McCamy Taylor's Journal
Member since: Tue Nov 9, 2004, 06:05 PM
Number of posts: 13,848
Number of posts: 13,848
Here is my fiction website: http://home.earthlink.net/~mccamytaylor/ My political cartoon site: http://www.grandtheftelectionohio.com/
Hi, I'm doing some research for a proposal about a patient education program sort of like the "Back to sleep" for babies---the one in which infants were put on their back in order to prevent SIDS---in which i am trying to find journal articles and studies that suggest that sleep can have certain specific beneficial effects and that certain sleep positions can have certain beneficial effects for adults. Some of the stuff I have come across is interesting.
If anyone wants the journal links for research send me a private message. Remember that most of these are retrospective studies. If the study is prospective with a control I will try to say so.
Most interesting to me (because I have an interest in infant mortality) 2013 study in Ghana, they asked women who delivered about their sleep during pregnancy, found a statistical association between 1) snoring and pre-eclampsia and 2) back sleeping (as opposed to side sleeping) and low birth weight and still birth. Association does not prove causality. Suggests that sleep disordered breathing (twice as prevalent among Africans and sometimes unmasked during pregnancy) could contribute to poor pregnancy outcome. Another reason to side sleep in pregnancy?
A recent prospective in which participants have serves as their own controls: the participants were given a regular nights sleep and allowed to choose unlimited food. They tended to choose healthy food in healthy calories. On the other nights, they were sleep deprived. After sleep deprivation, the same participants tended to choose high calorie foods with more fats---almost as if their body turned up its hunger thermostat in an attempt to make up for sleep deprivation. The moral here: If you are on a diet, get a good night's sleep or you will have a hard time sticking to the diet. Second moral, telling someone with severe OSA due to obesity "Just lose weight" may be sort of mean.
Another recent prospective study in which participants served as their own controls. After a full nights sleep, codeine had a certain effect for pain. After being sleep deprived, codeine in the same people with the same pain was less effective. Moral: if you have chronic pain issues, be sure to get enough sleep.
Another recent study, 115 people had sleep studies and A1c, disruption in REM sleep was associated with poor glucose control. If you use CPAP and throw the mask off in the middle of the night, this may be why your blood sugar is so high. Moral, dream sleep may do more than help us remember things.
And this review article might be interesting too (abstract below):
Do all sedentary activities lead to weight gain: sleep does not.
Chaput JP. Klingenberg L. Sjodin A.
Current Opinion in Clinical Nutrition & Metabolic Care. 13(6):601-7, 2010 Nov.
AB PURPOSE OF REVIEW: To discuss the benefits of having a good night's sleep for body weight stability. RECENT FINDINGS: Experimental studies have shown that short-term partial sleep restriction decreases glucose tolerance, increases sympathetic tone, elevates cortisol concentrations, decreases the satiety hormone leptin, increases the appetite-stimulating hormone ghrelin, and increases hunger and appetite. Short sleep duration might increase the risk of becoming obese, because it does not allow the recovery of a hormonal profile facilitating appetite control. Lack of sleep could also lead to weight gain and obesity by increasing the time available for eating and by making the maintenance of a healthy lifestyle more difficult. Furthermore, the increased fatigue and tiredness associated with sleeping too little could lessen one's resolve to follow exercise regimens. SUMMARY: Short sleep duration appears to be a novel and independent risk factor for obesity. With the growing prevalence of chronic sleep restriction, any causal association between reduced sleep and obesity would have substantial importance from a public health standpoint. Future research is needed to determine whether sleep extension in sleep-deprived obese individuals will influence appetite control and/or reduce the amount of body fat
I have sleep apnea, so I know the importance of sleep. But a lot of people who do not have sleep disorders treat sleep as if it is a luxury that only rich people with nannies can afford. Single mothers working and trying to go to school and trying to raise their kids may stay up late at night cleaning the house once the kids are asleep even though they have to get up at 5 am in the morning. What I am reading should be a warning to all of us. When you sacrifice sleep time so that you can do all the 1001 things you have to do each day, you are harming your health---and in the long run that will not do you or your family any good. Let the clothes go unfolded. Get your 7 or 8 or 9 hours of sleep.
Sleep is not a luxury. It is as essential as water and food. If someone told you that you do not "deserve" food you would laugh in their face. If someone tells you that you do not deserve sleep, laugh just as hard.
Posted by McCamy Taylor | Mon Apr 21, 2014, 05:42 PM (1 replies)
The GOP House is crying foul. Any day now, you can expect to hear armchair Republican quarterbacks claim that Obama should not get credit for the Eight Million enrollees in the Affordable Care Act---Obamacare, their choice of words, so they will have to live with it this fall when they plan to make the 2014 elections a referendum on Obamacare---because the GAO says that Health and Human Services Director Sebelius turned to private charitable groups that promote public health endeavors like universal health care in order to help roll out the ACA when Congress denied her necessary funds.
