Discussion:
The Last Child (1971) partly coming true
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Quadibloc
2019-05-09 04:54:27 UTC
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This movie included Ed Asner as a bad guy. I couldn't remember the title, but I
found it.

In any case, while people aren't fleeing the United States to have children, they
are leaving it to get something else that was prohibited in that movie...

https://www.cbc.ca/news/canada/nova-scotia/americans-diabetes-cross-canada-border-insulin-1.5125988

I know there are those here who feel Canadians shouldn't comment on U. S.
politics, but I feel that Canadians and Americans share a common humanity.

John Savard
Jack Bohn
2019-05-09 13:19:19 UTC
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I know there are those here who feel Canadians shouldn't comment on U. S. 
politics, but I feel that Canadians and Americans share a common humanity. 
Well we don't, so cut it out.
--
-Jack
a425couple
2019-05-09 14:30:39 UTC
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Post by Quadibloc
I know there are those here who feel Canadians shouldn't comment on U. S.
politics, but I feel that Canadians and Americans share a common humanity.
John Savard
Correct that US and Canadian citizens share a lot.
And need to value each other.

But do not tell us how to organize and run a country.
J. Clarke
2019-05-09 22:14:35 UTC
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Post by a425couple
Post by Quadibloc
I know there are those here who feel Canadians shouldn't comment on U. S.
politics, but I feel that Canadians and Americans share a common humanity.
John Savard
Correct that US and Canadian citizens share a lot.
And need to value each other.
But do not tell us how to organize and run a country.
I don't have any issue with foreigners _commenting_ but Quadi's
comment is generally of the nature "Americans should go die for my
cause".
Dorothy J Heydt
2019-05-09 22:46:07 UTC
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Post by J. Clarke
Post by a425couple
Post by Quadibloc
I know there are those here who feel Canadians shouldn't comment on U. S.
politics, but I feel that Canadians and Americans share a common humanity.
John Savard
Correct that US and Canadian citizens share a lot.
And need to value each other.
But do not tell us how to organize and run a country.
I don't have any issue with foreigners _commenting_ but Quadi's
comment is generally of the nature "Americans should go die for my
cause".
Only if they want to. For the love of whatever gods you care to
name, let people die for their own causes, not somebody else's.
--
Dorothy J. Heydt
Vallejo, California
djheydt at gmail dot com
www.kithrup.com/~djheydt/
Quadibloc
2019-05-10 03:57:24 UTC
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Post by Dorothy J Heydt
Post by J. Clarke
I don't have any issue with foreigners _commenting_ but Quadi's
comment is generally of the nature "Americans should go die for my
cause".
Only if they want to. For the love of whatever gods you care to
name, let people die for their own causes, not somebody else's.
The United States has the resources to deal with threats to world peace in ways
that are unavailable to other countries. And in the Suez Crisis, the allies of
the United States have learned they are not really permitted to act on their
own.

However, some of my comments that he has interpreted in this manner were instead
intended to indicate that it would be desirable to achieve some end... were
there a magic wand available to do so. I do not want to plunge America into
another Vietnam - or have it start World War III. But I do want to see an end to
war, terrorism, and tyranny.

John Savard
Juho Julkunen
2019-05-10 17:17:01 UTC
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In article <***@4ax.com>, jclarke.873638
@gmail.com says...
Post by J. Clarke
Post by a425couple
Post by Quadibloc
I know there are those here who feel Canadians shouldn't comment on U. S.
politics, but I feel that Canadians and Americans share a common humanity.
John Savard
Correct that US and Canadian citizens share a lot.
And need to value each other.
But do not tell us how to organize and run a country.
I don't have any issue with foreigners _commenting_ but Quadi's
comment is generally of the nature "Americans should go die for my
cause".
And remarkably often that cause is the wholesale slaughter of brown
people.
--
Juho Julkunen
Jibini Kula Tumbili Kujisalimisha
2019-05-10 20:38:05 UTC
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Post by Juho Julkunen
On Thu, 9 May 2019 07:30:39 -0700, a425couple
Post by a425couple
Post by Quadibloc
I know there are those here who feel Canadians shouldn't
comment on U. S. politics, but I feel that Canadians and
Americans share a common humanity. John Savard
Correct that US and Canadian citizens share a lot.
And need to value each other.
But do not tell us how to organize and run a country.
I don't have any issue with foreigners _commenting_ but Quadi's
comment is generally of the nature "Americans should go die for
my cause".
And remarkably often that cause is the wholesale slaughter of
brown people.
Those last two words apparently don't belong together (in
Quaddieworld). If it's brown, it's clearly not people.
--
Terry Austin

Vacation photos from Iceland:
https://plus.google.com/u/0/collection/QaXQkB

"Terry Austin: like the polio vaccine, only with more asshole."
-- David Bilek

Jesus forgives sinners, not criminals.
Gene Wirchenko
2019-05-10 02:14:27 UTC
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Post by a425couple
Post by Quadibloc
I know there are those here who feel Canadians shouldn't comment on U. S.
politics, but I feel that Canadians and Americans share a common humanity.
John Savard
Correct that US and Canadian citizens share a lot.
And need to value each other.
But do not tell us how to organize and run a country.
Hey, neighbour, how about you take care of your own?

I do not blame the people who want insulin so they can live.

