Jawdat
December 7, 2004 at 8:20 pm
5Also a lot of that mutation happens in birds and pigs before the flu even makes it to humans. Next up, aliens.
Mike Z
December 7, 2004 at 8:54 pm
6Adam: Quantum communication is just like regular communication except that it turns everything that used to be pseudoscience into “a real possibility” –maybe even “in our lifetime.”
By an amazing coincidence, quantum physics neatly explains and makes possible things like personal computers, cell phones, warp speed, teleportation, human consciousness, ESP, UFOs, paper clips, yoga, Creationism, modern art, spandex, and Bose-Einstein condensates.
Bob
December 7, 2004 at 9:06 pm
7With quantum communication, you won’t get teleported, but you may get lepton!
I never get tired of that joke.
Jerry
December 7, 2004 at 9:34 pm
8bjd -
No, no, no! This is the new Axis, Iran, Iraq and the PRK, except for Iraq, which, newly enfreed, is now a stable democracy and our bud.
The old Axis are now our buds. Except for Germany, which should be ignored. Except for the vaccine thing and the “letting us fly our wounded, maimed, and dying from Iraq there so they can be hospitalized out of sight of the general public” thing.
Excuse…I’m getting dizzy…
Fishmael
December 7, 2004 at 11:05 pm
9This just in: dit dit dit, da da da:
From Reuters:
House Passes Sweeping Intelligence Reforms.
Great. Just what we need: sweeping intelligence. Next we’ll probably get mopping intelligence. Where will it end?
tess
December 7, 2004 at 11:21 pm
10I just took my bio final so I still have elementary retention of both genetics, viruses, and evolution which my book’s authors defend against creationism with a great deal of curmugeonliness and irritation — more so than a person would normally expect from a dry college textbook.
Allison can probably say more on the topic even if it’s not quite her field of study, but from a college freshmen bio course that was apparently designed for bio majors who can’t get into place like, oh, say, anywhere with a decent bio program, the influenza virus is an RNA virus which can make copies with lots of flaws in them because there’s no error checking, and some of those errors allow the virus to spread faster, evade the body’s defences better, whatever. The point is that mutations in viruses, especially RNA viruses are far more common than even bacteria so resistance is far more inevitable in viruses to make a lil’ old vaccine resistance anything more than inevitability.
Or so I’m told. This stuff is fading rapidly in my memory and soon to be replaced with engineering stuff until the end of my finals.
hedera
December 7, 2004 at 11:55 pm
11“Sleep, baby, sleep, in peace may you slumber;
No danger lurks, your dreams to encumber.
We’ve got the missiles
Peace to determine,
And one of the fingers on the button will be German…”
Anybody else remember Tom Lehrer? I always loved that song, circa 1965; nobody did political satire better (not even you, Adam - you don’t make it rhyme, and you don’t play tack piano).
“…Some say the Germans were warlike and mean,
But that couldn’t happen again.
We taught them a lesson in 1918
And they’ve hardly bothered us since then…”
And the reason quantum communication won’t lead to transportation is that it only transports information, not things; and you can know where something is or how fast it’s moving, but not both at once.
Ananna
December 8, 2004 at 12:44 am
12You can know where something is or how fast it’s moving, but not both at once.
Ready-made explanation for the next time someone asks why we haven’t found Bin Laden after all these years.
Jerry
December 8, 2004 at 1:10 am
13And the Nobel Prize in Explanation goes jointly to hedera and Ananna for their work in applying Uncertainty to US terrorist hunting.
Perfect
Murray
December 8, 2004 at 7:18 am
14Hedra-
Adam DOES play the piano. He’s big into Jazz. It just doesn’t sound right in print.
Oh, and a cynical man might conclude that Americans are idots.
Mary
December 8, 2004 at 9:36 am
15A cynical man might say the administration is “in the back pocket” of the pharmaceutical companies; the health care insurance companies, and the oil companies. Also, that Canada and Germany are “Third World” countries with questionable manufacturing standards.
“If you visit American city,
You will find it very pretty.
Just two things of which you must beware-
Don’t drink the water and don’t breath the air…”
Tom Lehrer was a rare genius.
Mary Kay
December 8, 2004 at 10:58 am
16No matter how hard I try, I cannot say Flu Foe Flies Through 2 times quickly, much less 10 times. Now I’m stuttering. T-t-t-t-hanks, A-a-a-a-ad-d-d-d-d-am!
ginny
December 8, 2004 at 12:00 pm
17It seems we’ve had vacuuming intelligence for some time, because our counter-terrorism efforts thus far certainly suck.
Regarding Quantum communication, that happens every time Captain Archer flips open that little gizmo and says “Enterprise, two to beam up.”
(sorry, SF geek humor outbreak. Must sterilize)
Bob
December 8, 2004 at 12:35 pm
18Flu mutation is much more random than antibiotic resistant strains, as has been pointed out above. This is a very good thing, as if the 1918 Flu strain had kept getting stronger each year we probably wouldn’t be here to have this deep, meaningful discussion
And on the Tom Lehrer front, “Send the Marines” is still remarkably current for 40 year old political satire:
“When someone makes a move
Of which we don’t approve,
Who is it that always intervenes?
U.N. and O.A.S.,
They have their place, I guess,
But first - send the Marines!
We’ll send them all we’ve got,
John Wayne and Randolph Scott;
Remember those exciting fighting scenes?
To the shores of Tripoli,
But not to Mississippoli,
What do we do? We send the Marines!
For might makes right,
And till they’ve seen the light,
They’ve got to be protected,
All their rights respected,
Till somebody we like can be elected.
Members of the corps
All hate the thought of war;
They’d rather kill them off by peaceful means.
Stop calling it aggression,
Ooh, we hate that expression!
