A couple of weeks ago the news was filled with stories about Martin Shkreli the CEO of Turing Pharmaceuticals, a relatively small drug manufacturer. Some media branded him with this headline because he raised the price for one pill of Daraprim, a 62 year old drug,
from $13.50 to $750. That’s about 5,000 percent. Now, he says he will lower the price, but there’s no indication of how much or, as of this writing, when (According to Web MD Daraprim is used with other medication (such as a sulfonamide) to treat a serious parasite infection (toxoplasmosis) of the body, brain, or eye or to prevent toxoplasmosis infection in people with HIV infection).
As it turns out, though, the “World’s Biggest A–Hole case is not in the least bit unusual, it happens with pharmaceutical companies with great regularity as a tactic to increase profits on older drugs, drugs that have long since paid for themselves.
The global market for pharmaceuticals topped $1 trillion in sales in 2014. The world’s 10 largest drug companies generated $429.4 billion of that revenue. Five of these companies are headquartered in the U.S. They are: Johnson & Johnson, Pfizer, Abbot Laboratories, Merck and Eli Lilly.
Johnson and Johnson, America’s biggest pharmaceutical manufacturer raised prices on over 130 brand name products this year alone. Merck & Co. raised the price of 38 drugs. The increases in the U.S. have added over a billion dollars of revenue in the last three years. So, while Mr. Shkreli may get the award for being the biggest you know what, he is in good company — only the others were smart enough not to brag about it.
Before I go on it is important to point out that my interest in the topic is both personal and professional. I am a senior citizen, who has had a heart transplant and who also has Chronic Obstructive Pulmonary Disease (COPD). I take a good number of prescription drugs and despite having Medicare Part D insurance I still pay thousands of dollars a year for my prescriptions. Most of the drugs I take have been around for quite a while, but not long enough to allow the sale of generics and because there are few if any pricing restrictions, most of my meds are outrageously high priced.
One of the drugs I take is called Foradil. It was approved by the FDA in February 2001 for the maintenance treatment of asthma and the prevention of bronchospasm in reversible obstructive airways disease. Despite being on the market that long, it still retails for about $250.00 for a 30 day supply. Spiriva is another COPD drug and is often taken with Foradil. It retails for about $350.00. I take about a dozen drugs and these two alone total over $600.00 a month. Insurance cuts that cost in half, but they are still expensive. Because of these prices I know of many seniors and others who have to choose between eating and paying for their prescription meds.
In Europe, Asia, Australia and anywhere else with some form of socialized medicine strict government regulation helps prevent those kinds of actions and subsequently keeps prices down. Things are a whole lot looser in the U.S.
In 2013 each of us spent over $1,000 on prescription drugs. That works out to $429 billion. In case that figure boggles your mind, let me boggle it more by showing you what it looks like in black and white — $429,000,000,000. By anyone’s measure that’s a lot of money. To put it all in perspective Prescription medications make up close to 10 percent of the $2.9 trillion annual total spent on healthcare in the U.S.
Americans spend more on drugs than any other country in the world and – we also pay more for them than any other country.
Before we go into detail on why prescription drugs cost more here than anywhere else, let’s look at the biggest drug and biotech companies in the world. They account for more than a third of the industry’s total market share according to the World Health Organization. We won’t go into detail but here’s the top ten and their 2014 revenue.
- Gilead Sciences $24.474 billion.
- Bayer $25.47 billion.
- AstraZeneca $26.095 billion.
- GlaxoSmithKline $37.96 billion.
- Merck’$42.237 billion.
- Sanofi $43.07 billion.
- Pfizer 49.605 billion.
- Roche $49.86 billion.
- Johnson & Johnson $74.331 billion.
