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In the New Yorker today – HCV News April 24, 2014

Posted by voolavex in common sense, Economics, Health, health care, Medical, Social Issues.
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The day after my post: The Cure. Your Liver.  $84.000.  The brilliant financial author James Surowiecki, wrote a piece on the Financial Page (p23) in the New Yorker. entitled “Biotech’s Hard Bargain”.  I  am most grateful to read a piece on the cost of HCV in such a prestigious and well read publication.  He brings a much needed reinforcement to the arguments of others who find the $84,000 price tag distressing.  In his piece he points out that Medicare is forbidden to bargain for better prices for drugs and that private insurers  are very upset and pharmacy benefit companies are suggesting their customers wait for a cheaper “cure”.  Pharma has tremendous pricing power and this is  one of the lures for investors.  Rather than dropping price, pharmaceuticals actually increase.  Wonder leukemia drug, Gleevac, has tripled since 2001. I would strongly suggest you read Mr. Surowiecki’s piece and see for yourself.  Some people want to wait until it is cheaper, but others simply can’t wait – and are on donor lists in serious need of a fix of any kind.  I am grateful to have my observations reiterated in this post. Thanks James.  The New Yorker is online, on newsstands and in the library – I invite you to read the Financial Page and my own post. And I wish all of you good health – at a price you can afford. 

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Their Cure. Your Liver. $84,000? April 23, 2014

Posted by voolavex in Egypt, Health, hippies, Medical, Social Issues, solutions.
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I grew up in the age of “wonder” drugs.  New discoveries for diseases that needed eradication.  Dedicated researchers who  had devoted decades to finding cures.  Period.  In the words of Jonas Salk, when asked about patents for his polio vaccine, he replied, “There is no patent. Could you patent the sun” and with those words the Salk vaccine eliminated – for the most part, polio.  Albert Sabin developed the Sabin vaccine with the help of the Russians and it too was given freely – I received both while in grade school.  I have never had polio.  There was time when kids could not go swimming for fear of polio; couldn’t play with others for fear of polio and  people whose lives were lived in a contraption called an “iron lung” that breathed for them.  It was not a good thing.  The moral compass and integrity of Jonas Salk and Albert Sabin pointed in a different direction and they found a cure that was made available to everyone.  Polio is largely gone from the planet and with the efforts of the Gates Foundation may soon be simply extinct.

Doctors take the Hippocratic Oath which includes the words “First do no harm”.  I don’t think it includes the words – do not treat those with no money.  I could be wrong.  I am not certain what Big Pharma swears to do – but one thing it knows how to do is make money.  In my very skewed way of thinking if you are in the business of finding treatments and cures for deadly diseases, your motives should include making sure as many of those afflicted get them.  My first hint of the slippery, slimy slope Big Pharma had chosen were the TV and  print ads for prescription drugs – to the public.  I couldn’t figure out whyBig Pharma  was appealing directly to consumers for medications that had been the sole domain of the prescribing physician.  And the laundry list of side effects – read by a serious voice – was a legal requirement.  And scary.  In print it required pages.  Humans are gullible.  We want quick fixes.  Better, quicker fixes; an app for a cure.  Sneeze?  Wheeze, scratch, fidget, get the runs – watch and listen – an ad will tell you which med to “ask your doctor about”. (One appears to come with two free bathtubs but I am not sure). I have a suspicion doctors do not like to asked about these things. But Pharma spends a lot on consumer ads. Does this expand profit or eat into it.  Someone should ask.

It used to be that Baby Boomers, who were usually old Hippies, had the PDR or the US Pharmacopeia stored away in their heads somewhere.  I did.  In the 60’s we knew who made what and the side effects, the contraindications and the uses to which these meds were put. Words like “sulfate, hydrochloride, spansules, tartrate and indole rings” flowed poetically from many of us who chose an alternative lifestyle. And FYI – the “meth” we spoke of was not the meth cooked in kitchen and garages.  Ours came straight from drug companies; as my son used to say: “Back when drugs were good for you”.  He was not far wrong.  Such was our mindset.  Bad drugs were cocaine and heroin.  For me they still are.

Which takes us to 2014 and BIG Pharma – the profit stream that can mean life or death – your very own.

