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The Inexplicable American Consumer Revolts Against Prescription Drugs
Wolf Richter www.testosteronepit.com www.amazon.com/author/wolfrichter
Anecdotal evidence has been coagulating into numbers, and these numbers are now beginning to weigh down corporate earnings calls. It appears the toughest creature out there, the one that no one has been able to subdue yet, the ever wily and inexplicable American consumer, is having second thoughts about prescription drugs. And is fighting back. A paradigm shift.
We’ve already heard from some companies, such as drug maker Pfizer, whose revenues in the US plunged 18%, largely due to the collapse of its flagship drug Lipitor that is losing its battle with much cheaper generics. But the direst indications came from Express Scripts, the largest pharmacy benefit manager in the US—and perhaps one of the best gauges of spending patterns for prescription drugs.
During the earnings call, CEO George Paz, who ominously was “not prepared to provide 2013 guidance,” embarked on a dark speech. The company’s clients had “unprecedented concerns about our country’s economic outlook,” he said. Unprecedented concerns! So even worse than 2008-2009. He went on:
Our health claim clients are expecting membership reductions in 2013. Large employers have pulled back on hiring plans, using contractors and part-time employees when necessary. Mid to small employers are cutting back or postponing health care coverage decisions while waiting for more clarity on Health Care Reform. And we continue to see low rates of drug utilization as individuals deal with uncertainty at the household level.
He lamented “the current weak business climate and the unemployment outlook” and was worried about the “challenging macroeconomic environment.” Shorts must have felt a certain frisson. Remains to be seen whether the dive that Express Scripts shares performed is a buying opportunity that will add to a cushy retirement or one that will slice off your fingers.
But beyond the company’s fate, he’d pointed at what ails the US economy, including a shift to part-time workers and contractors often without healthcare benefits, and smaller employers who, in their struggle to survive, are cutting back on healthcare benefits. As these workers—the inexplicable American consumers—are left to their own devices, they have to make their own decisions about what prescription drugs, if any, to blow their scarce money on.
Express Scripts has seen this trend in another area. Its Drug Trend Report, which dissected prescription drugs sold to its members in 2010 and 2011, sketched the beginnings of the paradigm shift: in 2011, specialty drugs sales increased 17.1%, down from a 19.6% increase in 2010; traditional drugs only eked out a gain of 0.1%, the lowest increase since it began tracking the data; and spending on all prescription drugs combined rose only 2.7%, also a record low. That was for 2011.
But the report didn’t include insights into the buying behavior of the 48.6 million uninsured Americans who’re even more reluctant to spend money they don’t have on prescription drugs they can live without. And it didn’t include the trends of 2012, which as Paz phrased it, are cause for “unprecedented concerns.”
Whatever the reasons, whether prescribing behavior by doctors or buying behavior by consumers, lack of insurance or lack of money, or the growing prevalence of generic alternatives: spending on prescription drugs, long considered recession-proof, seems to have bumped into a wall for the first time ever.
Healthcare costs in the US, around $2.6 trillion a year, or 17.9% of GDP, may be reaching a level beyond which the various players in the economy cannot go, or refuse to go, a market-based barrier of sorts. And the inexplicable American consumer may be on the forefront—not only those who don’t have insurance, but also those who have high-deductible plans.
In 2012, plans with deductibles of $1,000 or more made up 19% of employee-sponsored health plans. Families covered by such plans, for better or worse, are cutting back medical spending ... by 14%, according to a study last year. They’re making medical decisions where at least one part of the equation is their own money. And they’re accomplishing what no one has been able to accomplish so far, namely taming the untamable healthcare expense monster.
That the US has too much debt is no longer a controversial statement. Some may believe other problems are more urgent, or that we need to grow our way out rather than slash spending. But the debt-to-GDP ratio must decrease if we are to have a stable, prosperous economy. Read... One Chart Explains Why Government Debt Is Dragging on the Economy.
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http://en.wikipedia.org/wiki/Kulaks
Great post. Ditched the wheat and lost 35 lbs. Easy. Wheat Belly...William Davis
The mineral content of our food is a fraction of what it was before Roundup/GMOs.
If our jobs and incomes are subject to global markets, why shouldn't our consuming habits be provided the same opportunity.
With medications, we in the US are footing the bill for pharma profits and lower prices to foreign countries. All of the EU countries have the gov't negotiate the price.
We're so fucking dumb that we don't realize "single payer" means single buyer, too. Many countries have semi-public/semi-privatized systems. A main money-saver is that the gov't negotiates medication prices.
A premier plan by BlueCross/BlueShield has a $6K deductible. The trick is that the employer fronts $3K/yr to spend first on the deductable, then the next $3K is on the employee.
