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Author Topic: Sicko
Belle
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My husband delivers babies on a regular basis - the latest was just last week. The population he serves (he's a firefighter/paramedic working in inner-city Birmingham) tends to be urban poor. Many if not most of the babies he delivers are to mothers who report receiving zero prenatal care. Zero.

Prenatal care is available to these mothers, free of charge at local health department clinics located on bus routes so public transportation is available. He tells them this, and hands out informational brochures about the programs to anyone he sees on an ob-related call, but he cannot force them to go to the department to get the prenatal care.

We have an issue in this country - no denying it. But whose fault is it? If the programs are out there, and they are - Mrs. M is right - but people are not motivated to take advantage of what is offered, how far do we go? We cannot force young women to go to health clinics and get prenatal care for their unborn children.

We can have programs, do our best to get the word out (Mrs. M's group has the right idea reaching out to community settings) and try to make it more convenient, especially for those who don't have reliable transportation, but how far can we take it? I would suspect that the overrepresentation of minority children in infant mortality statistics is related to the overrepresentation of minority mothers living in poverty. Poverty is the enemy, not race or ethnicity. So how do you fix it, if as we've stated there are programs available but many people will not take advantage of them?

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Dan_Frank
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CT, I'm not specifically familiar with the study Mrs. M mentioned, so I have no interest in discussing the apparent ... murder? Negligent care? I'm not sure what you're insinuating here... of black infants.

However, the information about the disparity of recorded infant mortality rates is very real and confirmed by many sources. The US follows the WHO's definition of a a live birth; any infant which shows a sign of life, such as a breath or a heartbeat, outside the mother's womb. Even if they die within minutes of coming out.

Very few industrialized nations are nearly so generous in their definition of a living baby. Aside from length and weight and how early the birth is (all of which, outside our utterly horrible medical system, typically disqualify infants as being alive), in many countries, most newborns which died within 24 hours of birth were counted as stillbirths.

It's a fairly common phenomenon in and outside of medicine. A place (or person) that holds itself to a higher standard is more likely to fail to meet their standard. That doesn't actually mean their less competent than the alternatives. Usually, it means the opposite.

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Kwea
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Lyr, what makes you think I haven't in the past? I have, and am aware of a lot of potential problems. However, I also have formal knowledge of this that you don't, and that very few people in the US do. I have been a part of drug trials, on both sides of a stethoscope, and have a first hand grasp of the drug approval process. I know the weight the drug companies bring to bear, and I have a decent idea how much money drug companies contribute to our politicians.


I said you are smart, and that you have some good points. I also said that the level of fear in your posts was inaccurate. I admitted that there ARE groups that take advantage of the fact that it is not as regulated, and that scams do happen. I also pointed out that it is a problem within the borders of the US as well.

You challenged my knowledge base based on an internet search basically, but now you are offended because I was off base?


Whatever.


I don't think you are petty, and I have considered your points. I understand the risks and consequences, but my risk assessment is different than yours. Considering why it is different might be more constructive than continuing to pick at us.

My point has been pretty much overlooked by you actually.....we shouldn't have to go do another country to buy these drugs. It is disgusting that it is at times a better choice than buying them here.


Considering I have personal and professional experience that you don't, I am fine with that.

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ClaudiaTherese
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quote:
Originally posted by Dan_Frank:
CT, I'm not specifically familiar with the study Mrs. M mentioned, so I have no interest in discussing the apparent ... murder? Negligent care? I'm not sure what you're insinuating here... of black infants.

Please. That's silly, as well as insulting, and it marks you as entering the discussion in bad faith. That's one mark -- you don't get two, at least not to discuss anything in depth with me.

I have a low tolerance of noise v. sound.

There is a difference in mortality rates. There are a host of potential explanations in the literature. If all you can come up with is murder or deliberate negligence, then the least insulting explanation I can come up with is that you must be hampered in mental creativity.
quote:
However, the information about the disparity of recorded infant mortality rates is very real and confirmed by many sources. ...
It's a fairly common phenomenon in and outside of medicine. A place (or person) that holds itself to a higher standard is more likely to fail to meet their standard. That doesn't actually mean their less competent than the alternatives. Usually, it means the opposite.

Right. So you should reread the study.

Again, it addresses mitigating some of the disparity by changing analysis, but -- by its own numbers -- confirms that a large disparity still exists.

