Archive: March, 2013
Daniel R. Hoffman, Ph.D.
In 2003 Gerard Anderson of Johns Hopkins University and Uwe Reinhardt from Princeton, together with two of their colleagues, published a study that concluded Americans pay health care costs that are as much as four times higher per person than other advanced countries. Just this week, the International Federation of Health Plans (IFHP), a global trade association of insurers, updated those findings by concluding that the disparity has even worsened, so Americans now pay even comparatively more. The question is, why are costs here so much higher?
Anderson and Reinhardt asked that question and answered it in the title of their 2003 paper: "It's the prices, stupid." They first examined other plausible factors that could conceivably account for higher US health care costs. These included suggestions that Americans are sicker or visit doctors and hospitals more often or have longer hospital stays. All of these diversionary explanations, offered by apologists for our system, are bogus. American hospital stays, for example, are shorter than those in Germany, while we visit physicians less often than Canadians. Yet Germany's per capita health care cost is about half of what the US pays, while Canada's is 60% of ours.
So why are prices so much higher here? Anderson told the Washington Post's Ezra Klein, “Other countries negotiate very aggressively with the providers and set rates that are much lower than we do.” They do this either by the government setting prices, as in Britain and Canada, or by insurers aggressively negotiating with providers, as in Germany and Japan, while their governments reserve the right to set prices if the two sides fail to reach a satisfactory agreement.
Daniel R. Hoffman, Ph.D.
An email from a reader last week contained a link to an article (see here) about the FDA's proposal to ease the efficacy and safety standards for approving new Alzheimer's drugs. His terse comment was, "If it goes through, it will open great opportunities for snake oil salesmen."
His brief remark was on target. When a society depends upon a competitive market to develop its new therapies, a proportion of snake oil salesmen will inevitably enter the mix. That applies especially to conditions such as Alzheimer's, where the precise disease mechanism remains open to question and even a diagnosis depends upon an imprecise combination of imaging, laboratory and behavioral screens. That kind of uncertainty applied to most conditions in the 19th century. As a result, charlatans went around in covered wagons selling snake oil to farm towns and mining camps.
But jeopardizing the rest of society in order to make a buck is the holiest of core values in this country, so don't expect things to change anytime soon. For example, Judy Segal from the University of British Columbia compared old advertisements for nineteenth century potions to contemporary ads for prescription pharmaceuticals. While the ads for miracle elixirs and nostrums claimed to relieve such symptoms as fatigue, nervousness, constipation and general disappointment with life, "Drug ads today," according to Segal, "are much the same." Ads for Lydia Pinkham’s vegetable compound played on the same moodiness theme as Yaz, the same menopausal symptoms as Premarin, and the depression that Zoloft promises to dispel.
Michael R. Cohen, R.Ph.
In Chicago last month 16 elementary school children were taken to local hospitals with a sudden illness. The children were 9- and 10-year olds who began vomiting after eating “mints” given to them by a classmate. It was later found that these “mints” were actually nicotine replacement lozenges, called NiQuitin Minis. NiQuitin is a product from the United Kingdom that is sold online. Nicorette, which is made in the US, has a similar product. These are used by people who want to stop smoking. The classmate had found the lozenges at home and brought them to school to share.
These lozenges look very similar to candy breath mints like Tic Tac. The size and shape of the container is similar to other breath mints, and the container does not have a child-resistant cap.
You can see why children might assume that the “mints” were candy. Fortunately, none of the children were seriously hurt.
I'm in my 30s and starting to notice some of my teeth are yellowing. Is this normal? What are safe ways to whiten?
I'm in my 30s and starting to notice some of my teeth are yellowing. Is this normal? What are safe ways to whiten? Is there anything that I can do the slow down the yellowing?
Markus B. Blatz, DMD, PhD, is a professor of restorative dentistry, and chairman of the department of preventive and restorative sciences at the University of Pennsylvania, School of Dental Medicine
Natural teeth have a tendency to get darker as we get older. There are several more or less effective over-the-counter tooth whitening products and toothpastes available in drug stores and pharmacies that may be helpful in making your teeth lighter again. The most effective and safest way, however, is to do this under the supervision of a dental professional, who can assess the reason for the darkening and select the most appropriate solution.
Daniel R. Hoffman, Ph.D.
Big Pharma has been keeping itself afloat for some time on a number of myths. For several years, as investors saw the industry's business model breaking down, pharma tried to assuage them by perpetrating the myth that the emerging global markets (China, India, Russia) will restore earlier profit levels. Then in response to the general public's complaint about high drug prices, pharma spread the myth that such exorbitance is needed to fund research. More recently pharma has shown the vacuity of the myth that it is downsizing and decentralizing its operations in such a way that it can approximate the innovativeness, mobility and accountability of smaller biotechs.
If that last one ever contained even the slightest plausibility, recent events have shown it to be pure myth. Of course, the idea of large corporations with their soul-killing accountants and time-wasting procedures as impediments to creative science makes axiomatic sense. So it seems reasonable if Big Pharmas, trying to distract from the mediocrity of their new brands, would want to show they're at least trying to justify their enormous margins by modifying operations to develop better drugs. Pharma's leaders can then boast that they possess the good aim to hit the broad side of a barn by virtue of their desire to emulate the industry's smaller companies. Innovation and a fervid devotion to research are good qualities, after all, not to mention the fact that biological drugs are more immune to steep revenue losses when their patents expire.
Toward that end, GlaxoSmithKline (GSK) announced a few years ago that it was separating its R&D into several silos, giving the collectivity a chamber of commerce designation as Centers of Excellence. The idea was that each unit would need to demonstrate the accountability for results and the fervor of inspired biotechs. Shortly afterward GSK recognized that some excellent centers could prove to be mediocre, so they decided to fund the silos with reviewable grants instead of annual budgets.