![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 25. This is the beginning of the thread.
Posted by stan_the_man70 on February 20, 2015, at 2:21:50
http://www.alternet.org/personal-health/are-americas-high-rates-mental-illness-actually-based-sham-science
--------------- quote reference---------------- snippets from article below
About one in five American adults (18.6%) has a mental illness in any given year, according to recent statistics from the National Institute of Mental Health. This statistic has been widely reported with alarm and concern.
But what NIMH quietly made disappear from its website is the fact that this number actually represented a dramatic drop.
Already, we have to wonder how significant a lot of these mental illnesses are, if they dont at all impair someone's functioning.
But if some depressions or anxieties last only a week or month, then its possible that at any time as few as 1-2% of the population are mentally ill.
But even that number may be overblown. Thats because these national-level statistics come from surveys of the general population using mental health screening questionnaires that produce extremely high false positive rates.
The politics of "mental illness"
Why is 18.6% the going rate of mental illnesses in America? SAMHSA's report takes many pages to explain all the adjustments they made to arrive at the numbers they did. However, its easy to imagine why they'd avoid going much higher or lower. If SAMHSA scored 90% of us as mentally ill, how seriously would we take them? Conversely, imagine if they went with a cut-off score that determined only 0.3% were mentally ill, while the rest of us were just sometimes really, really upset. How would that affect public narratives on Americas mental health crisis and debates about the importance of expanding mental health programs?
However well-meaning, the professional mental health sector develops such statistics to create public concern and support for their positions, to steer people towards their services, and to coax money out of public coffers. These statistics are bluffs in a national game of political poker. The major players are always pushing the rates as high as possible, while being careful not to push them so high that others skeptically demand to see the cards theyre holding. This year, 18.6% is the bet.
-----------------------author
Rob Wipond is an investigative journalist and News Editor for the website Mad In America.
Posted by stan_the_man70 on February 20, 2015, at 2:56:51
In reply to Why is 20% of the population mentally ill ?, posted by stan_the_man70 on February 20, 2015, at 2:21:50
http://www.alternet.org/drugs/pharma-drug-bankrupting-america
----------- reference quoteThe Pharma Drug That Is Bankrupting America
How can Gilead Sciences charge $84,000 for a drug that costs less than $300 to produce?
The basic facts are these. In December 2013, the Food and Drug Administration approved Sovaldi, and another formulation, Harvoni, which is sofosbuvir used in combination with another drug. Gilead set the price for a 12-week treatment course of Sovaldi at $84,000, amounting to $1,000 per pill. Gilead set the price of Harvoni at $94,000.
According to researchers at Liverpool University, the actual production costs of Sovaldi for the 12-week course is in the range $68-$136. Indeed, generic sofosbuvir is currently being marketed in India at $300 per treatment course, after India refused to grant Gilead a patent for the Indian market. In other words, the U.S. price-cost markup is roughly 1,000-to-1!
Posted by stan_the_man70 on February 20, 2015, at 4:57:09
In reply to Why is 20% of the population mentally ill ?, posted by stan_the_man70 on February 20, 2015, at 2:21:50
http://www.alternet.org/food/coffee-illusion-what-magic-brew-really-does-your-brain
-------------- quote referenceFood
The Coffee Illusion: What the Magic Brew Really Does to Your Brain
If youve been drinking coffee for a while, you arent getting nearly as much out of it as you used to. You're just curing an addiction.
By David McRaney / AlterNetFebruary 17, 2015
The Misconception: Coffee stimulates you.
The Truth: You become addicted to caffeine quickly, and soon you are drinking coffee to cure withdrawal more than for stimulation.
Mmmm, a warm cup of coffee with delicious cream, topped with a frothy head.
You smell it brewing and feel cozy inside as you browse cakes and brownies, scones and biscotti.
You get some of it in you, and you feel alive again you feel superhuman.
Suddenly, you feel like John Nash, you cant keep up with your own mind as geometric symbols float over the magazine articles in your lap. Someone strikes up a conversation about health care, and suddenly everything youve ever heard about the topic is at the tip of your tongue.
Damn, coffee is awesome.
Except, of course, much of this is an illusion.
The truth is, once youve been drinking coffee for a while, the feeling you are getting after a cup isnt the difference between the normal you and the super you, its the difference between the addict before and after a fix.
Ok, this is a very simplified explanation:
Caffeine is an adenosine antagonist. This means it prevents adenosine from doing its job.
Your brain is filled with keys which fit specific keyholes. Adenosine is one of those keys, but caffeine can fit in the same keyhole.
When caffeine gets in there, it keeps adenosine from getting in.
Adenosine does a lot of stuff all throughout your body, but the most noticeable job it has is to suppress your nervous system. With caffeine stuck in the keyhole, adenosine cant calm you down. It cant make you drowsy. It cant get you to shut up.
That crazy wired feeling you get when you drink a lot of coffee is what it feels like when your brain cant turn itself off.
To compensate, your brain creates a ton of new receptor sites. The plan is to have more keyholes than false keys.
The result is you become very sensitive to adenosine, and without coffee you get overwhelmed by its effects.
After eight hours of sleep, you wake up with a head swimming with adenosine. You feel like sh*t until you get that black gold in you to clean out those receptor sites.
That perk you feel isnt adding anything substantial to you its bringing you back to just above zero.
In addition, coffee stimulates your adrenal glands, which makes you feel like you could take a bullet and eat glass. When the adrenaline runs dry, you feel like youve been running a marathon, which leads you to look for more coffee to get those glands pumping again.
After a few rides on the adrenal roller-coaster, you crash.
You might think all of this probably takes a while, but it takes about seven days to become addicted to caffeine.
Once addicted, you need more and more coffee to get buzzed as your brain gets covered in receptor sites. Neurologists report seeing patients regularly who drink two or three pots of coffee in one sitting before starting their day.
Coffee also releases dopamine, the feel-good chemical in the brain which is released when you have an orgasm, win the lottery and shoot heroin. A similar addiction cycle with dopamine leads to depression and fatigue when you arent hitting the beans.
Finally, caffeine takes about six hours to leave your system. So if you drink coffee six hours or less before going to bed, you wont reach deep sleep as often. This means you wake up less rested, and need more coffee.
If youve been drinking coffee for a while, you arent getting nearly as much out of it as you did in the beginning. You are just curing an addiction.
