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Pharma Gouging: This Time It’s Personal

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Epipen

I have no way of knowing if an EpiPen has ever saved my live, because the counterfactual is eternally unknowable. But it may well have on multiple occasions. Even if you’re very conscientious, it’s very difficult to avoid triggering nut allergies, and I’ve averaged roughly an EpiPen use a year for a decade. So I can assure you that this is a big deal:

The extensive price hike for a vital, life-saving drug for many with allergies is causing concern among doctors, patients, and politicians—along with a guy responsible for an extensive price hike himself.

Mylan pharmaceutical, the maker of the EpiPen—a portable epinephrine injector that can potentially save someone having a life-threatening allergic reaction—is being accused of raising the price of the product from around $100 in 2008 to $500 today. In all, that’s an increase of over 400 percent.

This is especially worrying because Mylan has a near monopoly in the business, especially after one of its competitors issued a recall last year. Doctors have likened its brand dominance in schools to that of Kleenex. Many schools have emergency epinephrine in stock and there are states pushing for legislation to make that mandatory.

[…]

“The drug industry’s greed knows no bounds,” Sanders said. “The only explanation for Mylan raising the price by six times since 2009 is that the company values profits more than the lives of millions of Americans.”

NBC stated that while there isn’t a House committee investigation in the works, there is a lawsuit on the way.

“I’ve been looking at EpiPen for years,” said Ari Kresch, CEO of 1-800-LAW-FIRM. “It’s a very cheap drug but I haven’t been successful in getting any experts to tell me why the price has gone up as much as it has.”

The insurance I have until December at least has pretty good pharma coverage, so will the co-pay for an EpiPen is much higher than for any other prescription I’ve ever had to fill it’s not hard to afford on a middle-class salary.  But for people with worse insurance and/or more strained circumstances this could be a serious hardship, and I can see people taking the risk of going without one. It’s a serious problem.

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  • I don’t need an EpiPen, but I take another medication injected in the same way, Enbrel, and it is ridiculously expensive as well. I’m just lucky that Medi-CAL cover it, at least for now.

      • Warren Terra

        The site you linked is not available in the US.

        Embrel and other “biologicals” are large proteins, or more than one. These are expensive to make: as I understand it, the cell culture to make them isn’t incredibly expensive, but making absolutely sure the product hasn’t been contaminated by viruses or by toxins released by bacterial or fungal contaminants is quite expensive (an entire factory in the Boston area had to be shut down and cleaned to a degree resembling reconstruction a few years back because of such a problem); also, these large, delicate molecules present problems in distribution and storage compared to small molecules.

        So: producing “biologicals” for human use is not going to be cheap. I’m not saying this either explains or justifies the prices of “biologicals”; I’m fully prepared to believe gouging is going on, and indeed the high baseline costs of making “biologicals” may make gouging easier to get away with. But, I’m skeptical of claims that they need not be expensive.

        • The site you linked is not available in the US.

          You can’t read that page? Really? I didn’t think NICE geoblocked. Wacky.

          So: producing “biologicals” for human use is not going to be cheap.

          I believe that, but it’s the particular “hideously expensive” that I doubt.

          This describes the process a bit more (backing up what you said).

          However, we do see a price gap between US and other nations:

          The U.S. retail price of Enbrel has risen over time. In 2008, the cost of Enbrel was reported to be $1,500 per month or $18,000 per year.[22] By 2011, the cost had reportedly exceeded $20,000 per year.[23][24] In 2013, a survey by the International Federation of Health Plans (IFHP) found that the average U.S. cost for Enbrel was $2,225 per month, or $26,700 per year.[25] The IFHP report also found wide variation in prices charged to various U.S. health plans, between $1,946 per month at the 25th percentile and $4,006 per month at the 95th percentile.[25]

          Enbrel is more expensive in the U.S. than in other countries.[25] As of 2013, average monthly costs in surveyed nations ranged from $1,017 in Switzerland to $1,646 in Canada, compared to an average monthly cost of $2,225 per month in the U.S.[25]

          Amgen sells Enbrel within the U.S. and Canada, while Pfizer, Inc. sells the drug outside of the U.S. and Canada.[23] Sales within the U.S. and Canada were $3.5 billion in 2010.[23] Sales of Enbrel outside the U.S. and Canada were $3.3 billion in 2010.[26]

          They extended the patent, but unless there’s some force to share cell lines or fast track biosimilars (maybe not a good idea), then generics might not pop up.

          • The problem is less one of manufacture than the fact that as patents expire it is more expensive for competitors to make generic, actually biosimilar, versions of these drugs. Unlike generics which don’t require much for further testing or approval biosimilars do require testing and approval as they are unique compounds. It is also not clear that biosimilars will work the same as the original drug.
            Nevertheless the patient costs for these drugs are way out of line with manufacturing costs. I take a Remicade, another arthritis drug. Unlike Enbrel, Remicade is administered by infusion. In my case I take a fairly high dose on a five week cycle.
            The charge for each infusion is close to $13,000 although Blue Cross negotiates that down to about $7000. For the last twelve years I’ve had the infusion at my doctor’s office, about a three hour procedure.
            Recently my doctor’s practice was bought out by a for profit hospital system and the infusions were moved to the hospital which allows for additional administration charges. Also, Medicare allows a higher reimbursement for the drug when administered in a hospital setting.
            Most of the companies that sell these drugs have patient support or rebate programs. In my case the drug company reimburses all but $5 of my copay until I reach my maximum out of pocket (the reimbursed amounts still count against out of pocket expenses) after which the drug company receives the full amount. It’s an ingenious way of making sure patients can afford the drug while maintaining high prices. Of course ultimately we all pay for that in higher insurance premiums.
            These drugs are true lifesavers (actually quality of lifesavers). While it is true that the costs to manufacture these drugs are high there is little justification for the extraordinarily high prices and the wide variability in pricing.