If you were to ask any of those companies why prescription drugs cost so much they would likely tell you that the price reflects the immense costs of research and development. They would explain that it costs millions and millions of dollars to develop a new drug and then millions more to get through animal and human studies and FDA approval, and that’s partially true. Partially. Those costs are very high, but what big pharma won’t tell you is that you are also paying for the costs of marketing the drug to physicians and patients and those costs dwarf the research and development expense. http://tinyurl.com/pr23j3q
The world’s largest pharma company, Johnson & Johnson, spent $17.5 billion on sales and marketing in 2013, compared with $8.2 billion for R&D. Most of that marketing effort is aimed directly at physicians, the people who write the prescriptions, rather than customers like you and me. It should be noted that the U.S. and New Zealand are the only two countries that allow any form of advertising for prescription drugs.
No sane person can object to a company making a profit, it’s part of the American way, but the drug industry’s profits are excessive. At the risk of being accused of repetitiveness I must say again. We pay significantly more than any other country for the exact same drugs. United States spends more than $1,000 per person per year on pharmaceuticals. Per capita drug spending in the U.S. is about 40 percent higher than Canada, 75 percent greater than in Japan and nearly triple the amount spent in Denmark. So why is that?
Well, first the U.S. is a very rich and therefore lucrative market because we use more medicine than any other developed country. We account for 35 percent of the world market for pharmaceuticals. Americans have become quite accustomed to leaving their doctor’s office with a handful of prescriptions.
Due to our ill health and our wealth, companies often choose the U.S. in which to launch new products. And, because the US market is so big and profitable, investments in research and development have long been steered towards meeting clinical needs.
But if we Americans take more prescription drugs, we also pay an arm and a leg more for them. Why? Because other countries have tough regulations about pharmaceutical prices and they set reimbursement limits. Another smart thing they do is to agree to pay for a drug only if the price is justified by the medical benefits. In the U.S., Medicare which is the world’s largest buyer of prescription drugs is prohibited from negotiating prices with drug companies. If the company says that a pill is $100, Medicare has no choice, but to pay it if the patient needs it. They have no wiggle room and that costs taxpayers billions of dollars a year in a direct giveaway to the pharmaceutical behemoths and speaks to the power of their lobbyists.
Speaking of lobbyists, here’s the real rub. The pharmacy industry views congress as a place to invest against future price controls and this is what really adds to the price of your prescriptions.
Big Pharma Spends More on Lobbying Than Anyone
Since 1998, the industry spent more than $5 billion on lobbying in Washington, according to the Center for Responsive Politics. To put that in context, that’s more than the $1.53 billion spent by the defense industry and more than the $1.3 billion forked out by Big Oil.
From 1998 to 2013, Big Pharma spent nearly $2.7 billion on lobbying expenses — more than any other industry and 42 percent more than the second highest paying industry: insurance. And since 1990, individuals, lobbyists and political action committees affiliated with the industry have doled out $150 million in campaign contributions.
Now here’s how it works for you and me. In the U.S. insurers only accept the price set by the drug makers. If the drug is exclusive, meaning there is no competing medication from other companies. Insurers then cover the total cost by forcing a higher co-pay on patients. Unlike Medicare, insurers have bargaining power when there are competing drugs and therefore can reduce the co-pays.
Then, there is the Generic drug market, those are drugs in which the patent has run out and other manufacturers are allowed to produce the product. As an example the antidepressant Remeron is also known by its generic name Mirtazapine. Remeron is the brand name given it by the original manufacturer, but Mirtazapine can be made and distributed by any pharma company and sold for a much lower price.
Competition in that area is fierce and generic drug prices are usually low. Today generics account for about 85 percent of drugs dispensed in the U.S.