The take home is that regular use of caffeine produces no benefit to alertness, energy, or function. Regular caffeine users are simply staving off caffeine withdrawal with every dose using caffeine just to return them to their baseline. This makes caffeine a net negative for alertness, or neutral at best if use is regular enough to avoid any withdrawal.
- Neurologist Stephen Novella from his blog, NeurologicaMind you, this is not a dependency. You will experience withdrawal symptoms upon cessation, but not like with amphetamines and cocaine.
Coffee doesnt seem to affect the dopaminergic structures related to reward, but before you breathe a sigh of relief, ask yourself how long youve been drinking it. Try and stop for two weeks and see how hard it is.
A cup or three will still give you pep, but as with all stimulants, over time you need more and more to reach that golden hum.
Posted by stan_the_man70 on February 20, 2015, at 5:27:44
In reply to coffee illusion - sounds familiar ?, posted by stan_the_man70 on February 20, 2015, at 4:57:09
http://www.alternet.org/personal-health/5-ways-improve-performance-your-brain
----------------- reference linkPersonal Health
5 Ways to Improve the Performance of Your Brain
These activities will enhance your brainpower.
By Norman Doidge / The GuardianFebruary 16, 2015
It used to be thought that the brain was hardwired and that, unlike other organs, it could not repair itself or restore lost functions once damaged or diseased. Now we know that, in fact, the brain is neuroplastic that activity and mental experience can be used to change the structure of the connections within it. These new principles are being used to radically improve, and even sometimes cure, some brain problems that were previously seen as irreversible and some of them can also be used in everyday life to improve our brains health and performance. Here are five things to try.Walk two miles a day
Learn a new dance (or language or musical instrument)
Do serious brain exercises
(https://secure.brainhq.com/)Pay close to attention to your voice
Get the rest your body requests
Posted by linkadge on February 20, 2015, at 21:17:34
In reply to coffee illusion - sounds familiar ?, posted by stan_the_man70 on February 20, 2015, at 4:57:09
While this argument makes sense logically, it is overly simplistic and not supported by current research. While it is true, that your brain might adapt to the adenosine blocking effects of caffeine (in terms of dopamine release), caffeine is actually neuroprotective and can raise the activity of brain growth factors like BDNF (even after long term administration). Also, coffee is far more than simply caffeine. It contains other antioxidants, polyphenols and plant based compounds (such as caffeic acid, beta carbolines) which can improve brain function both after short, and long term administration.
Several studies have been done to investigate the impact of coffee and tea intake on cognitive function over long term administration. Coffee has been shown in some studies to preserve cognitive function, reduce Parkinson's disease, reduce the risk of depression and suicide lower the risk of type II diabetes (also linked to cognitive decline) improve blood lipid profiles, and reduce the risk of certain cancers.
While I agree, that some of the benefits of coffee (esp. caffeine) as a stimulant, may diminish over time, other brain benefits appear to continue and even strengthen, depending on the duration and level of coffee consumption.
Linkadge
Posted by stan_the_man70 on February 21, 2015, at 1:20:12
In reply to Re: Not true - sorry, posted by linkadge on February 20, 2015, at 21:17:34
Thanks for the reply ! I agree with the points you made...
So, if it's not only the caffeine causing problems/jitters, then drinking decaf would probably still provide benefits but in a different way. In case of cognitive impaired patients has it helped to take a caffeine boost? I remember reading about a study where elderly patients were given nicotine shots and how it helped.
Coffee contains chemicals. So maybe coffee could structurally affect the brain and rewire neurons. I guess there are other activities such as exercising that would provide similar benefits without the chemicals. I posted this article because I was trying to find similarities - I mean if people get used to coffee and have such effects then maybe psychotropic drugs also do similar things. Question is - how similar and how different.
Posted by linkadge on February 21, 2015, at 7:59:17
In reply to Re: Not true - agree » linkadge, posted by stan_the_man70 on February 21, 2015, at 1:20:12
I think there is evidence that even decaf coffee provides certain health benefits. For instance, in mice decaf coffee extracts still provide some neuroprotective effects against say glutamate overload or the injection of neurotoxic substances.
In terms of overall health, I don't think any single drug or food can replicate the effects of exercise.
In terms of mental health, there has been some look into whether coffee behaves like an "antidepressant" or not. From the studies I have read, it appears works like an antidepressant in certain forms of depression but not all. It is probably an effective self medication for some mild / moderate forms of depression. For example, it does contain compounds called "beta cabolines" which can inhibit monoamine oxidase (like the antidepressants parnate or nardil) to a measurable extent.
I think the key is moderation. A quality diet plus meaningful exercise is a foundation. Medication is still likely necessary for clinical mood disorders, but there is no reason to avoid coffee (unless an individual has a negative reaction to it). And, as noted, it may in fact protect against suicide (a few studies have shown a reduced rate of suicide among coffee drinkers).
I would assume that daily coffee consumption would not be a bad thing in the elderly with memory issues. While it may not prevent dementia or Alzheimer's outright, I think there is some belief that it still provides a subtle protective / restorative effect.
As mentioned, coffee consumption has been linked to lower rates of Parkinson's. Parkinson's is often linked to memory, attention and mood issues in its own right.
As a suggestion, if you are a heavy coffee drinker, I would try to drink organic coffee since coffee tends to be a highly pesticided crop.
Linkadge
Posted by ed_uk2010 on February 22, 2015, at 16:36:50
In reply to The Pharma Drug That Is Bankrupting America, posted by stan_the_man70 on February 20, 2015, at 2:56:51
Sovaldi is horrifically expensive but it's also a novel and immensely valuable treatment.
With respect to bankrupting America, why are you guys putting all and sundry on $$$ Crestor when other countries reserve it only for those with severely elevated cholesterol resistant or intolerant to other statins.Over here, generic atorvastatin (Lipitor) costs the health service little more than £1 to treat a patient for a month..... and this is a very effective and well-proven statin. Routinely using Crestor instead (rather than 2nd or 3rd line) would waste millions.
Don't even get me started on Nexium...
Posted by ed_uk2010 on February 23, 2015, at 13:58:25
In reply to Why is 20% of the population mentally ill ?, posted by stan_the_man70 on February 20, 2015, at 2:21:50
>About one in five American adults (18.6%) has a mental illness in any given year....