Sincerely,

Gene Wirchenko
Quadibloc
2019-05-10 04:01:05 UTC
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Post by Gene Wirchenko
I do not blame the people who want insulin so they can live.
Clearly, though, the U. S. Government is going to take quick action to stop people
stealing from pharmaceutical companies and violating their patents! They may not
be being stopped at the border now, but I expect this to change soon, if past
experience is any guide.

John Savard
J. Clarke
2019-05-10 11:24:41 UTC
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Post by Quadibloc
Post by Gene Wirchenko
I do not blame the people who want insulin so they can live.
Clearly, though, the U. S. Government is going to take quick action to stop people
stealing from pharmaceutical companies and violating their patents! They may not
be being stopped at the border now, but I expect this to change soon, if past
experience is any guide.
Patents? Patents in the US are good for 17 years. Insulin as a
medication dates back to the 1930s.
Quadibloc
2019-05-10 12:29:49 UTC
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Post by J. Clarke
Post by Quadibloc
Post by Gene Wirchenko
I do not blame the people who want insulin so they can live.
Clearly, though, the U. S. Government is going to take quick action to stop people
stealing from pharmaceutical companies and violating their patents! They may not
be being stopped at the border now, but I expect this to change soon, if past
experience is any guide.
Patents? Patents in the US are good for 17 years. Insulin as a
medication dates back to the 1930s.
That's true. But the companies making insulin can still patent improvements they
make to provide a better, safer medication to patients. And apparently these
improvements are sufficient that no company in the U.S. has considered it
worthwhile to make a generic version of insulin based on any preparation that is
no longer under patent protection.

John Savard
Cryptoengineer
2019-05-10 15:20:37 UTC
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Post by Quadibloc
On Thu, 9 May 2019 21:01:05 -0700 (PDT), Quadibloc
Post by Quadibloc
Post by Gene Wirchenko
I do not blame the people who want insulin so they can live.
Clearly, though, the U. S. Government is going to take quick action
to stop people stealing from pharmaceutical companies and violating
their patents! They may not be being stopped at the border now, but
I expect this to change soon, if past experience is any guide.
Patents? Patents in the US are good for 17 years. Insulin as a
medication dates back to the 1930s.
That's true. But the companies making insulin can still patent
improvements they make to provide a better, safer medication to
patients. And apparently these improvements are sufficient that no
company in the U.S. has considered it worthwhile to make a generic
version of insulin based on any preparation that is no longer under
patent protection.
From: https://fas.org/sgp/crs/misc/IF11026.pdf:

November 19, 2018
Insulin Products and the Cost of Diabetes Treatment

"From 2001 to 2015, the price of one type of insulin (insulin
lispro) increased 585% (from $35 to $234 per vial). One vial
might last a patient less than two weeks. "

pt
r***@rosettacondot.com
2019-05-10 15:59:49 UTC
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Post by Cryptoengineer
Post by Quadibloc
On Thu, 9 May 2019 21:01:05 -0700 (PDT), Quadibloc
Post by Quadibloc
Post by Gene Wirchenko
I do not blame the people who want insulin so they can live.
Clearly, though, the U. S. Government is going to take quick action
to stop people stealing from pharmaceutical companies and violating
their patents! They may not be being stopped at the border now, but
I expect this to change soon, if past experience is any guide.
Patents? Patents in the US are good for 17 years. Insulin as a
medication dates back to the 1930s.
That's true. But the companies making insulin can still patent
improvements they make to provide a better, safer medication to
patients. And apparently these improvements are sufficient that no
company in the U.S. has considered it worthwhile to make a generic
version of insulin based on any preparation that is no longer under
patent protection.
November 19, 2018
Insulin Products and the Cost of Diabetes Treatment
"From 2001 to 2015, the price of one type of insulin (insulin
lispro) increased 585% (from $35 to $234 per vial). One vial
might last a patient less than two weeks. "
https://www.walmart.com/ip/Novolin-ReliOn-Insulin-N/167672445
https://www.walmart.com/ip/Novolin-ReliOn-Insulin-R/129783484
Both $24.88 at our local Walmart.
We used to use the "N" version for our dog with diabetes. At least in Texas
insulin and syringes don't require a prescription. I don't think the price
on these has moved much in the last 10 years. It's interesting that Wikipedia
quotes the US cost as $134.00.

Robert
--
Robert K. Shull Email: rkshull at rosettacon dot com
Cryptoengineer
2019-05-10 16:38:33 UTC
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Post by r***@rosettacondot.com
Post by Cryptoengineer
Post by Quadibloc
On Thu, 9 May 2019 21:01:05 -0700 (PDT), Quadibloc
Post by Quadibloc
Post by Gene Wirchenko
I do not blame the people who want insulin so they can live.
Clearly, though, the U. S. Government is going to take quick
action to stop people stealing from pharmaceutical companies and
violating their patents! They may not be being stopped at the
border now, but I expect this to change soon, if past experience
is any guide.
Patents? Patents in the US are good for 17 years. Insulin as a
medication dates back to the 1930s.
That's true. But the companies making insulin can still patent
improvements they make to provide a better, safer medication to
patients. And apparently these improvements are sufficient that no
company in the U.S. has considered it worthwhile to make a generic
version of insulin based on any preparation that is no longer under
patent protection.
November 19, 2018
Insulin Products and the Cost of Diabetes Treatment
"From 2001 to 2015, the price of one type of insulin (insulin
lispro) increased 585% (from $35 to $234 per vial). One vial might
last a patient less than two weeks. "
https://www.walmart.com/ip/Novolin-ReliOn-Insulin-N/167672445
https://www.walmart.com/ip/Novolin-ReliOn-Insulin-R/129783484
Both $24.88 at our local Walmart.
We used to use the "N" version for our dog with diabetes. At least in
Texas insulin and syringes don't require a prescription. I don't think
the price on these has moved much in the last 10 years. It's
interesting that Wikipedia quotes the US cost as $134.00.
Interesting. Its about $0.25 per unit.