Recently a small “pharm” created a “cure” for Hepatitis C (for certain genotypes. and not a 100% cure – more like 95%).  It made it through clinical trials, appeared and appears to be very beneficial and was approved for use by the FDA.  Millions of us have this virus which didn’t even have a name before the 90’s.  Millions didn’t know they had it. Millions still don’t.  It is global. It is a slow progressor and can be asymptomatic for some and the virus is only interested in the liver.  Unlike HIV – it does not wreak the same havoc with the immune system but many with HIV also have HCV and this is a horrid situation.  Adding insult to injury.  Unlike HIV (in its early days) HCV is possible to acquire by anyone who might be exposed through blood transfer.  Unlike certain cancers it can afflict males or females equally.  So,unlike many more publicized viral infections it can get lost in the shuffle.  But if you have it – you could be facing cirrhosis, liver cancer or chronic fatigue and for many,  a liver transplant.  It is more complicated than this but that is a nutshell.

Voila!!! Someone finds a really effective oral treatment that can nail and rid many a body of it without the hideous side effects of previous treatments (interferon and ribaviran are two). A ORAL medication that is shown to be extremely effective, short regimen and now what?  Oh, now here’s the price tag for this: $84,000 for an 84 day course.  ACA, Medicare and insurance companies are not happy campers.  I am not a happy camper.  I have the right genotype and I have Medicare – but I am short about $84,000. Which brings me back to Big and small Pharma and their duty of care to cure if they can ,incurable diseases that will hugely reduce organ transplants, hospital care, rejection drug costs and generally better this country, both financially and medically .   Do they even have a duty of care or do they first shun no profit.  A drug company will tell us the costs for developing effective and important new drugs is astronomical – but who ever asks to see a breakdown of those costs?  Seriously.  The company I have in mind is publicly traded so showing investors a HUGE profit is, I suspect, far more important that cleaning up some sick livers.  The Pharm contrasts the $84K spent to the cost of liver transplants but if this drug can reduce dramatically the need for this procedure, it makes more sense to dispense it to more people.  And on the subject of liver transplants:  donor organs are just that – donated.  You cannot go to the doc and say – “okay let’s get me a new liver – when shall I come back” because you may never get one.  So a liver transplant v. a high percentage cure is not a bet I would take to my turf accountant.  I find it a specious argument.

 

But it gets better.  Oh yes it does. It is perfectly legal for Pharma to sell pricey drugs to foreign countries at very discounted prices.  Let’s say Egypt has a large load of cases of – let’s say – HCV – a pharm with a good product that can achieve maximum results can be had at a 90+% discount. Feeling edgy right about now?  There’s more. Individual state Departments of Corrections can choose to give their felons and bad folks, let’s say, a certain high result drug for about a $3750 per inmate pop.  So let’s say a slammer treats everyone – it could cost up to $315,000,000 to cover them all.  Which takes us back to the duty to heal.  The duty to cure.  The duty to care?  And my question is simply this: when does the humanitarian good exceed the addiction to profit.  For me, right about now.  It gets my goat.

Appreciation and Depreciation April 8, 2014

Posted by voolavex in common sense, freedom, Random thoughts, Social Issues.
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In a blinding epiphany last night, I realized that I am beginning to appreciate my life Accomplishments are not appreciation.  Accomplishments are simply the things you have done and they have a positive aura – but even robbing a bank can be a sort of accomplishment.  It is not so much the “aha” moments – but the number of them that snowball down the side of our individual middens as we careen through the years. And we do careen – I can’t walk a straight line in bare feet anymore.  Sad.  True.

In my case it was like suddenly understanding string theory or hearing the music of the spheres or realizing that all the crap I think is crap IS crap.  I no longer ask why we cling to our 2nd Amendment rights, nor shoot each other or serial kill each other – that’s what we watch on the screen.  Big, little, on demand, anytime – click and kill.  There’s an app for it.  But I now appreciate that this is what is happening and I can see it and despair or see it and know I will not change my direction due to it. For example; I do not own a gun.  The reason is simple.  Fear that I will use it.  Most people don’t actually think of this when they shy away from the gun issue.  They are afraid it will get into the wrong hands, they hate guns,  it won’t make a difference in the long haul.  Not me.  I am simply afraid I will not be afraid, I will be the wrong hands and I will use it.  My feeling is that to own a gun you must be willing to use it.  My fear is that I would.  So no gun.  But it is the appreciation of that knowledge that anchors me and lets me out of the whole argument.  Guns may not kill people, but people with guns do.  I am grateful I am not a bigot.  I like being a Jew.  I do not trust Putin. I know I am being watched. I treasure the right to vote and still get a frisson of joy when I do it. I do not miss having grandchildren (from my own kids).