People become real aware of keeping their maladies under $3K/yr.
If somebody has a chronic condition, they get hit for the premium + $3K/yr. It's a fuckin' shell game.
It's also easy to know what comes next, as the employer cuts their front money.
This is offered to small businesses. Therein lies the exquisite beauty of it. The $25K/yr employee doesn't realize they can't afford the insurance plan until after they are signed up and paying the premiums.
This is how you get insurance for everybody, with the kicker that they will avoid using it beyond $3K/yr.
And people thought credit default swaps were a clever innovation.
Yep, fuck'em. The only solution is to fucking destroy them.
Pig Pharma goes on a diet. About fucking time.
The profit from disease systems are the result of medicine actually being inside of militarism, but refusing to admit that. Therefore, the money took control over the medicine, but refuses to admit that. The positive feedbacks of making money from medicine have been amplifying themselves for over a hundred years! Those who make the most money can then use that to influence the political process the most, which then enable them to make even more money, and reinvest the profits from their frauds in even more frauds, by corrupting the political processes even more than before.
Those who promote more truth tend to make less money. Those who get away with frauds, including medical frauds, then are even more able to appear respectable, and to pay for more political corruption, and so, make ever more money. There was a long history whereby medical research and education was captured and taken control of by those who made money from doing so. There was another related long history of those who made the most money being able to capture and take control over the legislation and regulative bodies. Those things have become such extreme runaways, with such obvious bad consequences, that more and more Americans are belatedly becoming aware of those social facts.
As with the financial crises, these things have been more than a Century in the making, but have only reached the point where a significant number of people are aware of them recently, especially since the magnitudes of the accumulating problems have become so great than more and more people are being forced to notice how bad it really is!
That the profit from disease systems are the result of medicine being inside of the combined money/murder system should drive us to think much more deeply about militarism. IN FACT, the death controls being done through the profit from disease systems are an order of magnitude BIGGER in absolute magnitude than all the death controls overtly done in all the real wars! It has always been the case that, amongst the forms of death control, through crime, poverty and disease, becoming amplified to war, famine and plague, disease and plagues have always been an order of magnitude BIGGER than war and famine combined. If one is serious about the death controls and the debt controls, then the way that medicine operates inside of militarism, and therefore, the profit from disease business model, are the most important factors!
For more on this kind of topic:
http://www.marijuanaparty.ca/forum/showflat.pl?Cat=&Board=CMPmarijuanapa...
Stupid American schmucks. Your doctors and pharmaceutical companies are robbing you blind and you are too stupid to understand it.
I take nexium - 30caps, 40mg. In Australia the cost to me AUD$ 35.40. The cheapest American price I found was health warehouse on line US$203.08
Don't you understand you are being raped?
I am also in Australia. However, I eat food that we cook from fresh ingredients and never drink soft-drinks or eat quick-food rubbish. I am 62 and slim and I don't need crap like Nexium.
This guy is basically saying that he can buy poison more cheaply than Americans can. What a dummy!
When was the last time an Australian drug company developed and brought a new drug to the market? Foreign governments have allowed the US to pay the freight on R&D then implement price controls to put a ceiling on drug costs.
Christ. You fucking idiot, boasting about being on nexium. Do you not understand why the drug companies love the proton pump inhibitors so much? It's because you're on them for life. recurring revenue stream. All other acid-suppresing or neutralizing meds can be temporary. Not yours mate.
And you're fucking proud of it? Don't you understand you are being raped?
two years ago developed a chronic cough for 6 months. Trial and error over 3 months and figured it out to be esophageal reflux. Nixed all caffeine and most simple carbs for 1 week and knew i was getting better. After 4 weeks all symptoms were gone. Now able to drink coffee (2 cups a day) without recurrence. Lot better than proton pump inhibitors. Lot better, believe me.
PPI's as a class inhibit mineral absorbtion in the gut..not that this side effect is important..LOL just need to add more vits and min to your diet ..some in the medical community are slowly understanding this.
I used to be on Nexium/Zantac until I started taking Magniesium supplimets. Cured my sciatica and heartburn in about a week. We all have Mg deficiency.
Mg helps skeletal muscles relax, which takes pressure off your spinal disks.
vit D3 4000 to 5000 iu per day add mg++ if you have no renal disease (many DM pts do) and (Iodine..such can be gotten from kelp tabs)..you will drop weight, fight infection such as flu more effectively, and metabolize foods better improving DM outcomes for many..PS do not take anyone posting here for good Medical advice..do your own research- if you are on ZH I assume you can..good health in Mind and body..avoid hand to mouth disease (overeating)
added note: if you do not exercise all is for nought.
had a nasty sore throat/head cold last month. kept spraying the throat with chloraseptic
and got a bit of relief but certainly no cure. added some lugol's iodine to the chloraseptic
and was instantly cured.
http://www.amazon.com/J-CROWS%C2%AE-Lugols-Solution-Iodine-2%25/dp/B001A...
