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Let’s All Tell Mr. Trump We’re Sick of Big Pharma Ripping Us Off.


By Bob Aronson

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cartoon-2Everyone, unless you have the riches of Donald Trump, everyone complains about the cost of prescription drugs and the complaints are justified. No other country in the world pays as much for prescription drugs as Americans do.  Big Pharma, that’s Washington DC talk for the huge pharmaceutical companies, is making sky high profits and they aren’t going to end anytime soon. In the latest year in which I was able to find numbers 2012 the top 11 global drug companies made nearly $85 billion in net profits. That’s net, folks, not gross. The gross number is, well, gross.

Big pharma is ripping off Americans and no one seems to care other than ripped off Americans. The Republican congress sure doesn’t care, they all have their hands out for the lobbying money big pharma so liberally spreads about. And – the Democratic White House of the last 8 years hasn’t said much either. Now we have a new President about to take office and several months ago in a primary debate he made a big deal out of the high cost of drugs, but we haven’t heard much from him since. Let’s hope he has the guts to take on big pharma.  The pressure on Trump to do nothing will be tremendous. He’ll get it not only from the drug companies, but from all the politicians whose pockets have been lined with campaign donations by big pharma lobbyists. Trump can bellow all he wants, if congress won’t go along he’ll be shooting blanks at a stationary target.

During the Democratic Primary campaign Bernie Sanders made a big deal out of reversing the Citizens United ruling that allows corporations, unions and the like to make almost unlimited contributions to political campaigns. So if you are asking where the politicians are who are supposed to be looking out for us. I’ll tell you where. They are out being fitted for new big pharma cheer leading outfits. The more money big pharma makes, the more money they get in the campaign coffers.

The number of conflicts of interest between the regulators and the regulated boggles thecartoon-3 mind. How do these people who are so obviously biased and in the industry’s pocket, get into these positions of power? I shouldn’t even ask the question, because the answer is so obvious. For example; PhRMA, (the Pharmaceutical Research and Manufacturers of America) which spent $18.4 million lobbying lawmakers last year and BIO (Bio-technology Innovation Organization) which spent $8.4 million, are among the most visible groups on Capitol Hill.  Get this. Former Louisiana Congressman Billy Tauzin chaired the committee which oversees the drug industry. You know how he got the chairmanship? Well, he was a Democrat, but when the Republicans took over the majority he switched parties. Now that’s a lust for power. Then he abruptly resigned his congressional seat and shortly thereafter emerged as the new leader of PhRMA where was a paid a cool $2 million a year. That deal leaves a stench on the paper this is printed on.

The Tauzin defection and sell out of his integrity was among the beginning rumbles of even greater conflicts of interest. For example, the Obama FDA commissioner, Robert Califf, was confirmed despite the fact that there were 23 proven financial links to drug makers. And – it gets worse. Did you know that 30 percent of sitting U.S. Senators and 20 percent of U.S. congressmen own pharma stock? I won’t go into detail here, but if you want to learn more about this disgrace go to https://www.statnews.com/2015/12/01/congress-pharmaceutical-investment/

When did you first realize how bad this gouging was?  Was it last year when that cocky little jerk Martin Shkreli of Turing Pharmaceuticals, testified about the Daraprim price hike from $13.50 to $750. As a result the anti-parasitic drug became unaffordable for thousands of Americans. In the meantime Shkreli was on Twitter calling lawmakers “imbeciles” for even asking any questions about his unethical and immoral price hikes.

Others of you with Hep C may have experienced the greed of Gilead Sciences drug Sovedeldi which sold for $84,000 for a 12 week course of treatment in 2014. Headlines were screaming “Rip-off,” patients were dying because they couldn’t afford the drug, but Gilead was unaffected. One of their execs even sent out an internal memo saying, “Let’s hold our position whatever competitors do or whatever the headlines.” In an incredible understatement the GOP led Senate Finance Committee said the price did not reflect research and development but a “revenue” push. Revenue push nuts! That’s unabashed price gouging especially in light of the fact that the same drug cost $900 a year in Egypt. Forbes, the conservative business magazine, pointed out that US taxpayers are picking up the tab since most US hepatitis C patients are uninsured, underinsured or imprisoned. Those in prison don’t qualify for any help at all. They are destined to suffer and because they are suffering run the risk of contributing to the Hep C epidemic.

But that’s only, and I hate clichés, but here goes anyway – the tip of the iceberg that sank the Titanic. Let’s hope the big pharma ship hits the same obstacle. There are many, many more rip offs that most of us don’t’ know about because we only have a familiarity with the drugs we personally take and for some reason the mass media have mostly ignored the get rich schemes of big pharma.

They will tell you that the high prices reflect the cost of research and development. I know from first –hand experience that’s not true. For some 25 years I was a communication’s consultant that helped large and small pharma companies bring the products to market. Developing new drugs and or devices is expensive. Just getting FDA approval costs a lot of money in clinical trials and in paying physician experts for their testimony, but big pharma in particular doesn’t bat an eye at those costs because they spend more on promoting drugs and on advertising than they do on research and development and they pass those costs on to you.

death-cartoonYou probably didn’t know this but we, the United States and New Zealand are the only two countries in the world that allow prescription drug advertising. The companies are trying to put pressure on doctors to prescribe by going directly to consumers and asking them to ask their docs for a prescription of the latest snake oil and some of it is snake oil. Some drug companies will make minute changes in the chemical structure of a drug, rename it and call it a new drug. Prilosec, for example became Nexium. It was essentially the same drug but changing the formula a smidgeon and giving it a new name netted billions for the parent company. http://articles.mercola.com/sites/articles/archive/2002/12/18/nexium.aspx

Here’s a partial list of some very expensive drugs. So expensive some patients choose to die because they can’t afford them. It used to be said that some seniors had to choose between eating and taking their drugs. That’s no longer true, even giving up eating won’t save enough money to buy these drugs.