Compare to https://www.drugs.com/price-guide/lantus-solostar, which
is a very common perscription, and about $3.00 per unit.

Why the difference? See
https://insulinnation.com/treatment/why-walmart-insulins-arent-the-
answer-to-high-insulin-prices/

TL,DNR: Lantus, etal, are much easier to live with. The Walmart
insulin requires very close and frequent monitoring of blood
sugar and diet, and a lot of discipline.

I wonder of 'looping' will change the equation, making it easier
to use the cheaper drug:

https://www.theatlantic.com/science/archive/2019/04/looping-created-
insulin-pump-underground-market/588091/

pt
r***@rosettacondot.com
2019-05-10 18:37:50 UTC
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Post by Cryptoengineer
Post by r***@rosettacondot.com
Post by Cryptoengineer
Post by Quadibloc
On Thu, 9 May 2019 21:01:05 -0700 (PDT), Quadibloc
Post by Quadibloc
Post by Gene Wirchenko
I do not blame the people who want insulin so they can live.
Clearly, though, the U. S. Government is going to take quick
action to stop people stealing from pharmaceutical companies and
violating their patents! They may not be being stopped at the
border now, but I expect this to change soon, if past experience
is any guide.
Patents? Patents in the US are good for 17 years. Insulin as a
medication dates back to the 1930s.
That's true. But the companies making insulin can still patent
improvements they make to provide a better, safer medication to
patients. And apparently these improvements are sufficient that no
company in the U.S. has considered it worthwhile to make a generic
version of insulin based on any preparation that is no longer under
patent protection.
November 19, 2018
Insulin Products and the Cost of Diabetes Treatment
"From 2001 to 2015, the price of one type of insulin (insulin
lispro) increased 585% (from $35 to $234 per vial). One vial might
last a patient less than two weeks. "
https://www.walmart.com/ip/Novolin-ReliOn-Insulin-N/167672445
https://www.walmart.com/ip/Novolin-ReliOn-Insulin-R/129783484
Both $24.88 at our local Walmart.
We used to use the "N" version for our dog with diabetes. At least in
Texas insulin and syringes don't require a prescription. I don't think
the price on these has moved much in the last 10 years. It's
interesting that Wikipedia quotes the US cost as $134.00.
Interesting. Its about $0.25 per unit.
Compare to https://www.drugs.com/price-guide/lantus-solostar, which
is a very common perscription, and about $3.00 per unit.
Why the difference? See
https://insulinnation.com/treatment/why-walmart-insulins-arent-the-
answer-to-high-insulin-prices/
TL,DNR: Lantus, etal, are much easier to live with. The Walmart
insulin requires very close and frequent monitoring of blood
sugar and diet, and a lot of discipline.
Right...I think these are state of the art from roughly 40 years ago,
when rDNA versions of human insulin replaced animal-derived.
I suspect they're still better than none at all.
The porcine versions that these replaced are still around as well, I think
primarily for veterinary use. Human insulin doesn't work too well in cats, but
porcine does. It's also substantially more expensive ($1.25-1.50/unit).
(Human insulin works well enough in dogs.)
Post by Cryptoengineer
I wonder of 'looping' will change the equation, making it easier
https://www.theatlantic.com/science/archive/2019/04/looping-created-
insulin-pump-underground-market/588091/
The cynical part of me thinks that new regulations will be forthcoming.


Robert
--
Robert K. Shull Email: rkshull at rosettacon dot com
f***@gmail.com
2019-05-13 06:38:04 UTC
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<<snippped - apologies if I mis-attribute>>
Post by r***@rosettacondot.com
Post by Cryptoengineer
"From 2001 to 2015, the price of one type of insulin (insulin
lispro) increased 585% (from $35 to $234 per vial). One vial
might last a patient less than two weeks. "
https://www.walmart.com/ip/Novolin-ReliOn-Insulin-N/167672445
https://www.walmart.com/ip/Novolin-ReliOn-Insulin-R/129783484
Both $24.88 at our local Walmart.
We used to use the "N" version for our dog with diabetes. At least in Texas
insulin and syringes don't require a prescription. I don't think the price
on these has moved much in the last 10 years. It's interesting that Wikipedia
quotes the US cost as $134.00.
I'm highly suspicious of the alleged price of insulin in the US.

I'm in South Africa, hardly a hotbed of inexpensive health care. My Medical Aid pays for 3.5 Optisulin SoloStar pens a month, at about R 140 (that is 140 Rands, Rands being South Africa's currency). On a good day one $ = R14. On a bad day, it could be closed to R14.5 . The MA doesn't pay for Lantus because it is allegedly 15% more expensive for the exact same product with a different name.