We only want the world to know
That we support the status quo.
They love us everywhere we go,
So when in doubt,
Send the Marines!”
Johnnyboy
December 8, 2004 at 12:56 pm
19>God only knows what would have come to pass had the French been the only ones with a backup supply of vaccine. Freedom flu anyone?
The other flu vaccine supplier, the one providing basically all flu vaccines currently administered in the US, is Aventis, which is very francais. Something that no one in the administration is advertising loudly.
This said, there’s something deeply bothering to me about the lefty tendency to demonize drug companies, and to push for drug reimportation at any cost. As someone who works in research and development for one of the Great-Satan-big pharma companies, I cannot fathom how drug reimportation can be justified as anything else than a short-sighted, screw-big-pharma measure. Somewhere along the lines, the concept got lost that pharmaceutical companies are actually inventing drugs, and in so doing are pouring billions of research dollars into an insanely risky business whose ultimate goal is the bettering of people’s health. Yes they are making profits from it: welcome to capitalism - if there is any other system that can reward invention and investment, I’d like to know it. Whether these profits are too high is I think beyond the knowledge of anyone on this board (including myself). What I do know is that these profits go in large part into developing new drugs for the future. Yes there is substantial investment in marketing as well, but that’ s inevitable in such a fractionated, competitive business (where the biggest company has only a 10% market share). For once I’d like to see some blame heaped on private insurance companies, for a change, who are making money while not providing anything of value to the public. Or on the politicians who have not shown any inkling of a desire to remake the US health system into a universal program, something pretty much every western country has managed to do decades ago.
Oh and by the way, of the 5 US companies that gave the largest charity donations last year, the top 4 are evil big pharma (the 5th: Microsoft).
You may commence hurling abuse below.
Sharon
December 8, 2004 at 1:08 pm
20Johnnyboy, I think all of us here understand that Big Drug Companies are doing a Good Thing and must make a profit in order to continue to do good things. What I question is why there is such a significant price differential just because a drug is being sold on one side or the other of the U.S-Canadian border, for example. I have no doubt that American taxpayers are already providing financial support to American drug companies in the form of tax credits for R&D, etc. So why must we also pay higher prices?
Mary Kay
December 8, 2004 at 1:30 pm
21Johnnyboy: Here comes the abuse. I have been in the healthcare field for 30+ years, most of it on the hospital/physian side, and more recently on the managed care insurance side. I absolutely agree with everything you said about both the drug companies AND the insurance companies. However, what was left unsaid needs to be said. If all the drug companies profits were driven by the expense associated with research and development, they would be my heroes. However, it makes me cry to think of all the $$$ spent by drug reps wining and dining my physicians and staff (before it became illegal), not to mention all the marketing freebies (note pads, pens, toys) freely dumped in every office. Now the rep only has to wheel in a VCR in the lunch room and play a tape no one ever watches to justify bringing in a catered lunch for 20 people so the office staff will let him/her get an appointment with the physician. And the billions of dollars worth or “samples” that were unloaded in every office! The office staff controlls which drug samples come in, not the physician…even though you have a signature from the physican that says he ordered them. Don’t even get me started. The few samples that actually ended being used were personally used by office staff and their family and friends, not financially destitute patients who couldn’t afford to pay for a prescription. The vast majority of the samples sat in the “drug closets” until they reached the expiration date, and then they were all thrown out. Granted, the physician and office staff have to assume some accountability for this waste, but where are your controls??? If you give out samples for patients to try, or for poor patients, why don’t you require an accounting of which patients the samples were dispensed to? And how about the environment? Do you have a clue how much pharmaceutical samples contribute to the landfill problems? The amount and expense of the packaging for 2 little pills is obscene. And how can you possibly justify the expense of all those commercials and magazine ads??? End of hurl.
Jerry
December 8, 2004 at 2:20 pm
22OK, my 2 cents worth. Am I stupid? Do I just not understand the clear, logical reasoning that makes it cheaper to import products that DrugReasearchMaxiCo sent to Canada than to buy them here in the US? Are they only recovering research costs from US buyers? Are they losing money on sales to Canada; if so, why?
Sorry for being so dense.
Allison in Santa Cruz
December 8, 2004 at 2:29 pm
23Sorry to be jumping into this thread so late. I’ve been writing a final exam, holding last-minute office hours, leading review sessions, and such. Tomorrow morning the kids take the final, then the TAs and I will spend the rest of the day grading it.
Anyway, yes to Tess’s summary of virus’s mutational capabilities. I think part of why they can mutate so quickly is that they don’t have to maintain any of their own cellular machinery, which quickly goes wonky if the wrong mutation pops up. Without those constraints, their RNA can mutate like crazy, and some of these mutations will lead to new infectious strains and such. Tess, I’d like to hear which intro bio text your class used.
As for the drug and pharmaceutical companies, I guess I don’t have a problem with their making a profit (although the socialist in me become truly nauseated at how rich the big guys at the top of ANY large company can get — it’s hard for me to imagine that they are inherently worth so much $$$). My major beef is probably against the insurance company bureaucrats who make the decisions about who gets covered for what medical condition, and how much it’ll cost. Still, I’d be a bit less inclined to rag on the pharmaceutical companies if I felt that the decision to pursue or not pursue a particular course of interest were based more on the idea of serving the public good (who, after all, provide the bucks) than the almighty dollar.
That said, I can’t think of why American taxpayers, who fund most of the pharmaceutical research and development, pay higher prices for drugs than folks in other countries. I’ve heard this discussed on many talk shows, and it never makes sense to me. Maybe I’m economically stupid. And how is a drug that is made in the USA to FDA standards, shipped to Canada, then shipped back to the USA inherently less “safe and effective” than the same drug that never left US soil? Presumably it would be subject to FDA standards again when it gets reimported?