  • Kalydeco  treats a rare form of cystic fibrosis in patient’s ages 6 years and older priced at a $300,000 a year.
  • Acthar, a drug that treats treat seizures in infants under 2-years-old priced at a $300,000 a year.
  • Kadcyla, a breast cancer drug that costs $94,000 for a year.
  • Zydelig, a leukemia drug, made by Gilead the (Hep C drug maker) that costs $57,755 a year.
  • Xyrem, a drug that treats narcolepsy for $35,000 per year (Honesty suggests that I (Bob Aronson) disclose having helped the developers of Xyrem get FDA approval)
  • Abilify, a psychiatric drug usually added on to another expensive psychiatric drug, that costs $17,316 year.

(Some of the above was developed by Martha Rosenberg an investigative reporter whose work has appeared in Consumers Digest, the Boston Globe, San Francisco Chronicle, Chicago Tribune, New Orleans Times-Picayune, Los Angeles Times, Providence Journal and Newsday. Her Random House food and drug expose, Born with a Junk Food Deficiency: How Flaks, Quacks and Hacks Pimp The Public Health, was cited in the American Society of Journalists and Authors 2013 Outstanding Books awards. On Twitter you can find her at @MarthRosenberg.

It’s bad enough that Big and even small Pharma gouges us with high prices, their greedgreed knows no bounds. Now I understand, many pharma companies are attempting to re-incorporate outside of the US in order to dodge U.S. taxes. Does that really surprise anyone?

So far we’ve dealt with the high prices of prescription drugs, the multi-million dollar lobbying effort on the part of big pharma and lawmakers and administrators who have clear conflicts of interest. But what about physicians. Well, they’re not clean either.

According to a federal on-line data base, pharmaceutical companies and device makers paid doctors some $380 million in speaking and consulting fees over a five-month period in 2013. http://www.nytimes.com/2014/10/01/business/Database-of-payments-to-doctors-by-drug-and-medical-device-makers.html?_r=0 some doctors were paid over half a million dollars each, and others made a lot more by sharing in the royalties from products they helped develop.

lobbyistsBig pharma says paying physicians has little or no effect on what they prescribe. Ok, if that’s true why the drug do companies pay doctors all of that money if they aren’t getting a huge return on investment. To be fair, there are efforts to reduce the influence Pharma representatives have on physicians. Many hospitals and clinics no longer take samples as a display of independence, but that’s a double edged sword. A good any patients counted on getting those free samples to cut the cost of the drugs they take. Doctors claim these pharma payments have no effect on what they prescribe. But why would drug companies pay out all those millions of dollars if the practice didn’t provide them a healthy return on their investment?

Americans spend more money per person on prescription drugs than any other nation on earth and we aren’t anywhere near being the healthiest. We spend nearly $3 Trillion a year on health care and a full ten percent of that is spent on prescription drugs.  While Government pays some of this tab through Medicare, Medicaid, and subsidies under the Affordable Care Act we pick up the rest through insurance premiums and taxes. And – the premiums, co-payments and deductibles are getting higher all the time. .

Big pharma, not satisfied with their outrageous profits are so driven by greed that they will go to any extreme to continue the revenue flow. Not long ago just before its patent  expired on Namenda, one of the only Alzheimer’s drugs, Forest Laboratories said it would quite selling it in favor of a new formula that offered an extended release. But there was really nothing new about it, just a minor change in the chemical structure and that kept it from going generic at a lower price.

And, of course, you are all likely familiar with the fact that U.S. law prohibits the U.S. government from using its considerable bargaining power under Medicare and Medicaid to negotiate lower drug prices. No one wants to admit to this but that came about because it was big pharma’s payoff for not opposing the 2003 Medicare Part D Bill of the George W. Bush Administration.

Lest I haven’t made my case about how big Pharma is ripping us off, did you know that ceo-payhealthcare and big pharma pay their CEOs more than any other industry? Want proof? Median pay for healthcare and pharmaceutical executives amounted to $14.5 million in 2015, higher than for leaders in any other sector, according to Equilar, a California firm that researches and analyzes executive compensation. Median compensation for all CEOs in the study, which looked at pay packages of 341 executives at S&P 500 companies across multiple sectors in 2015, was $10.8 million.

The increase in healthcare executive pay from 2014 to 2015 was also greater than in other sectors. Healthcare CEO Pay rose 7 percent last year over the amount in 2014, while the comparable median pay increase for all industries was 4.5 percent.

Here are just a few examples of CEO pay in healthcare and pharma. Leonard S. Schleifer CEO of Rgeneron Pharmaceuticals total compensation in 2015 was $47,462,526, Jeffrey M. Leeiden of Vertex Pharmaceuticals got $28,099,826 and Larry J. Merlo of CVS health took home $22,855,374

Who is worth that? Compare that to the $400,000 annual salary of the President of the United States who also gets a $50,000 annual expense account, a $100,000 nontaxable travel account, and $19,000 for entertainment. Add it all up and it doesn’t begin to compare with the health care and pharma CEOs.

I don’t know about any of you readers, but if I was the head of a pharma company making that much money and read about all the people who were dying or sick because they couldn’t afford meds I would likely shoot myself.

Because The U.S. just held elections it is too early to provide information on who chairs the committees in the house and senate that might influence the price of prescription drugs. This website might offer you some assistance. http://physics.mnstate.edu/cabanela/contacting_the_congress_shutdown.php

If you’d like to write to the President of the United States, Here’s his address.  If you write now your letter will go to President Obama. If you write after inauguration day on January 20th it will go to President Trump.

The President.
The White House.
1600 Pennsylvania Avenue, N.W.
Washington, DC 20500.

PLEASE SHARE THIS PIECE. NO PERMISSION NEEDED, BUT ATTRIBUTION APPRECIATED. 