Despite generics and their low prices, there are still many Americans who daily make the choice between food or drugs, between paying the rent and drugs or giving up some other type of health care in order to afford the drugs that keep them going. Many Americans don’t take their recommended prescriptions because they can’t afford them. One recent survey showed that about one in five U.S. adults did not fill their prescription or skipped doses due to cost as opposed to Australia and some other countries where the ratio is one in ten. http://tinyurl.com/pejvoyn
Some people have turned to foreign sources for their prescriptions and there are many with some of the more popular ones thriving in Canada. Here’s an example of the savings that can be had. If you want a three month supply of the popular asthma inhaler Advair it will likely cost you somewhere in the neighborhood of $600 to purchase it from one of your local pharmacies. If you select one of the Canadian pharmacies you can import the same three month supply of the same medication, Advair, for about $150, with shipping included. That amount may not mean much to the Donald Trump tax bracket, but to average Americans it’s a whole lot of money. Advair is just the tip of the iceberg. ABC news reports the following price comparisons:
- Mirapex, for Parkinson’s disease: $157 in Canada vs. $263 in the United States.
- Celexa, for depression: $149 in Canada vs. $253 in the United States.
- Diovan, for high blood pressure: $149 in Canada vs. $253 in the United States.
- Oxazepam, for insomnia: $13 in Canada vs. $70 in the United States.
- Seroquel, for insomnia: $33 in Canada vs. $124 in the United States.
Tufts University in Boston released a study in the year 2000 that placed the cost of approval for a single drug at $802 million, and that was fifteen years ago. To be fair it must be revealed that the dollar amount adds in each successful drug’s prorated share of failures (only one out of fifty drugs eventually reaches the market), but that still does not explain why the retail price is higher here than anywhere else.
The only logical explanation I can come up after some a fair amount of research is that pharmaceutical companies can get away with much higher prices in the U.S. and they can’t elsewhere. Period!
Well, there are several steps you can take. Among them are:
- Contact state and federal legislators and ask them to allow Medicare to negotiate the price of prescription drugs
- Also ask them to allow importing of essential drugs from foreign companies through approved pharmacies.
- Ask big pharma companies to see if you qualify for their reduced prices for people who have trouble affording them.
- Read the Consumers Report story on the issue. It will give you the information you need to identify trustworthy pharmacies. http://tinyurl.com/qbflucm
But, if you are like me you want even more detail. Ok. Here’s the best I can do.
You can shop for the best price and because of the internet that’s become a whole lot easier. You can look up a specific drug and find the best price at a pharmacy near you. Here are two resources. I’m sure you can find a lot more https://www.lowestmed.com/Search#/ orhttp://www.goodrx.com/ All you have to do is type in the drug you need and your zip code and it will find the price of that drug in pharmacies near you.
Transplant recipients might be interested in the cost of anti-rejection drugs. The price is hard to stomach but easy to find. In my zip code 32244 100 Mg Cyclosporine capsules range in price from $526.00 at Wall Mart to $584 at Target. If you are a heart patient and take Carvedilol in my neighborhood it ranges from $4.00 at Wal Mart to $9.54 at Kmart. Lisinopril also has a wide range. At the Publix Supermarket pharmacy near me it is FREE…that’s right FREE. But at CVS it is $12.00. Those price variations might make it worth a little longer drive to get a better bargain.
You can also get help with coupons which are an obvious choice to savemoney when grocery or clothes shopping, but they’re often overlooked as a way to cut costs of over-the-counter and prescription drugs. Manufactures frequently offer one time and repeat coupons that can save consumers hundreds of dollars on their medicines. “For our family it has been incredibly effective [in saving money] for a number of regular prescriptions,” says Stephanie Nelson, founder of the coupon website CouponMom.com.
The costs of prescription drugs and over-the-counter medications have been steadily rising and patients facing tight budgets are often forced to make hard decisions when it comes to what they can afford.
The savings vary by manufacturer, but many companies offer discounts at each prescription refill while others offer discount cards that take $20 off co-pays. Others offer one-time coupons to cover the first use of a drug.
- Consumer Reports Magazine says that there are other ways to save money, too. Whichever drugstore or pharmacy you use, choosing generics over brand-name drugs will save you money. Talk to your doctor, who may be able to prescribe lower-cost alternatives in the same class of drug. In addition, follow these CR tips.