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ClaudiaTherese
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Belle, I completely agree with you that individual actions are a possible explanation for at least some of the disparity, although I have reason to think it is more complicated than that. However, the details of why is a complicated discussion probably worth a separate thread. (one I'd be willing to participate in, by the way)

Here I was addressing the interpretation of a particular study raised in a post, and the data given therein (and its interpretation in terms of the numbers themselves, regardless of reasons driving those numbers) was all I was speaking to directly. I say this explicitly not in order to pull back or shut down discussion, but to make clear why I wasn't responding to you, too. It's relevant and interesting, but it is more of a tangent than I want to take on int his thread, as infant mortality rates aren't the central issue I was discussing in the main flow of the thread, and -- though details came up -- I'm not willing to address more than just the details raised, unless the general conversation follows that line as well.

I am doing too much typing as it is. *grin

[ June 21, 2007, 02:24 PM: Message edited by: ClaudiaTherese ]

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Lisa
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quote:
Originally posted by Angiomorphism:
So Micheal Moore's new movie, Sicko, recently leaked. Since he has stated several times that he encourages illegal downloading and sharing of his movies (as long as it is not for profit), I decided to download it and see what all the fuss is about.

Since he's not the sole owner of the film, downloading it is just as illegal (and immoral, if you consider it immoral in general) as downloading any other film.
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Angiomorphism
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I don't think there is any mention of it being legal in there... in fact I think I explicitly mentioned it was illegal. And you hit the nail right on the head: I do not consider it immoral, especially considering that it is his intellectual property, and he doesn't mind, and in fact, encourages people to get the word out - it just means more money in his pockets.

EDIT: but getting into piracy really isn't the point of this thread.. you must be a lobbyist from the health care companies trying to derail this important topic! (I think Moore would agree)

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Lyrhawn
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quote:
Originally posted by Kwea:
Lyr, what makes you think I haven't in the past? I have, and am aware of a lot of potential problems. However, I also have formal knowledge of this that you don't, and that very few people in the US do. I have been a part of drug trials, on both sides of a stethoscope, and have a first hand grasp of the drug approval process. I know the weight the drug companies bring to bear, and I have a decent idea how much money drug companies contribute to our politicians.

I said you are smart, and that you have some good points. I also said that the level of fear in your posts was inaccurate. I admitted that there ARE groups that take advantage of the fact that it is not as regulated, and that scams do happen. I also pointed out that it is a problem within the borders of the US as well.

You challenged my knowledge base based on an internet search basically, but now you are offended because I was off base?

Whatever.

I don't think you are petty, and I have considered your points. I understand the risks and consequences, but my risk assessment is different than yours. Considering why it is different might be more constructive than continuing to pick at us.

My point has been pretty much overlooked by you actually.....we shouldn't have to go do another country to buy these drugs. It is disgusting that it is at times a better choice than buying them here.

Considering I have personal and professional experience that you don't, I am fine with that.

I'm not questioning your knowledge, at least, I'm not now. ::sheepish look:: I didn't know your credentials beforehand, and I was unfairly (to you) pissy in the midst of the last few posts we've made so I kind of ignored it.

Anyways, I accept that you have superior knowledge, and it's good to know the danger isn't nearly so pronounced. And I'm not offended, not personally anyways. I often don't mind being wrong or corrected (though sometimes I do, hey, we all have egos). I think the reason I was so snippy before (which I apologize for btw), is because I thought I was chiming in with a cautionary note, and I felt like I was being totally smacked down for it. Overreaction maybe, but every argument needs a devil's advocate.

Your overarching point is something I totally agree with, and given your expertise, you could probably answer the only question I'd have on the feasibility of doing such a thing (giving us cheaper drugs):

We subsidize the production of these drugs, which can cost billions to research, right? If the price were to suddenly bottom out in the US, I have to imagine the big Pharma companies would lose millions if not billions of dollars over the life of the drug, especially given they have a limited amount of time to recoup their losses before generics may be made for a fraction of the cost and sold at a fraction of the price. Correct?

If we drop the price in the US, how will they be able to afford to spend billions on research, absorbt the loss on failed drugs, recoup their research funds and still turn a profit? Or do we just raise the price everywhere else and lower ours to a global happy medium?

I don't accept that prices should be as expensive as they are, and I'm curious to see how we'd fairly, to both the people and the companies, set a price that everyone can live with.

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Dan_Frank
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quote:
Please. That's silly, as well as insulting, and it marks you as entering the discussion in bad faith. That's one mark -- you don't get two, at least not to discuss anything in depth with me.

I don't know you from Eve, ma'am, and I'm quite certain I have no interest in being subjected to "marks" for the privilege of carrying on a conversation with you. So, if you decide you're done talking to me, I suppose I'll just soldier on as best I can.

Obviously you aren't insinutating literal murder. But from the tone I interpreted from your posts (which could of course be totally off the mark), you were insinuating that our health care system is killing more black babies through negligence/apathy/etc.

