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President Trump Says He Will Lower Drug Prices???

5/18/2018

2 Comments

 
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Read NYT Article

On Friday, May 11, 2018, President Donald Trump announced a plan to provide Americans relief from high prescription drug costs. That’s not what is happening at all! President Trump is protecting the same players that he says he is attacking.

In response to the announcement, the stock of pharmaceutical companies, insurance companies, drug supply chains and middlemen have INCREASED. If this new plan of President Trump’s passes, the cost of Medicare Part D will go up, not down.  

If President Trump really wanted to lower drug costs, he should start by doing three things:

1. Allow Americans and American corporations to buy FDA approved medications from wherever they are sold (at local prices), and bring them into the United States.

Currently, it is illegal. The price of many U.S. medications can be ten to twenty times the price they are sold for in other countries. For example: menopausal estrogen replacement patches are approximately $120/month in the U.S. From the same manufacturer, they sell for 17 euros or about $20/month. The birth control Mirena IUD, sells for $100 in Europe versus $950 in the U.S. Cancer drugs are highly expensive in the U.S. as well.

2. Ban all prescription drug advertising in the public media. This is already the case in most parts of the world.

Americans have no idea how the financial aspects of U.S. healthcare really operate. For most of the 20th century it was illegal for prescription medications to be advertised to the public. Ronald Reagan changed that. He allowed prescription drug ads for freedom of speech reasons. This allowed the pharmaceutical industry to control the news. The news contains mostly drug ads, never revealing the real story of American medical care. Aside from the U.S., only New Zealand allows drug advertisements to the public.

We knew for a long time about the problems with smoking and health. Yet no progress was made in reducing smoking until cigarette ads were banned from the public media in 1968 — a year that had one of the highest smoking rates in America. Finally, the news media began spreading the truth about cigarettes and sickness.

3. Allow Medicare, all insurance companies and consumer groups to bargain with pharmaceutical industries for better pricing.

Right from the start of Medicare Part D (the drug plan initiated under President George W. Bush), Medicare was forced to pay full retail price for all medications. They were forbidden from negotiating better prices. Medicare Part D became a big boon for the pharmaceutical industry and a huge cost to U.S. taxpayers. Drug prices massively rose at a time when inflation was very low. This was a big driver of the rising costs of health insurance.

Drug companies claim they need the higher profits to pay for research. This is not true. Most basic research is paid for by the federal government. The drug companies then buy up the patents and sell the medications for huge profits.

These are not all of the changes needed, but minimally, they should be a necessary start. President Trump has proposed some other minor changes but it is still not correcting the cause of our huge price increases.
2 Comments

Why Are They Frightening American Women?

12/14/2017

0 Comments

 

Many Modern Contraceptives Still
Linked to Breast Cancer, Study Finds

NY Times, 12/7/2017

Picture

Read NY Times article

You can’t just read the headlines. You have to dig into the details of the story.
 
When I saw this headline, I was curious and skeptical. Birth control pills have been around for over fifty years. They have been studied many times and they are associated with slight or no increase in breast cancer. They have the benefit of reducing endometriosis, endometrial cancer and ovarian cancer. They give women control over their reproductive lives. Mostly, the benefits outweigh the risks. What do they mean “STILL” linked to breast cancer? Any linkage to breast cancer has been weak at most.
 
The study was done in Denmark where everyone is part of  the national health service. So basically the whole population is the study group. Novo Nordisk, a drug company, conducted the study.
 
The study indicated that for every 100,000 women not on birth control, 55 women per year were diagnosed with breast cancer. For every 100,000 women using birth control, 68 women were diagnosed annually with breast cancer. Women who had used Progestin Implants and the Mirena IUD had the same numbers as the women who took oral contraceptives.  
 
The article stated that the longer a woman is on the birth control, the higher the risk of her developing breast cancer. It has been known for decades that women who have more children and breastfeed have lower risks of becoming diagnosed with breast cancer. I suspect women who take contraception for many years probably experience fewer pregnancies, births and breastfeeding. These small differences could simply be due to women having fewer babies and not based on the contraceptive method itself. In studies conducted in the 1960s, Irish nuns had higher rates of breast cancer than Irish women who had many children. I am assuming the nuns were not on birth control.
 