Republicans said such solicitations were meant to circumvent limits on government spending imposed by Congress. But in a report to Congress, the accountability office did not give a legal opinion on the propriety of the fund-raising. Administration officials said it was legal. Under federal law, they said, the secretary of health and human services can encourage support for nonprofits that promote public health.
Let’s read that again. No laws broken. Nothing to see here. Move along. But wait. Here’s Fox alleging all kinds of wrongdoing. As in someone inside the White House talked to someone at a charity. Eeks! Conspiracy!:
Sometimes, I really, really despise Faux.
How about this? How about we credit Obama and public health entities like the Robert Wood Johnson Foundation and the Kaiser Foundation for our lucky 8,000,000. And, while we are at it, let’s give a hand for Sebelius and all the workers on the ground who helped people sign up for ACA, even though many of their states (read Texas) under orders from their local politicians (read Rick Perry) tried to make it all but impossible for them to reach the goal line.
I like that number. I am going to repeat it again. 8,000,000. It has given the GOP a bad case of sour grape-itis.
And now a question for all you folks who have insurance, thanks to the ACA---thanks to Obamacare: how do you feel knowing that funds given by the Robert Woods Johnson Foundation may have assisted you in signing up for your new insurance?
Posted by McCamy Taylor | Mon Apr 21, 2014, 02:35 PM (1 replies)
Sorry in advance. This is not a "feel good" thread. This is not a human interest piece. This is not designed to make anyone feel warm and fuzzy. This is a word of warning. There is an industry that some may feel tempted to call out friend. However, this industry has spent the last two decades stabbing us in the back with very sharp knives over and over again----
In 1995, George W. Bush becomes governor thanks to Texas voters who mistake him for his dad. Texas is in the middle of an HMO crisis. Managed Care plans have seized control of health care from physicians. Patients and doctors are fed up, scared, and, in the worst cases, dying from lack of appropriate health care. The legislature passes the first Patient Protection Act to stop HMO abuses. It is overwhelmingly popular. Then Gov. George W. Bush waits until the legislature is out of session to veto the bill. It is his first controversial act as governor. The veto is so controversial that when the act is brought up again two years later, he allows it to go into law---grudgingly. During a debate with Al Gore in 2000, he brags that he is responsible for the passage of the Texas Patient Protection Act—a bald faced lie. Ceci Connelly, the health insurance industry’s date-for-money (the other word is so ugly) in the news media leads the Gore is a Liar Big Lie that year. She does not report on the Bush lie. Bush gets into office. Attorney General John Ashcroft is assigned the job of going to court to get the Texas Patient Protection Act---about which Bush bragged and lied in the debate—struck down in federal court. Bush has now managed to kill the Texas Patient Protection Act twice. The law is designed to protect patients from HMO abuses which deny them appropriate medical care. These abuses---denying coverage for drugs, denying referrals for specialists, tests and surgery, sometimes after the fact—are used by HMOs to reverse cherry pick---drive sick people off their plans since they are not allowed to refuse to sign up people with pre-existing conditions.
We all know that Enron’s fate depended upon the 2000 election. However, few realized that the health insurance industry was also in trouble. Huge trouble. The first time the White House and both Houses of Congress were under Democratic control, health care legislation would be passed. This was inevitable. Newt Gingrich had helped the industry dodge the bullet in the 1990s, but one day the Dems would have power. Connelly’s job was the delay that event. She served her corporate masters well. That is why she is in the private sector now.
Medicare was the big threat to private health insurers, because it was a model for single payer. Under Bush, they began their War on Medicare. Bush allowed private insurers to raid Medicare, giving them outrageous sums of money for taking care of cherry picked healthy seniors aka Medicare Advantage. He allowed Big Pharm to raid Medicare by coming up with Medicare Part D, the outrageous plan that forced Medicare to pay Big Pharm exactly what it wanted for its overpriced drugs. No bargaining allowed. Drug prices soared. Medicare spending rose. For the first time in decades, people began to speak disparagingly of Medicare.
In 2008, the unthinkable happened (for the health insurance industry). A Democratic grand slam. All they could do was bribe, bargain, threaten and wheedle Washington politicians into giving them a seat at the table. They could alter the Affordable Care Act, but they could not prevent it its passage. And so they said “Hey, come on. Give us a chance. We want this to work.”