I think it's rather unfortunate that the 'mental illness is extremely common' propaganda, which has probably made it more 'acceptable' to have a mental health problem, has also potentially trivialised mental illness in the eyes of the general public. In the past, psychiatry was often associated with negative concepts of 'crazy people' locked up for years in state mental institutions. Now, we run the risk of creating the impression that it's something minor, which most people have from time to time... and which can usually be fixed by popping a pill in a shiny new box.
Posted by Robert_Burton_1621 on February 26, 2015, at 19:01:56
In reply to Acceptable vs trivial » stan_the_man70, posted by ed_uk2010 on February 23, 2015, at 13:58:25
> >About one in five American adults (18.6%) has a mental illness in any given year....
>
> I think it's rather unfortunate that the 'mental illness is extremely common' propaganda, which has probably made it more 'acceptable' to have a mental health problem, has also potentially trivialised mental illness in the eyes of the general public. In the past, psychiatry was often associated with negative concepts of 'crazy people' locked up for years in state mental institutions. Now, we run the risk of creating the impression that it's something minor, which most people have from time to time... and which can usually be fixed by popping a pill in a shiny new box.
>This comment, Ed, is lapidary. I agree with it entirely. Putting aside for the moment the commercial interests of pharmaceutical companies in disease-mongering and the loose diagnostic criteria authorised by the DSM, the general problem seems to be partly driven by people with, or who consider themselves to have, very good intentions, promoting the exaggerated statistics as a means, almost as a form of political obligation, to destigmatise conditions which they rightly observe are often sources of shame. But the strategy of destigmatisation is frequently pursued by seeking to "normalise" the prevalence of the conditions, and by a programmatic scepticism (which presents itself as a form of sophisticated insight evidencing an admirable lack of prejudice) to disabuse the general public that the conditions are minority ones.
I agree that this strategy can lead illicitly but almost inevitably to the creation of a climate which denies the often intractable suffering of a minority of patients, and to the arrogant and ignorant belief that, since "depression" is really a form of pathologised "sadness" that most people confront, once you can seek help to "work through" that "sadness", the idea that "pills" should be shoved down your thoat becomes viewed as a pitiful, even a positively unethical, one.
The American philosophy professor and blogger, Professor Brian Leiter, recently ran on online survey at his site seeking to identify (in a preliminary way, subject to the statistical limitations of such an online survey) the prevalence of mental health disorders among philosophy students and faculty. Unsurprisingly, he concluded from the results that "the majority of faculty and students in philosophy have confronted some kind of mental illness in their lives".
An attempt was offered in the open comments section to explain critically the extraordinary statistic that 60% of survery participants "reported some diagnosis for mental illness", but elicited no feedback.
If anyone's interested, you can read the results and commentary here:
http://leiterreports.typepad.com/blog/2015/02/mental-illness-in-academic-philosophy.html#comments
Posted by stan_the_man70 on February 27, 2015, at 2:54:21
In reply to Re: The Pharma Drug That Is Bankrupting America » stan_the_man70, posted by ed_uk2010 on February 22, 2015, at 16:36:50
ed, based on your post I did some searching for the most expensive drugs....
----- quote reference
http://www.cbsnews.com/news/20-expensive-drugs-that-could-bankrupt-medicare/2/
----- quote reference1. Soliris, Alexion Pharmaceutical, $409,500 a year. Monoclonal antibody drug treats a rare disorder in which the immune system destroys red blood cells at night.
2.Elaprase, Shire, $375,000 per year. Treats Hunter's syndrome, a metabolic disorder.
3.Naglazyme, BioMarin, $365,000 a year. Treats rare connective tissue disorder.
4.Cinryze, ViroPharma, $350,000 a year. Treats hereditary angioedema, a rare, life-threatening genetic disorder that causes painful swelling.
5.Arcalyst, Regeneron, $250,000 a year. An anti-inflammatory for patients with impaired immune systems.
6.Myozyme, Sanofi, $300,000 per year. Treats Pompe disease.
7.Cerezyme, Sanofi, $200,000 per year. Treats Gaucher disease.
8.Fabrazyme, Sanofi, $200,000, per year. Treats Fabry disease.
9.Aldurazyme, Sanofi, $200,000, per year. Treats Hurler syndrome.
10.Provenge, Dendreon $93,000 per year. Treats prostate cancer.
11.Erbitux, Eli Lilly, $80,000 per year. Treats lung cancer.
12.Folotyn, Allos Therapeutics, $60,000 per two-month treatment. Treats a rare type of lymphoma.
13.Lemtrada (alemtuzumab), Sanofi, $60,000.* Treats M.S.
14.Avastin, Roche, $50,000 a year. Treats colon cancer.
15.Jevtana, Sanofi, $48,000 per year. Treats prostate cancer.
16.Gilenya, Novartis, $40,000 per year. Treats multiple sclerosis.
17.Zytiga, J&J, $40,000 per year. Treats prostate cancer.
18.Xgeva, Amgen, $21,500 per year. Treats prostate cancer.
19.Tofacitinib, Pfizer $20,000 a year.* An anti-inflammatory biologic.
20.Fuzeon, Roche, $20,000 per year. Treats HIV.
--------- quote reference
http://www.cbsnews.com/news/20-expensive-drugs-that-could-bankrupt-medicare/
-------------- quote reference20 Expensive Drugs That Could Bankrupt Medicare
Last Updated Jun 29, 2011 9:00 AM EDT
It's not until you see the list of the 20 most expensive drugs in the U.S. that the reason why Medicare will become insolvent in 2024 hits home: As Medicare is banned by law from negotiating drug prices, and must accept whatever pharmaceutical companies charge, it is no wonder that companies are announcing prices in excess of $400,000 for one year's treatment.
The most expensive drug in the U.S. is Soliris, from Alexion (ALXN). It costs $409,500 a year, and treats a rare disorder in which the immune system destroys red blood cells at night.
Many of the most expensive drugs -- such as Soliris -- treat rare diseases that only a few hundred people suffer from. Those drugs aren't the real problem. Rather, it's the drugs in the $20,000 to $100,000 range, which mainly treat cancer and multiple sclerosis. Those diseases are very common in the elderly population.
These drugs are also frequently delivered by infusion rather than in a pill form, which forces Medicare to reimburse them at 100 percent of the asking price.