Heading back up to campus for yet more office hours. I hope someone shows up this time. Ingrates.
Dan
December 8, 2004 at 2:38 pm
24I must be coming down with the flu because I am not feeling well after reading todays postings. So here it goes…..
Jerry, I fear France more than the New Axis. After we finish with Iraq we should invade France and liberate them.
Johnnyboy, Careful what you wish for. If universal care is forced upon us then the current remarkable productivity of the drug industry will turn into legislated mediocrity. What major drug has France produced in the last ten years? What major drug has any country with a nationalized healthcare program produced in the last ten years?
Sharon, I agree that drug pricing is out of whack in this country. The government can’t fix that, only the free market can. I suggest you buy stock in drug and healthcare companies to offset your higher costs.
Mary Kay, healthcare companies are not the problem. They merely reflect the wishes of the market, that is…..consumers who want endless and low cost care without being informed consumers, providers who seek reimbursement to match their egos and not the value of their services, and attorneys who seek deep pockets for the purpose of self enrichment without regard to the impact on healthcare delivery system.
I think I need a flu shot!
Mary Kay
December 8, 2004 at 2:49 pm
25Dan: If you need a flu shot, you might want to check this out:
Take-A-Flu Vacation, Ltd. The Victoria Clipper, a high-speed catamaran service between Seattle and Victoria, B.C, announced a round-trip-and-flu-shot package at a discount price of $105.
You’re not going to be able to get one in this great, modern, industrialized nation we call home.
tess
December 8, 2004 at 3:17 pm
26Allison:
Reece&Campbell; the standard in Berkeley, and apparently the standard in Calpoly. I love the fact that this thing can pass the saucepan test (If you want to know if your saucepan is any good, imagine using it to whack someone’s head. If there’re any doubts about which would dent first, thrown the pan out.), and weighs and costs as much as a gold brick.
My two cents about big pharma: Somehow I don’t think this is really one that should be left to the market. Under market forces, we would never get any new antibiotics but instead get a lot of drugs for impotence even if there are reports looming that bacteria are developing resistance. And yes, big pharma are big charity contributors, especially research in universities. I think it’s cheaper for them to give money to universities because they can have a load of grad students doing the work for a lot cheaper than their own scientists. But as Majikthise pointed out on her blog, ultimately what the universities want is to publish their findings, but the pharmas want to keep the info under wraps so that they can exclusively make a specific drug without another company making a knock-off that they can patent because its slightly different.
And my own word on private vs public funding: stem cell research. Someone I once viewed with respect complained that private industry hasn’t taken up research in stem cells even though they don’t have to fall the federal restrictions and guidelines that universities recieving public money do, saying that it should be all controlled by the market. Well, the market has just proclaimed that it’s too big of a risk to take, having to create new lines from fertility clinic embryos, and then spending quite possibly years to catch up with other countries.
You really can’t expect everything to be done through the market alone.
Sharon
December 8, 2004 at 3:26 pm
27Dan, re supply, demand, and free markets. Do you mean that Canadians don’t *want* flu shots as much as we Americans do, and so therefore the price is lower in Canada?
Somehow I doubt that that’s the whole picture.
Dee
December 8, 2004 at 3:44 pm
28Coming very late to this but damned if they didn’t make me WORK all day at my job. Which is managing a humongous NIH study on diabetes and cardiovascular disease. So let me say a few words about drug companies.
I’ve done clinical research for 20 years now, and I know the amount of money that is spent on research. I also know the amount that is wasted, and the way studies are manipulated so that only the results the drug comany wnats to see get published. I’ve also seen the ridiculous advertising trinkets and junkets described above.
If I believed for one minute that the obscene profits made by Big Pharma were being reinvested in research and development, I would be the first one in line to say God Bless and Keep It Coming. But why prescription medications need to be advertised — heavily — on television and in print is beyond me. All that does is make patients/consumers demand the Little Purple Pill they saw during the Evening News, when last year’s little white pill works just as well and costs half as much.
Those who are innovators and take the risk should reap the reward, but they shouldn’t wring every last dollar from the American public in doing so. This transparent lie about reimported drugs not being safe is maddening on so many levels. And the hypocricy of this administration suddenly discovering that a vaccine made overseas is just fine and dandy is infuriating.
Whew. I’ll rest now.
dan
December 8, 2004 at 3:48 pm
29Sharon, The reason companies don’t produce more flu vacines is because there is no economic incentive to do that in the U.S. due to federal legislation controlling the allowable pricing for the vaccine. The meager potential return is offset by the large legal risks associated with production and distribution, therefore manufactures wisely choose not to take that risk. Perhaps you should address your concerns to your congressperson.
Allison, Insurance “bureaucrats” don’t decide what services are covered. That decision is made by your employer when they choose your insurance coverage. Your coverage reflects what your employer is willing to pay for.
Allison in Santa Cruz
December 8, 2004 at 4:07 pm
30Dan — Yes, the health coverage that I have depends on the package that I am buying (in my case, my employer does not provide my health insurance; my husband and I are paying for it ourselves). This is true for everyone who has an insurance plan, whether through an employer or not. This doesn’t change the fact that the health insurance companies are telling doctors how much they will be reimbursed for certain procedures. This forces doctors to make medical decisions not based primarily on what is best for the patient, but on whether or not he/she or the clinic will be fully reimbursed for the care provided. That’s not medicine, it’s bureaucracy. And maybe we’re not there yet and that’s a last case scenario, but I for one am disturbed by the trends I see around me.
dan
December 8, 2004 at 4:18 pm
31Allison, You sell physicians and other providers short using your logic. Providers provide care based on the patients needs. To do otherwise is to violate their hypocratic oath. Providers also know that they won’t be “fully” reimbursed and base their operating budgets on “expected” reimbursement. Putting accounting issues aside, providers will do whatever is required for the welfare of their patients.