The insulin is IMPORTED into South Africa, none made locally, not even imported in bulk and packaged here. Somewhere, at one of South Africa's ports, a container (either ship or air freight) of insulin and sundry other imported medication is arriving right now to make sure that millions of South Africans can get their meds at the end of the month.

Lantus is manufactured in the US, and somehow it is 14 x more expensive there than in a third world country in Africa. How does that work? Please tell me the excuse is not Liability Insurance, or some such crock.

I don't know what non-pen type insulin costs. I do have a friend who is a type I who uses bottled insulin with a pump. I'll need to ask.
Post by r***@rosettacondot.com
Robert
--
Robert K. Shull Email: rkshull at rosettacon dot com
Regards
Frank
r***@rosettacondot.com
2019-05-13 15:47:47 UTC
Reply
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Post by f***@gmail.com
<<snippped - apologies if I mis-attribute>>
Post by r***@rosettacondot.com
Post by Cryptoengineer
"From 2001 to 2015, the price of one type of insulin (insulin
lispro) increased 585% (from $35 to $234 per vial). One vial
might last a patient less than two weeks. "
https://www.walmart.com/ip/Novolin-ReliOn-Insulin-N/167672445
https://www.walmart.com/ip/Novolin-ReliOn-Insulin-R/129783484
Both $24.88 at our local Walmart.
We used to use the "N" version for our dog with diabetes. At least in Texas
insulin and syringes don't require a prescription. I don't think the price
on these has moved much in the last 10 years. It's interesting that Wikipedia
quotes the US cost as $134.00.
I'm highly suspicious of the alleged price of insulin in the US.
I'm in South Africa, hardly a hotbed of inexpensive health care. My Medical Aid pays for 3.5 Optisulin SoloStar pens a month, at about R 140 (that is 140 Rands, Rands being South Africa's currency). On a good day one $ = R14. On a bad day, it could be closed to R14.5 . The MA doesn't pay for Lantus because it is allegedly 15% more expensive for the exact same product with a different name.
Is R 140 what you pay or what your plan pays on your behalf? My "out-of-pocket"
ranges from $0 (most generic "maintenance medications") to 20% of insurance
cost (most other medications) to 100% of retail (medications for which there
is an equivalent "preferred" by the insurance company).
Drugs.com shows the lowest retail price for Lantus SoloStar as $452.52/5 pens.
That's retail...no insurance, no discount card, no patient assistance program.
A patient could pay anything from full retail to nothing depending on a
combination of all of those.
For example, my insurance won't pay for Lantus at all, but my cost for Basaglar would be $0.
It's very common in the US for doctors to write (or re-write) prescriptions to
meet the requirements of the patient's insurance. The unfortunate thing is that
many of them won't offer and many patients (especially elderly patients) don't
know to ask. This can make a huge difference...I recall that a doctor
prescribed a medication for my mom. When my dad went to pick up the first
month's supply the cost was over $700. He called the doctor, who replaced it
with a different medication, dropping the price to $30.

Robert
--
Robert K. Shull Email: rkshull at rosettacon dot com
f***@gmail.com
2019-05-14 07:31:07 UTC
Reply
Permalink
Hi all and Robert in particular,
<<stuff snipped>>
Post by r***@rosettacondot.com
Post by f***@gmail.com
I'm in South Africa, hardly a hotbed of inexpensive health care. My Medical Aid pays for 3.5 Optisulin SoloStar pens a month, at about R 140 (that is 140 Rands, Rands being South Africa's currency). On a good day one $ = R14. On a bad day, it could be closed to R14.5 . The MA doesn't pay for Lantus because it is allegedly 15% more expensive for the exact same product with a different name.
Is R 140 what you pay or what your plan pays on your behalf? My "out-of-pocket"
R 140 is the approximate price of one Optisulin Solostar pen. Its the same price whether I pay for or my plan pays for it. The Medical Aid pays for 3.5 so R 490. I can choose to buy more, if I could afford it, which I can't. I've had my doctors (three up to this point) argue with them that 3 pens a month is not enough but Medical Aids are stubborn. If I insisted on getting Lantus I would have to pay +- 15% on the 3 pens, or R 563.5. Seeing as everyone insists that Optisulin and Lantus are basically the same thing I'm OK to go with the cheaper product.
Post by r***@rosettacondot.com
ranges from $0 (most generic "maintenance medications") to 20% of insurance
cost (most other medications) to 100% of retail (medications for which there
is an equivalent "preferred" by the insurance company).
Drugs.com shows the lowest retail price for Lantus SoloStar as $452.52/5 pens.
That's retail...no insurance, no discount card, no patient assistance program.
This is why I'm suspicious of the high costs being spoken about in the US. How can a First country supply a third world country with medicine at 1/14 of the cost that its own citizens have to pay? Someone, somewhere, is somehow cooking the books.
Post by r***@rosettacondot.com
A patient could pay anything from full retail to nothing depending on a
combination of all of those.
Are the people paying the "full price" doing so because they don't have Health Insurance?
Post by r***@rosettacondot.com
For example, my insurance won't pay for Lantus at all, but my cost for Basaglar would be $0.
It's very common in the US for doctors to write (or re-write) prescriptions to
meet the requirements of the patient's insurance. The unfortunate thing is that
In South Africa this is an ACTUAL LEGAL REQUIREMENT! Doctors have to write the scripts that your plan pays for. And they have to do the legwork when it comes to motivating for Medical Aid to make an exception for a medically sound reason (like a life-threatening allergy to the prescribed med). Unfortunately not enough doctors, or patients know this. I've learned it the hard way from butting heads with the Medical Aids for far too long.
Post by r***@rosettacondot.com
many of them won't offer and many patients (especially elderly patients) don't
know to ask. This can make a huge difference...I recall that a doctor
prescribed a medication for my mom. When my dad went to pick up the first
month's supply the cost was over $700. He called the doctor, who replaced it
with a different medication, dropping the price to $30.
The only class of medication that you'd get that kind of percentage saving on in SA are Antibiotics. I've often had a doctor write up the original Augmentum (I think that is how it is spelt), at multiple hundreds of rands, and the pharmacist suggests I take the generic for R 50. Same stuff just 5% to 10% of the price. However my wife seems to have some real issues with the generics, and if we have to get her Augmentum we need to pick the generic very carefully.
Post by r***@rosettacondot.com
Robert
--
Robert K. Shull Email: rkshull at rosettacon dot com
What are other diabetic meds (Metformin, pioglitazone, glipizide, etc) costing? Is this simply a case of US drug makers / sellers exploiting a captive audience across the board, or insulin a special case?