Dendreon (DNDN)'s Provenge is one of four prostate cancer drugs costing between $21,500 and $93,000 a year. Similarly, Sanofi (SNY) will soon launch Lemtrada (alemtuzumab), an M.S. treatment that costs $60,000 per year. It will compete against Gilenya from Novartis (NVS), which is already on the market at $40,000 per year.
Medicare spending is out of control
Slowly but surely, healthcare policy makers are waking up to the fact that Medicare will bankrupt us all if drug prices run unchecked. The debate currently revolves around the Independent Payment Advisory Board established in President Obama's healthcare reform act. IPAB will review Medicare expenditure and in 2014 submit a raft of proposals to rein in spending, mainly through eliminating waste. It is specifically prohibited from rationing care.If Medicare spending is still out of control -- and as drug companies show no sign of moderating their pricing policies, it will be -- Congress must then either accept the IPAB cuts or implement cuts of its own.
Some Republicans regard IPAB as Obama's long-promised death panel. Rep. Phil Gingrey, R-Ga., said last week:
But under this IPAB we described that the Democrats put in Obamacare, where a bunch of bureaucrats decide whether you get care, such as continuing on dialysis or cancer chemotherapy, I guarantee you when you withdraw that the patient is going to die ... It's rationing.
Oddly, the Republican alternative involves a far more extreme form of rationing that will kill anyone on dialysis or cancer therapy who suddenly runs out of money: A Medicare voucher system in which the vouchers progressively lose their value. No part of Wisconsin Rep. Paul Ryan's plan calls for curbing drug prices. Remember, those prices are not subject to free market competition because Medicare provides them with corporate welfare. That welfare has led to Americans paying twice as much as Canadians for their drugs.Worse, there is a shortage of cheap, generic cancer medicines. Again, because U.S. prices are uncontrolled, companies cannot make a profit manufacturing them. It would actually make both business and public health sense to mandate a small rise in the price of generics -- guaranteeing companies a viable margin -- and a cut in the price of new drugs.
That sort of Big Gummint meddling may be beyond the pale for both Congress and the U.S. electorate, however. Which will lead inevitably to the worst type of rationing of all, when Medicare goes belly up completely with no alternative plan in place.
Posted by ed_uk2010 on February 27, 2015, at 3:17:46
In reply to Re: The Pharma Drug That Is Bankrupting America » ed_uk2010, posted by stan_the_man70 on February 27, 2015, at 2:54:21
> ed, based on your post I did some searching for the most expensive drugs....
Definitely, these drugs are phenomenally expensive.
The issue with drugs like Crestor is that although they are much less expensive per patient per year, they are greatly overpriced in comparison to similar alternatives and are so frequently prescribed (over prolonged periods of time) in comparison to the drugs below that the total cost is immense.
>
> ----- quote reference
> http://www.cbsnews.com/news/20-expensive-drugs-that-could-bankrupt-medicare/2/
> ----- quote reference
>
> 1. Soliris, Alexion Pharmaceutical, $409,500 a year. Monoclonal antibody drug treats a rare disorder in which the immune system destroys red blood cells at night.
> 2.Elaprase, Shire, $375,000 per year. Treats Hunter's syndrome, a metabolic disorder.
> 3.Naglazyme, BioMarin, $365,000 a year. Treats rare connective tissue disorder.
> 4.Cinryze, ViroPharma, $350,000 a year. Treats hereditary angioedema, a rare, life-threatening genetic disorder that causes painful swelling.
> 5.Arcalyst, Regeneron, $250,000 a year. An anti-inflammatory for patients with impaired immune systems.
> 6.Myozyme, Sanofi, $300,000 per year. Treats Pompe disease.
> 7.Cerezyme, Sanofi, $200,000 per year. Treats Gaucher disease.
> 8.Fabrazyme, Sanofi, $200,000, per year. Treats Fabry disease.
> 9.Aldurazyme, Sanofi, $200,000, per year. Treats Hurler syndrome.
> 10.Provenge, Dendreon $93,000 per year. Treats prostate cancer.
> 11.Erbitux, Eli Lilly, $80,000 per year. Treats lung cancer.
> 12.Folotyn, Allos Therapeutics, $60,000 per two-month treatment. Treats a rare type of lymphoma.
> 13.Lemtrada (alemtuzumab), Sanofi, $60,000.* Treats M.S.
> 14.Avastin, Roche, $50,000 a year. Treats colon cancer.
> 15.Jevtana, Sanofi, $48,000 per year. Treats prostate cancer.
> 16.Gilenya, Novartis, $40,000 per year. Treats multiple sclerosis.
> 17.Zytiga, J&J, $40,000 per year. Treats prostate cancer.
> 18.Xgeva, Amgen, $21,500 per year. Treats prostate cancer.
> 19.Tofacitinib, Pfizer $20,000 a year.* An anti-inflammatory biologic.
> 20.Fuzeon, Roche, $20,000 per year. Treats HIV.
>
>
> --------- quote reference
> http://www.cbsnews.com/news/20-expensive-drugs-that-could-bankrupt-medicare/
> -------------- quote reference
>
> 20 Expensive Drugs That Could Bankrupt Medicare
>
> Last Updated Jun 29, 2011 9:00 AM EDT
>
> It's not until you see the list of the 20 most expensive drugs in the U.S. that the reason why Medicare will become insolvent in 2024 hits home: As Medicare is banned by law from negotiating drug prices, and must accept whatever pharmaceutical companies charge, it is no wonder that companies are announcing prices in excess of $400,000 for one year's treatment.
>
> The most expensive drug in the U.S. is Soliris, from Alexion (ALXN). It costs $409,500 a year, and treats a rare disorder in which the immune system destroys red blood cells at night.
>
> Many of the most expensive drugs -- such as Soliris -- treat rare diseases that only a few hundred people suffer from. Those drugs aren't the real problem. Rather, it's the drugs in the $20,000 to $100,000 range, which mainly treat cancer and multiple sclerosis. Those diseases are very common in the elderly population.
>
> These drugs are also frequently delivered by infusion rather than in a pill form, which forces Medicare to reimburse them at 100 percent of the asking price.
>
> Dendreon (DNDN)'s Provenge is one of four prostate cancer drugs costing between $21,500 and $93,000 a year. Similarly, Sanofi (SNY) will soon launch Lemtrada (alemtuzumab), an M.S. treatment that costs $60,000 per year. It will compete against Gilenya from Novartis (NVS), which is already on the market at $40,000 per year.