- Request the lowest price. Our analysis showed that shoppers didn’t always receive the lowest
available price when they called the pharmacy. Sometimes they were given a discounted price, and other times they were quoted the list price. Be sure to explain—whether you have insurance or not—that you want the lowest possible price. Our shoppers found that student and senior discounts may also apply, but again, you have to ask.
- Leave the city. Grocery-store pharmacies and independent drugstores sometimes charge higher prices in urban areas than in rural areas. For example, our shoppers found that for a 30-day supply of generic Actos, an independent pharmacy in the city of Raleigh, N.C., charged $203. A store in a rural area of the state sold it for $37.
- Get a refill for 90 days, not 30 days. Most pharmacies offer discounts on a three-month supply.
- Consider paying retail. At Costco, the drugstore websites, and a few independents, the retail prices were lower for certain drugs than many insurance copays.
- Look for additional discounts. All chain and big-box drugstores offer discount generic-drug programs, with some selling hundreds of generic drugs for $4 a month or $10 for a three-month supply. Other programs require you to join to get the discount. (Restrictions apply and certain programs charge annual fees.)
- Experts say that although the low costs could entice you to get your prescriptions filled at multiple pharmacies, research indicates that it’s best to use a single pharmacy. That keeps all of the drugs you take in one system, which can help you avoid dangerous drug interactions.”
Finally, what do you do if you’ve done the shopping, used coupons, followed all of the Consumer Report Tips and are still unable to pay for your prescriptions? Well, there is some limited assistance. Here are some resources.
Bob Aronson of Bob’s Newheart is a 2007 heart transplant recipient, the founder of Facebook’s over 4,200 member Organ Transplant Initiative (OTI) and the author of most of these donation/transplantation blogs. You may comment in the space provided or email your thoughts to me at email@example.com. And – please spread the word about the immediate need for more organ donors. There is nothing you can do that is of greater importance. If you convince one person to be an organ and tissue donor you may save or positively affect over 60 lives. Some of those lives may be people you know and love. You can register to be a donor at http://www.donatelife.net. It only takes a few minutes. Then, when registered, tell your family about your decision so there is no confusion when the time comes.
Reprinted and reformatted from WikiHow
With Additions by Bob Aronson
Have you just started a new medicinal regimen that requires you to take pills every day? Remembering to take your medication every day can be a chore, but it is also very important for your health. If you’re forgetful or simply have too many medications to track, then maybe this guide can help you remember to get the job done.
Start using a calendar. You can purchase a paper calendar and hang it in your room and teach yourself to look at it every day, making and leaving notes accordingly. You can also search through free electronic calendars on the Internet or use calendar software that may have come with your computer. Some of these allow you to add notes and automatically send you reminders by email or by SMS (i.e. text messaging).
Set visual reminders.
- Put the medication close to something you need to deal with on a daily basis anyway. For example, if you take your medication in the morning, make sure that before going to bed at night, you place it next to the coffee pot, if you make coffee in the morning. Or, you can attach your medication bottle or pill box to your toothbrush with Velcro.
- Make it part of your routine. If you take it every morning, make it a habit to take it as soon as you step out of the shower, or as soon as you get out of bed.
- You can purchase sticky notes to leave in your kitchen, your car, or anywhere that you frequently visit. For medication that is stored in the fridge, you should paste a post-it note on the fridge door (or on your coffee pot) that says Take Pills.
- Remember medication that needs to be taken with a meal, by keeping it right on the table, in front of the place that you eat.
- If you are on your computer often, you might create a text file on your desktop that contains a list of things that you need to do. You can search the Internet for “electronic” sticky notes that you can place directly on your desktop, rather than purchasing paper ones. These programs will often allow you to set timers and reminders directly to the notes to flash or emit sounds accordingly.
- If you have a complex regimen, write a list with the medication, time and date and tape the list to the mirror in your bathroom. You can also print this on a grid and check off each medication after you take it.