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bob 2Bob Aronson is a former Journalist, Governor’s press secretary and international communications consultant. He is retired and lives with wife Robin in Jacksonville, Florida. Bob had a heart transplant at the Mayo Clinic in Jacksonville in 2007 and spends most of his time promoting organ donation and writing blogs about donation/transplantation and related subjects. He is the founder of Facebook’s over 4,000 member Organ Transplant Initiative (OTI) and of Bob’s Newheart blogs where there are nearly 300 posts on subjects like this. http://www.bobsnewheart.wordpress.com

 

 

 

 

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Why Prescriptions Cost So Much and What You Can Do About It


cartoon
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 world's biggest a holebecause 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.

big pharmaBefore 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 andcosts 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. MedicareAnother 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
lobbyistsSince 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.

generic drugs1Then, 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 advairthere 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!

So what are your options, what can average patients who have difficulty Optionaffording some drugs do to stay healthy and be able to eat and pay their rent and other bills at the same time?

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 savecouponmoney 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.

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bob half of bob and jay photoBob 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 bob@baronson.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. 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.

 

Pay Up or Die. The High Cost of Prescription Drugs


By Bob Aronson

At the onset of this post it is important to point out that capitalism (or the desire to make money) works.  If the public demand for any product real or imagined is high enough, someone, somewhere will invest the dollars to develop it and in return they expect a profit.  There is absolutely nothing wrong with that.  If they are taking the risk, they deserve a profit, even a healthy profit.

As a business owner myself I always sought to make a healthy profit.  I could easily justify my pricing because it took years of learning and investing my own money to develop a detailed and highly effective method of persuasive communication that would result in helping my clients increase their profit margins. So, on to the question we are addressing.

Every physician, nurse practitioner, pharmacist and insurance company is familiar with this oft heard question, “Why do drug companies charge so much for my medications?”

Well, the answer can be either complex or simple.  This blog tries to provide a glimpse of the complex answer but the simple answer to the question may be, “Because they can.”

Simple answers always sound good but they are seldom accurate so let’s begin by taking a good look at the problem.

Prescription drug prices are very high, higher in the United States than any other developed country in the world. 

It is estimated that about 48 percent of Americans take at least one prescription drug but the high cost of drugs hits older people the hardest.  It is a fact of life that as you age you need more medical attention and must take more prescribed drugs to stay healthy. 

The cost of drugs for people with chronic diseases, transplant patients, and mental illnesses is in some cases prohibitive.  Many patients are faced with making tough choices about how they spend their money and often the choice is between medicine and food, but rather than allude to the problem I will address it head on with examples.

Cancer is a condition into which billions of dollars has been poured.  The disease offers a great example of research that sometimes results in medication and/or therapy that effectively treats and sometimes even cures the patient.  But, and this is a huge but, those who need the drugs the most may also be unlikely to afford them.

Overall, cancer drug prices are skyrocketing. Of the dozen drugs approved by the Food and Drug Administration for various cancers in 2012, eleven were priced above $100,000 for a year of treatment. Writing in an op-ed in the New York Times in October 2012, three physicians at New York City’s Memorial Sloan Kettering Cancer Center noted that “the typical new cancer drug coming on the market a decade ago cost $4,500 per month (in 2012 dollars); since 2010 the median price has been around $10,000.” 

$10,000 a month for one drug? That is beyond outrageous, right? Detractors would strongly suggest that the price borders on obscene.  Well, if you think that is bad, chew on this one. There is now an approved prescription drug that costs $295,000 a year.

Let’s digest that piece of information for just a moment. There is now a prescription drug that costs twice as much as a college education and because it keeps you alive you might need to take it for years. There’s a lot of money to be made in treating diseases, probably a whole lot more than in curing them (that’s a topic for another day).

Some might say, “That $250,000 figure is an extreme example” and they would be correct, but extreme does not mean uncommon.  According to Fox News, Gattex, which is prescribed for short bowel syndrome, is the fourth drug approved in 2012 that was priced above $200,000 per patient, per year. http://tinyurl.com/lnmr353

NPS pharmaceuticals in Bedminster, New Jersey, the company that makes Gattex says, no patient will have to pay out of pocket for the drug. Instead, it will be covered by a patchwork of insurance, coupons and charitable organizations. They say that commercial insurers will pay for part of the drug, around 70%. The remaining co-pay will be covered by NPS Pharmaceutical’s co-pay assistance plan or–in the case of Medicare patients–by rare disease organizations that get funding help from NPS Pharmaceuticals. About 15% of patients who can’t pay anything will get it for free. But the cost ultimately is paid by everyone through your insurance premiums, taxes or co-pays.    

NPS would like to have you believe that a quarter of a million dollars for a pill is ok as long as you don’t get the full bill.  But is it OK?  Read on about how drug companies make and spend their money.

 

There are still millions of uninsured Americans, millions more are underinsured and millions more even with good insurance might not be able to afford the co-pay.  So the question that needs an answer is, “What good is a new, effective drug if those who need it can’t afford it?”

So, back to the topic of this blog. Why do prescriptions cost so much?  Let’s first examine the question from the perspective of the pharmaceutical companies. I want to be fair and honest here so I am going to provide some necessary details.  Here’s what they say, “Prescription drugs cost a lot because we spend a lot to develop them.”  Some examples:

·         A single clinical trial can cost $100 million at the high end, and the combined cost of manufacturing and clinical testing for some drugs has added up to $1 billion and even then there is no guarantee that the U.S. Food and Drug Administration (FDA) will approve it.”

·         While the United States has only 5% of the world’s population, it accounts for 36% of worldwide research and development of pharmaceutical drugs.  The industry says that in the next quarter century drug research will save almost three fourths of a trillion dollars in treatment costs for just five Illnesses (Aids, heart disease, cancer, Alzheimer’s and arthritis). As a further example the industry says that drugs developed to treat Schizophrenia which cost the patient about $4,500 a year save patients about $70,000 a year by keeping them out of the hospital.

·         The drug companies also justify their high prices by explaining that only about ten percent of drugs that go through the clinical trial process get approval from the U.S. Food and Drug Administration (FDA).  0Overall, the case made by the pharmaceutical companies sounds convincing.   Drug development is an expensive process and each year scores of companies spend millions to develop promising drugs that either fail to get into trials, fail the trials or complete the trials and are turned down by the FDA.  Investors lose many billions of dollars each year on promising drugs that simply don’t live up to their expectations.