>
> Medicare spending is out of control
> Slowly but surely, healthcare policy makers are waking up to the fact that Medicare will bankrupt us all if drug prices run unchecked. The debate currently revolves around the Independent Payment Advisory Board established in President Obama's healthcare reform act. IPAB will review Medicare expenditure and in 2014 submit a raft of proposals to rein in spending, mainly through eliminating waste. It is specifically prohibited from rationing care.
>
> If Medicare spending is still out of control -- and as drug companies show no sign of moderating their pricing policies, it will be -- Congress must then either accept the IPAB cuts or implement cuts of its own.
>
> Some Republicans regard IPAB as Obama's long-promised death panel. Rep. Phil Gingrey, R-Ga., said last week:
>
> But under this IPAB we described that the Democrats put in Obamacare, where a bunch of bureaucrats decide whether you get care, such as continuing on dialysis or cancer chemotherapy, I guarantee you when you withdraw that the patient is going to die ... It's rationing.
> Oddly, the Republican alternative involves a far more extreme form of rationing that will kill anyone on dialysis or cancer therapy who suddenly runs out of money: A Medicare voucher system in which the vouchers progressively lose their value. No part of Wisconsin Rep. Paul Ryan's plan calls for curbing drug prices. Remember, those prices are not subject to free market competition because Medicare provides them with corporate welfare. That welfare has led to Americans paying twice as much as Canadians for their drugs.
>
> Worse, there is a shortage of cheap, generic cancer medicines. Again, because U.S. prices are uncontrolled, companies cannot make a profit manufacturing them. It would actually make both business and public health sense to mandate a small rise in the price of generics -- guaranteeing companies a viable margin -- and a cut in the price of new drugs.
>
> That sort of Big Gummint meddling may be beyond the pale for both Congress and the U.S. electorate, however. Which will lead inevitably to the worst type of rationing of all, when Medicare goes belly up completely with no alternative plan in place.
Posted by ed_uk2010 on February 27, 2015, at 3:21:33
In reply to Ed on Mental Health Statistics » ed_uk2010, posted by Robert_Burton_1621 on February 26, 2015, at 19:01:56
>lapidary
Must confess I had to google that word :)
>I agree that this strategy can lead illicitly but almost inevitably to the creation of a climate which denies the often intractable suffering of a minority of patients
We are often presented with two claims:
'Depression is a serious illness, different from normal emotions of sadness etc'
and
'Many people are depressed in any given year'.
It doesn't quite fit...
Posted by stan_the_man70 on February 27, 2015, at 7:47:13
In reply to Re: The Pharma Drug That Is Bankrupting America » stan_the_man70, posted by ed_uk2010 on February 27, 2015, at 3:17:46
But if I look at drugs based on revenue, the picture is entirely different
-----------quote reference
http://en.wikipedia.org/wiki/List_of_largest_selling_pharmaceutical_products
----------------quote referenceRank 1, Abilify for depression, sales: $1.6B/quarter
Rank 7, Cymbalta for depression, sales: $1B/quarter
Rank 27, Vyvance for ADD, sales: $0.4B/quarter
Rank 38, Methylphenidate for ADHD, $0.3B/quarter
Rank 46, Seroquel for depression, sales: $0.29B/quarter
Rank 66, Amphetamine for ADD, sales: $0.24B/quarter
Rank 72, Lunesta for sleep, sales: $0.22B/quarter
Rank 74, Modafinil for work, sales: $0.22B/quarter
Rank 96, Depakote for gastro, sales: $0.18B/quarter
Rank 97, Dexmethylphenidate for ADD, sales: $0.18B/quarter
Rank 99, Afinitor for ADD, sales: $0.17B/quarter
Posted by stan_the_man70 on February 27, 2015, at 8:21:49
In reply to Re: Ed on Mental Health Statistics » Robert_Burton_1621, posted by ed_uk2010 on February 27, 2015, at 3:21:33
largest increase: Wellbutrin 30%
Amphetamine salts 29%largest decrease: pristiq 21%
------------quote reference
http://psychcentral.com/lib/top-25-psychiatric-medication-prescriptions-for-2013/00019543
------------quote reference2013 Rank Brand name
(generic name)
Used for
U.S. Prescriptions
(% change from 2011)__1. Xanax
(alprazolam)
Anxiety
48,465,000
(1%)
__2. Zoloft
(sertraline)
Depression, Anxiety, OCD, PTSD, PMDD
41,416,000
(11%)
__3. Celexa
(citalopram)
Depression, Anxiety
39,445,000
(5%)
__4. Prozac
(fluoxetine HCL)
Depression, Anxiety
28,258,000
(15%)
__5. Ativan
(lorazepam)
Anxiety, panic disorder
27,948,000
(3%)
__6. Desyrel
(trazodone HCL)
Depression, Anxiety
26,242,000
(17%)
__7. Lexapro
(escitalopram)
Depression, Anxiety
24,920,000
(5%)
__8. Cymbalta
(duloxetine)
Depression, Anxiety, fibromyalgia, diabetic neuropathy
18,573,000
(5%)
__9. Wellbutrin XL
(bupropion HCL XL)
Depression
16,053,000
(30%)
__10. Effexor ER
(venlafaxine HCL ER)
Depression, Anxiety, Panic disorder
15,796,000
(26%)
__11. Valium
(diazepam)
Anxiety, Panic disorder
14,754,000
(1%)
__12. Paxil
(paroxetine HCL)
Depression, Anxiety, Panic disorder
14,335,000
(3%)
__13. Seroquel
(quetiapine)
Bipolar disorder, Depression
14,326,000
()
__14. Amphetamine salts
(Generic)
Attention deficit disorder
12,785,000
(29%)
__15. Risperdal
(risperidone)
Bipolar disorder, Schizophrenia, irritability in autism
12,320,000
(1%)
__16. Vyvanse
(lisdexamfetamine)
Attention deficit disorder
9,842,000
(19%)
__17. Concerta ER
(methylphenidate ER)
Attention deficit disorder
8,803,000
()
__18. Abilify
(aripiprazole)
Bipolar disorder, Schizophrenia, Depression
8,747,000
()
__19. Wellbutrin SR-W
(bupropion HCL SR W)
Depression
8,238,000
()
__20. Buspar
(buspirone HCL)
Sleep, Anxiety
8,065,000
(26%)
__21. Vistaril*
(hydroxyzine HCL)
Anxiety, tension
8,052,000
(11%)
__22. Amphetamine salts ER
(Generic)
Attention deficit disorder
7,925,000
(21%)
__23. Zyprexa
(olanzapine)
Bipolar disorder, Schizophrenia
5,101,000
(12%)
__24. Methylphenidate
(generic)
Attention deficit disorder
5,335,000
(26%)
__25. Pristiq
(desvenlafaxine)
Depression
3,217,000
(-21%)
Posted by ed_uk2010 on February 27, 2015, at 10:51:22
In reply to sales of psychotropic drugs » ed_uk2010, posted by stan_the_man70 on February 27, 2015, at 8:21:49
> largest increase: Wellbutrin 30%
> Amphetamine salts 29%They do say the US accounts for the large majority of the world's pharmaceutical stimulant usage.