Keep in mind that in South Africa you are technically allowed to go to any government hospital, show them your SA ID, and demand Care (and meds) for Free. In practice the process is a meat grinder designed to make sure only the toughest or most stubborn actually complete the process to the point of getting their meds. My wife and I tried to use the state system and found it to be hostile to the point of being abusive.


Anyway....

Regards
Frank
r***@rosettacondot.com
2019-05-15 01:26:38 UTC
Reply
Permalink
Post by f***@gmail.com
Hi all and Robert in particular,
Post by r***@rosettacondot.com
ranges from $0 (most generic "maintenance medications") to 20% of insurance
cost (most other medications) to 100% of retail (medications for which there
is an equivalent "preferred" by the insurance company).
Drugs.com shows the lowest retail price for Lantus SoloStar as $452.52/5 pens.
That's retail...no insurance, no discount card, no patient assistance program.
This is why I'm suspicious of the high costs being spoken about in the US. How can a First country supply a third world country with medicine at 1/14 of the cost that its own citizens have to pay? Someone, somewhere, is somehow cooking the books.
The answer to this is really complicated. The short summary is:
(a) because getting a drug approved and on the market in the US is incredibly
expensive
(b) because the retail price gives them a starting point for negotiation with
insurance companies
(c) because they spend a ton of money promoting drugs in the US, primarily in
the form of free samples but also in advertising and "inducements" to doctors
(d) (guessing here) because they can write off all of the discounts they
give to uninsured people and the higher the price the more they benefit
(e) because people in the US are used to paying more for just about everything
(f) because they can
Post by f***@gmail.com
Post by r***@rosettacondot.com
A patient could pay anything from full retail to nothing depending on a
combination of all of those.
Are the people paying the "full price" doing so because they don't have Health Insurance?
Generally yes. There are usually other discount options, but they require
research or assistance and the people most in need of discounts tend to be
those least able to find them. I've been getting one of my medications fully
reimbursed by the manufacturer for years because they want to increase their
market share (and the number of insurance companies which will cover their
drug).
Post by f***@gmail.com
Post by r***@rosettacondot.com
many of them won't offer and many patients (especially elderly patients) don't
know to ask. This can make a huge difference...I recall that a doctor
prescribed a medication for my mom. When my dad went to pick up the first
month's supply the cost was over $700. He called the doctor, who replaced it
with a different medication, dropping the price to $30.
The only class of medication that you'd get that kind of percentage saving on in SA are Antibiotics. I've often had a doctor write up the original Augmentum (I think that is how it is spelt), at multiple hundreds of rands, and the pharmacist suggests I take the generic for R 50. Same stuff just 5% to 10% of the price. However my wife seems to have some real issues with the generics, and if we have to get her Augmentum we need to pick the generic very carefully.
This was a change to a different medication in the same class...presumably
one preferred by their insurance. That sort of change in price isn't
uncommon since you typically go from paying full retail to 20% of the
insurance provider's negotiated price (sometimes nothing). Going from brand
to generic can be just as spectacular. My insurance company needs written
justification from my doctor and approval by them to cover brands when a
generic is available. In the case of Augmentin my cost for the generic is
$7.14, for the brand it's $416.38.
Post by f***@gmail.com
What are other diabetic meds (Metformin, pioglitazone, glipizide, etc) costing? Is this simply a case of US drug makers / sellers exploiting a captive audience across the board, or insulin a special case?
A quick check shows retail price (Walmart):
Metformin ER 500mg $10/360
Pioglitazone (15, 30 or 45mg) $24/90
Glipizide (5 or 10mg) $10/180
Those are all available as generics. I don't know if there are any "modern"
generic insulins.