- Set an auditory reminder. This is a common and fairly effective way to remind yourself to take your medicine. Most cell phones have an alarm function that allows you to set a “daily” alarm time where it rings. Choose a tone that will remind you that you need to take your medicine. If you do not own a cell phone, you might set your alarm clock to go off at a particular time each day for the same effect. Another alternative is to buy a digital watch and set the alarm to go off as many times per day as you need to take medication. A small digital kitchen timer with a numeric keyboard can be useful. Be sure to get one that can be set for hours, not just minutes and seconds. As soon as the alarm goes off, immediately take your medication to reinforce the habit. Saying “Oh, I’ll do it in a few minutes” can lead to repeated forgetfulness and defeat the purpose of having an alarm.
- Sort your medication. Place all your medications, including your daily dose of vitamins on your kitchen counter. As you take one pill, close the bottle, and place it to the left of the counter, making two piles. Do the same for each pill you take. Remember that the ones you need to take are in front of you. The ones you have already taken are to the left of you. After you are finished taking all your pills for the day, place all those on the left hand side back into the kitchen cabinet. Now you will know that all of your pills have been taken. Pre-sorting the pills into a plastic container designed for this purpose (a pill box or medicine box) is another way to avoid taking the same medication twice by accident. If that compartment is empty, you know you took the meds. Pill sorters come in different sizes and different colors. Aim to have enough to sort two weeks of meds at a time.
- Adopt a “divide and conquer” strategy. In other words, take half of your medicine and keep it in a place other than your household, such as your office at work. If you happen to forget to take your medicine in the morning, you can easily access your medicine at work.
- Be mindful of your medicine’s storing conditions, especially if you plan to keep your pills in your car’s glove box on a hot summer day.
- Get another person to remind you. Have a friend or loved one to remind you to take your medicine, or to ask you if you remembered to take your medicine.
- Use your phone calendar to set recurring reminders daily. It’s a more subtle way to be reminded. If you use your company phone/Outlook, make sure you mark the appointment as “private” and keep the reminder description generic to protect your privacy
Be careful when deciding on reminders. If you get too comfortable with them (such as a note on your fridge or by your pill box) you may be more likely to overlook it or ignore it.
- Not all medication is available or legal in all countries so you should check ahead. Any medication that may have a controlled substance may not be allowed in some countries so make sure you bring your prescription bottle and if possible a photocopy of your physician’s prescription.
- If you choose to set an alarm on your cell phone, be sure that it is a tone that you can easily associate with taking your medicine, so that you do not become too accustomed to hearing a soft tone. Or, if all else fails, set it to the same tone as your normal ring tone.
- Remember to take your medication with you when you go on holiday. When you pack your toothbrush, pack the medications you take also. IMPORTANT! NEVER CHECK MEDICATION WITH YOUR BAGGAGE. ALWAYS KEEP YOUR MEDS WITH YOU IN CASE YOUR BAGGAGE GETS LOST.
- If on vacation, pack your original, pharmacy-labeled medication bottles or keep a detailed list in your purse or wallet. I have attached a sample list to the end of this blog.
- Your meds list should also include critical medical information like insurance, physicians and clinics, and medical conditions. If it happens that you need emergency medical care, this will help the care providers to quickly determine what medications you take and how and why you take them, should you not be able to remember them or not speak for yourself. It is difficult, time-consuming and sometimes impossible for health care providers to identify unlabeled pills. For the same reason, do not dump different medications into the same bottle.
- Before you go on a long vacation, ask your doctor to give you an extra prescription for your pills, so that if you run out, lose them, or spill them, you can have the prescription filled at any drugstore.
- If you are taking medication for a serious condition such as heart disease, wear a Medical Alert tag, necklace or bracelet listing the name(s) of your illness and the medications you use to treat it/each. Also list any potentially hazardous interactions and allergies.