You would be less disturbed about trends if you understood all the facts.
Ken
December 8, 2004 at 4:35 pm
32It nearly brought a tear to my eye to read Tom Lehrer being spoken of so highly. He was a genius at comedy and political satire, and even though I was actually born AFTER the high point of his career, I can still sing many of his songs from memory (and often do, to the embarassment of my wife). But it is indeed frightening how much of his material continues to be timely. Hell, with the boom of the Internet, and the ongoing controversy over its most important feature, we should be singing his songs all the more fervently now!
“Smut!
Give me smut and nothing but!
A dirty novel I can’t shut
If it’s uncut
and unsubt-le.
I’ve never quibbled
If it was ribald.
I would devour
Where others merely nibbled.
As the judge remarked the day that he acquitted my Aunt Hortense,
“To be smut
It must be ut-
Terly without redeeming social importance.”
Por-
Nographic pictures I adore.
Indecent magazines galore,
I like them more
If they’re hard core.
Bring on the obscene movies, murals, postcards, neckties, samplers, stained
glass windows, tattoos, anything!
More, more, I’m still not satisfied!
Stories of tortures
Used by debauchers
Lurid, licentious and vile,
Make me smile.
Novels that pander
To my taste for candor
Give me a pleasure sublime.
Let’s face it I love slime!
Old books can be indecent books,
Though recent books are bolder.
For filth, I’m glad to say,
Is in the mind of the beholder.
When correctly viewed,
Everything is lewd.
I could tell you things about Peter Pan
And the Wizard of Oz - there’s a dirty old man!
I thrill
To any book like Fanny Hill,
And I suppose I always will
If it is swill
And really fil-thy.
Who needs a hobby like tennis or philately?
I’ve got a hobby: rereading Lady Chatterley.
But now they’re trying to take it all away from us unless
We take a stand, and hand in hand we fight for freedom of the press.
In other words: Smut! I love it.
Ah, the adventures of a slut.
Oh, I’m a market they can’t glut.
I don’t know what
Compares with smut.
Hip, hip, hooray!
Let’s hear it for the Supreme Court!
Don’t let them take it away!”
Harold
December 8, 2004 at 5:26 pm
33Damn, I may have a degree in Physics, but I’m starting to feel like I should be sitting at the children’s table with a coloring book. I don’t think I can keep up with the rest of you!
And why is everyone speaking of Tom Lehrer in the past tense? I do believe he is still among the living.
Murray
December 8, 2004 at 5:52 pm
34Regarding free market and drugs.
I sell bikes and take people for bike tours. They can decide for themselves if I’m worth it (I am). But say I made the only drug that would save your life? What is your life worth? (Crook to Jack Benny “your money or your life”……… Jack Benny “I’m thinking!”). There are just times that the free market doesn’t work. Life and death issues cannot have a dollar amount placed on them.
I too would be big Pharma’s cheerleader if their R & D budget wasn’t less than half of their marketing budget. When they spend millions telling me to demand the purple pill from my doctor with out telling me what it does, they loose my respect.
I think that people are missing the point. We shouldn’t be buying drugs from Canada.
We should BE Canada. Right eh?
If Canada can go to the drug companies and come up with a price that both can live with, why can’t we?
Because we would rather fund a health care insurance industry that makes a profit by getting between our money and our health care, and a willingness to tolerate a “Free market system” in an area where no one should.
Why is it that in every area that we differ from
Canada, they do it right and we don’t? (If only they could do something about being so far north).
Allison- If you think that college students are ingrates try 6th 7th 8th 9th 10th 11th and 12th graders (I’ve got a month long gig subbing as a gym teacher for 450 students).
Bob
December 8, 2004 at 6:05 pm
35Tom Lehrer is still alive, and last I heard was at UC Santa Cruz, but he has retired from public performing, with rare exceptions, for a very long time.
Ken
December 8, 2004 at 6:26 pm
36I wasn’t sure which tense to speak of Mr. Lehrer in. I was aware that he was at UCSC some years ago, teaching math, but it’s been a while since I’ve heard an update. If he’s still going, more power to him! I always thought he beat the pants off Mark Russell (not that I’d want to see Mark Russell with his pants off, of course).
SeattleDan
December 8, 2004 at 6:36 pm
37I had the privelege of seeing Tom Lehrer perform back in 65 when he was promoting That Was The Year That Was. I was 15 and my folks dragged me to the concert at the Santa Monica Theatre. I didn’t know who the heck he was or why my folks thought I would be remotely interested in seeing him. I left a huge fan.My understanding is that he really did not like to tour. He did do some songs later for Sesame Street. God bless ‘em and hope he is doing well.
Jerry
December 8, 2004 at 6:52 pm
38“My two cents about big pharma: Somehow I don’t think this is really one that should be left to the market. Under market forces, we would never get any new antibiotics but instead get a lot of drugs for impotence…”
Uh, like we don’t get more hard-on drugs than new antibiotics?!?!
But more to the point, free-market use of antibiotics has been a DISASTER!! Physicians giving sub-clinical doses to everyone who comes in with a viral infection just because they ask for it, the MASSIVE use of sub-clinical doses for mammals in feed-lots, unsupervised use of prescription anti-biotics against serious infective organisms has resulted in the squandering of one of the great gifts mankind has ever had. And quickly! When I was a kid, penicillan was effective against just about every nasty organism out there, and there were antibiotics specific to TB that were highly effective.