So, do the pharmaceutical companies make a good case for their high prices?  Certainly one could say it is compelling in the manner and context in which it is presented.  The icing on the drug company argument might be that because so many foreign governments place a cap on prescription prices American consumers wind up paying the freight for the rest of the world.  And…while drug companies blame R&D costs for their high prices insiders also readily admit to pressure to increase profits before drug patents expire with the resultant generic drugs selling for far less with slimmer profit margins. So, in a rather large nutshell, that’s the case made by the pharmaceutical companies to explain the high price of prescription drugs.

As former journalist my genetic makeup dictates that I cannot present the pharmaceutical company argument and end the blog.  Balance is what makes the teeter–totter a pleasant ride.  Without it one end will hit the ground with a resounding, “thump.”   Most people assume that a story is balanced when both sides are presented.  But, what if there is more to the story?  What if there are more than two sides?  In the previous paragraphs I offered several angles for justifying high drug prices.  Now, let’s try to offer some balance…a few judgments, of course, but mostly balance.

The above justification for drug prices makes sense when you don’t have a corporate balance sheet in front of you because we are being told only part of the story.  What happens when we ask this question?  Do research and development costs comprise the majority of corporate expenditures?  If they do, then their argument may be justified but if not it is suspect.

Critics of pharmaceutical companies point out that only a small portion of the drug companies’ expenditures are used for research and development, with the majority of their money being spent on marketing and administration. A recent report indicates that pharmaceutical companies spend nineteen (19) times more on self-promotion than on basic research.  http://tinyurl.com/bzrpsg6

According to a report in BMJ, a medical journal based in London it is more profitable for drug companies to create a products that are only slightly different from drugs already on the market.

“Pharmaceutical research and development turns out mostly minor variations on existing drugs,” the authors write. “Sales from these drugs generate steady profits throughout the ups and downs of blockbusters coming off patents.”

The authors go on to say that for every dollar pharmaceutical companies spend on “basic research,” $19 goes toward promotion and marketing and the strategy seems to be working.  According to the website MinnPost http://tinyurl.com/mywen48drug company revenues climbed more than $200 billion in the years between 1995 and 2010.

MinnPost says that in recent years more than one in five Americans age 50 and up had to cut down on dosages, switch to cheaper generic drugs (if they are available) or quit taking their drugs completely.  Often the choice is between medication and food.

The argument that R and D costs account for the high cost of prescription drugs erodes when one considers that promotion not R&D is what they really spend their money on. But…the dam begins to spring a whole bunch of leaks with the knowledge that not all, in fact a majority of new drugs come from non-American companies.

 

Here’s a little more water to add to the bursting price dam.  As I noted earlier, the U.S. is the only nation that does not have price controls and negotiate our drug prices, so it is true that in a sense, we are bearing the cost of the world’s R&D.   But, even conceding that point American drug prices still appear to be excessive — and in fact, drug companies are increasingly pocketing their huge profits rather than reinvesting them.

 

In 2002, 78 new drugs were approved by the FDA. Of those, only 17 were deemed by the FDA to have new active ingredients, and only seven were found to be improvements over the older drugs. On top of that, of the seven found to be an improvement over the older drug, not one of them came from U.S. companies.  Not a single drug.  Now, to be fair, that is not true in every year but it is true often enough to destroy the defense of high drug prices the manufacturers continue to offer.

Back to the MinnPost story and we quote;

“For the past decade or so, we’ve been hearing repeatedly about an “innovation” crisis in pharmaceuticals. Big Pharma and its friends in government and elsewhere have claimed that research into new drugs is slowing down, primarily, they say, because of onerous regulatory demands.

“With the growing difficulty of getting drugs through the [Food and Drug Administration] labyrinth and the rising cost of drug approval, Pfizer must produce revenue for continued research — the lifeblood of pharmaceutical companies,” lamented the president of the Galen Institute, an industry-funded and free-market public policy organization, in Forbes last December. “Without this research, the pipeline would run dry, delaying or even killing new medicines for Alzheimer’s, Parkinson’s, and countless other diseases.”

But is it true? Is there really an innovation crisis? “No,” according to an analysis published on BMJ.com. The real crisis is in a system that rewards drug companies for developing new products that offer few, if any, therapeutic benefits over existing ones, argue Donald Light, a professor of social medicine and comparative health care at the University of Medicine and Dentistry of New Jersey, and Joel Lexchin, a professor of health policy and management at York University in Toro.”

Let us rely even further on the BMJ report and this startling fact.  Most funds for basic research are public funds!   So not only is R and D not responsible for high prices, the companies aren’t even paying for the R &D.  That money comes primarily from taxpayer dollars funneled through publicly supported research institutions.

A cutback on public money for basic research, therefore, would seem to be a key threat to drug innovation.  And, yes, research and development costs have risen significantly for drug companies (by an estimated $34.2 billion between 1995 and 2010), but revenues have risen faster (by $200.4 billion within that same time period).

Suddenly, that very air-tight case presented by the drug companies that justifies what some call price gouging — suddenly the case is full of holes and not a few distortions.

Here, though, is the capper and it is a big one. In the United States, the priciest medicines aren’t necessarily the ones that cost the most to develop, nor are they the ones that save the most lives. The most expensive drugs are those that have no competitors. It’s as simple as that.  When there is no competition and the government refuses to intervene the pharmaceutical companies are free to molest the consumer’s bank account.

When a real blockbuster drug hits the market, there is very little to guide manufacturers and insurers as they negotiate prices.  The largest constraint is public perception. Yes, public opinion still has some effect, not much but some.  Insurers fear that, if they refuse to pay at least something, their sick customers will be outraged.

Manufacturers don’t want the public or lawmaking bodies to see them as price gougers (I think we are smarter than that) so negotiators eventually settle on a price between two extreme poles. This, however, is not a common problem.  Few pharmaceutical companies face it. Most newly developed and introduced drugs find the market already crowded with competition and it is the competition that ultimately sets the prices.