The least insulting interpretation I can think of is that a higher percentage of blacks live in poverty. So your point was more about our health care system with regards to the poor, and less about racism. But like I said, I don't know you, and a charge of racism isn't uncommon in discussions about this subject. There tends to be a lot of histrionics and hyperbole.

quote:
Right. So you should reread the study.
I can't reread it if I've never read it. None of my information on this topic is based on that study. It's a Canadian study, right? Is there any particularly stunning credential this study has, that might convince me not to write it off? I wouldn't put much faith in a study of Israeli politics that was published by Hamas, and I don't have a lot of patience for critiques of our health care as done by the average Canadian.

That was a good example of the aforementioned hyperbole.

Hey Kwea, I'll freely admit I don't have a thimble of the expertise on the drug topic as you. So this question is just a shot in the dark, but I'm going to ask anyway.

Most companies, in general, try to hit the sweet spot of pricing with a maximum balance of purchasers and price, to get the best possible profit. That doesn't mean it's not still profitable to sell cheaper to other markets. Airlines have done this for years; charging different people what they think they can get that person to spend, for essentially the same product.

Isn't the issue of cheaper out-of-country drugs at least in part a result of this policy? They charge different markets what they think they can get away with. So long as every market is still bringing in a profit, they win.

I like a lot of what Lyrhawn just said too.

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dkw
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Since you don't know her and she won't toot her own horn, I'll fill you in that CT is a pediatrician. I also know that she's worked at a University hospital and been involved in research studies. And has a degree in medical ethics. I'm pretty confident that when she says that studies show poorer outcomes for black babies in the US she isn't insinuating anything about anyone's intent, merely pointing out that, contrary to what was earlier asserted, that we do not have the best outcomes in infant mortality rates for all population groups in this country.
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fugu13
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Is her PhD in medical ethics or philosophy of science? I have vague recollections of the latter, but the former makes sense too.
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ClaudiaTherese
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quote:
Originally posted by Dan_Frank:
I can't reread it if I've never read it. None of my information on this topic is based on that study.

Interesting that you still felt equipped to comment on it [the topic].
quote:
It's a Canadian study, right? Is there any particularly stunning credential this study has, that might convince me not to write it off?

The same as for assessing any study. It is well-designed, published in a top-of-the-line peer-reviewed journal (Paediatric and Perinatal Epidemiology), and was performed through an internationally recognized academic and medical institution. The authors work with the Robert Wood Johnson Foundation and the Harvard School of Public Health as well.

Provincialism does not become you.
quote:
I wouldn't put much faith in a study of Israeli politics that was published by Hamas
Odd comparison. Marks for creativity, after all. *amused
quote:
and I don't have a lot of patience for critiques of our health care as done by the average Canadian.

Ah, yes, well, these are Canadians with epidemiological, medical, and statistical training. And your qualifications to assess medical epidemiology are ... ?

I'll follow up on the kind words of dkw and fugu13 above [and toot my own horn after all, as it is now relevant to the discussion]. I am a US-trained physician with a degree in medical ethics who spent 2 further years in an NIH-funded research fellowship as a National Service Research Award Fellow studying healthcare outcomes in international pediatric populations, particularly with respect to substance abuse, poverty, and risk-taking behavior. I did some cross-training in Canada and currently teach medical students in British Columbia how to critically assess medical literature as well as how to practice medicine.

I am American, not Canadian. But I care enough about making the US system the best it can be to look wherever I can for good, solid, scientific information to use in improving it. To do otherwise seems to treat that topic as one not worth the utmost care and importance, and I find that egregious.

[ June 22, 2007, 12:19 PM: Message edited by: ClaudiaTherese ]

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ClaudiaTherese
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quote:
I'm pretty confident that when she says that studies show poorer outcomes for black babies in the US she isn't insinuating anything about anyone's intent, merely pointing out that, contrary to what was earlier asserted, that we do not have the best outcomes in infant mortality rates for all population groups in this country.
And most assuredly what dkw said. (Thanks! [Smile] )

As I clarified in my post to Belle above, I was not commenting on whether individual choices and/or the influences of poverty in other ways played a role, or to the extent it played a role. I think it does, but that is tangential to my posts -- I was commenting on the interpretation of the data in this article, as I went back and looked at the numbers myself. I think that there are many sources online which are taking the implications of the study to be greater than intended by the authors of the study, as from the article itself, they acknowledge that what they see is a mitigation of the disparity, although they acknowledge that a great disparity does still exist.

You see, Dan_Frank, these Canadian authors published an article that was arguing against the US numbers being as bad as is generally presented. Yes, the same Canadians you were disparaging.