- If one or more of your medications causes photo sensitivity, be sure to put on sunscreen before leaving your house, no matter what it looks like outside; you’d be surprised how little light is required to get a full-blown sunburn!
- Be mindful of making a mental note to yourself when you take your medicine. Forgetting to take your medication is one thing, doubling your dosage because you forgot that you’d already taken your medication for today is another. You could make a box next to your “Remember Pills”-note, tick it off when you’ve taken it.
- If you do forget to take a dose, read the instructions that come with your medication carefully. Don’t assume that you should take your dose anyway- although this is the case for most, it can be different for others. If you have trouble reading, ask the pharmacist to explain the dosage directions.
- Before leaving the pharmacy, check to make sure that the pills in the bag are the pills that you use. Pharmacists make mistakes also.
- When leaving your medicine bottles around to remind you to take them, be careful if you have children so you do not leave the pills in a easy spot for a child to grab.
- Be aware that certain prescription medications have a high potential for addiction or abuse. If you find yourself taking more of a medication than prescribed, call your doctor immediately to talk about the change.
- Some medications, such as those classed as controlled substances, may not be appropriate to leave around the house. Place them in a locked cabinet, box or drawer, and do not move them from one building to the next. Try to not let others know that you are on such medications and avoid taking them in public. It’s not uncommon for people to steal certain medications, either to abuse themselves or to sell to others with similar intent.
- It’s a Federal offence to transfer a controlled substance to anyone other than the person to whom it was prescribed (you). If you do wind up victim of a theft, report it immediately to avoid potential prosecution.
- Some medications have ‘black box warnings’. This means that when taken incorrectly, or by those with certain conditions, fatalities may arise. Place these and other such medications in a safe location and call your doctor right away if you think you might have accidentally taken more than prescribed.
- Sometimes the pharmacist gives out a stranger’s prescriptions by accident, read the label carefully.
Sample Medical Info Sheet to Carry With You
HEART TRANSPLANT RECIPIENT
Best Hospital USA
Birth date 2-17-1950
9180 orchard lane anycity, USA
Home 555-555-5555 Cell phone 555-555-5555
SS # 555-55-5555 Spouse; Jane Doe; Cell phone 555-555-5555
Primary, Dr.Sawbones Anycity USA
Transplant Pulmonologist, Dr. Breatheasy best clinic USA
Transplant Cardiologists, Dr. Heartthump best clinic USA
Transplant Coordinator: Nurse Jane best clinic USA
Primary: Best Pharmacy USS
Secondary: Second best pharmacy USA
Primary — Medicare part A, Hospital, part B, Medical.
Secondary, AARP Medicare Supplement .
Medicare part D Prescriptions, AARP Medicare RxEnhanced
Allergies:Penicillin, cats, all seafood/fish, mold, dust.
Blood Type: B Positive
Heart related medications
- Anti-rejection Cyclosporine 200 mg twice a day
- Anti-rejection — Cellcept 1000 mg twice a day
- Anti-cholesterol — Prevastatin 20 mg once a day
- Blood Thinner – Aspirin 81 mg once a day
- Blood Pressure – Amlodipine Besylate 5 mg twice a day
- Reflux – Omeprozole (Prilosec) two 40 mg twice a day
- Thyroid — Levothyroxine .088 MG once a day (upon arising)
- Asthma – ProAir albuterol rescue inhaler as needed
- COPD – Foradilinhale one capsule twice a day
- COPD – Spiriva inhale one capsule once a day (upon arising)
- Depression-Remeron 7.5 –mg once a day-
Calcium – 600 mg tablet with Vitamin D twice a day
Multi-vitamin– one tablet once a day
- Asthma, hay fever, allergies diagnosed 1941
- COPD diagnosed October 2000
- Restless leg syndrome diagnosed 1996
- Chronic lower back pain
- Heart transplantBest Hospital
- Anywhere USA August 2007
- Cholecystectomy 1994
- Total left knee replacement 1998
Bob Aronson of Bob’s Newheart is a 2007 heart transplant recipient, the founder of Facebook’s nearly 2,500 member Organ Transplant Initiative and the author of most of these donation/transplantation blogs.