Robert
--
Robert K. Shull Email: rkshull at rosettacon dot com
f***@gmail.com
2019-05-15 06:32:38 UTC
Reply
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On Wednesday, May 15, 2019 at 3:32:05 AM UTC+2, ***@rosettacondot.com wrote:

<much snipped>
Post by r***@rosettacondot.com
Metformin ER 500mg $10/360
Metformin 500mg X 56 : R43.19 + R 25.85. So R 414.24 for 336, or +-$ 29.58
Post by r***@rosettacondot.com
Pioglitazone (15, 30 or 45mg) $24/90
Cipla Pioglitazone Hydrochloride 15mg X 30: R 179.90 + R 73.15 dispensing fee. So R 759.15 for 90 or about $ 54.22.
Post by r***@rosettacondot.com
Glipizide (5 or 10mg) $10/180
Glipizide 5mg X 100 : R 523.80 + R 154.55 dispensing fee. So R 1221.03 for 180, or about $ 87.21.

Gliclazide 80mg X 60 : R112 + R 49.76 dispensing fee. So R 323.52 for 120 (that is the dose I take) $ 23.10.
Post by r***@rosettacondot.com
Those are all available as generics. I don't know if there are any "modern"
generic insulins.
AFAIK Optisulin is the 'generic' of Lantus, but Lantus isn't even the original either.

But, in short, looking at what South Africans ( or their Medical Aids are) paying compared with the USA citizen, I concluding that despite price regulation we're paying too much for all diabetic meds, except Insulin. And it strongly suggests that something is wrong with the pricing model for American Insulin.

I confidently say that this is the only product in the world that is manufactured outside of South Africa and ends up costing 1/14 of what Americans are paying for it. Shipping to SA is no cheap. Dealing with the SA bureaucracy is not cheap. How can anyone account for this other than to conclude that a whole lot of dollars are going into someone's pocket, and it isn't the researchers who made the medicine possible, or the end-user who needs it to stay alive.

Heck, for the kind of money we're talking about a couple of dozen diabetics could get together, pool their money and order some Optisulin online from a South African pharmacy, and get a third party to ship it to them. Of cause US customs would probably have a whole herd of cows when the X-ray machine reveals the parcel's contents, but assuming you could get around that hurdle....
Post by r***@rosettacondot.com
Robert
--
Robert K. Shull Email: rkshull at rosettacon dot com
Regards
Frank
Quadibloc
2019-05-16 05:53:25 UTC
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Post by f***@gmail.com
This is why I'm suspicious of the high costs being spoken about in the US. How
can a First country supply a third world country with medicine at 1/14 of the
cost that its own citizens have to pay? Someone, somewhere, is somehow cooking
the books.
Speaking of books, there are cheap "International Student Editions" of textbooks
that cost much more than students in first world countries have to pay for the
same book.

So I think there is a simple explanation. Drug companies recover the costs of
researching new drugs from patent royalties on what they make for rich
countries, but they don't add this on to what they sell for poor countries.

This isn't dishonest accounting, it's market segmentation.

John Savard
f***@gmail.com
2019-05-16 07:35:03 UTC
Reply
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On Thursday, May 16, 2019 at 7:53:29 AM UTC+2, Quadibloc wrote:

<<my stuff snipped>>
Post by Quadibloc
Speaking of books, there are cheap "International Student Editions" of textbooks
that cost much more than students in first world countries have to pay for the
same book.
Don't get me start on the price of books. Books in South Africa are ridiculously priced. A cheap paperback novel that is going to start disintegrating along the spine after the second read-through costs R 350 new, or maybe R 200 if you buy it at the Bargain Book store. Although somehow the same store manages to sell 3 for R99 soft-po..., ... sorry Romance novels.
Post by Quadibloc
So I think there is a simple explanation. Drug companies recover the costs of
researching new drugs from patent royalties on what they make for rich
countries, but they don't add this on to what they sell for poor countries.
How long are they (or should they) be able to continue doing this? The patents on the actual insulin apparently ran out in the 90s. The insulin pens have been around for at least as long, and AFAIK there have been no significant advances to radically improve their design.

More telling is that the price increase has been sharp and recent (something like 500% in a few years). Nothing else is increasing in price that fast, and neither the Canadians or Mexicans are complaining about a sudden drastic increase in the cost of insulin.

More over, despite our tanked economy, despite our inflation, despite the reputation for our pharmacy chain stores, and medical aids to be greedy bastards, the price of insulin in SA has not changed much in the last 10 years. Its steadily been creeping up by about 0.5% a year. This slow increase is why my medical aid stopped paying for Lantus and got me to switch to Optisulin.
Post by Quadibloc
This isn't dishonest accounting, it's market segmentation.
Market segmentation sounds like dishonest accounting to me. Or like stealing from the consumer because he doesn't have any option other than to buy your product Is Market segmentation the same term used by the media producers to justify the zoning of DVDs to force people to buy locally made discs at the locally inflated prices?
Post by Quadibloc
John Savard
Also, isn't most of the REAL research into new drugs done by government labs and universities, primarily because the money-grubbing bastards in charge of multi-national drug companies don't want to be involved in billion dollar, multi-year projects that might end up not going to market for some tricky reason like life-threatening side effects in a small percentage of consumers.