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orlox
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"To the Point" on NPR did a show on Sicko:
http://www.kcrw.com/news/programs/tp/tp070622will_sicko_change_am

[ June 22, 2007, 05:02 PM: Message edited by: orlox ]

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sndrake
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Diane and I went to the Chicago rally yesterday - speakers included Studs Terkel, Michael Moore, and Quentin Young (National Coordinator of the Physicians for a National Health Program).

Then we went and watched SiCKO at a theater a mile away. Free tickets for members of sponsoring organizations. [Smile]

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JLM
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We have an nice little universal healthcare experiment going on in Massachusetts. Lets wait a few years (at least 5) and see how well it works before we even think about wading into the waters at a national level.
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sndrake
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Video of the rally at our local Fox channel, includes a brief shot of Diane wearing her "Not Dead Yet" tshirt. [Smile] (I'm there, too, but my head's cut off in the clip.)
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mackillian
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I'm not sure of the Massachusetts healthcare experiment is exactly universal healthcare. Residents are now legally required to purchase heath insurance, like the requirement that insurance must be purchased for cars.

edit: sndrake—diane's shirt made me giggle, especially knowing her sense of humor

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ClaudiaTherese
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quote:
Originally posted by JLM:
We have an nice little universal healthcare experiment going on in Massachusetts. Lets wait a few years (at least 5) and see how well it works before we even think about wading into the waters at a national level.

Alternatively, you could look at the outcomes of the 50 state-wide programs providing universal access to children that have been in place for the last 10 years, as per Title XXI of the Social Security Act.
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Icec0o1
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quote:
WE pay for ALL the research and development for most of the drug companies, and the rest of the world pays almost nothing of the cost compared to us. THAT is why they are more expensive here then anywhere else in the world.

That's what the drug companies brainwash the American public to think and it's complete BULL. It does not take billions of dollars to create a drug. Most of the enormous amounts of money the drug companies make go towards TV and other advertisement, gifts and lunches to doctors who prescribe the drugs, lawyers, and of course a thick lining of the corporation's pockets.

Drugs aren't expensive because of R&D, it's because they're a necessity and drug companies can charge anything they want for them.

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Angiomorphism
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Case and point, Genetech's Avastin and Herceptin, two revolutionary cancer drugs, priced through the roof, just because they can be:

_________________________________________

Until now, drug makers have typically defended high prices by noting the cost of developing new medicines. But executives at Genentech and its majority owner, Roche, are now using a separate argument — citing the inherent value of life-sustaining therapies.

If society wants the benefits, they say, it must be ready to spend more for treatments like Avastin and another of the company's cancer drugs, Herceptin, which sells for $40,000 a year.

"As we look at Avastin and Herceptin pricing, right now the health economics hold up, and therefore I don't see any reason to be touching them," said William M. Burns, the chief executive of Roche's pharmaceutical division and a member of Genentech's board. "The pressure on society to use strong and good products is there."
____________________________________________

http://www.nytimes.com/2006/02/15/business/15drug.html?ex=1297659600&en=62aabaec5acffa8c&ei=5090&partner=rssuserland&emc=rss

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TomDavidson
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quote:
I'm there, too, but my head's cut off in the clip.
Wow. You guys are SERIOUS about that "no disability makes me less of a human" rhetoric. [Wink]
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Samprimary
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quote:
Originally posted by Dan_Frank:
[QB] Samprimary, you seem to have an idealized view of European socialized medicine.

I wish I could idealize, but about the best I'm saying for their systems is that 'they work better than the American system.'

This is like idealizing a car by saying that it isn't a rusted hulk sitting on blocks. Glowing praise, indeed.

And if one doesn't turn a limited anecdotal perspective into a scientific study of which system is better, the socialized systems win, hands down. There is not even a comparison. The American system is a failure.

We have fewer doctors per capita. We go to the hospital less frequently. We waste many orders of magnitude more of our healthcare costs on inefficient bureaucracy and paperwork. We are less satisfied with the healthcare we receive. We have about the lowest life expectancy of any modern nation, and we have higher infant mortality rates than some developing countries. It's obscene.

And, of course, every single other country in the industrialized world insures every single one of its citizens. We spend hundreds of billions of dollars more on health care -- over two and a half times the industrialized world's median -- and still leave over 50 million people without insurance of any sort.

And if you'll excuse my sudden bluntness, I'm going to jump on the idea of having limited tolerance for noise. Don't waste time with useless anecdotal criticism, and don't try to run an Argument by Question.

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Samprimary
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I watched Sicko.