Earlier I said there are rarely just two sides to a story and this story is no different than any other about which I’ve written.  The final side is the seedy side, the illegal, greedy and immoral side, the side that should result in people going to jail.  It has to do with kickbacks and while there may be very few medical and business professional people involved there are some. 

This headline got a lot of attention and still is.

Pay to Prescribe? Two Dozen Doctors Named in Novartis Kickback Case

http://tinyurl.com/mecleg5

From the New YorkTimes:

Less than three years ago, Novartis settled criminal and civil investigations into whether it had illegally promoted drugs to health care professionals for uses not approved by the Food and Drug Administration. The company was accused of providing illegal kickbacks to doctors through such mechanisms as entertainment, travel, and appointment to advisory boards or speaker programs. It paid $422.5 million to settle the case and signed a “corporate integrity agreement” to ensure that its promotional functions would comply with a federal anti-kickback statute.

Last week Preet Bharara, the United States attorney for the Southern District of New York, announced the filing of a lawsuit accusing the company of providing even more blatant kickbacks to pharmacies to generate sales of one of its better-selling drugs. The suit charged that Novartis provided illegal rebates and discounts to 20 or more influential pharmacies based on their success in persuading institutions and doctors to switch patients from other drugs to Myfortic, an immune suppressant used to prevent rejection of kidney transplants. (If prosecutors want to send an even stronger message, they should also pursue the corrupt pharmacies, which are suspected of pocketing tens or hundreds of thousands of dollars in illegal kickbacks.)

http://www.justice.gov/usao/nys/pressreleases/April13/NovartisLawsuitPR.php

And Pharmacists are not immune from corruption either.

http://www.dailynews.com/opinions/ci_23150510/samuel-i-fink-improper-pharmacist-kickbacks-threaten-health

 

Efforts to reduce health care spending have given rise to questionable financial arrangements that may be jeopardizing the health of California patients.

Some health insurers are improperly incentivizing pharmacists to switch patient medications to older, cheaper, non-chemically equivalent drugs from those originally prescribed by their doctor, often without patients’ or physicians’ knowledge.

As a former businessman I do not begrudge any company a profit…even a good profit but I also expect honesty in reporting how they spend their money and in the case of health care there should be some compassion — just a smidgen of concern for the patient.  Just how much compassion is there in a $10,000 per treatment cancer bill?  The message is, “Either pay the price or die.”

 

That leaves us with the question, “What do we do about this situation?  How do we make drugs affordable and accessible to patients?  That doesn’t seem to be a topic that the U.S. congress is willing to deal with.  In fact, many of our elected officials have great health care plans and don’t have to worry about the high prices.  Then of course there are the millions of dollars the pharmaceutical industry spends on lobbying elected officials to resist consumer protection and if the lobbying doesn’t work, they’ll spend millions more on financing the campaigns of those who will, if elected, support them.

 

In closing let me refer to a point made earlier.  Companies do respond to public opinion, more accurately phrased, they respond to outrage.  The greater the outrage the greater the hazard to their existence so if you want change you must generate outrage and that outrage has to reach two key audiences 1) the congress of the United States and 2) the drug companies.  Go for it!

 

Bob Aronson of Bob’s Newheart is a 2007 heart transplant recipient, the founder of Facebook’s nearly 3,000 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 bob@baronson.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 new music video “Dawn Anita The Gift of Life” on YouTube https://www.youtube.com/watch?v=eYFFJoHJwHs.  This video is free to anyone who wants to use it and no permission is needed. 

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 bob@baronson.org 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.

En Espanol

Puede comentar en el espacio proporcionado o por correo electrónico sus pensamientos a mí en bob@baronson.org. Y – por favor, difundir la palabra acerca de la necesidad inmediata de más donantes de órganos. No hay nada que puedas hacer lo que es de mayor importancia. Si usted convence a una persona de ser donante de órganos y tejidos puede salvar o afectar positivamente a más de 60 vidas. Algunas de esas vidas pueden ser personas que conoces y amas.

Por favor, consulte nuestro nuevo video musical “Dawn Anita The Gift of Life” en https://www.youtube.com/watch?v=eYFFJoHJwHs YouTube. Este video es libre para cualquier persona que quiera usarlo y no se necesita permiso.

Si quieres correr la voz acerca de la donación de órganos personalmente, tenemos otra presentación de PowerPoint para su uso libre y sin permiso. Sólo tienes que ir a http://www.organti.org y haga clic en “Life Pass It On” en el lado izquierdo de la pantalla y luego sólo tienes que seguir las instrucciones. Esto no es un espectáculo independiente, sino que necesita un presentador pero es profesionalmente producida y sonido hechos. Si usted decide usar el programa le enviaré una copia gratuita de mi libro electrónico, “Cómo obtener un pie” O “que le ayudará con habilidades de presentación. Sólo tiene que escribir a bob@baronson.org y por lo general usted recibirá una copia del mismo día.

Además … hay más información sobre este sitio de blogs sobre otros donación / trasplante temas. Además nos encantaría que te unas a nuestro grupo de Facebook, la Iniciativa de Trasplante de Órganos Cuantos más miembros que obtenemos mayor será nuestra influencia con los tomadores de decisiones.

 

Supremes Say You Can’t Sue Generic Drug Makers But FDA May Change That


On June 24, 2-13 the U.S. Supreme Court, in a 5-4 decision ruled that generic drug manufacturers are not liable for the design of the drugs. supreme court That means if their drugs make you sick you can’t sue them. gavel on money One could easily believe that’s like saying that a Jet passenger airliner that was approved as safe by the FAA in the 1960’s is immune from all law suits even if in ensuing years it was proven that stress fractures caused engines to fall off and planes to crash killing hundreds— but I am getting ahead of myself and besides a ruling by the Food and Drug Administration (FDA) could change all that.  Confused?  Read on.