Now, the health insurance industry is at a crossroads. It desperately wants to keep collecting premiums from healthy people—and shunting all the poor, sick and elderly people into government programs. That is their business model. They do not prevent disease. They never have. When people get sick enough, they lose their jobs, they can not pay their premiums, they go on disability and Medicare. If the ACA continues as written and is never changed, the private insurers will do fine---
Until some government bean counter notices that the federal government is doing most of the actual health care spending and the privates are collecting premiums but not paying out as much in expenditures. Until the bean counters notice that a lot of health insurance "expenditures" are actually meaningless internal Q&A--paper pushing. And, as health care spending grows and taxes grow and people demand tax relief, eventually the government will look at the private insurance company's profits and say "Do we really need this middle man here? We can collect premiums from healthy people and not pay out much in health care spending, too." And once that happens, the very next Democratic White House/ Congress combo will author ACA II---and the privates will be out.
What is a concerned health insurance industry executive to do? Play along with the administration in power, do whatever it takes to keep the GOP in charge of at least one House of Congress and try to get a friendlier party back in control of Health and Human Services in 2016.
Ok, you can start crying "Burn the heretic!" But please keep this in mind: Big oil likes the GOP but Big Oil will always have a buyer for its product no matter which administration is in power. Banking may prefer the GOP, but we will always need banks. The private health insurance industry---if you think about it, they are not essential to life as we know it on this planet. They have to work extra hard to keep their house of cards standing.
Posted by McCamy Taylor | Mon Apr 21, 2014, 01:13 AM (10 replies)
Divide and Conquer is the GOP's favorite tool. They use it to pit one labor group---say Latinos---against another---say Irish--against another---say women---against another---say Blacks. The message is "Sorry guys, I have to pay you shit wages and give you no benefits because those____ will work for so little. It ain't my fault. Blame the _____."
In politics, it happens when people who are basically like minded get distracted with infighting. As in
"I'm vegetarian but I drink milk."
"Shame on you! Only a strict vegan can call itself vegetarian. Heretic!"
There is nothing wrong with having a playful debate with your friends and colleagues. It's good fun, and it sharpens the debate skills for when you really need them---when you have to talk to some right wing a-hole whose idea of debate is to cut you off at a gazillion decibels so that you can not get heard. But please remember, the other side has a point, too. And everyone is right on this one and everyone is wrong.
I like Obama because he is a strong commander in chief who will keep me safe.
I like Snowden, because he is protecting our right against unlawful search.
In a big world like ours, we get along because lots of different people take stands and then they work in opposition to others who take stands that appear to be opposing but in fact they are part of a balancing act. Sort of like good cop, bad cop. Obama has a role to play. In his heart of heart, he wants us to be free from unlawful search too but he has to keep us safe. Snowden wants us safe, too, but that's not his job.
If you think of each man in terms of what he DOES and not what he represents, it gets easier. I had to come to terms with these things young. When I was 8, living in Austin, all my Mom's civil rights friends loved LBJ. And all her UT male draft age friends hated LBJ---hated him so much they were running off to Canada and chopping off their toes to avoid going to VietNam. Same man. Two different things he was doing. I remember talking about it will my third grade teacher. That conversation helped a lot over the years. I feel for the conflicted LBJ, trying so hard to do the right thing in a country where it is never easy to do the right thing all of the time for everyone. Juggling civil liberties and safety is touch. I challenge anyone to do it better than Obama.
Posted by McCamy Taylor | Sat Apr 19, 2014, 03:12 PM (11 replies)
Serious question. In this month's Texas Medical Association magazine, there is an article in which they warn providers that there is no way to know that a patient is actually covered by ACA insurance due to the premium payment grace period loophole. When the doctor and hospital call for eligibility, the insurer will say "Yeah, he is covered." The insurance is not required to mention that the patient is late with his last payment. The problem comes if the patient decides not to make last month's premium payment of $100 bucks after the surgery. If he never makes that payment, the health plan can then go back to the doctor and hospital and demand that all of its money be refunded. But before they take back the money they have to warn you "Your patient has not made a payment. Time is running out." If this happens, the article warns, doctors and hospitals are advised NOT to make the premium payment for the patient, at least that is the recommendation of the CMS.
Why not? What happens if you pay the $100 bucks for the insurance so that you get to keep the $5000 that you earned?
That is not a rhetorical question. CMS has said "Don't do it." Why not? Do you get hauled into court, charged with committing some kind of fraud? I.e "The patient only stayed in the hospital and had the life saving appendectomy because the hospital agreed to pay his $100 insurance premium. Had they not agreed to pay that premium, he obviously would have walked out the door and died." Yes, it sounds stupid. But replace "appendectomy" with something elective like "chiropractic manipulation" and maybe the insurance company has a case. According to Medicare, failure to do something as simple as charge a patient a copayment is "fraud" designed to drum up business and bilk the government out of money.
Lots of rural areas can not keep doctors or hospitals, because their poor and/or self employed residents do not have health insurance. In the 24 states that did not take the Medicaid expansion, rural areas are in big trouble. Is there any law that would prevent a rural county in Texas from coming up with the money to pay the additional premiums to buy all of its poor and uninsured citizens silver or even gold insurance under the Affordable Care Act?