You are getting esomeprazole as an Authority item: If you were to pay the Private Script Rate the base price is still a cheap $45.79 (plus Pharmacy Mark-up, usually about 10% or $5 in this case). http://pbs.gov.au/medicine/item/3401B-8601Q.
If you were to switch to another PPI (such as Pantoprazole), you'd immediately save: Although the Authority indications are slightly different, the PBS cost (to you) is $26.74 MAX; Private script cost is $21.59 + markup, so a private script actually might be cheaper. Pack size is the same as for esomeprazole - 30 tabs. http://pbs.gov.au/medicine/item/8007K-8008L
This is why almost everyone's now switched to Pantoprazole - just as effective, costs far less.
Do you understand that that rape is done by law? It is illegal for Americans to purchase pharmaceuticals (in quantity) in foreign countries and then bring them home. The American consumer basically subsidizes R&D for the entire world.
Legal protectionism sucking uncle sams crooked dick is fanfuckingtastic business! Join the racket, or die.
Age 51 and do not use prescription drugs at all, no need. Exercise and eating right eliminates the necessity of popping pills in your pie hole. I take a multi vitamin once a day, that's it. If I ever need to have a pill tray for each day, I'd rather swallow a bullet. I rarely ever get sick, been at least three years that I can recall having a cold or the flu. And when I do, I take no medicine, and it's gone in a matter of days.
I have health insurance, but do not make much use of it. Been to a doctor once, in June 2012. Prior to that was in June 1987. Once again, a good exercise plan eliminates the need for doctors. Even Karl Denninger has been harping on this point for awhile now. When things go downhill in the not-too-terribly-far future, visiting the doctor is not gonna happen, austerity ya know.
Get in shape now while you still can.
I hope all them companies go out of business. It's coming soon enough anyhow. Pretty soon no one will be able to afford to eat, let alone pay for drugs.
same here. I feel better than I did in my mid 30's at 50. Cut out sugar, HFCS, MSG, put the bacteria back in my colon, organic greens every day, and exercise. Reducing stress is also critical.
I'm with you, except the methodology turns to shit as your body turns 65, 70, 75. And if you are not going for check-ups and tests, you are drawing a bullseye on yourself.
If you stay in shape and don't go to the physician, all you do is increase your probability that your dirtnap will come from something simple left go too long.
There was a interesting article in Time magizine, regarding a long term study comparing groups of people that went for regular checkups, and groups that never saw a doctor.
The mortality rates for the group who got regular checkups was HIGHER.
And people bitch about banksters.
The Obama administration cut a deal with big pharma to pass Obamacare but the Dems are really no worse than the Republicans, who under Bush forbade government agencies from negotiating on the price of medication.
My simple solution that really should be applied to all government purchases - a classic "most favored nation clause" requiring pharma to sell medication that the government pays for at a rate no greater than that paid by other countries, such as Canada, or negotiated by insurance companies. The USA would pay a little less and the rest of the world a bit more.
Worried about Pharma not having $ to develop drugs, increase their ability to deduct R&D costs.
It's not the R&D costs that are killing the Industry; rather it's the jaw-dropping bureaucracy imposed by Governments and their pet Agencies (think FDA), since "everyone has a right to TOTALLY safe drugs".
Sorry, there is NO SUCH ANIMAL. Aspirin kills nicely if used incorrectly. Prescription-only medicines are prescription-only for a reason - inadequate monitoring / dosage can (and will) kill, especially those popular with the elderly and not-so-elderly but unfit population.
Warfarin (for Atrial fibrillation) is the same stuff as used to be used as rat poison - and if you get the dosage wrong, it'll do you just fine: Same goes for Digoxin - one of the more toxic drugs out there (one of the narrowesr therapeutic indices of any drug) - overdose on that and you're off to the Mortuary unless you have access to specialist Medical care (and specialist (i.e. costly) drugs).
Becasue of the bureaucracies, "poor ROI" drugs - typically antibiotics, have seen a really significant drop in development , whereas R&D money has gone in to the better ROI area of chronic disease medications - your customer will be on them for life, rather than a few days, maybe only once of twice in their lifetime.
http://www.davolterra.com/content/antibiotics-wonder-drugs
When ICI (UK) developed Inderal (Propranolol), the height of the "pile" of regulatory documents "needed" then was the same as the height of the Eiffel Tower: When Wyeth developed Tigecycline (Tygacil) it was rumoured that the "pile" had grown to the height of the cruising altitude of commercial aircraft (30,000 feet).