- You may comment in the space provided or email your thoughts to me at firstname.lastname@example.org. And – please spread the word about the immediate need for more organ donors. There is nothing you can do that is of greater importance. If you convince one person to be an organ and tissue donor you may save or positively affect over 60 lives. Some of those lives may be people you know and love.Please view our video “Thank You From the Bottom of my Donor’s heart” on http://www.organti.org This video was produced to promote organ donation so it is free and no permission is needed for its use.If you want to spread the word personally about organ donation, we have another PowerPoint slide show for your use free and without permission. Just go to http://www.organti.org and click on “Life Pass It On” on the left side of the screen and then just follow the directions. This is NOT a stand-alone show, it needs a presenter but is professionally produced and factually sound. If you decide to use the show I will send you a free copy of my e-book, “How to Get a Standing “O” that will help you with presentation skills. Just write to email@example.com and usually you will get a copy the same day.Also…there is more information on this blog site about other donation/transplantation issues. Additionally we would love to have you join our Facebook group, Organ Transplant Initiative The more members we get the greater our clout with decision makers.
Besides causing cancer and any one of a number of other health problems, smoking can destroy organs like the heart and lungs and can seriously damage or destroy others.
There are about 110,000 people in the U.S. waiting for organ transplants and there are not enough donor organs, so each year thousands of our loved ones, friends and neighbors die waiting. The number of organ donors is not increasing fast enough to end the shortage any time soon so one way of dealing with the crisis is to prevent the need for organ transplants. One way to do that is to quit damaging our organs by quitting smoking.
From time to time I will be publishing blogs from guest writers. The following post was written by Dr. Michael Burke, Ed.D, Assistant Professor of Medicine at the Mayo Clinic School of Medicine and Program Coordinator at the Mayo Clinic Nicotine Dependence Center. Dr. Burke is a highly respected expert in the field of tobacco addiction and smoking cessation.
There is nothing that is healthier for a person who smokes than to stop. Within a short time after one stops smoking, lung function and circulation improve, risk of heart attack and stroke diminish, and the likelihood of acquiring 14 different cancers begins to drop.
Symptoms from illnesses as different as diabetes, sleep apnea, and Crohn’s disease get better after a person stops smoking. Stopping before surgery significantly improves surgical outcomes through less infection, better wound healing and bone mending. Stopping smoking leads to less skin wrinkles and better erectile function, and the list goes on and on. Although people usually underestimate how dangerous smoking is, nearly everybody knows that it is unhealthy. However, about 1 in 5 Americans continue to smoke, and each day in the US, as many people die from smoking as three fully loaded 747’s crashing. Worldwide 100 million people died from smoking in the 20th century. Predictions are that one billion people will die from smoking tobacco this century. So why doesn’t everyone quit?
One reason is that cigarettes are quite addicting. A cigarette delivers nicotine to the brain more quickly than a hypodermic needle. It is probably the best drug delivery device ever created by man. It delivers volatile high dose nicotine that, for some people, causes physical changes to a part of the brain that is responsible for pleasure, attention and stress. I say ‘for some people’.
Smoking affects people differently. Stopping smoking is actually physically harder for some people than it is for others. The differences are in large part due to genetics. To shed light on these genetic differences a group at the Mayo Clinic is, oddly enough, studying Zebra fish. http://discoverysedge.mayo.edu/zebrafish-genetics/ Dr. Steve Ekker’s group has discovered two genes that make the fish more reactive to nicotine. If exposed to nicotine when in the larvae stage Zebra fish bred to have these two specific genes will become sensitized to the nicotine. Later in life they will move and dart more quickly in the water when nicotine is added to the tank. However, if these genes are ‘knocked out’ the fish won’t become sensitized to nicotine and then later will not react when exposed to nicotine. It is wonderful to have a geneticist with a sense of humor. Dr. Ekker’s group named the nicotine activating genes Humphrey Bogart and Bette Davis after those two Hollywood stars whose style of smoking became iconic.