THE BAD:

- Heavy anecdotal pressuring
- Emotional appeals
- Michael Moore is still smarmy
- So are his sound and retro video clips

THE GOOD:

- Essentially right
- Makes sure to establish that it's actually covering the story of America's 'insured' patients
- Picks on all the right baddies, including incriminating evidence about Nixon's collaborations
- Sickening
- Actually goes a fair bit into the damning statistics about american health care
- Hillary Clinton gets some overglorification. You THINK. Then there's a startling plot twist!
- Pillories the false crap that is used to defensively demonize socialized healthcare
- Actually turns some of that on its head in a creative way: in the same field, we've socialized nearly every other public service and it works ... better?

I mean, he's attacking the American healthcare system. How easy does it get? He had it made with this one.

As a person who won't sit through his other movies, I think everyone needs to suck it up and watch this one.

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Icarus
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What's the point in watching if you already agree? (Or, frankly, if you're educated on the topic at all?) It won't help you discuss the issue, if it's true to Michael Moore form, because it will be so full of half-truths that anybody knowledgeable on the other side will skewer you if you try. It's not really educational. So you get a fun rah-rah! for your side, but is that worth the nine bucks?

I can see hoping that the uneducated and the apathetic on the other side see it, because it may change their views and motivate them. I don't feel that way personally, though. For one thing, if they're on the other side and unmotivated, they won't be interested in this movie. For another, it feels vaguely intellectually dishonest of me to wish for easy conversions from propaganda.

ADDED: I wish Michael Moore movies weren't on the scene. As someone who agree with him on some major issues, I don't think they help at all. I think he damages discourse.

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Dagonee
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quote:
It does not take billions of dollars to create a drug.
No, it takes about $800 million, counting everything necessary to get approval to offer the drug on the market.

There are differing estimates (e.g., $500 million to more than $2,000 million) but they're still large amounts of money.

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Belle
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I used to work for a pharmaceutical company. It was about seven years ago, so my first hand info is definitely out of date, but I can promise you that R&D is in fact a huge part of the budget, even more than sales and marketing.

And, sales and marketing efforts wouldn't have to be so aggressive and thus so expensive if drug companies weren't pressured to have to make back all the R&D cost so quickly because of expiring patents and cheap generics.

Don't forget about the R&D on all the drugs that didn't make it to the market.

Oh, and compliance costs a lot of money. We actually employed more people in our regulatory department than we did our marketing department. Regulatory's job was to ensure drug safety and compliance with all FDA regulations. Those regulations are exact and very detailed and we got audited twice while I worked there, big drug companies get audited even more often. Those are good things, though for the American consumer. The FDA inspectors came in and checked things like whether we were keeping proper records on our samples (in case of recall), were the drugs stored at the proper temperature, was all packaging labeling correct, etc.

America does have the safest drug supply in the world, but that safety costs money. We also had an indigent program where we supplied drugs to people who couldn't afford it. Most if not all pharmaceutical companies have similar programs. Since we marketed a drug to kids with cystic fibrosis, we were also very active in the local CF charity events, and donated quite a lot of money not to mention pretty much every employee volunteered time in such activities.

Lest you think I'm a Big Pharma Kool-Aid drinker, however, I do feel obligated to point out that much of what was spent in the sales and marketing department was excessive. We did not need to hold sales meetings in exotic locales when brining our reps to Birmingham Alabama would have served just fine and been a lot cheaper. Yes, there is a lot of waste. However, I don't think pharmaceutical companies deserve quite the bad rap they always get. There's a lot going on the average public doesn't know about. Saying that R&D costs money is not an excuse to charge vast amounts for a drug because R&D really DOES cost money. So does regulatory, so do indigent care programs.

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Bob the Lawyer
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Belle, out of curiousity, roughly how large was the company you worked for? (~number of employees. tens, hundreds, thousands, tens of thousands?)
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Belle
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Hundreds. We were very small. While I worked there they only marketed one prescription drug and several other non-prescription. They have since been purchased by a large company and absorbed into the larger one.
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Kwea
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quote:
Originally posted by Icec0o1:
quote:
WE pay for ALL the research and development for most of the drug companies, and the rest of the world pays almost nothing of the cost compared to us. THAT is why they are more expensive here then anywhere else in the world.

That's what the drug companies brainwash the American public to think and it's complete BULL. It does not take billions of dollars to create a drug. Most of the enormous amounts of money the drug companies make go towards TV and other advertisement, gifts and lunches to doctors who prescribe the drugs, lawyers, and of course a thick lining of the corporation's pockets.

Drugs aren't expensive because of R&D, it's because they're a necessity and drug companies can charge anything they want for them.