How about large urban areas, like Dallas County, which often spend a lot of money running public health clinics for the uninsured? Could they legally pay the patient's portion of the insurance premiums for a private insurer?
Parkland is considering paying the Affordable Care Act insurance exchange premiums for some of its patients, a move that would help stem the tide of uncompensated care, WFAA reports.
Can Parkland in Dallas, which serves a huge population of sick lower income workers legally dip into its deep pockets and pay the premiums of its working patients who qualify for ACA so that it can then bill their ACA insurer for the care they receive at Parkland Hospital and its clinics? Keep in mind that a Parkland patient is not your typical patient. Your Parkland patient is the one that used to be called "uninsurable"--lupus, sickle cell, cancer, renal failure, heart failure--you name it. The privates hope that lack of money---i.e. the poverty that accompanies being chronically ill---will keep these folks off their plans in states that did not take the Medicaid expansion. They hope that they will be stuck on the so called "bronze" plans with high deductibles and no participating providers in their part of town and no drug coverage--so they never use their new insurance, they will just keep getting uncompensated care at their local Parkland. So, what happens if Parkland tells Blue Cross, Blue Shield "Here's your $50,000 check for this month's premiums for our 1000 patients who have you ACA insurance---and here's your bill for their $500,000 in care"?
We know that a third party without a financial concern can make the payments. And we know that insurers do not want any third parties making anyone's payments.
Three Louisiana health insurance companies have agreed to continue accepting federally-funded third-party payments for premiums, according to a statement from the LGBT group Lambda Legal, which with the New Orleans AIDS Task Force filed a federal class action discrimination lawsuit against the insurers.
Insurance plans will only make a profit under the ACA if the number of healthy people signing up outweighs the number of chronically ill people. In the United States, "Sick and Poor" is something you hear a lot, because illness and poverty go hand in hand. If you are too sick to work, you are poor. If you are poor, you can not well. That $50 to $150 means tested monthly premium may be all that stands between a private health insurer and bankruptcy---and it may be all the stands between life and death for one chronically ill individual.
Which matters more? The health of the health insurance industry that makes up the backbone of the ACA or the healths of the individual men and women whom the ACA is here to serve? Note: there is no answer to this one. It's just here to make us think. Life is full of hard choices.
Posted by McCamy Taylor | Mon Apr 14, 2014, 07:18 PM (6 replies)
I have known Opal for five years. In that time, her health has gone from not too good to pretty bad, but she is hanging in there. Or rather, she was hanging in there. I am a family physician at a county clinic for the uninsured in Texas, one of the 24 states that refused the Medicaid expansion. Our governor did everything he could to make the ACA rollout a failure. But nevertheless, Opal’s husband works, and he makes just enough to qualify for care under the Affordable Care Act. Great, right? Having some insurance is always better than having no insurance, right?
Like many urban areas, my county funds a public clinic for the uninsured. We pay for necessary medications, surgeries. We do screening colonoscopies. We do mammograms and immunizations. If you have a heart attack, you can get your coronary artery stented. If you get cancer, you can get your chemo. No deductible, no caps, no pre-existing conditions exclusions and while there are some medication copayments, you can get them waived. We don’t want to see anyone die for lack of $5.
The Medicaid expansion would have taken over the cost of running the clinic. Since Rick Perry thinks he has a shot at becoming Vice President, he said “No” to billions of dollars. Therefore, taxpayers in our states urban areas will continue to face double taxation---once to pay for health care for our own poor, once to pay for health care for the poor in the lucky 26 states that took the expansion. Tax payers in rural areas will continue to see their hospitals close and their doctors flee----but this is not about them. This is about Opal.
The county was told that the ACA’s so called “bronze plan” would allow its members to keep seeing their county doctors and getting the care they are used to receiving through the county. Opal and her husband were told the same thing. They were relieved. The bronze plan only cost them pennies a month out of pocket. The next cheapest plan would have cost them $100 a month---and people who live with chronic illness don’t have that much cash lying around. Once they signed on the dotted line. Opal and her husband---and the county—learned the truth. Opal now had insurance that had an enormous deductible. Her insurance would cover care only if it was prescribed by a tiny handful of providers---anyone who believes that HMO provider directories are accurate has obviously never dealt with an HMO. Anyone who believes that the people who sign you up for an HMO tell the truth has never encountered an HMO rep.
Opal needed her medication. Her medication cost $500. Opal did not have $500. Opal had not met her deductible. Her $5000 deductible. Opal had a heart attack. Opal went back to the county hospital. She is getting care again with her county doctors. Too bad it was that last little bit of her heart that she could not afford to lose. I wish you could hear the fluid in Opal’s lungs when she breathes. I wish you could see the fear in her eyes as she faces her mortality.