This is why we're awash with generic copies of the drugs we really don't NEED (since lifestyle changes could eliminate their need in most (OK, not ALL) cases), yet we are facing the grim reality of a World without effective antibiotics.
Think this is hype? Maybe the following sites might help to re-educate you on the situation we're facing RIGHT NOW.
http://www.euro.who.int/en/what-we-do/health-topics/disease-prevention/antimicrobial-resistance/antibiotic-resistance
http://www.who.int/mediacentre/news/notes/2006/np23/en/index.html
http://www.biomedcentral.com/1471-2334/12/200
http://www.medicinenet.com/ndm-1/article.htm
http://www.nejm.org/doi/full/10.1056/NEJMp1011715
We all better start hoping that there ISN'T WW3 - this problem will survive even a nuclear war very nicely, and with no effective new antibiotics (and shortages of the "old" drugs) it won't be radiation / zombies you need to worry about, but it will be the infections arising from even minor, unnoticed injuries . . . . .
Very informative post.
Except to say that wafarin does not treat atrial fib, as nothing does. Warfarin and Plavix reduce the risk of blood clots forming when the heart is churning and not pumping, thus reducing the risk of stroke.
:D
Correct: Warfarin is used to reduce the risk of thrombotic events secondary to clot dehiscence, however from most Patients' perspective it's seen as "treating" their AF, which is why I took this particular liberty.
OK we don't often see cases of REALLY bad overanticoagulation (i.e. INR>30) but there have been a few, and asymptomatic at that, which is scary. At least Vit K can be a start (but FFP will be inevitably necessary).
Looked like Dabigatran might supplant warfarin (no testing needed - "one dose fits all" mentality), but with the fatalities slowly racking up maybe not the case!).
Personally I'd go for dual antiplatelet (Clopi and Aspirin) right now, since some long term outcome data suggests that it's as effective as Warfarin. OUr cardiologists are keen on using very low-dose Metoprolol to "rate manage" AF as an extra risk reduction, but getting Patients to cut a 50mg tablet in quarters is not particularly reliable from a dosage perspective . . . !
You might want to take a look at the data on clopidogrel (plavix) and cerebral bleeds. Not too encouraging.
As an earlier poster said, better off eating well and doing a bit of exercise. "Eating well", of course, means ignoring what the cardiologists say. They seem to be particularly ignorant when it comes to diet.
One thing I've learned from many years in the field of medicine. The fundamental tenet of the Hippocratic oath, "first, do no harm", is taken seriously by very few. The ones that do tend to be old and wise, and have learned the hard way. Every fucking drug out there can kill you. Medicine kills somewhere between 100,00 and 750,000 Americans annually. Or maybe more.
Caveat emptor.
It also heavily depends on what country the doctors are trained and practice in. US-trained physicians tend to be very heavy users of medical technology and very aggressive in their treatment plans. Best physicians I have ever encountered at making a diagnosis based upon a basic physical exam and talking to patients are Cuban physicians. Often have access to very limited/no sophisciated diagnostic imaging or lab tests and instead have to heavily rely upon basic like vital signs and patient history to make a diagnosis. Pretty amazed at watching them do their stuff when I was at a medical conference in Montreal.
Also baffled by the logic in this thread (and in every medical article on here it seems) that the common lay person is seemingly empowered and better informed to treat diagnose and treat themselves than trained medical professionals just because they have access to medical information on the Internet. Sorry but that is just a$$ backwards thinking.
You shouldn't take drugs unless you need them nor should you needly take antibiotics for a common cold especially if it is viral. Completely another to honestly think that almost all pharmaceuticals are 'poison' or scams that kill you.
After having struggled for the past year to figure out what was afflicting my mother (turned out to be a nephrotic lupus condition that was finally diagnosed at Columbia in NYC that is incredibly rare and only the 6th case in the US diagnosed with this particular genetic defenciency), even I couldn't keep up with all of the information I received. Thank God that my sister was a trained pharmacist and that I was able to consult colleagues in the health care industry. She is now on a medical regimen that has done wonders for her daily ability to function & perform basic activities instead of struggling to get out of bed certain days.
"take antibiotics for a common cold especially if it is viral'
Here's a trick question for ya. Colds are all caused by Rhinovirus variants. Thus, what % of colds are not caused by a virus? Would you have to be an idiot to take an antibiotic for either cold or a flu?