Bullshit.


How much does a single study cost, on average? I know, because I was a part of 12 of them....but I bet you have no idea.

How many studies are required, on average, before a drug is approved? What are the legal repercussions if a drug is unsafe, even if it passes every single clinical study the USDA requires before being released. What type of liability does the drug company have in those cases?


How many lawsuits does an average drug company deal with per day?

What percent of all drugs under development actually make it to the shelf? What is the average cost of each one that doesn't make it, and how long does it take before the company finds out it isn't effective?


What type of liability does the company assume during the testing process?


What is the average time frame before a drug becomes available?


Before you make any such claims again, you should be able to answer...and document each answer...each of those. And that is just to get the BASICS down, the basics of the claim you have already made.


Ours system is broke, no doubt. A lot of money DOES go to some of what you mentioned. But a HUGE part of it goes to R&D.

Ignorance isn't the cure.

[ June 23, 2007, 08:19 PM: Message edited by: Kwea ]

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Bob the Lawyer
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Kwea, if you know half as much as you say you do you know that most of those questions don't have answers. What's an "average" drug company? The size of the company and the nature of the work they're conducting has an enormous impact on costs.

Not to mention that lawyer costs are in a different category. The fact that drug companies have to employ many, many more lawyers than research scientists may well be a problem, but it's a different problem from research costs.

I also wonder how applicable your time with USAMRIID is. Their drug targets are, by and large, completely different from what Big PharmaTM goes after (which is another huge problem with the system).

For that matter, I think you're suffering from the same problem, Belle. Small start up companies generally look at diseases that Big PharmaTM does not, and generally goes about their research "by the fine touch of a chemist's hand." Nobody who has the money not to that does that. The game is so different between companies with a few hundred people than one with thousands that it's not really fair to compare.

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Kwea
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quote:
Originally posted by Bob the Lawyer:
Kwea, if you know half as much as you say you do you know that most of those questions don't have answers. What's an "average" drug company? The size of the company and the nature of the work they're conducting has an enormous impact on costs.

Not to mention that lawyer costs are in a different category. The fact that drug companies have to employ many, many more lawyers than research scientists may well be a problem, but it's a different problem from research costs.

I also wonder how applicable your time with USAMRIID is. Their drug targets are, by and large, completely different from what Big PharmaTM goes after (which is another huge problem with the system).

For that matter, I think you're suffering from the same problem, Belle. Small start up companies generally look at diseases that Big PharmaTM does not, and generally goes about their research "by the fine touch of a chemist's hand." Nobody who has the money not to that does that. The game is so different between companies with a few hundred people than one with thousands that it's not really fair to compare.

There are answers, but some of them are not clearly defined. That in itself was a correct answer to some of those questions. [Smile]


USAMRIID is the place that created (after some very dangerous and sometimes immoral experiments in the past) one of the best informed-consent programs for human testing of drug protocols in the world, a model that is held up as a gold standard for human testing of final stage protocols all over the world.

I realize that not all of the costs are the same, but I have a better-than-average knowledge of the system used and it's costs than most. I am NOT an expert....12 years ago was when I had the majority of my experience, and a lot of that was a the lower end of those protocols. The LEAST expensive protocol I worked o was well in excess of 2.3 million dollars, though...just to give a baseline for comparison. That was for the final stage alone...there were 6 other stages before that, and 3 other groups after mine, to address complications that were a part of our study.


I am not aware of the final costs, but it was AT LEAST half a billion if I had to guess.....not including production, of course. That was also using our world-class labs and personell.

The Army has LOWER costs than the drug companies on average, and their base findings are more dependable on average because their base population for MRVS's are healthier, with fewer confounding complications than most test populations.

Bob, the only reason I addressed the points of lawyers is that that IS an associated cost for companies that test on humans, even with informed consent. It is also a HUGE part of the risk assessment of a drug protocol, which bears on the over all cost of R&D in general.


I personally worked on new anti-Malarial drugs, Chick/VEE, Hantana, and RVF protocols. Most of the work USAMRIID does is NOT related to biological counters, although there are some of those going on all the time as well.


You can find stats on the "average" cost of a lot of the points I brought up earlier, but you are correct in assuming that the size of the companies involved plays a part in the over all cost of medical research. The problem is that the risks are so high that all it takes to bankrupt even a fairly large company is one or two drugs that don't pan out....or even worse, accidentally ccause harm to people taking it. Most drugs tested never pan out, but that doesn't mean it didn't take millions of dollars to find that out.