Kind regards
Frank
r***@rosettacondot.com
2019-05-16 14:47:57 UTC
Reply
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Post by f***@gmail.com
Post by Quadibloc
This isn't dishonest accounting, it's market segmentation.
Market segmentation sounds like dishonest accounting to me. Or like stealing from the consumer because he doesn't have any option other than to buy your product Is Market segmentation the same term used by the media producers to justify the zoning of DVDs to force people to buy locally made discs at the locally inflated prices?
Market segmentation has a lot to do with boundaries, political, legal, social
and economic. DVD region codes were a recognition of one of those...the
boundaries formed by film distribution rights and patterns.
When a manufacturer prices something, they have a lot of different
ways they can come up with their cost to produce it. The simplest (and lowest)
is to try and add up their cost in materials, labor, market-specific
regulatory, administrative and sales expenditures, etc. That pays for making
and selling the product, but not for the cost of developing it and not for the
costs expended on all of the research that didn't result in a product. Market
segmentation lets them use a pricing model that "works" for the target market.
Using the pricing model from the US would result in huge increases in other
markets. The US pricing model is especially extreme. AFAICT it essentially
adds all of the costs that they didn't include in any other market, then it
adds a huge markup on the assumption that they're going to apply a big discount
when they negotiate with insurers. This means that anyone who has to pay retail
(i.e. the roughly 9% who have no insurance) gets slammed, assuming they can't
(or don't know how to) find a discount program.
Post by f***@gmail.com
Also, isn't most of the REAL research into new drugs done by government labs and universities, primarily because the money-grubbing bastards in charge of multi-national drug companies don't want to be involved in billion dollar, multi-year projects that might end up not going to market for some tricky reason like life-threatening side effects in a small percentage of consumers.
The short answer is "no".
The US government spends about $39 billion on medical research via the National
Institutes of Health while the US pharmaceutical industry spends about
$71 billion. Industry does include some items that are only somewhat related
to research (like regulatory costs during the approval process), but government
sponsored research includes things that aren't really related to medicines
(i.e. $7 billion on behavioral and social science).
The pharmaceutical industry typically spends more as a percentage of revenue
on R&D than any other industry except semiconductors*.
The real difference is that industry spends on research that is likely to
result in products they can sell while governments aren't so limited. This is
why, for example, cancer gets a huge investment by industry and tropical
diseases don't.
Universities (or rather research groups within universities) tend to do
research more than pay for it. I was in engineering, not medicine, but
researchers were typically supported by government or industry grants, not by
the university itself. For instance, petroleum engineering research and the
PE faculty positions themselves were primarily sponsored by the oil industry.
Medicine probably has a lot of charitable grants as well, engineering not so
much.
OTOH, the government tends to pay for research more than it engages in research
(roughly 80:20 in the US).
There are, of course, exceptions. I know that there are some government
research institutes and there are also some universities than run research
as a profit center (generally via patent licensing).
My completely unsupported suspicion is that a lot of industry money goes to
universities for basic research and the companies use the results to decide
where to concentrate their real effort (and expenditure). Given the $billions
it takes to get a drug into production they'd probably prefer letting the
universities, with their cheap disposable graduate students, do the first pass.

Robert

* <https://www.investopedia.com/ask/answers/060115/how-much-drug-companys-spending-allocated-research-and-development-average.asp>
--
Robert K. Shull Email: rkshull at rosettacon dot com
Robert Carnegie
2019-05-16 22:47:41 UTC
Reply
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Post by Quadibloc
Post by f***@gmail.com
This is why I'm suspicious of the high costs being spoken about in the US. How
can a First country supply a third world country with medicine at 1/14 of the
cost that its own citizens have to pay? Someone, somewhere, is somehow cooking
the books.
Speaking of books, there are cheap "International Student Editions" of textbooks
that cost much more than students in first world countries have to pay for the
same book.
?um, do you mean "cost much more", or "cost much less"?
Post by Quadibloc
So I think there is a simple explanation. Drug companies recover the costs of
researching new drugs from patent royalties on what they make for rich
countries, but they don't add this on to what they sell for poor countries.
This isn't dishonest accounting, it's market segmentation.
The willingness of poor countries to make bootlegs
of desperately needed products and services that they
can't afford, also is a factor.
Quadibloc
2019-05-16 23:21:10 UTC
Reply
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Post by Robert Carnegie
Post by Quadibloc
Speaking of books, there are cheap "International Student Editions" of textbooks
that cost much more than students in first world countries have to pay for the
same book.
?um, do you mean "cost much more", or "cost much less"?
Oops, yes, less.

John Savard

Peter Trei
2019-05-16 19:10:06 UTC
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Post by f***@gmail.com
<<snippped - apologies if I mis-attribute>>
Post by r***@rosettacondot.com
Post by Cryptoengineer
"From 2001 to 2015, the price of one type of insulin (insulin
lispro) increased 585% (from $35 to $234 per vial). One vial
might last a patient less than two weeks. "
https://www.walmart.com/ip/Novolin-ReliOn-Insulin-N/167672445
https://www.walmart.com/ip/Novolin-ReliOn-Insulin-R/129783484
Both $24.88 at our local Walmart.
We used to use the "N" version for our dog with diabetes. At least in Texas
insulin and syringes don't require a prescription. I don't think the price
on these has moved much in the last 10 years. It's interesting that Wikipedia
quotes the US cost as $134.00.
I'm highly suspicious of the alleged price of insulin in the US.
You can look it up. For example:

https://www.goodrx.com/lantus
https://www.drugs.com/price-guide/lantus-solostar

When doing so, remember to compare the cost per 'Unit'.