But we have thrown away this gift. For money. For profits in the beef and swine industries. For MDs making themselves even more God-like by “curing” viral infections in a week that would have taken seven whole days without antibiotics.
And don’t even try to convince me that the Big Pharmas don’t push their products on farmers, rancher, physicians, and the public to increase profits!
Jerry
December 8, 2004 at 7:17 pm
39“Allison, You sell physicians and other providers short using your logic. Providers provide care based on the patients needs. To do otherwise is to violate their hypocratic oath. Providers also know that they won’t be “fully” reimbursed and base their operating budgets on “expected” reimbursement. Putting accounting issues aside, providers will do whatever is required for the welfare of their patients.
Dan, I bet a shiny new nickle that you have never worked around doctors. In fairness, I have known some, hell, many that would impoverish themselves to provide care. I have known many, many, many more doctors who quite simply view their productive life as time to get as rich as fucking possible.
And those are individuals! Lets consider how most physicians practice today, as a “productive unit” in a “health care delivery organization.” While they may even try to provide the best care possible, subtle and not-so-subtle pressures (such as being “fired” for not producing enough “billable patient care units”) make the bottom line maximized profit and NOT patient care with a reasonable profit.
George
December 8, 2004 at 9:05 pm
40Dan, you right wing ninny. You don’t have the foggiest clue what you’re talking about, do you? (Everyone else on this forum has been so respectful and has argued eloquently with actual facts, so I thought you would feel more at home if I sounded like one of your talk radio guys.) Seriously, I spent most of my working life in big pharma, Dan. Take a look at one of their annual reports. It’s right there in black and white- More money spent on marketing than R&D. Regarding “What major drug has any country with a nationalized healthcare program produced in the last ten years?” Since GSK, Aventis, Roche, Novartis, etc are from countries with nationalized healthcare, maybe it would be easier if we counted the ones that came from countries *without* nationalized healthcare. To whoever it was in this thread would advised bying pharma stocks to help you afford drugs, that’s rich. This year I dumped nearly all my pharma holdings. It’s my personal opinion that the jig is about up on those crooks. But you do what you want, bro. It’s a “free” country.
George
We’s torturin’ for jeeesus! Y’all pissed off? Good.
tess
December 8, 2004 at 9:16 pm
41Hi Jerry,
Just to clarify, I was remarking on the new antibiotics we need to counter the increasing number of resistant strains out there. I did read about how we get the new strains, the abuse, etc, so no need to preach to the choir here.
Matt
December 8, 2004 at 11:41 pm
42Prime suggestion to lower drug cost: ban direct advertising of drugs that require prescription. The public gets no useful information from TV ads, and it just causes them to hound their docs for the latest and most expensive (is Bextra more effective than Alleve for pain? I don’t think so. Not as frequent stomach upset.)
By the way, the government effectively sets prices for physician and hospital reimbursement through Medicare. Insurace companies decide they’ll pay @ medicare rates or 120% of medicare, or whatever but it’s really all tied to the Federal government pay scale. Why are drug companies given a pass on this anti-free market system, even when the government is paying the bill? Answer: drug companies give bigger campaign contributions than doctors and hospitals?
Dee
December 9, 2004 at 8:12 am
43This is my simple and elegant proposal to lower the cost of health care:
Make every third party provider — Medicare, Medicaid, private insurers — use the same claim form.
You’re welcome.
Dan
December 9, 2004 at 9:35 am
44Jerry, Pony up the nickel. I have worked with providers for the last 20 years, with positions in practice management, healthcare insurance and ancillary practices. Not to mention being married to one for 22 years and virtually living with the rest of them through that time.
Like all industries you have the majority of the individuals trying to do the right thing. Yes, I know plenty of providers who love the nickel. But they do not represent the majority.
As for socialized medicine why is the French government facing the wrath of its citizens for increasing the standard workweek? Because the government has determined, and stated, that the cost of socialized medicine is unsustainable and productivity needs to be increased to cover the ever increasing cost. Nationlized programs still need to follow economic principles. The same is also underway in other European countries.
Finally, I find it interesting that, while I agree with some of the principles discussed in this blog, when someone takes a different path from the group that the level of discourse is harsher. What ever happened to civilized discussions with respect for differences of opinions?
Mary
December 9, 2004 at 9:53 am
45Dee for President. At the very least, head of Health and Human Services.
Pharmacia and Pfizer merged and who lost their jobs? Not the lawyers. Tech writers and researchers. Pfizer has a larger law department than the University of Michigan- and we have a Law School!!! Does that say something?
Johnnyboy
December 9, 2004 at 1:14 pm
46Canadian drug prices: *New* drugs are cheaper in Canada, because the various canadian health agencies set price limits; i.e. they won’t buy certain drugs above certain prices. The US doesn’t have price controls so the drug companies can charge more (US Agencies that buy a lot of drugs (e.g. Medicare) could theoretically negociate lower prices, but from what I understand of the new Medicare bill they won’t be able to do that anymore). So by paying less for drugs, citizens of contries with price controls contribute less to pharma R&D than US citizens. Or in other words, US drug-buyers are shouldering a bigger burden of drug development costs then foreigners. Whether that’s fair or not depends on your point-of-view. So are the pharma company losing money by selling cheaper to Canada ? Probably not, but that’s hard to answer, because making a drug is not like making a car, say. Car companies know precisely what the manufacturing costs are, because they’re easy to calculate (materials + manpower). But the problem for drugs, the cost of producing the actual pill is minute per pill. What is costly is the 10-15 years of research that has gone into it, plus the research into all the other drug candidates that failed along the way (after 1, 5, 10 years of development efforts). So when you’re buying a new drug, you’re not actually paying for the cost of making that drug, but rather for all the other drugs that are currently being researched (plus the marketing, of course). And the cost of drug research keeps getting higher, because the FDA regulations keep getting stricter, and the public has an ever-diminishing tolerance for side effects and risks. Which is why drug companies want to charge as much as they can for new drugs, since that’s the best way of ensuring that they can survive and develop new drugs.
