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Here are my comments and the links to three interesting and informative articles. I hope you enjoy.
DrG – Why are prescription drugs so expensive in the US? “Asthma — the most common chronic disease that affects Americans of all ages, about 40 million people — can usually be well controlled with drugs. But being able to afford prescription medications in the United States often requires top-notch insurance or plenty of disposable income, and time to hunt for deals and bargains….Pulmicort, a steroid inhaler, generally retails for over $175 in the United States, while pharmacists in Britain buy the identical product for about $20 and dispense it free of charge to asthma patients. Albuterol, one of the oldest asthma medicines, typically costs $50 to $100 per inhaler in the United States, but it was less than $15 a decade ago, before it was repatented. “The one that really blew my mind was the nasal spray,” said Robin Levi, Hannah and Abby’s mother, referring to her $80 co-payment for Rhinocort Aqua, a prescription drug that was selling for more than $250 a month in Oakland pharmacies last year but costs under $7 in Europe, where it is available over the counter. With its high prescription prices, the United States spends far more per capita on medicines than other developed countries…many generics are still expensive, even if insurers are paying the bulk of the bill…the high price of many commonly used medications contributes heavily to health care costs and certainly causes more widespread anguish, since many insurance policies offer only partial coverage for medicines…Unlike other countries, where the government directly or indirectly sets an allowed national wholesale price for each drug, the United States leaves prices to market competition among pharmaceutical companies, including generic drug makers. But competition is often a mirage in today’s health care arena — a surprising number of lifesaving drugs are made by only one manufacturer — and businesses often successfully blunt market forces…The repatenting of older drugs like some birth control pills, insulin and colchicine, the primary treatment for gout, has rendered medicines that once cost pennies many times more expensive. Pharmaceutical companies…even pay generic drug makers not to produce cut-rate competitors in a controversial scheme called pay for delay. Thanks in part to the $250 million last year spent on lobbying for pharmaceutical and health products — more than even the defense industry — the government allows such practices. Lawmakers in Washington have forbidden Medicare, the largest government purchaser of health care, to negotiate drug prices…“Producing these drugs is cheap. And yet we are paying very high prices.” He added that because inhalers were so effective at keeping patients out of hospitals, most national health systems made sure they were free or inexpensive…“The high prices in the U.S. are because the F.D.A. has set the bar so high that there is no clear pathway for generics,” said Lisa Urquhart of EvaluatePharma, a consulting firm based in London that provides drug and biotech analysis. “I’m sure the brands are thrilled.”…a significant problem is that none of the agencies that determine whether medicines come to market in the United States are required to consider patient access, affordability or need…the United States patent office grants new protections for tweaks to drugs without weighing the financial impact on patients…Drug companies have long argued that pharmaceutical pricing reflects the cost of developing and testing innovative new drugs, many of which do not pan out or make it to market…Critics counter that drug companies spend far more on marketing and sales than the 15 percent and 20 percent of their revenues that they devote to research and development…Also, the focus of much pharmaceutical research in recent years has shifted from simple drugs for common diseases that would have widespread use to complicated molecules that would most likely benefit fewer patients but carry far higher price tags, in the realm of tens of thousands of dollars…In all other developed countries, governments similarly use a variety of tools to make sure that drug manufacturers sell their products at affordable prices. In Germany, regulators set drug wholesale and retail prices. Across Europe, national health authorities refuse to pay more than their neighbors for any drug. In Japan, the price of a drug must go down every two years…This year the price of Advair dropped 10 percent in France, but in pharmacies in the Bronx, it has doubled in the last two years.”
DrG – While no reason to panic, be aware that antidepressant drugs can cause liver damage in a small percentage of people who take them. If you are: elderly, take multiple prescriptions, drink significant amounts of alcohol, use/abuse other drugs, have liver disease or other toxic exposure, be careful with antidepressants. “All antidepressant drugs may potentially cause liver injury, even at recommended doses…”Antidepressant liver toxicity has been underestimated in the scientific literature,”…0.5% to 3% of patients treated with antidepressants may develop asymptomatic mild elevation of serum alanine aminotransferase (ALT) levels…Liver damage may occur between several days and 6 months after initiation of an antidepressant…Based on the evidence, the antidepressants associated with highest risk for hepatotoxicity are monoamine oxidase (MAO) inhibitors, tricyclic/tetracyclic antidepressants, nefazodone, bupropion, duloxetine, and agomelatine. Those with seemingly lower risks are citalopram, escitalopram, paroxetine, and fluvoxamine…antidepressants with a higher potential for hepatotoxicity “should be used with caution in elderly patients, in patients with coprescriptions, and in patients with substantial alcohol use, illicit substance use, or evidence of chronic liver disease.”
DrG – What improvements does “gastric bypass” provide for the liver? “Obese patients were studied before bariatric surgery (either sleeve gastrectomy or Roux-en-Y gastric bypass) and six months after surgery…bariatric surgery leads to a significant improvement in hepatic [liver] insulin sensitivity: insulin-stimulated hepatic glucose uptake was improved and endogenous glucose production reduced when measured, six-months, after surgery. These metabolic effects were accompanied by a marked reduction in hepatic volume and fat content.” All good improvements. Now if only it didn’t require mutilation of the digestive tract to accomplish!
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