Posted by Robert_Burton_1621 on February 27, 2015, at 15:00:17
In reply to sales of psychotropic drugs » ed_uk2010, posted by stan_the_man70 on February 27, 2015, at 8:21:49
> largest increase: Wellbutrin 30%
> Amphetamine salts 29%
>
> largest decrease: pristiq 21%
> ------------quote reference
> http://psychcentral.com/lib/top-25-psychiatric-medication-prescriptions-for-2013/00019543
> ------------quote reference
>Very interesting, stan. I thought it might be additionally relevant to examine the cost per strength (which does not necessarily equate with cost per minimum or average therapeutic unit) of anti-depressants. The below list is adapted from Schatzberg (et al), "Manual of Clinical Pychopharmacology," 7th Ed, Amercian Psychiatric Publishing, 2010, pp 669 - 672.
The data is a bit dated now, but still worth looking at. Comparing the relative costs per unit of the new agents with the older agents (TCAs, MAOIs) might be revealing.
There is some data included on comparative cost of generic and brand versions of medications, as well as the number of units per packet a particular medication is routinely sold in.
(I've tried to tabulate this data a number of times, but when I submit my message the format reverts to the untabulate version).
Strength (mg) / Cost per 100
*ANTIDEPRESSANTS*amitriptyline 25 / 36
amoxapine 25 / 62
bupropion (generic) 100 / 96
bupropion sustained release
(generic) 100 / 169
bupropion extended release
(generic) 150 / 152 (per 30)
bupropion (Wellbutrin) 100 / 338
bupropion sustained release
(Wellbutrin SR) 100 / 209 (per 60)
bupropion extended release
(Wellbutrin XL) 150 / 194 (per 30)
citalopram (Celexa) 20 / 372
clomipramine 50 / 106
desipramine 25 / 116
desvenlafaxine (Pristiq) 100 / 129 (per 30)
duloxetine (Cymbalta) 60 / 480
doxepin 25 / 44
escitalopram (Lexapro) 20 / 338
fluoxetine (Prozac) 20 / 630
fluoxetine delayed release
(Prozac Weekly) 90 / 130 (per 4)
fluvoxamine 50 / 257
imipramine 25 / 72
mirtazapine (Remeron) 30 / 126 (per 30)
nefazodone 100 / 92 (per 60)
nortriptyline 25 / 80
paroxetine (generic) 20 / 81 (per 30)
paroxetine (Paxil) 20 / 116 (per 30)
paroxetine controlled release
(Paxil CR) 25 / 120 (per 30)
phenelzine (Nardil) 15 / 53 (per 60)
protriptyline (generic) 10 / 307
protriptyline (Vivactil) 10 / 379
sertraline (generic) 50 / 285
sertraline (Zoloft) 50 / 302
tranylcypromine (Parnate) 10 / 153
trazodone 50 / 57
trimipramine (Surmontil) 25 / 226
venlafaxine (generic) 37.5 / 200 (per 100)
venlafaxine (Effexor) 37.5 / 148 (per 60)
venlafaxine sustained release
(Effexor XR) 37.5 / 382 (per 90)*ANTIPSYCHOTICS*
aripiprazole (Abilify) 15 / 485 (per 30)
aripiprazole ODT (Abilify Oral
Disintegrating Tabs) 15 / 577 (per 30)
chlorpromazine 100 / 81
clozapine (generic) 25 / 136
100 / 314
clozapine (Clozaril) 25 / 261
100 / 676
fluphenazine decanoate 25 mg/mL / 16 (per 5-mL)
haloperidol 5 / 78
haloperidol decanoate 100 mg/mL / 30 (per 5-mL)
loxapine 10 / 127
olanzapine (Zyprexa) 5 / 311 (per 30)
10 / 468 (per 30)
olanzapine (Zydis) 5 / 346 (per 30)
10 / 503 (per 30)
perphenazine 8 / 137
pimozide (Orap) 2 / 162
quetiapine (Seroquel) 200 / 949
quetiapine extended release
(Seroquel XR) 200 / 515 (per 60)
risperidone (generic) 2 / 456 (per 60)
3 / 536 (per 60)
risperidone (Risperdal) 2 / 535 (per 60)
3 / 628 (per 60)
risperidone (Risperdal M-Tab) 2 / 279 (per 28)
risperidone ODT (generic) 2 / 263 (per 28)
risperidone (Risperdal Consta) 25 / 296 (per syringe)
37.5 / 445 (per syringe)
ziprasidone (Geodon) 60 / 543 (per 60)
80 / 543 (per 60)*MOOD STABILIZERS*
carbamazepine (Tegretol) 200 / 34
carbamazepine extended release
(Tegretol XR) 200 / 100
divalproex (generic) 500 / 325
divalproex (Depakote) 500 / 385
divalproex extended release
(generic) 500 / 295 (per 100)
divalproex extended release
(Depakote ER) 500 / 334
gabapentin (generic) 400 / 160
gabapentin (Neurontin) 400 / 230
lamotrigine (generic) 100 / 475 (per 100)
lamotrigine (Lamictal) 100 / 582
lamotrigine extended release
(Lamictal XR) 100 / 328 (per 30)
lithium carbonate 300 / 19
lithium carbonate ER (generic) 300 / 47
450 / 53 (per 100)
lithium carbonate ER
(Lithobid) 300 / 218
topiramate (generic) 100 / 418 (per 60)
topiramate (Topamax) 100 / 464 (per 60)Note: "Cost is reported as the average wholesale price (AWP) based on AmerisourceBergen Drug Distribution, 2009. If a generic drug is available from more than one manufacturer, at least three prices were averaged to obtain an AWP for the drug." (p. 672)
Posted by stan_the_man70 on February 28, 2015, at 9:51:05
In reply to Re: sales of psychotropic drugs » stan_the_man70, posted by Robert_Burton_1621 on February 27, 2015, at 15:00:17
Robert,
Based on the statistics what I can see is that Prozac seems to be the most expensive.