You can make some things right, after they get messed up, but you can’t put back dead myocardium or restore a dead kidney or replace infarcted brain. Yes, I love my party. Yes, I want to see it do well in the elections this fall and in 2016. But I am not going to keep my mouth shut and watch Opal and people like her get sick and die, because the ACA has as many holes in it as the god damned Titanic, and the GOP and the SCOTUS and the Tea Party is exploiting every last one of them.
So, if you want to go back to circling the wagons around the ACA, insisting that everything is just fine, go right ahead. You can even accuse me of not being a Family Physician and of not working with the chronically ill and uninsured. But if you try to accuse me of being a Bad Democrat, of not supporting the President, because I won’t keep my mouth shut, I have to ask:
What kind of Democrat would ask another Democrat to keep quiet about the suffering of the chronically ill? No Democrat, that’s who. The only folks who hate the chronically ill are the bean counters of the private health insurance industry. And they will do whatever it takes to make sure that those who make the mistake of signing up for their “bronze” plans get the hell back off---assuming that they don’t die first.
And that is no exaggeration. Though Opal’s name has been changed, for reasons of patient confidentiality. The fluid filled lungs, her fear, my anger---they are all real.
Posted by McCamy Taylor | Sun Apr 13, 2014, 11:28 PM (141 replies)
SUPER LONG Thread Warning: Enter at your own risk. If you have Fidgets Disease, be sure to take your medication first.
Before you start reading this, this is not a medical literature review of the pros and cons of any specific treatment for Hepatitis C. This is a study about how Things Are Done in the United States by Private Pharmaceutical Companies and Public Health Departments and Elected and Selected Political Leaders that have the potential to make a very few, very lucky people even richer than they already are. This is a medical economic case study of the Medical Industrial Complex. I am not alleging any illegal activities or ungodly conspiracies. Everything I am about to describe is 100% business as usual in the land of Greatest Health Care System in the World. Anyone looking for a conspiracy theory, move along. You don't have to break the law in order to make it rich in a land where Citizens United is the law.
Those who follow Big Pharm know that Former Bush Defense Secretary Donald Rumsfeld is a very savvy businessman. No, I am not talking about the petrochemical industry or the Military Industrial Complex. The Iraq War did not turn a profit for either Chevron or Halliburton, not when you consider the cost in dollars and lives to the people of the United States and Iraq. Corporate Welfare would have been much cheaper and more compassionate.
Rummie knows how to make a buck from the Medical Industrial Complex. He owned a lot of stock in Gilead which owns Tamiflu, which the US government stockpiled in 2005 under orders from W. during the scare over the possibility of a pandemic and which has become a mainstay of medical treatment for the various swine flu epidemics that have ravaged this country since 2009. Rummie's Gilead stock made him a very rich man.
Well, Gilead is about to strike it even richer. That is because in 2011, it acquired Pharmasset Inc., a company that makes, among other things, a new Hepatitis C medication, Sofosbuvir, which will be available in an easy to take one pill a day for eight weeks form (no more injections, yeah!). Supposedly, the cure rate with this one will be close to 100%. Supposedly, there will be fewer side effects. Definitely, it will require a 2nd and 3rd home mortgage to afford, because it is priced at a whopping $1000 a pill.
I can hear you through the ether-net. The manufacturer has to recoup the research cost. A thousand dollars a day is not too much to prevent my liver cancer. Thank God I just signed up for my new ACA Insurance/got my new Medicaid card. Thank God my doctor just tested me for Hep C. Oh, wait. I haven’t been in for a checkup yet. I’ll be sure to ask for a test. The Republicans might repeal the ACA.
This is not just about the cost of the pill. This is about some other things that have happened since Gilead acquired Sofosbuvir in 2011. Two other things to be precise.
First, in 2012, the CDC proposed that all Baby Boomers (born between 1945 and 1965) be screened for Hepatitis C. If you saw a doctor in 2013 for a routine checkup, you very likely had a Hepatitis C test done. And a few of you were surprised when it came back positive. Hepatitis C was not on your radar of things to worry about. Some of you probably were not even asked if you wanted it done. Your doctor talked to you, told you not to worry, your liver tests were normal. “And, in any case, there is a new, safe, effective treatment coming out.”
If you are lucky enough to live in one of the 26 states that took the Medicaid expansion, meaning that all its citizens have access to health insurance, you just got your Affordable Care Act insurance or your Medicaid this year. A Hepatitis C test is likely to be one of the things your new doctor orders, if you were born between 1945 and 1965. Your doctor is required to order it. Or at least ask you if you want the test done. It is now part of the recommended panel of health screens. And, if the test comes out positive, you will go online and look it up. You will be relieved to see that there are new drugs that the FDA claims are effective and safe. You will be dismayed when you see the price tag---$1000 a pill—but hey, that is what insurance is for, right? Which brings me to my Second point. Gilead’s new drug will be rolled out right as millions of Baby Boomers 1) get insured and 2) find out that they have Hepatitis C.