Lyr.....don't worry about it. [Wink] I am fairly knowledgeable about these issues, but hardly an expert. I did my homework, to be sure, but every person should always make up their own mind about serious issues like these. I just happen to have some personal...and professional... experiences that helped me make up my own mind.

Dan...that is part of the problem. Medical knowledge does belong to those who discover and develop it. They should be able to price it according to a market value, but there also has to be some sort of balance between that and the common good. It isn't black and white....but the grays are pretty dark these days, IMO. [Wink]

Point blank...we spend more money for less results than almost any other country, and that has to change, one way or another.

[ June 24, 2007, 01:52 AM: Message edited by: Kwea ]

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Xaposert
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quote:
What's the point in watching if you already agree? (Or, frankly, if you're educated on the topic at all?) It won't help you discuss the issue, if it's true to Michael Moore form, because it will be so full of half-truths that anybody knowledgeable on the other side will skewer you if you try. It's not really educational. So you get a fun rah-rah! for your side, but is that worth the nine bucks?
Is it ever be worthwhile for an educated person to read or watch a persuasive essay, article, book, or film? All of these will deliberately slant the truth towards whatever the work is persuading us to agree with, and will show only a set of facts that the author believes shows his conclusion to be true, but does that make the work worthless and not really educational?
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Bob the Lawyer
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Ah, I had thought you were referring to lawyers handling suits after the drug was released and resolving patent issues, neither of which should really be factored into R&D (although patent lawyers often are, I believe).

The reason I questioned your experience is because the design philosophy of the army and Big PharmTM are completely opposed. The army works on new vaccines. Large American companies, as a general rule, do not. Heck, just looking for novel cures is a big difference. The money is in treatments for conditions that already have treatments on the market. Sure chemical libraries cost a lot of money, but you already know where to look.

I disagree with your risk assessment. Or rather, I agree but think what I just mentioned above is how companies have worked around it. Once you're using chemical libraries based on existing comounds and using preclinical simulations software (which, to be fair, didn't exist 12 years ago), your risk plummets and your development cycle shrinks by a few years. (5-7 years standard as opposed to 10ish). At this point, how much of a risk are you taking? A big one, but not nearly the risk that most people think.

Most drugs don't pan out. Most drugs don't cost millions of dollars to find that out. Anything before preclinical is pretty cheap, and preclinical is getting cheaper and cheaper. The ~3 drugs that make it to clinical trials are where the expense lies.

Pardon this if it rambles and meanders. I just got off a 12 hour shift [Smile]

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Kwea
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No....I agree to a point, although as you said a lot of things depend on a number of variables.


Hell...I know about this stuff more than most, but as I said I am hardly an expert. My experience was in administering those drugs and recording data for the study, not in drawing up compounds for testing myself. However, my day day to day job was in the safety office so I got a fairly well-rounded view of the whole process. [Smile]


I am a fine jewelry manager these days, and I know more about that than I do about safety OR drug development. [Wink]


But to say that R&D isn't a major cost, if not THE major cost, is complete bunk.


Gotta love thread shift. [Big Grin]

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Chanie
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I am wondering whether the average American with decent health insurance gets better/worse/same health care as a Canadian. Is the wait time less? Are there tests/treatments better? Does it depend on whether it is a routine problem (say ear infection) or a serious problem (maybe a heart attack)? I have seen statistics such as life expectancy and cost/person for an entire country's health care system. But a lot of detail can be lost in those aggregates.

Why *are* the drug prices so radically different? I got my prescription when I was in Spain for less than I pay with insurance, and 10% of what I would have paid without insurance. Are other countries subsidizing those drugs? I would imagine they are, and if Americans started allowing mass imports, they would stop allowing them out of the country. Allowing drugs from Canada doesn't seem like a viable solution to me.

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ClaudiaTherese
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quote:
Originally posted by Chanie:
But a lot of detail can be lost in those aggregates.

Aggregates are made up of details -- large numbers of details. Where details really get lost is when you focus on individual cases, since that way you lose everyone eles's details.

That being said, I'd be happy to try to answer your question, but I'm not sure I can make sense of it yet. What do you mean by "average American" and "a Canadian"? American with the most common brand of insurance, or American with the median income, or American most like you (sometimes people do mean this), or what? And by "a Canadian," do you mean "most Canadians" or an "average Canadian" (see previous)?

Canadians don't actually all get the same experience of healthcare. There are federal funds [as well as provincial], but they are allocated provincially, so there are differences between provinces. Also, if you are way out in a relatively unpopulated area, your healthcare experience is driven as much by travel issues as it is by insurance.