Are US drugs reimported from Canada un-safe ? Of course not. Of course when you’re buying from an unknown online outfit you don’t know if the drug you’re getting is really from the US or if it’s some knock-off made in a lab who knows where. But if you’re buying from a large, established canadian pharmacy, there’s no safety issue.
As for marketing budgets: yes, a lot of money is being spent, both in advertising and in direct sales. But I don’t think the pharma execs and shareholders are stupid; if they’re spending these millions, it’s because they feel they have to, to be able to have a successful product - the cost of doing business, basically. Are drug ads ridiculous and potentially misleading ? Of course they are, like all advertising. Someone who begs his doctor to give him a drug just because he saw it in an advert is an idiot. The job of doctors is to keep up on new drugs being produced and figure out which is best for each patient. A doctor who gets talked into prescribing a drug because of trinkets he got from a rep is also an idiot.
tess
December 9, 2004 at 1:32 pm
47Dan,
This is civilized discourse. Were this any other place, someone would probably take such umbrage at your comments and tell you “to take your head out of your ass,” a “troll,” “fuck-nut right-winger” or any number of other epithets. I personally think you’ve been reasonably decent which is why no one has said that to you yet. So why do you feel this way? Are you offended we haven’t folded to your reasoning yet?
Because I can tell you that my own family physician (who doubles as a plastic surgeon on weekends to supplement his income because he serves mostly immigrants without insurance) would not perform a simple surgical procedure on my mother because her insurance company would only reimburse him $5 because he’s a “primary practioner” even though he is a licensed surgeon. This ain’t freezing warts, nor is this reconnecting a limb, but I’m sure you’ll agree that $5 won’t cover materials, much less the hour he would’ve had to spend sewing my mother up.
Now this is anecdotal, but it says something when a surgical procedure is reimbursed based on how the physician is categorized by the insurance company.
This system is fucked-up, especially because there’re so many “providers” that a large percentage of the cost is actually the paperwork that the doctor/hospital has to fill out to each different insurance company to get reimbursed. That’s not even mentioning the scariness that I imagine Medicaid and Medicare paperwork to be.
And personally, if I had a choice, I would chose socialized health care over privatized any day — being regularly unemployed or not being to get health insurance through your employer seems to be rapidly becoming the norm these days. I would rather not have my life savings wiped out because I broke my arm, or I have to spend a week in a hospital because of appendicitis and I’m footing a larger-than-average bill because the hospital has to cover it’s costs somehow when they’re being stiffed by patients, insurance companies, and the gov’t.
dan
December 9, 2004 at 1:57 pm
48Tess,
This is my last comment, I promise.
A few barbs were thrown my way early on which I can handle and, I admit, in response to my jabs. I apologize if I offended anyone. As for being a right wing nut job, at least you didn’t call me a Republican. FYI, I am a confused independent. I tend to be a fiscal conservative and social liberal. Also, I don’t expect to change peoples opinions just as I doubt anyone will change mine. The fun is in the discourse.
Finally, the main problem with the healthcare delivery system is that the cost of a service rendered has nothing to do with the value of the service, which has no relation to the price paid for it. Despite the irrational nature of it we still manage to produce a reasonably viable healthcare delivery system. Yes, it can be better.
Mary Kay
December 9, 2004 at 2:22 pm
49Hey Dan: In response to Johnnyboy, would you ask your wife if she prescribes cetain drugs based on the behavior/actions of the drug rep? Then ask her if she’s an idiot.
NLB
December 9, 2004 at 3:03 pm
50So help me out, because I don’t know enough about this stuff to know where the breakdown is. And this has been bothering me for a while.
I have a very comprehensive and expensive health care plan. My co-pays are relatively low, as are my covered prescriptions. I currently live in CA and have had Kaiser (usually voted the best in CA but goodness knows why), Blue Shield, and Blue Cross. So why is it:
1) that there is routinely a 9-month wait to see my primary care physician and then another 1-year wait to see a specialist for a non-emergency?
2) that it takes 72 hours (standard set by the doctor’s group) to get a call back to answer a question, even if it’s urgent?
3) that relatively new medications are not at all covered by my insurance, even though the doctor tells me that many of his patients, after trying the samples, finally have something that works? (btw, I looked into getting the medication from Canada or Mexico, but it was the same price)
4) that allergy shot pen that you can use to save yourself if you have a severe reaction - not covered by insurance. Have yet to find anyone whose insurance does cover it when it’s prescribed.
5) when I was checked into the emergency room unconscious, I was not only not given a bed, but after trying to prop me up in a chair for 3 HOURS, my EMT-trained husband finally gave up and took me home so at least I could be laid out on a bed. We then fought the insurance company for 4 months because they still wanted $100 because someone in the emergency room had written down my name before saying no one could see me.
Seriously, where is the breakdown? I know that the doctors have too many patients, but who sets that? Providers, doctors’ groups? Why is it that in a real emergency, the prescription is not covered? There are several people posting who have intimate knowledge of several sides of this, and I’m hoping they can help. I’m not looking to point fingers so much as find out where the bottlenecks are.
adam
December 9, 2004 at 4:51 pm
51a few points…
- Pharmaceutical companies make a whole lot of money - they are among our nation’s most profitable businesses, if not THE most profitable business. This is after the R&D and advertising costs and whatnot. There’s nothing wrong with profitability, but it seems to me that the argument that US citizens aren’t paying too much and Canadians (for example) are paying to little simply doesn’t stand up to the fiscal reality. We’re being fleeced. And we’re being fleeced because our government is letting us be fleeced; in fact, they’re standing directly in the way of us getting a better deal.