Before we get to the decision it is important to understand just what a generic drug is and how it becomes one.  When a new, FDA-approved drug goes on the market, it may have patent or other protection that enables the manufacturer to sell the drug exclusively for a period of time. When those protections expire other companies can make it in generic form but the FDA must approve the generic drug before it can be marketed.FDA approved drug

For a generic drug to be approved by FDA, its manufacturer must show that it is “equivalent” to the innovator drug (brand name). This means that to gain FDA approval, a generic drug must:

  • Contain the same active ingredients as the innovator drug. Active ingredients make the drug effective against the disease or condition it is treating.
  • Come in the same dosage form. If the brand name is a capsule, the generic should be a capsule, too.
  • Be administered the same way. If the brand name is taken orally, the generic should be taken orally, too.
  • Be identical in strength
  • Have the same conditions of use
  • Be bioequivalent (an equal rate and extent of drug absorbed in the bloodstream)
  • Meet the same standards for identity, strength, purity and quality
  • Be manufactured under the same standards that FDA requires for the manufacture of innovator products

As I researched this story I found that the FDA encourages people to notify them of side effects or reactions to these generic drugs.  I found little or no information that suggested how or even if the FDA acted upon public complaints so conceivably there could be a great number of complaints about an adverse effect  but if the FDA takes no formal action the Generic manufacturer has no obligation to issue any warnings or reformulate the drug…which leads us to today’s supreme court ruling.

In a dissenting opinion, Justice Sonia Sotomayor said a decision by the F.D.A. to approve a drug should not absolve a company of its responsibility to sell a safe product.

“Manufacturers regularly take drugs off the market when evidence emerges about a drug’s risks, particularly when safer drugs that provide the same therapeutic benefits are available,” she wrote in her dissent, which was joined by Justice Ruth Bader Ginsburg. Justice Stephen G. Breyer wrote a separate dissent, which was joined by Justice Elena Kagan.

Some have called on Congress and the F.D.A. to make generic drug companies more accountable by permitting them to change their warning labels when they become aware of a safety risk. Brand-name companies can already do so. Such a change would, presumably, allow the generic manufacturers to be sued again. FDA sign

Generic drug makers now have a responsibility to mirror the safety label of the brand-name company and to alert the F.D.A. whenever they learn of an adverse event related to their products. It is then up to the agency to decide whether to change the label.

Critics have said the current system works too slowly, and does not account for situations when problems arise with a drug after the brand-name manufacturer has left the market.

The consumer advocacy group Public Citizen released a report Monday that found 11 instances over the last five years in which serious safety warnings were added to the labels of drugs for which there were no longer any brand-name versions on the market.

This situation “poses a threat to the safety of prescription drugs, creating unnecessary risks to patients,” Dr. Michael Carome, director of the Health Research Group at Public Citizen, said in a statement Monday.

But now a new twist.

The June action by the supreme  court slashed the right of individuals to sue for damages when injured by generic drug makers…..but an action by the Food and Drug Administration might change that.   The Times Katie Thomas reported this good news yesterday:

Consumer advocates applauded the development, calling it a necessary fix for a system that they say is unfair to patients who take generic medicines. FDA logo

“It’s common sense,” said Dr. Sidney M. Wolfe, a senior adviser to the Health Research Group at Public Citizen, which in 2011 petitioned the F.D.A. to pass just such a rule. “It will obviously end this situation where people are being harmed physically and yet, although they are harmed, they have no right to go into court and get redress for serious damages.”

Dozens of lawsuits against generic drug manufacturers have been dismissed since 2011, when the Supreme Court ruled that because the generic companies must, by law, use the same label warnings as their brand name counterparts they cannot be sued for failing to alert patients about the risks of taking their drugs. Last month, the Supreme Court ruled — on similar grounds — that patients also may not sue generic drug makers by claiming that the drug was defectively designed.

Have we heard the last of this issue? No way.  The pharmaceutical industry has billions to spend to defend itself and to launch massive PR campaigns.  They’ve done it in the past and you can bet the will do it again.  Stay tuned. 

Bob Aronson of Bob’s Newheart is a 2007 heart transplant recipient, the founder of Facebook’s nearly 3,000 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 bob@baronson.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 new music video “Dawn Anita The Gift of Life” on YouTube https://www.youtube.com/watch?v=eYFFJoHJwHs.  This video is free to anyone who wants to use it and no permission is needed. 

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 bob@baronson.org 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.

En Espanol

Puede comentar en el espacio proporcionado o por correo electrónico sus pensamientos a mí en bob@baronson.org. Y – por favor, difundir la palabra acerca de la necesidad inmediata de más donantes de órganos. No hay nada que puedas hacer lo que es de mayor importancia. Si usted convence a una persona de ser donante de órganos y tejidos puede salvar o afectar positivamente a más de 60 vidas. Algunas de esas vidas pueden ser personas que conoces y amas.

Por favor, consulte nuestro nuevo video musical “Dawn Anita The Gift of Life” en https://www.youtube.com/watch?v=eYFFJoHJwHs YouTube. Este video es libre para cualquier persona que quiera usarlo y no se necesita permiso.

Si quieres correr la voz acerca de la donación de órganos personalmente, tenemos otra presentación de PowerPoint para su uso libre y sin permiso. Sólo tienes que ir a http://www.organti.org y haga clic en “Life Pass It On” en el lado izquierdo de la pantalla y luego sólo tienes que seguir las instrucciones. Esto no es un espectáculo independiente, sino que necesita un presentador pero es profesionalmente producida y sonido hechos. Si usted decide usar el programa le enviaré una copia gratuita de mi libro electrónico, “Cómo obtener un pie” O “que le ayudará con habilidades de presentación. Sólo tiene que escribir a bob@baronson.org y por lo general usted recibirá una copia del mismo día.

Además … hay más información sobre este sitio de blogs sobre otros donación / trasplante temas. Además nos encantaría que te unas a nuestro grupo de Facebook, la Iniciativa de Trasplante de Órganos Cuantos más miembros que obtenemos mayor será nuestra influencia con los tomadores de decisiones.

 

 

Altruism Isn’t Working — Should We Be Able to Buy Organs?