Now that is good planning. That is how you become a success in Big Pharm today. You identify your target, you create a demand, and you make sure that your target has someone else it can demand pay your exorbitant rate because no individual in his right mind is going to pay $1000 a pill for something that is not even bothering him, but if he can get it for “free” from his insurer or the government then “What the hell? Why not?” And the more asymptomatic, healthy individuals you treat with your drug, the better its profile will be and the lower the rate of bad outcomes will be.
Hint for people in the 24 states that did not take the Medicaid expansion. If you want the drug and you have no insurance, most drug companies have a compassionate use program that allows needy folks to get their drugs for free. Let’s see how compassionate Former Defense Secretary Rumsfeld’s old pharmaceutical company is.
Everyone else, be prepared for some hardball as insurance companies and those who manage public health care dollars wrestle with Gilead over sums of money that have the potential to bankrupt some healthcare plans. Not kidding. There are an estimated 15 million Americans with Hepatitis C (2/3 don’t know it yet). If we treat them all, that is $15 billion a day for 8 weeks. That is getting mighty close to…$2 trillion. And that is just the US market. Then there is Europe. And Japan, where all those poor women were given Hepatitis C tainted products after routine delivery. (see the Bloomberg link below if you have not followed this one) But wait. Japan has approved the competing drug, Simeprevir to treat Hep C. Yes, you read that right. There is competition. Yes, I know that competition is supposed to keep down prices. Imagine how much these drugs would cost if there was not a similar drug being released at the same time. $10,000 a pill? Thank God, Allah, Buddha and the Goddess for the Free Market system!
What about the third world? Gilead’s negotiating the price down in places like India. If they don’t, they knows India will make their own cheap generic. But in the US, Gilead has patent protection and can charge whatever you the taxpayer and insurance policyholder and your attorney think is reasonable. (Not a lawyer, so if I have the next bit wrong would welcome any free legal advice, hint, hint.) For the ERISA loophole---the one that limits damages against a health insurer that denies a treatment to the cost of the denied treatment in the event that something bad happens to you because of the denial of the treatment---probably does not apply to your new ACA insurance, which you are not getting through your employer. So, if your new ACA insurer says “No.” and you die of liver cancer, your new insurer could lose big in court. And Gilead knows it.*
I expect that the $1000 a pill won’t be the final offer. It is a flashy number that was probably chosen because it would generate a lot of media attention. And a new, one a day oral eight week treatment for Hepatitis C can not get too much free publicity right now, with everyone getting new insurance and everyone getting tested for Hepatitis C. I expect Gilead to show some compassion and bring it down to $400-500 a pill. A mere $1 trillion. From the US.
Not to make light of the costs of developing drugs. Forbes estimates that Big Pharm spends $12 billion per drug approved to get a product on the market. But Gilead did not make Sofosbuvir. It bought the company that made it.
Oh, and since no cost is too high to prevent your liver cancer, how about to prevent liver cancer in the guy who is in jail for breaking and entering? How about the guy who allows himself to be sent to jail for possession so that he can get the Hepatitis C treatment he cannot afford on the outside? You’re good with that, too, right?
In case you thought that this was the only Big Drug that is coming down the pipeline, Silly Rabbit, what's sauce for Gilead is sauce for every other pharmaceutical company. Expect a massive onslaught of new drugs that you and your family absolutely can not live without for conditions, some of which you did not even know existed---until now that some drug company is trying to get its piece of our country's annual $3.8 trillion (and growing!) health care spending. And you believed Glenn Beck when he told you to invest in gold. Sigh. I hope we have enough left to pay for vitamins for pregnant women and vaccines for babies once we are finished treating every child with Fidgets Disease and every man with Insufficient Machismo.
*Special plea to any lawyers out there. I know this is a tough one. Did ACA change the way ERISA affects lawsuits against employer sponsored health insurance? Did it expand ERISA? Close the loophole? You know the one I am talking about. The one that says that your Health Insurer can refuse to pay for your heart medication and if you die of a heart attack your family can only sue to get reimbursed for the cost of the pill, not your life. Because I cannot imagine Congress knowingly changing the Health Insurance industry’s favorite loophole, and if it stays the way it is, then once employers start providing more of the coverage then folks going to court to seek relief during disputes with their health insurance will find their options (including their choice of attorneys) limited, since the health insurer will only be responsible for the cost of the treatment, not the cost of the consequence of the missed treatment, including suffering and death.
Oh, look! <----A pumpkin smiley! Hmm. Did I take my pill for Fidgets Disease today?
Posted by McCamy Taylor | Sun Apr 13, 2014, 05:05 PM (1 replies)
"Mommy, what did you do during the 2008 Democratic Presidential Primary War?"
"Uh..I wrote shit online. Mostly about other shit that was being written."