- Dan asks if pharmaceuticals are losing money by selling to Canada, and answers “probably not.” I can’t see that any answer other than “No” would make any sense whatsoever. Pharmaceutical companies aren’t obligated to sell to Canada, nor are they obligated to do so for the prices that Canada sets.
- Socializing healthcare would cost a lot of money. Yes. But the current system already costs a lot of money, and it costs more each year. Insurance costs are not going down, far from it. No government action has even managed to slow their rate of growth, and the costs are already beyond millions of Americans’ ability to pay. The percentage of uninsured continues to increase, and I’ve yet to see it decrease. The system works for those who can afford it, but even for them it’s getting harder. It’s embarrassing.
Having identified these problems, can anyone think of a single plan that isn’t some sort of government healthcare program that has even the remotest chance of working? Not the airy “tort reform” hypotheticals that Republicans like to float out there, but actual reform that really will reduce costs and allow all Americans to have healthcare… anyone?
Anyone?
ABM
December 9, 2004 at 5:25 pm
52Adam - I would suggest alternative care and complementry medicine. I have frequent problems with my back and while my pcp doctor will only try to send me to physical therapy, which does nothing but cost a fortune not covered by insurance, I started going to a licensed acupuncturist, which is covered by most insurances (in fact the # of insurers covering it has risen almost 40% in 2 years), and makes me feel much better. And not just my back but my arthritis (and therefore stomach since Celebrex tears up one’s stomach), and a couple other ailments. So I would suggest we follow England’s rising model and use more alternative medicine. Besides, on average, a patient spends 7 minutes an appointment with a pcp doctor versus 28 minutes with an acupuncturist; and instead of feeding you pills and treating illnesses, practioners of acupuncture and Oriental medicine treat the person as a whole and as an individual. It’s worth a try at least.
NLB
December 9, 2004 at 6:29 pm
53Adam - wasn’t Hillary supposed to get back to us on that one?
Murray
December 9, 2004 at 8:50 pm
54Dan-
With the exception of George, I don’t think that any one has been attacking you personally. In fact I think that most (certainly I) appreciate a differing point of view to get the old posting juices flowing.
I don’t like the idea of a private company (lowest bidder) doing air traffic control, or inspecting our meat. A free market with no controls will not give us clean air and water, or even air bags. There are just places where the free market doesn’t belong and health care is one of them.
Health care is expensive. You can pay for it in your taxes, everyone is covered and the government runs the show, or you can have some of the public pay an industry to dole out coverage as they see fit for their bottom line and the rest can only be covered by going to an emergency room (by far the most expensive) and passing the costs on to those who are paying for insurance.
It is hard to imagine a worse system than the latter. EVERYONE pays more and a large portion gets only emergency care.
When people talk about how expensive health care is in other countries they miss the point that American healthcare is THE MOST EXPENSIVE ON EARTH. Our system is designed to reward the worst insurance carriers at the expense of everyone else. It is also designed to reward big Pharma.
One small note. Living among the very unwealthy residents of Bedford Co. PA I am able to go to a wellness clinic. The last time I went they gave me free antibiotic samples for a sinus infection and charged $15 for the visit. It’s too bad this isn’t available elsewhere.
George
December 9, 2004 at 10:12 pm
55As the official grumpster of this thread, I’d like to comment on Dan’s observation: “…when someone takes a different path from the group that the level of discourse is harsher. What ever happened to civilized discussions with respect for differences of opinions?”
Our country has arrived at a point where half the nation’s heads have been pumped full of lies, such as Free Markets Solve Everything, All Democrats are raving left wing loons, Iraq was behind 9/11, France should be bombed because they weren’t behind our really great plan to improve Iraq… you get the picture. The propagandizing and demonizing has been going on for about thirty years, and the results are truly stunning. We are now a nation that tortures people as a matter of policy. Wellll, some of us are kinda ticked off that our country has been hijacked by oligarchs. So when somebody presents points that are largely, if innocently based on such lies, the more hot-headed of us might tend to go off. I mean, for godsake, Dan, you suggested we invade France! Five years ago it would have been obvious that was a joke, but now it’s not so obvious. Sounds more like our foreign policy.
To sum up: Differences of opinion that are based on correct premises absolutely deserve a respectful hearing. If one’s opinions are poorly researched or just silly, well, some people don’t suffer fools gladly, but most of us are generous. Finally, if one is relaying right wing propaganda and lies, don’t be surprised if you get a flame or two.
Auros
December 9, 2004 at 10:58 pm
56Don’t know if you caught it, but after warning about dangerous Canadian drugs, in the very next debate, Bush, asked about the flu vaccine shortage, mentioned that the administration was looking into importing vaccine from Canada. I was bummed that Kerry didn’t remind him of how dangerous that was.
My parents introduced me to Tom Lehrer’s music when I was maybe 13 or so. This probably explains a lot about me…
These four books have much useful to say about American Pharma:
http://www.amazon.com/exec/obidos/ASIN/0195176847/ref=nosim/strangehor izons
http://www.amazon.com/exec/obidos/ASIN/0060568526/ref=nosim/strangehor izons
http://www.amazon.com/exec/obidos/ASIN/0375414835/ref=nosim/strangehor izons
http://www.amazon.com/exec/obidos/ASIN/0375508465/ref=nosim/strangehor izons
Not sure if it’s still available, but there was a review here:
http://query.nytimes.com/gst/fullpage.html?res=9402E0D7173CF937A25752C 1A9629C8B63
BTW, as for international drug production: The French were derided by JohnnyBoy. A French team was, in the 80s, jointly responsible for coming up with the first reasonably-accurate test for HIV. And of course, Aventis-Pasteur, one of the largest PharmaCorps, is French. I don’t know their products off-hand, but they’re huge. Bayer and Merck are both German. The provider of US flu vaccine is British. Several of the US corps have research and production facilities in Canada.