But what is not clear is the potency/required dosage - meaning even 1 mg of Zyprexa can work while you need 1000mg upwards of Depakote for effect.
Posted by stan_the_man70 on February 28, 2015, at 9:59:04
In reply to Re: sales of psychotropic drugs » stan_the_man70, posted by Robert_Burton_1621 on February 27, 2015, at 15:00:17
------------quote reference
http://www.politicsdaily.com/2010/06/17/psychotropic-drug-abuse-in-foster-care-costs-government-billions/
-------------------quote referenceThese are just snippets of the entire article. But it is really alarming. I mean it is about children in foster care. Not sure what the true picture is. But the ending of the article is poignant?
----------snippets
According to a number of foster care experts who spoke with Politics Daily, children in foster care, who are typically concurrently enrolled in Medicaid, are three or four more times as likely to be on psychotropic medications than other children on Medicaid. Alarmingly, many of these drugs are medically prohibited for minors and dangerous to the children taking them. Often young patients under state supervision are also prescribed three or four high-risk drugs at a time -- all paid for by Medicaid.State foster care programs and child protective services have had mixed success addressing the pervasiveness of dosing their clients with prescription psychotropic drugs. Using federal Medicaid money to purchase dangerous prohibited prescriptions for children, which cost the government up to $600 per dose, is technically a violation of the law.
Statistics on psychotropic drugs in foster care have until now come out in scattered reports, mostly from investigations of foster care failures by individual states. For example, in 2003 a Florida Statewide Advocacy Council study found that 55 percent of Florida's foster children were being administered psychotropic medications. Forty percent of them had no record of a psychiatric evaluation. Another Florida report also indicated anti-psychotic medication use increased an astonishing 528 percent from 2000 to 2005.
A Texas state study in 2004 revealed that 34.7 percent of Texas foster children were prescribed at least one anti-psychotic drug -- and 174 children aged 6-12 in the care of the state were taking five or more psychotropic medications at once.
Last April, an investigation by the Atlanta Journal-Constitution exposed several companies operating foster care homes in Georgia repeatedly used anti-psychotic medications to "subdue" children in their care. Despite being cited repeatedly, none of the agencies were fined more than $500.
How to Fix It
"Having a drug to take the edge off the pain and fear and sadness saved my life a time or two, but it's not a lifestyle." said Misty Stenslie, a former foster child who is currently the deputy director of Foster Care Alumni of America. Children under the protection of government agencies deserve the assurance of safe and decent health care. Especially, as Stenslie points out, "We can't give kids what they really need, and that's a family and love."
Posted by Lou Pilder on February 28, 2015, at 14:19:17
In reply to these sales are alarming !!! » Robert_Burton_1621, posted by stan_the_man70 on February 28, 2015, at 9:59:04
> ------------quote reference
> http://www.politicsdaily.com/2010/06/17/psychotropic-drug-abuse-in-foster-care-costs-government-billions/
> -------------------quote reference
>
> These are just snippets of the entire article. But it is really alarming. I mean it is about children in foster care. Not sure what the true picture is. But the ending of the article is poignant?
>
> ----------snippets
> According to a number of foster care experts who spoke with Politics Daily, children in foster care, who are typically concurrently enrolled in Medicaid, are three or four more times as likely to be on psychotropic medications than other children on Medicaid. Alarmingly, many of these drugs are medically prohibited for minors and dangerous to the children taking them. Often young patients under state supervision are also prescribed three or four high-risk drugs at a time -- all paid for by Medicaid.
>
> State foster care programs and child protective services have had mixed success addressing the pervasiveness of dosing their clients with prescription psychotropic drugs. Using federal Medicaid money to purchase dangerous prohibited prescriptions for children, which cost the government up to $600 per dose, is technically a violation of the law.
>
> Statistics on psychotropic drugs in foster care have until now come out in scattered reports, mostly from investigations of foster care failures by individual states. For example, in 2003 a Florida Statewide Advocacy Council study found that 55 percent of Florida's foster children were being administered psychotropic medications. Forty percent of them had no record of a psychiatric evaluation. Another Florida report also indicated anti-psychotic medication use increased an astonishing 528 percent from 2000 to 2005.
>
> A Texas state study in 2004 revealed that 34.7 percent of Texas foster children were prescribed at least one anti-psychotic drug -- and 174 children aged 6-12 in the care of the state were taking five or more psychotropic medications at once.
>
> Last April, an investigation by the Atlanta Journal-Constitution exposed several companies operating foster care homes in Georgia repeatedly used anti-psychotic medications to "subdue" children in their care. Despite being cited repeatedly, none of the agencies were fined more than $500.
>
> How to Fix It
>
> "Having a drug to take the edge off the pain and fear and sadness saved my life a time or two, but it's not a lifestyle." said Misty Stenslie, a former foster child who is currently the deputy director of Foster Care Alumni of America. Children under the protection of government agencies deserve the assurance of safe and decent health care. Especially, as Stenslie points out, "We can't give kids what they really need, and that's a family and love."stan,
Here is a video that I would like for you to watch and then the others that follow from it and then the others shown on the page. To see this video, bring up Google and type in:
[ youtube, Psychiatric Drugging of Foster Children-One ]
the time is 3:51 and was posted on June 21, 2011
Lou
Posted by Robert_Burton_1621 on March 2, 2015, at 0:02:45
In reply to Re: sales of psychotropic drugs » Robert_Burton_1621, posted by stan_the_man70 on February 28, 2015, at 9:51:05
> Robert,
> Based on the statistics what I can see is that Prozac seems to be the most expensive.