Everyone makes money on organ transplants except the donor.  That’s right physicians, hospitals, clinics, Organ Procurement Organizations  (OPOs) and funeral homes all make money on organ donation.  The 258 solid organ transplant centers in the U.S. share the wealth of this multi-billion dollar industry but the organ donor gets nothing more than the satisfaction of having done a good thing.

There are 117,000 people waiting for transplants in the United States.  Only about 28,000 of the procedures are done here yearly and that fact has remained static for several years while the number of people on the list keeps increasing.  Last year there were about 6,000 living donations and over 7,000 patients died while waiting for their names to come up on the transplant list.  Those are very disturbing numbers.

What is more disturbing, even infuriating is the fact that while survey’s show overwhelming  American support for organ donation (over 90% of us think it’s a great idea) only about 40% of us ever get around to becoming donors.  That’s why people are dying.  It’s not that Americans don’t want to donate…it’s just that they don’t get around to it…there is no sense of urgency for them as there is for the patient who quietly waits for his or her call to come.

With only 40% donating organs it is obvious we should be trying something else,  Perhaps it is time to find a new way to encourage people to become donors now rather than continuing to kick the can down the road and allowing more people to die .  Guilt trips haven’t worked well and neither have appeals to the human sense of sacrifice and doing the right thing so that means we absolutely must try something else and that something is money.  Money talks, money works and money motivates.

Before I get into any suggestions on how to use money or where to get it let’s go back to my opening comments.  Everyone is making money on organ transplants except the patient.  Let’s look at just how much money is involved.

According to Transplant Living http://www.transplantliving.org/before-the-transplant/financing-a-transplant/the-costs/  These are the estimated  U.S. Average 2011 Billed Charges Per Transplant

Transplant

30 Days
Pre-
transplant

Organ

Procurement

Hospital
Transplant Admission

Physician
During Transplant

180 Days
Post-transplant
Admission

Immuno-
suppressants

 Total
Heart Only $47,200 $80,400 $634,300  $67,700 $137,800 $30,300 $997,700
Single Lung $10,300 $73,100 $302,900 $33,500 $117,700 $23,700 $561,200
Double Lung $21,400 $90,300 $458,500 $56,300 $142,600 $28,200 $797,300
Heart-Lung $56,800 $130,500 $777,700 $81,000 $169,100 $33,300 $1,148,400
Liver $25,400 $71,000 $316,900 $46,600 $93,900 $23,300 $577,100
Kidney $17,000 $67,200 $91,200 $18,500 $50,800 $18,200 $262,900
Pancreas $17,000 $65,000 $108,900 $17,800 $61,400 $19,300 $289,400
Intestine $55,100 $78,500 $787,900 $104,100 $146,600 $34,600 $1,206,800

*Most transplant programs have social workers and financial coordinators who can help you with the financial details of your transplant. Depending on the structure at your center, one or both will help you develop a strategy.  For a finely detailed analysis of the cost of transplants you’ll want to study this report from 2008 http://publications.milliman.com/research/health-rr/pdfs/2008-us-organ-tisse-RR4-1-08.pdf

Medical costs include:

  • insurance deductibles
  • insurance co-pays
  • pre-transplant evaluation and testing
  • surgery
  • fees for the recovery of the organ from the donor
  • follow-up care and testing
  • additional hospital stays for complications
  • fees for surgeons, physicians, radiologist, anesthesiologist and recurrent lab testing
  • anti-rejection and other drugs, which can easily exceed $2,500 per month
  • rehabilitation

Non-Medical Costs

Non-medical costs include:

  • food, lodging and long distance phone calls for you and your family
  • transportation, to and from your transplant center, before and after your transplant
  • plane travel to get to your transplant hospital quickly
  • child care
  • lost wages if your employer does not pay for the time you or a family member spends away from work
  • If your transplant center is not close to your home, lodging close to the center before and after your surgery. Some centers offer free or low-cost hospitality houses for you and your family.

The above data clearly establish that transplants are expensive and that a good many people and organizations are profiting from it and I have no objection to that.  People ought to be paid for their work.  At the same time, though, is it fair that donor’s and their families get nothing?  Is it fair that in many cases donors, especially living donors may have substantial out of pocket expenses that are not reimbursed?

Living donors actually face a disincentive because they may have to pay the bills for travel, meals, accommodations, lost income and other expenses, including medical costs if their own health is compromised because of the operations. They also take on at least some risk of future discrimination from employers or insurers.

The American Medical Association says that at the low end, the added expense of donating may be a few hundred dollars, but the range can rise to about $20,000.   The AMA points out that while Federal law strictly prohibits the selling of any organs, donors may be reimbursed legally for their expenses. Still, that hardly is a guarantee.

Not well known is the fact that low-income donors and recipients can get financial aid through the National Living Donor Assistance Center, which is federally funded. More affluent recipients also can choose to pay donors’ expenses directly. But most donors come from that great middle ground where they may have to experience a financial loss in order to donate an organ.  That is an extraordinary and unreasonable expectations and should be addressed.  Why should a donor have to pay a financial price for doing the right thing?

According to the American Medical Association (AMA) the ir House of Delegates voiced its support in June of 2012  for an important proposition: http://www.ama-assn.org/amednews/2012/08/13/edsa0813.htm

“Living donors should not have to fear negative financial consequences for giving the gift of life. The recommendations call on governments, state and federal, to help remove financial barriers to living donation. That includes provisions for mitigating out-of-pocket expenses, ensuring access to health insurance, and guaranteeing freedom from discrimination in employment and in obtaining life insurance.

One example noted in a report to delegates is the proposed federal “Share Your Spare Act,” which would provide a tax credit of up to $10,000 to cover donor expenses or lost wages. A number of states and the federal government already have enacted a patchwork of donor work leave provisions, mostly for government employees. There also are a number of state tax credit provisions for donors.