Matt
December 9, 2004 at 11:09 pm
57Tess, all physicians are licensed surgeons. Licensing, at least in the states I am familiar with, does not discriminate between how an MD practices. There’s no law that prevents me from performing brain surgery. However, hospitals, surgicenters, third-party payors, and a doctors own good sense determine what one can do.
You seem surprised that an insurance company would prefer board certified plastic surgeons over family physicians.
tess
December 10, 2004 at 3:35 am
58Actually, since he routinely does surgery in his private primary care practice, it was just a lot more convenient for my mother to go to him to have a hernia sewn up than to a hospital where she was far less comfortable. And I’m sure he is a board-certified plastic surgeon, or else the hospital he works at on weekends is a little less than scrupulous about how they employ people. And as well admitted to my mother that he can do the procedure just fine, but that if he perfoms it as opposed to someone else he refers her to, her insurance company would only reimburse him $5.
Johnnyboy
December 10, 2004 at 10:11 am
59Auros: please be careful in your reading and writing. I never derided the french. I actually pointed out that the flu vaccines being used in the US this year are made by Aventis.
Mary Kay
December 10, 2004 at 10:35 am
60Dan’s the one who hates France.
Matt
December 11, 2004 at 3:26 pm
61so, tess, he’s a primary care doctor, and a plastic surgeon, and a general surgeon?
must have gone to about 30th grade.
hospitals generally don’t employ their surgeons, although they do go thru a credentialing process. Anesthesiologists, emergency physicians, radiologists, and pathologists (so-called hospital-based physicians) are often employed by the hospital.
hedera
December 12, 2004 at 1:00 am
62NLB was complaining about his current insurance, and his reference to Kaiser implies that he once had it and now doesn’t; also that he wasn’t pleased with it when he had it. I also live in CA and currently have Kaiser with very good coverage. Frankly, I think I’m doing better than he is:
- I see my primary physician about 3 times a year and make the appointment about 2 months out.
- I just got a non-emergency referral to a specialist; saw the primary last month, visiting the specialist at the end of this.
- I found my self in the ER (for something that fortunately wasn’t a heart attack), got immediate attention and a bed (well, a gurney); of course, I was on the gurney for 7 hours until they found me a hospital bed but that’s just the ER at work.
- If I really need to see my primary physician, I can usually get in on the day I call.
- I can now communicate by secure email with two of my specialists (my primary is still resisting taking the training but I’m sure he’s swamped), and get very prompt responses for nonemergency stuff
- I order prescription refills through a secure web site, charge them to my credit card, and they’re mailed to my home within a week
Kaiser isn’t perfect, and some Kaisers are worse than others; but my experience has been very good. They stick pretty close to their drug formulary. As an arthritis patient, I asked my doctor a couple years ago about Vioxx, and he said in his opinion it wasn’t any better than the stuff I was taking (which is a generic and much cheaper). Right now his advice looks pretty sound. I’ve heard the tales of misdiagnosis and mistreatment from Kaiser, but you know, you can get those from any medical outfit - see NLB’s story. You just hear more about it when it’s Kaiser because Kaiser is so big.
Frankly, the health care - especially the preventive health care - that I get from Kaiser is so good that my major objection to a single payer health care system (which I do think is the right way to go) is that I’d probably lose the wonderful service I’m getting. And Kaiser, with its doctors on salary, is about as close to “socialized medicine” as we have now.
tess
December 12, 2004 at 4:40 pm
63Matt:
I’ll be damned if I know: the man is in his mid-60s and is still the only one taking care of his practice. So as far as I can tell, yes, he’s a primary care physician, general surgeon, and plastic surgeon (mostly small things like scar removal, moles, cysts, etc). To boot, I think he speaks about 5-6 languages, 4 of them fluently because I’ve heard him speak Cantonese, Mandarin, Japanese, and of course, English. The man’s probably picked up a bit of Vietnamese and Spanish along the way.
He can probably manage to do these things because he’s mostly focused on immigrants and he’s had to do a lot of surgical procedures under the table because a lot of immigrants seem to be very nervous around hospitals. I’ve seen him take in a guy with a rather nasty chainsaw cut on his hand (I think he was working as part of a tree-cutting crew), despite telling this guy that he really can’t fix him up that well, but taking about 2 hours to patch the guy up anyway because the poor sod refused to leave and go to an ER. It’s an awful way to learn on the job, but what else is he going to do? He’s certain that many of these people wouldn’t see a doctor otherwise.
Murray
December 12, 2004 at 6:24 pm
64Tess
If there were ever a moral argument for cloning, your doctor would be it.
Those who say that we are acting as God, when we want to clone a human, are sort of misguided. Some one who says “I’m not going to let you do this” is the one taking God’s authority.
If the world could be filled with clones of your doctor, it would be vastly better place.
g
December 13, 2004 at 2:56 am
65I live in Germany (not army related) and socialized healthcare is pretty good for my family (except that its going down the drain because the population is becoming too old).
- I can see my primary care phyician (who I can choose freely) on the day I call, in an emergency and normally I can see him within a week if it’s not an emergency,
- I have checkups with my primary care physician, my gynecologist and my dentist twice a year,
- Since I’m a minor all perscription drugs are free, and my parents don’t have to pay much for theirs either,
- Most often I can see a specialist on the same or next day that I’m referred,
- and I’ve never had to wait more than an hour at an ER,