"Because someone had to. It was not the corporate media's finest hour. Not their worst either. That was 2001-3, the "(Oil) Drumbeat to War". Oh, and 2000, "Gore is a Liar". And 2004, "Exit Polls are Reliable in the Ukraine but Not in Ohio." Actually, what passes for a 'free press' in this country has been neither 'free' nor a 'press' in a long time. More like Pravda, if Pravda, represented four or five giant financial consortia rather than one country."
"What's a financial consortia, Mommy?"
"They're the ones who try to pick your party nominee, honey."
"I thought we did that, Mommy."
"Silly, rabbit. What do you think this is? A democracy?"
Read about why you thought Edwards was a Phony and Hillary was a Bitch and Obama was a Scary, Scary Black Muslim in this collection of essays by yours truly from 2007-2008 which I call "Food Fight at a Monster Truck Rally." It's FREE at Amazon for Kindle for the next five days, along with most of my fiction. Your democracy is not free. It takes lots of work.
Posted by McCamy Taylor | Thu Mar 27, 2014, 08:21 AM (2 replies)
Warning! Long thread ahead! Travel at your own risk.
"No looking back on tomorrow...better think on today."
If you choose to read this, please listen to the music at the following link simultaneously. And if you don't want to read this, please listen anyway. This song is about a million times better than what I am about to write.
Peter Hammill performs the song "Flight" from his album Black Box, this is a live solo version, Hammill doing vocals (duh) and accompanying himself on piano. Video is someone's compilation (not live).
Now, on to the topic, which is...
Mammon or muse?
"Mammon and Muse walk into a bar..."
I have been listening to lots of Peter Hammill on You Tube recently. Which raises the question, where is the Peter Hammill Needs Money Police? You know, the folks who spend their time shutting down Internet bootleg? Apparently, Mr, Hammill is too busy writing, recording and performing to do it himself. Good for him. He survived his heart attack. May he live forever---meaning long enough---and keep writing and recording. Praise Gog.
And now, to the---no, not the, a ----as in one of many point(s), which is, how do we juggle the need to create art with the need to eat? This is an extremely loaded topic, right up with there with 1) Religion and 2) Politics on the list of Things Thou Shalt Not Talk About at the Thanksgiving Dinner Table Unless You Want a Food Fight.
I do not want to precipitate any food fights, so I am going to move this discussion to the far side of the Pacific Ocean. In Japan there is another term for mangaka. It is "richer than Croesus." Meaning that the people who create manga make a whole lot of money. Not like the US where DC and Marvel (now Disney) own your characters. That is why so many people create manga. So, consider two of the most successful mangaka, Rumiko Takahashi (Inuyasha) and Takehiko Inoue (Vagabond). It helps if you are familiar with their work. But if you are not, Rumiko's is sort of cutsie, shoujo-shonen-esque with so-so art, Takehiko's tends to be more mature, takes more risks, extremely inspired/technically competent art even by western standards. Now, Takehiko Inoue is on record as saying he does not care who posts his stuff on line and he even posts manga himself for free for fans (Buzzer Beater was an online manga). Rumiko Takahashi, on the other hand, has a rep as not tolerating any form of piracy--and that is saying a lot for a country that does not tolerate piracy. Keep in mind that both of them have more money than they will ever spend.
Where is this all going? The same place we are all going. No where. But, just to pass the time until we get there, I will step out on a limb and hazard a guess. I suspect that when Takehiko Inoue pens another chapter about swordsman Musashi learning universal truths from watching rice grow (Vagabond) or describing the struggles of wheelchair basketball players (REAL), he has a deep sense of personal satisfaction that makes the box office grosses ( I don't know if there is an equivalent term for this for manga) irrelevant. But when Rumiko Takahashi churns out another bit of Inuyasha clone, she is just going through the motions--in which case that royalty check is the carrot. But that could be----no, that probably is just my personal bias.
(And if you are not listening to Peter Hammill perform "Flight" please go click on the link.)
Now, for the counter argument. Think about Alan Moore, probably the most talented English language author alive today now that William Burroughs has gone off to the Western Land. Think about how the Comic Book Industry has used him. Think about Hermann Melville, whose Moby Dick, the greatest American novel of the 19th century was trashed by the British critics---who were not amused by the novel's themes of God-killing which is another form of anti-colonialism---and who therefore died in near obscurity. Think about William Blake, whose poetry was rescued by the merest chance---his Free Love agenda coincided with that of Victorian poet Algernon Swinburne. And no, I am not going to argue for a state subsidy for starving artists and poets. These writers received support----not financial support, moral support. They were and are the "Voice of honest indignation" (to quote Blake) which we so revere---
But you've gotta wonder. Worry and wonder. What Donnes labored and died in the cotton fields of Alabama, their words of beauty and wisdom lost forever, because it was illegal for slaves to learn to read and write? What Yeats are going unheard at this very moment, because they are too poor to afford a computer, and even if they had one, they don't have electricity in their third world hovel? All those rebels with a cause I mentioned above, those were and are all white guys with educations and good health and supportive families. When your life is a plane crash, how do you make yourself heard? What do you do if society does not give you a black box?