Unless of course you have idiopathic pulmonary disease, or fibrotic changes, or pulmonary hypertension, or Chronic Airways Limitation / Obstructive Lung Disease., or any other of the fairly vast umbrella of lung pathologies that can leave you predisposed to invasive colonisation.
If you're unlucky enough to be a CF sufferer, even a "minor" RSV infection can (and for many HAS) proved fatal, even in the era of "Modern Medicine".
It might be viral, but for many the risk is the secondary bacterial superinfection - and infection with an extensively resistant Klebsiella can mean a one way trip to the ICU for even a formerly healthy individual. . .
I think the point is that there are certain meds people take to make life BETTER, but aren't needed to SURVIVE. I take singulair and nasonex, which significantly improves my quality of life. Non-stop throat-clearing, sneezing, and itchy, watery eyes make me miserable! Do I need these to STAY ALIVE? No, but they make life better. I could save money and cut these meds out.
Similarly with cholesterol meds ... you ain't going to die today by not taking them, right? Consequently, people looking to save some bucks will not fill those prescriptions. I think that is the point of the article.
Basically, as the standard of living plummets, these Pharma companies that are benefitting from "non-essential" drugs will take a beating.
Diabetic will survive without insulin? Cases on statins is out but your dead wrong on the rate of fatal heart attacks and death due to cororonary events. Not a debatable point. Just go to the CDC figures on causes of mortality and see for yourself.
No one cares.
Thanks for adding to the conversation. Anything of substance to actually say on the topic?
maybe it's time for another "War on drugs" companies that is.
It is pretty easy to argue that the US healthcare system is the most bloated in the world from a cost perspective for several reasons. When you get down to it though, someone has to ration care whether it be the government throught an annual budget that caps expenses as national payer systems do or the private sector/insurers. Americans simply have been unwilling to accept this reality & as a result costs have exploded since the early 90s when Americans bucked against managed care.
It is even easier to argue that the US people are the most bloated from a FAT standpoint. FAT lazy slobs have lots of health problems. That's why US health care is 17% of GDP. Europeans, by contrast actually walk around a lot so their costs at only about 10-12% of GDP. Its really that simple! I try to visit my physician about once a decade and then just to shoot the breeze, so I'm subsidizing a lot of fat lazy slobs but its worth it to be fit and healthy.
Effects of obesity are tough to calculate (Ken Thorpe at Emory has done so) but the #1 reason is that the input costs are simply much higher across the board in the US for a couple of reasons. That's the reason why healthcare is so much more expensive.
Costs have exploded because of state based monoplies and regional codex established by Federal Guidelines. I like seeing people that have never actually studied the issue blab on about it though. It's nice hearing them tell us that we have to have more what drove the costs up in the first place to bring the costs back down. It's like you never sat down and actually read about how Insurance works in the US and who actually controls what.
Break up the Government/Insurance Cartel and your prices will come down. Slap the AMA off it's pedestal and they will get back into doing what they should be doing, competing.
I don't remotely know how this got 8 thumbs up. It says nothing specific excpet general vagaries (break up monopolies) and lessen gov't regulation.
Best comment on here. The AMA is in the fucking way! It is the root of shitty doctors and broken medicine.
I have a PhD in Health Economis and I have no idea of what you are blabbering about. Are you saying that there should a much greater supply of physician and medical personnel? No licensure requirements for physicians? AMA doesn't directly control either process right now anyways and frankly has lost a lot of its power as the number of physicians/DOs who are members has declined notably over the past 20-25 years.
As for allowing insurers across state lines, its effect would be marginal since local health market conditions are effected to a larger degree by provider consolidation tha insurere consolidation anyways.
AMA = crooked influence. Fuck them and fuck you and your bullshit phd in... basically nothing.
Nice try though.
It's a cabal. It's sleight-of-hand. The consumer doesn't even know how much something costs.
You may have a Ph.D. in Health Economics (is there such a thing...) but you're not opening your eyes to a basic and simple premise: stuff is way over-priced in medicine and that's because all the transactions are done behind closed doors.
An MRI costs $1500-$2500, not including reading fee? Fer reals? C'mon. At least be a little honest about it and stop talking your book.
:/
Always Make Money
I have a Ph.D. in Economics, and I am not aware of any respectful institution offering Ph.D. program in Health Economics. Do you mean to say that you are an econ phd with research focus in health economics?
There are several including the Health Management and Economics program at Wharton at Penn. PhD from University of Minnesota through the school of Public Health with a post-doc at Haas at Berkeley.
THANK YOU! Saw right through that spineless fuck, too.