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Chanie
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Ah, sorry. I meant, for Mrs. M.'s example of premie care on the previous page. One could say that a certain country spent less of premie care and got the same life expectancy. But are more of the premies disabled? I was trying to say that perhaps if you randomly chose a set of premies that had similar birth circumstances and compared them after say a year, you may be able to get a better idea of the quality.

I guess for American, I would go with "most common plan on the most common insurance." Pretty much everyone that I discuss this with has health insurance. Their argument is that if we went to a system like Canada, those who currently have health care would get better service. But people like them (say assistant professors) would have inferior care than what they currently have.

I guess what I'm asking it how the median American with insurance compares with the median Canadian. I know it's not a rigorous measure, but what I have not really been able to find is an objective measure. For example, does the median Canadian wait longer/shorter if they have an ear infection and want to see a doctor? What if they have back pain? This is the sorta question that while not comprehensive, at least gives an intuitive way to compare health care systems.

I thank you for any help you can be answering these questions.

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Bob the Lawyer
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quote:

But to say that R&D isn't a major cost, if not THE major cost, is complete bunk.

Well, R&D and marketing combined are a drop in the bucket in comparison to production costs.

quote:
No....I agree to a point, although as you said a lot of things depend on a number of variables.
Hey, that's something, I'm not even sure I know what my point was! [Smile]
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ClaudiaTherese
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quote:
Originally posted by Chanie:
I was trying to say that perhaps if you randomly chose a set of premies that had similar birth circumstances and compared them after say a year, you may be able to get a better idea of the quality.

This is indeed what is done in many of the comparison studies already referenced. A sample population is drawn randomly, double-checked to make sure it is representative, and then generalized to the whole population.

Sometimes there are aggregate numbers used for the whole population, but often these are not available, so samples are used.

quote:
I guess for American, I would go with "most common plan on the most common insurance."

I'm pretty sure that no individual plan covers more than Kaiser Permanente, which has a total of 8.5 million plan members. So there are more people with no insurance plan (~46 million) than there are with any given private plan. (And I think Kaiser offers multiple plans, so even the 8.5 million is probably smaller.)

We could use "no plan," though, since it is technically the most common individual plan by how I understand what you are asking for.
quote:
Pretty much everyone that I discuss this with has health insurance. Their argument is that if we went to a system like Canada, those who currently have health care would get better service. But people like them (say assistant professors) would have inferior care than what they currently have.

I don't think the data supports this, but I am not sure why many people believe many of the things they do.
quote:
I guess what I'm asking it how the median American with insurance compares with the median Canadian.

"Median" always has to refer to some particular scale, and until I am sure what scale you are using, I don't think I can make sense of the term you are using. It is too vague to mean anything specific, and you have to be specific if you are going to compare numbers.
quote:
For example, does the median Canadian wait longer/shorter if they have an ear infection and want to see a doctor? What if they have back pain? This is the sorta question that while not comprehensive, at least gives an intuitive way to compare health care systems.

Again, it's hard to be specific without defining the terms carefully. But I expect that for most primary care types of problems (which are most problems people see a physician about), Candians probably wait less on average to be seen by a physician. This is because Canadians with a healthcare insurance from any of the provinces can walk into any primary care doctor's office -- anywhere in Canada -- and have that visit covered by their insurance.

In contrast, many (if not most) Americans with private insurance have HMO plans, which means they are only covered (for most common problems) if they see one of a very limited number of physicians employed by their HMO. Otherwise, they have to pay out of pocket.

But that is just a hazarded guess based on how the systems work -- we'd have to define terms more carefully to look at actual numbers.

quote:
I thank you for any help you can be answering these questions.

Delighted! [Smile] They are interesting questions.

----

Edited to add: You could also look at the numbers of people on Medicaid, Medicare, and/or other State or Federal programs and look at wait times, if you included these as "insurance plans." (You seemed to be going for private plans, not public, though.) Many premature infants are covered on non-private plans, for example.

[ June 24, 2007, 04:08 PM: Message edited by: ClaudiaTherese ]

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jlt
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Just commenting on my own experience...
My friend who moved here from England (her family moved because of business) who has a chronic joint problem (she's in the hospital almost once a week, with big needles to drain stuff)said that the system in England was slow at first but that once you had a doctor and regular appointments things were fine. I asked her if it was more expensive here- she said very much so.
Also, I wanted to bring up that bureaucracy is rarely efficient, for example, the state run hospitals where I live are much worse than the private ones.
Personally, I like the idea of both private and public healthcare co existing (if it was possible). I think that if someone really needs treatment for an injury or illness, or something lifesaving, then (in almost all cases-there's so many what ifs)they should be able to get it without having to worry about the cost. But I really don't know enough about the issue to make a strong judgement.

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