For people with insurance, most or all of the price is covered.

pt
Quadibloc
2019-05-10 04:06:28 UTC
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Post by a425couple
But do not tell us how to organize and run a country.
Oh, it certainly _is_ true - as can be seen from history - that countries run
like Canada, on the Parliamentary system, tend to have a lower MTBF than the
United States; lots of such countries have elected a dictator, and stopped
having elections.

Britain stands as one exception to this - it has kept its Parliamentary system
working well for longer than the United States has been in existence. Various
theories have been advanced as to why it has been more successful than the
typical nation of Continental Europe, but the question is not settled.

So, while the American checks and balances system has obvious drawbacks (such as
the fact that pork barrel politics, unlike patronage, has positive feedback) it
has worked very well in the most important respect. There is, however, cause for
concern that the election of Donald J. Trump may indicate your luck is running
out.

John Savard
Dorothy J Heydt
2019-05-10 04:35:30 UTC
Reply
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Post by Quadibloc
Post by a425couple
But do not tell us how to organize and run a country.
Oh, it certainly _is_ true - as can be seen from history - that countries run
like Canada, on the Parliamentary system, tend to have a lower MTBF than the
United States; lots of such countries have elected a dictator, and stopped
having elections.
Britain stands as one exception to this - it has kept its Parliamentary system
working well for longer than the United States has been in existence. Various
theories have been advanced as to why it has been more successful than the
typical nation of Continental Europe, but the question is not settled.
ObFantasy: in Wrede and Stevermer's _The Mislaid Magician,_ it
turns out that ley lines crossing Britain are magical bonds that
keep the UK together (and have done since long before there was a
UK).

Clearly, in some other world than OTL. (Reign of George IV, with
magic.)
--
Dorothy J. Heydt
Vallejo, California
djheydt at gmail dot com
www.kithrup.com/~djheydt/
David Johnston
2019-05-10 17:12:14 UTC
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Post by Quadibloc
Post by a425couple
But do not tell us how to organize and run a country.
Oh, it certainly _is_ true - as can be seen from history - that countries run
like Canada, on the Parliamentary system, tend to have a lower MTBF than the
United States; lots of such countries have elected a dictator, and stopped
having elections.
How can a single nation that has not yet fallen have a calculable MTBF?
Jibini Kula Tumbili Kujisalimisha
2019-05-10 17:16:34 UTC
Reply
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Post by David Johnston
Post by Quadibloc
Post by a425couple
But do not tell us how to organize and run a country.
Oh, it certainly _is_ true - as can be seen from history - that
countries run like Canada, on the Parliamentary system, tend to
have a lower MTBF than the United States; lots of such
countries have elected a dictator, and stopped having
elections.
How can a single nation that has not yet fallen have a
calculable MTBF?
In the minds of some (and only in their minds), human civlization
ended when Donald Trump won the election. The hallucinations are
pretty strong.
--
Terry Austin

Vacation photos from Iceland:
https://plus.google.com/u/0/collection/QaXQkB

"Terry Austin: like the polio vaccine, only with more asshole."
-- David Bilek

Jesus forgives sinners, not criminals.
Quadibloc
2019-05-10 17:30:12 UTC
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Post by David Johnston
How can a single nation that has not yet fallen have a calculable MTBF?
It can have a lower bound. Of course, there would be error bars on it.

John Savard
David Johnston
2019-05-10 22:41:26 UTC
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Post by Quadibloc
Post by David Johnston
How can a single nation that has not yet fallen have a calculable MTBF?
It can have a lower bound.
No, it can't. It could be that it was a coin toss whether or not it
became a dictatorship in the first twenty years or so after it was
founded. It could be it was a fluke that it didn't collapse. In fact
that's what generally happens with democracies that collapse. They
collapse or are subverted because they're kind of new to this democracy
deal and haven't firmly established their attachment to it.

In the case of the United States...probably not because their
quasi-democracy was an outgrowth of England's quasi-democracy that had
been developing for centuries and had firmly established traditions but
that has nothing to do with the specific quirks of the system they
established
a425couple
2019-05-10 02:25:09 UTC
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Post by Quadibloc
I know there are those here who feel Canadians shouldn't comment on U. S.
politics, but I feel that Canadians and Americans share a common humanity.
John Savard
So, John / Quadibloc
chew on this curruption going in in your own country:

https://nationalpost.com/news/canada/in-an-inspired-performance-henein-did-incalculable-damage-to-the-trudeau-brand

"Henein took pains to praise the prosecutors in the Norman case
for their integrity and professionalism. She was not as kind about
the Prime Minister’s Office and the Privy Council Office, which
she blamed collectively for withholding a host of documents, over
months and even years, that she felt were crucial to her client’s
defence."
Quadibloc
2019-05-10 03:59:29 UTC
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Post by a425couple
So, John / Quadibloc
Well, he finally got exonerated, so that is proof that our system works!

John Savard
Stephen Harker
2019-05-10 07:58:01 UTC
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Post by Quadibloc
Post by a425couple
So, John / Quadibloc
Well, he finally got exonerated, so that is proof that our system works!
The Roman system worked much better. Rather than our speciest
appointment of presidents, prime ministers or such they appointed a
horse as consul. Until we can match that example we cannot talk of
equality!
--
Stephen Harker ***@netspace.net.au
was: http://sjharker.customer.netspace.net.au/
now: http://members.iinet.net.au/~***@netspace.net.au/
or: http://members.iinet.net.au/~sjharker_nbn/
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