Ok, now read the lyrics to Peter Hammill's song that I hope you have listened to at least once or twice by now. But do not read the lyrics unless you have listened to him sing them, because he is a singer-song writer not a poet and the delivery is three parts of the poetry. (In keeping with the four paragraph rule I'll post two stanzas, I urge you to go read the rest yourself, the lyrics are from the album version, the live version is a little different):
It was then that I knew I'd been thoughtless -
What the hell did any of that stuff about mammon and muse and voices of honest indignation have to do with Peter Hammill's 1981 version of a song about a plane crash as a metaphor for life? If we did not have people willing to do art for art's sake, then we would not have so many works of art waiting to touch that nerve that needs to be touched when the proper moment arrives. As we do our forensic investigation, read the tea leaves, examine the entrails and consult the stars for the answers that will keep something like this from ever happening again, I suggest that we also examine ourselves, because if we do not know ourselves we can not hope to know anything. And because life is so very fragile and so very fleeting and because so many people with such beautiful stories were not gifted with beautiful voices, I recommend that we take time to listen and then tell those stories. If every work of art strove to be Grapes of Wrath rather than---say---Twilight---think about what the world might be.
"I can't tell you nothin'. You got to go there." John Steinbeck The Grapes of Wrath
Posted by McCamy Taylor | Sun Mar 23, 2014, 04:15 PM (1 replies)
Yes, this is a scary headline. Almost sounds sensational. It isn't. It is a cold hard fact. At this moment, if you are counting your pennies, trying to scrape up enough to pay for a $4 drug at Wal-Mart or Target, you can not afford an antibiotic that will treat your walking pneumonia---meaning that you could end up in the hospital saddled with tens of thousands of dollars in medical bills.
For years, doxycycline has been a valuable drug for physicians who treat the indigent --- unemployed or underemployed folks without insurance. A staple of $4 drug lists, it can be used to treat everything from bronchitis to "walking" pneumonia to urinary tract infections to skin infections to acne to venereal disease---and it covers some rarer infections like Lyme's and is sometimes used for malaria prevention, too.
For as long as I can remember--and I am pretty damn old---doxycycline, a twice a day form of tetracycline has been widely available and cheap as dirt.
And then, this winter, something surprising and very troubling happened. A patient with a list of medical problems longer than his arm and no income (he was still appealing a Social Security Disability denial) came down with bronchitis, possible early pneumonia--the two can be difficult to differentiate. I wrote him a prescription for doxycycline. He took it to the pharmacy. They wanted over $50 for it. He did not have over $50. He had $4. That was how much the drug used to cost at the same pharmacy.
He is not alone. Here is an LA Times Story about someone who had the same problem last year. Turns out that the difference can depend upon which generic drug manufacturer is making a specific medication at any given time. And apparently, right now, the one making doxycycline charges an arm and a leg for it.
A CVS pharmacist in Los Angeles, who asked that his name by withheld because of fear of retaliation by the company, shared with me the average wholesale price of different makers' doxycycline, as made available to pharmacists by the McKesson Connect online ordering system.
Mylan? Where have I heard that name before? Oh, yes. ALEC. As in "The Koch Brothers" and their corporate welfare mentality.
Where else have I heard of Mylan? Oh yes, the great lorazepam price fixing scandal.
The Federal Trade Commission approved a $100 million settlement with Mylan Laboratories, the largest monetary settlement in the commission’s history.
Mylan is now the third largest generic drug manufacturer in the world since it acquired an Indian generic drug manufacturer--meaning that it is in great shape to corner the market on these all important key ingredients needed for drug manufacturing.
Not so long ago, the nation watched as patent drug manufacturers paid generic drug makers NOT to produce their product---keeping drug prices high. Keep that in mind as you ask yourself why a drug as popular as doxycycline is in short supply. This is not one of those orphan drugs that no one wants to make because almost no one needs it. This stuff sells itself. The more that is made, the more we will see it used. Why isn't supply attempting to keep up with demand? Where is the bottleneck in the so called "free market economy"?
If this were a fictional mystery, I would now tell you why doxycycline has gotten so expensive that poor folks can no longer afford it. Since this is real life, I don't know. If someone out there knows the answer, please tell me. Meanwhile, when a patient without money and without prescription drug coverage comes in which bronchitis/and or pneumonia, I am going to be hard pressed to get him treated with what is currently available on most $4 lists.
Posted by McCamy Taylor | Sun Mar 9, 2014, 05:23 PM (48 replies)