Another issue supporting this idea is that the results were the same for all of the birth control methods used. If synthetic hormones were the problem, the results should have varied with different methods and doses. The implants and IUD are progestin only, with no estrogen. The IUDs have only a tiny amount of progestin which acts on the uterus directly. I have tested the hormone levels of many women on the Mirena IUD and concluded that the IUD had minimal effect on the woman’s own hormone production.
 
Women with estrogen/progesterone receptor positive breast cancers have only a 15% mortality rate. 85% never die of their breast cancer. This means that any additional number of women actually dying of breast cancer would be quite small. Some women also die from pregnancy complications. If women become frightened of using these birth control methods, they are at an increased risk of the consequences for any unintended babies or undesired pregnancies.
 
Just because there is a “statistically” significant difference between two groups does not mean that the difference is meaningful for the women involved. If you buy two lottery tickets instead of one, it is true that you double the opportunity to win. But if that means you go from one chance in a billion to two chances in a billion, your odds haven’t changed in a meaningful way.
 
Novo Nordisk is a global healthcare company that focuses on diabetes care. Why did they fund this study? Is there some marketing reason why they want to frighten women away from using contraception?
 
I am not arguing with statistics or the numbers in the study. I just find the conclusions and suggested actions to be questionable.
 


0 Comments

An American Sickness: How Healthcare Became Big Business and How You Can Take It Back

11/20/2017

1 Comment

 
An American Sickness How Healthcare Became Big Business and How You Can Take It Back

At the recommendation of one of my patients, I have recently read An American Sickness, by Elisabeth Rosenthal, MD. Dr. Rosenthal is a Harvard trained physician and also worked as a medical reporter for the New York Times.

Ironically, some of the information pointed out in Dr. Rosenthal's book are stories I have been telling my patients for years. It is not about how to stay healthy or how to stay out of the medical system. This book is about the business of American medicine. It is intended to give the layman understanding of the financial aspects of our medical system and what an individual can do in self defense. Dr. Rosenthal also provides ideas of what people should demand from their senators and representatives. No one in Washington (of either party), seems to be working for the public. They are working for the many big financial players in a 3 trillion dollars a year business that makes up nearly 20% of the entire U.S. economy.


Dr. Rosenthal discusses why Americans pay so much more for their medical care than it costs in any other developed country. It is meticulous in its history about where we were years ago and how we arrived at the current state of affairs.

The book also includes the development of American health insurance companies, why insurance is so costly, and why it is beneficial to insurance company profits for medical costs to go up and up, but not down.

Also discussed is the growth of the pharmaceutical industry and legislation that has led to huge increases in the cost of medications. Dr. Rosenthal points out why our prices are so much higher than anywhere else on the planet. She also discusses why drug advertising was only relatively recently permitted in the U.S. Only the U.S. and New Zealand permit pharmaceutical ads to the public.

Hospital costs and billing practices are examined and why hospital bills are so incomprehensible and how they became so high.


Other topics cover what drives some physicians to choose medical procedures and practices that maximize their income and patient’s costs. Even the location of where procedures are performed can have huge effects on pricing!

She also discusses the pharmacy business and how they increase drug costs for the patients. Rarely do Americans shop for medications like they would for many other products.

Most importantly, Dr. Rosenthal gives instructions and reference materials for patients to help get control of their own medical costs.

I am not sure that Dr. Rosenthal understands deeply the flaws in the medical education system and how doctors are being taught to treat patients. She does not discuss how the professors of medicine are now tied in deeply with the pharmaceutical and equipment industries. Still, this book is very well documented and would be an eye opener, not only for most lay people but even for most medical professionals.

I highly recommend it.
1 Comment

    Robert P. Goldman, M.D.

    Dr. Robert P. Goldman provides guidance for female and male hormone balance, menopause management, holistic therapies and routine gynecological care.

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