The Affordable Care Act and its prohibition against preexisting condition denials, upheld by the U.S. Supreme Court after the delegates’ vote, is expected largely to take care of concerns about donors’ future access to health insurance coverage starting in 2014. Necessary legal protections against discrimination in employment and in purchasing life insurance are still lacking.”

Deceased donors pay nothing for the organ recovery and transplant process but their families still have to foot the bill for the illness that caused them to die and for all expenses following the death including funerals.  Somehow it seems as though there should be some accommodation for donors.  More for Living donors who can actually experience considerable cost to both their financial and physical health but why not at least pay funeral expenses for the gift of life from deceased donors?

When the National Organ Transplant Act (NOTA) passed and was signed into law in 1984 it prohibited payments for organs but did not prohibit reimbursement of expenses.  It didn’t address that subject at all.  That would be a perfectly legal step to take and maybe, given the right explanation, the public would approve of a financial incentive to donate that would at least cover expenses including funerals.  Other incentives could  be contributions to retirement plans, college scholarships or paying some or all of the cost of health care for the surviving spouse or partner.

We should point out here that the organ in greatest demand is, of course, the kidney.  In the U.S. of the 117,000 people on the transplant list, about 90,000 of them are waiting for kidneys.   How do we get more kidneys?  One way is to pay for them which is strictly prohibited by the 1984 law that established the organ transplant industry.   Laws, though, can be changed and if the proper safeguards are in place paying for organs could work.   An example of a country where organs are legally bought and sold is Iran.   Yes, Iran.  Not often an example of anything good this system seems to be working for Iran as they have virtually eliminated their kidney shortage.

Iran is the only country where the selling and buying of kidneys is legal. As a result, there is no shortage of the organs.  Here’s how it works there. The system allows people to sell and buy kidneys under state-regulated surveillance.  Two charities facilitate the process by finding potential vendors and introducing them to the recipients, and are charged with checking the compatibility of a possible donation and ensuring a fair trade.  After the transplant, the vendor is compensated by both the government and the recipient.  Iranians are not allowed to donate kidneys to non-citizens.

Would that work here…there are pros and cons but there’s also a little bit of research on the subject.  In 2010 a survey of 409 Philadelphia, Pennsylvania commuters was published by the American Medical Association on how willing people would be to donate under 12 different scenarios.  The study found that many concerns about paying kidney donors may be overblown. Among other things, participants were asked how willing they would be to donate a kidney to family members or strangers for no pay, for $10,000, or $100,000.

“The study provides no evidence whatsoever that the poor would be exploited or wouldn’t make informed choices,” said Scott D. Halpern, MD, PhD, the study’s lead author and assistant professor of medicine and epidemiology in the division of pulmonary and critical care medicine at the University of Pennsylvania School of Medicine. “The central finding is that payments do not seem to influence the poor more than the rich. The influence of a $10,000 payment on people earning more than $100,000 a year is the same as a $10,000 payment is for people earning less than $20,000 a year.”

On the flip side of the “pay for organs” issue there are some very serious concerns.  Pakistan, for example, is rife with kidney for sale nightmares. According to a 2007 story in the Washington Post  http://www.washingtonpost.com/wp-dyn/content/article/2007/04/13/AR2007041302066.html  “About 40 percent of the people in some Pakistani villages are turning up with only one kidney. Charts presented at the meetings show that the number of “donations” from unrelated Pakistanis is skyrocketing. Two-thirds of the people receiving these organs are foreigners. Data from the Philippines show the same thing.”  And it is even worse today in 2013.

A number of arguments against selling organs get bandied about, but there are two which lie behind most of the others. The first involves the concern with how selling organs leads to the commodification of human bodies, and the second is the concern with the exploitation of the poor for the benefit of the rich. These are difficult arguments to explain and are not convincing to everyone, but they cut to the heart of what we want our society ultimately to be like.

The bottom line is that something must be done to meet the demand for organs. It is at least as unethical to let people die because of being afraid to change the system as it is to pay for organs from poor people.  You can learn more on this subject by checking out these links:

http://www.cnn.com/2012/07/03/health/allowed-sell-organs-time/index.html

http://www.npr.org/2008/05/21/90632108/should-we-legalize-the-market-for-human-organs

http://www.newint.org/argument/2010/10/01/human-organ-trade-debate/

http://plato.stanford.edu/entries/organs-sale/

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 bob@baronson.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 bob@baronson.org 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.

Are Profits More Important Than Cures?


By Bob Aronson

A Treatment for Almost Everything but Few Vaccines & Even Fewer Cures — Why?

Fair and balanced journalism is a very nice catch phrase but the stated goal is more than illusive, it is almost non-existent and that’s because there are never just two sides to a story.  There are often several sides so no matter how hard a reporter might try to be objective, there is no way you can cover every angle.  I do not pretend that this post is the endeavor of an investigative journalist, nor do I contend that this is an objective report.  What I offer here represents some observations and a few links to help illuminate the information.  I hope you find it useful.

According to the U.S. Census Bureau, the average life expectancy at the beginning of the 20th century was just over 47 years. A century later, that number had increased to nearly 78 years, due largely to the development of vaccinations and other treatments for deadly diseases.  We are living longer because medical science has provided us with treatments, medications, devices and surgeries that cure little but keep most threatening diseases at bay…and often at a phenomenal cost.

As a communications consultant specializing in healthcare I have worked with several pharmaceutical companies.  I know many researchers and I am aware of the dedication they bring to their jobs and to providing help to patients.  I know, too, how expensive it is to develop new drugs and all too often I have seen those efforts fail resulting in the loss of millions of hard-earned investor dollars.  In short, I have at least a passing acquaintance with the pharmaceutical industry and the financial risks they take to bring new drugs, treatments, procedures and devices to the marketplace.

At the same time I also understand the desire and the necessity to be profitable.  Without profitability no business can survive.  It is only fair to point out that the pharmaceutical industry (Big Pharma) has been incredibly profitable, despite the investments and even the losses.

Here is the list of the five biggest pharmaceutical companies based on 2010 revenues, in billions of dollars.

1.Pfizer                                                        $58,523,
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