As I really begin to appreciate these small things, other smaller ones follow.  I hate to go to movies.  Very simple.  I do not like to go. And I get so many arguments (not offers) and find myself using hackneyed phrases like “it’s not my cup of tea” – and this works because everyone knows what a cup of tea is.    I have no desire to own property. I have by and large always been a cliff dweller (as my mother would say) and I like apartment living. It’s not for everyone, but it is for me.  And all this appreciation is not always positive.  I realize that I was a very terrible mother – something two other adults know too.  And in the fullness of knowing comes the reality there is nothing I can do to go back and do better. Even though I know better.  But I do know it and I can say it and I know why it is true.  I don’t want to have a dog.  I do like the way many dogs look, but they are not an animal that lures me. For some this is character flaw – but it’s just what I know.As I know I like red meat. And these shocks of wisdom – as I personally depreciate and time becomes more scarce also allow me to let stuff go.  Like movie theaters, mortgages and dusting.  They allow me to read India (my preferred subject matter), mystery novels, genetics, Jewish history, and anything else whose title sounds alluring.   Because I appreciate that time does flow like a river and we all sink at some point as we float.

Is there a message in all this – kinda.  If you can feel the shocks of appreciation, wait for even more. You will get them and for the fortunate ones who do, they will lighten it up as you drift – the buoyancy will astonish you as it does me and you may even appreciate that our demographic may be the last who can do this and probably because there is no app for it.

Just One Day and So Many Fools April 1, 2014

Posted by voolavex in Social Issues.
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March went out with a short squirt.  April 1st is chilly.

I imagine most cogent people have some sort of love/hate relationship with the Internet.  I do. In our 15 year romance we have spent far too much time together.  I have found and met many people I would like to know better.  I have shopped online and thus no longer cruise the shops in general (sort of sad too).  I play far too much Angry Birds. But the downside is the information and lies I find everyday.  And I have figured out that it is possible to know too much about everything because everything known is not always knowledge. (Bet you wish you had used that one Rummy).  

Having been a Luddite spin doctor in the 80’s I know the value of the media and I also know how it is manipulated and used to make or break almost anything.  Put another way – the Internet has turned this  mechanical spinning into an acid trip.   We can eliminate the word “discovery” from our reality (assuming this is one) because there is nothing unknown under the sun or if there is you will know it in a second.  If this were coming from people with any sense of proportion or vestigial dignity – it might be okay – but it is a tabloid covered world.  And we are all susceptible to it.  If you say you are not you are probably deluding yourself.  Be careful – someone with take a picture of you in this state of mind and upload it somewhere and your dilemma will soon be the object of worldwide ridicule.  Viral.

Full disclosure:  I watch TV and I like TV.  I am torn between really enjoying the dramas I like but then wondering if they are actually training films for a specific audience.  I know I will not be quite as squeamish about autopsies. “Victim or perpetrator – it seems we are being watched.”  This does not come as a shock to me but I wonder why it comes as one to so many others.  As a species we are not a very nice lot.  The Internet is a dream come true. We covet and envy and want what is usually not easily available to us.  Technology, countries, oil, money in large amounts, sex.  As the ability to “spy” gets better and better and easier and easier – we have embraced spying with a vengeance.  But, in the words of Tom Lehrer – “always be sure to call it research”.  

Do the terms beta version, beta testing, focus group slink by you so often you no longer pay attention?  Not a good idea.  We are being made part of a global family of guinea pigs.  Every time a bank or  grocer or credit card gets a swipe from your “rewards” card – believe me they first reward themselves.   None of this comes to me as a shock.  Occam’s Razor – usually the simplest answer is the right one.  If any of those aforementioned places really wanted to reward us they would give better interest rates, sell goods at much better prices and dispense with the little plastic cards.  Businesses, the governments of the world, religions, arms dealers and even nice folks are finding out things about you that you thought were secrets locked in your own head.  Wrong.  We can fight it or yield to it but we have become so delighted to have these little perks that they will continue.  We will no longer be as surprised as we once were and we will soon eliminate naiveté from the world.  It still exists so enjoy it while you can. There is a preciousness to it – it’s in the eyes of a newborn creature but it doesn’t last very long.  In a not too distant future it will vanish and as we look back and try to regain the feeling it gave us – we will realize that for the last 15 years or so – everyday has been April Fool’s Day.