> But what is not clear is the potency/required dosage - meaning even 1 mg of Zyprexa can work while you need 1000mg upwards of Depakote for effect.Yes, Stan, that's true about therapeutic dosage. I tried to make that distinction in my orginal post suppylyng the data. I'm not sure how you'd go about finding or producing data which shows the costs of the minimally therapeutic units of each medication.
I was struck by the fact that higher cost (clearly of the newer agents) does not necessarily track higher efficacy.
Posted by stan_the_man70 on March 2, 2015, at 8:03:05
In reply to Re: sales of psychotropic drugs, posted by Robert_Burton_1621 on March 2, 2015, at 0:02:45
------------quote reference
http://lajeunepolitique.com/2014/05/24/drugged-up-studies-reveal-alarming-psychotropic-drug-use-in-france/
------------- quote referenceDrugged-Up: Studies Reveal Alarming Psychotropic Drug Use in France
May 24, 2014 by Emma Hurt
Drug overuse has emerged as an unintended side effect of the French universal national health care system. It is not surprising that the French people are one of the worlds top consumers of prescription drugs considering the 20 million Euros the French government spends on prescription reimbursements annually (the single greatest expense on governmental health insurance). However, a recent study by the Agence Nationale de Sécurité du Médicament (ANSM) has revealed that 32% of French people use psychotropic drugs on a regular basis. Given the dangers of psychotropic medications, this figure is especially concerning.
According to the ANSM, The level of consummation [of psychotropic drugs] remains important. These drugs are too-often prescribed and over too-long a duration. Previously established health risks remain while new risks are emerging.
Besides Frances purported pill-popping habit, in 2011 the World Health Organization identified French individuals as the most likely people to experience a major depressive episode in their lifetimes. This could partially explain the extensive drug use.
In their 2012 book The Guide to 4,000 Useful, Useless and Dangerous Medicines, Philippe Even, former head of the Necker Hospital in Paris, and Bernard Debré, a doctor and member of French Parliament, conclude that nearly half of all drugs prescribed in France serve no purpose or adversely affect patients health. The authors go on to blame the powerful pharmaceutical industry for pressuring doctors to prescribe medications and pressuring the government to make these products easily available.
According to France24, the average French citizen will use 47 medicine packs annually, amounting to 532 Euros per capita. The government fronts most of this cost. According to a survey published last week for the Fédération Hospitalière de France, almost 90% of French people believe they are over-prescribed medication by their healthcare providers.
All that being said, a study published by Child and Adolescent Psychiatry and Mental Health in 2008 found that American children are three times more likely to be prescribed psychotropic medications than European children. Furthermore, Swedens antidepressant usage increased at about 59% annually between 1995 and 2009 compared to a 5% increase per year in France over the same period. While headlines highlight French overuse in particular, the problem of psychotropic drug use may be global.
Posted by stan_the_man70 on March 2, 2015, at 8:11:49
In reply to Lou's response-psehvlyvz » stan_the_man70, posted by Lou Pilder on February 28, 2015, at 14:19:17
-------------quote reference
http://webspecial.mercurynews.com/druggedkids/?page=pt1
--------------- quote referenceI don't want to post the entire article because it has photos, videos, audio alongside - 5 part article
BAY AREA NEWS GROUP INVESTIGATION
DRUGGING
OUR KIDS
Children in Californias foster care system are prescribed unproven, risky medications at alarming ratesStory by KAREN DE SÁ
Photographs and video by DAI SUGANO
Design by QIN CHEN
PUBLICATION: AUGUST 24, 2014
Posted by Lou Pilder on March 2, 2015, at 9:13:54
In reply to Huge article about california drugging foster kids » Lou Pilder, posted by stan_the_man70 on March 2, 2015, at 8:11:49
> -------------quote reference
> http://webspecial.mercurynews.com/druggedkids/?page=pt1
> --------------- quote reference
>
> I don't want to post the entire article because it has photos, videos, audio alongside - 5 part article
>
> BAY AREA NEWS GROUP INVESTIGATION
>
> DRUGGING
> OUR KIDS
> Children in Californias foster care system are prescribed unproven, risky medications at alarming rates
>
> Story by KAREN DE SÁ
> Photographs and video by DAI SUGANO
> Design by QIN CHEN
> PUBLICATION: AUGUST 24, 2014
>stan,
Thank you for posting this. The information contained could save lives, prevent life-ruining conditions and addictions.
One of my concerns here is that members are allowed to post to advocate the drugging of children. I hope that your article informs readers about what my concerns are and the concerns of others in order to have posts here that advocate the drugging of children be stopped by the psychiatrist here that says that readers are to trust him in that he doing in his thinking what will be good for this community as a whole as his basis for allowing the advocating of drugging children.
The children that read here could be powerfully influenced by seeing that drugging of children is considered to be supportive here and in the theme of the Golden Rule, according to the TOS here. This could persuade parents to drug their children in collaboration with a psychiatrist/doctor, and the fact that I am prevented from posting what I need to in order to inform readers due to the prohibitions posted to me here by Mr. Hsiung, IMHO parents could be easily persuaded to drug their children by reading here. And it's so easy to persuade the un informed.
And a greater tragedy here is that anti-Semitic propaganda is allowed here to be seen as supportive and that in Mr. Hsiung's thinking, by him not intervening where statements that could lead a Jew to feel that their faith is being put down, that, in his thinking, will be good for his community as a whole. When a Jewish child in depression reads here, and sees that hatred toward the Jews being allowed to be seen as supportive where it is originally posted, this could cause the tears of shame and humiliation to overwhelm the child and the feelings of unworthiness and inferiority could ravage the mind of the child to cause hopelessness and despair and cause the child to kill themselves, for the child could see that Mr. Hsiung says to trust him, not the God that they cherish that gave them life.
Lou
Posted by stan_the_man70 on March 8, 2015, at 16:37:05
In reply to Hard to believe this article about France » Robert_Burton_1621, posted by stan_the_man70 on March 2, 2015, at 8:03:05
-------------quote reference
http://livingtraditionally.com/officials-declare-eating-healthy-mental-disorder/
-------------quote referenceNot sure if this is real news or a hoax
Orthorexia nervosa is a label designated to those who are concerned about eating healthy. Characterized by disordered eating fueled by a desire for clean or healthy foods, those diagnosed with the condition are overly pre-occupied with the nutritional makeup of what they eat.
This is the end of the thread.
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