Although it is a more complex story in human beings, some people have Humphrey Bogart and Bette Davis genes. These people experience a heightened reward from cigarettes when they first start smoking and more intense craving and withdrawal when they try to stop. Too often these people feel ashamed, think that they just have less willpower, or think that they just don’t want to stop badly enough. Instead these folks can stop, they just need more tools and ammunition.
I once treated a woman, a nurse, from Bayonne NJ. She was clearly a strong lady. My dad would have admirably described her as a ‘tough old broad’. “People tell me I’m weak, that I should just quit smoking” she said “But, when I go half a day without a cigarette, I’m on my knees in tears I just feel so awful”. “I’m not weak” she went on. “I left a bad man, raised three kids, worked sometimes two jobs, bought my own home, and sent all three kids to college. I’m not weak! What is it about this that is so hard?” she asked me. She was most likely genetically set to have a more difficult time stopping, and she needed treatment to match that extra difficulty. We provided treatment and one year later she was still tobacco free.
Many people try and stop ‘cold-turkey’. That’s good if it works. However, less than 5% of the people who use this method are successful at six months. Counseling and medications have been proven to significantly increase the chances of successfully stopping smoking. You can learn more about how counseling works by viewing the short video at this link. http://www.youtube.com/watch?v=5EDaA26unVw
Your health care provider may provide counseling or they may have a Tobacco Treatment Specialist in the office or local area. Professional help is also available through a telephone Quit line. Every state in the US, and province in Canada have one that can be accessed through calling 1800 QUIT NOW. One online resource that many people find helpful is www.becomeanex.org. Mayo Clinic also has a Residential Treatment Program – an 8 day program that works for people who have ‘tried everything’. http://ndc.mayo.edu
There are seven ‘first line’ medications that have been proven to be safe and effective for helping people stop smoking. Five are nicotine replacement products and two are pills available by prescription: varenicline (Chantix) and bupropion (Zyban).
There is too much confusion about nicotine replacement. Nicotine replacement medications have saved many lives and can save many more. Nicotine is not the ingredient in cigarettes that causes health problems. Smoking health problems are caused by 4,000 other chemicals that people ingest when they smoke. Some of these chemicals are natural to tobacco others are added by the tobacco industry. Nicotine replacement helps manage cravings and withdrawal symptoms safely, while eliminating exposure to the awful toxins in tobacco. We encourage people to take enough of these medicines for long enough to stop smoking.
People who smoke can also talk to their health care provider about two other medications varenicline and bupropion. These medications are proven to help people safely stop smoking. Like most medications, there are some potential side effects and you should talk to your health care provider before taking these medications. But remember, if the tobacco industry had to list the side effects from smoking, it would probably fill a telephone book. Cigarettes are the only product that will kill over 60% of the people who use it in the way it is intended. Stopping smoking, by any means necessary, is the healthy choice.
Please comment in the space provided or email your thoughts to me at firstname.lastname@example.org. And – spread the word about the immediate need for more organ donors. On-line registration can be done at http://www.donatelife.net/index.php Whenever you can, help people formally register. There is nothing you can do that is of greater importance. If you convince one person to be a donor you may save or positively affect over 50 lives. Some of those lives may be people you know and love.
You are also invited to join Organ Transplantation Initiative (OTI) http://www.facebook.com/#!/group.php?gid=152655364765710 a group dedicated to providing help and information to donors, donor families, transplant patients and families, caregivers and all other interested parties. Your participation is important if we are to influence decision makers to support efforts to increase organ donation and support organ regeneration, replacement and research efforts.