            • The problem is less one of manufacture than the fact that as patents expire it is more expensive for competitors to make generic, actually biosimilar, versions of these drugs. Unlike generics which don’t require much for further testing or approval biosimilars do require testing and approval as they are unique compounds. It is also not clear that biosimilars will work the same as the original drug.

              But that’s what I mean by sharing cell lines etc. It’s not enough to have permission to manufacture, you actually need critical material or you are doing biosimilar rather than general manufacturing. In some sense, the patent isn’t as necessary because the cost and difficulty of replication is too high.

              That will increasingly be the case, so we almost certainly need an alternative mechanism, including forcing RAND licensing or sharing of the key infrastructure.

              • MPAVictoria

                The vast difference in prices charged between countries should put to rest forever the idea that drugs are expensive because they are costly to make.

                • Well, it’s not that simple. You might be price smoothing. In one country you might be negotiating with the government for the entire country and in another with lots of individual hospitals (which drive up costs in that country). A *lot* of price variation in the US is price smoothing.

                  Plus, biologicals are genuinely expensive to make.

                  Plus, traditionally, the argument isn’t that drugs are costly to *manufacture* but to *develop*.

                  That being said, it is a warning sign when there are such differentials.

                • MPAVictoria

                  “Well, it’s not that simple.”

                  In fact it IS that simple Bijan.

                • As my comment explained, it isn’t.

                  But feel free to reassert.

                • Pat

                  Without providing new facts or logic.

                • MPAVictoria

                  “Plus, traditionally, the argument isn’t that drugs are costly to *manufacture* but to *develop*.”

                  This is the give away that you have been taken in by Pharma company propaganda. The vast majority of drug research is funded by the government or through charities not by big pharma companies.

                  “You might be price smoothing.”
                  So a difference of $90,000 is “price smoothing”?
                  http://www.reuters.com/article/us-hepatitis-egypt-gilead-sciences-idUSBREA2K1VF20140321

                  “Plus, biologicals are genuinely expensive to make.”
                  They are more expensive to make than traditional pharmaceuticals but because cost of manufacture has almost no impact on the final price of these drugs I fail to see why that matters in the slightest.

                • sibusisodan

                  Here in the UK, the government contributes around 2% of the cost of R&D.

                  There is a considerable amount of basic research funded by state and charity, but that’s not at all the same thing as taking a promising drug candidate and making it through Phase III trials…

                  I spent a large part of my postgraduate chemistry research being rather angry at the Big Pharma reps for what seemed to me like complacency in the face of genuine social issues regarding affordability of medicine…but that’s a separate argument from the costs of pharma R&D, which are both real and large.

                • Thanks for replying substantively.

                  I didn’t say that it was never gouging, just that you can’t go immediately from a price differential to mere gouging, and explained why. That there are counterexamples doesn’t invalidate my claim that it’s more complicated than you made out.

                  This is the give away that you have been taken in by Pharma company propaganda. The vast majority of drug research is funded by the government or through charities not by big pharma companies.

                  See sibusisodan’s comment and this:

                  In a Journal of the American Medical Association (JAMA) study published in January 2010, the largest study to date to attempt to quantify U.S. funding of biomedical research by the pharmaceutical industry, government and private sources, researchers estimate that U.S.

                  biomedical research currently stands at about over $100 billion annually.

                  The pharmaceutical industry is the largest contributor towards fundingresearch, funding over 60 percent. The government contributes to about a third of the costs, with foundations, advocacy organizations and individual donors responsible for the remaining investments.

                  “You might be price smoothing.”
                  So a difference of $90,000 is “price smoothing”?
                  http://www.reuters.com/article/us-hepatitis-egypt-gilead-sciences-idUSBREA2K1VF20140321

                  It could be. Again, probably not for manufacturing, given the fact that generics seem cheap to produce, but for total investment? Some of the smoothing is over failed drugs.

                  “Plus, biologicals are genuinely expensive to make.”
                  They are more expensive to make than traditional pharmaceuticals but because cost of manufacture has almost no impact on the final price of these drugs I fail to see why that matters in the slightest.

                  It’s unclear that cost of manufacture has almost no impact esp. for the biologicals, but yes, I agree that in general it seems that the bulk of the cost of non-generics in patent is not marginal cost of production of a pill. If you add on the amortised cost of development, things might be closer.

                  That being said, it’s just a complication.

                • MPAVictoria

                  You probably don’t have access to this article but high R&D costs are mostly a myth:

                  http://www.springer.com/social+sciences/journal/41292

                  I good summary of the article is available here.
                  http://www.theglobeandmail.com/life/health-and-fitness/drug-rd-costs-are-less-than-estimated—so-why-the-high-prices/article623054/

                • sibusisodan

                  You probably don’t have access to this article but high R&D costs are mostly a myth:

                  That’s a useful article, but doesn’t seem to deal at all with the costs of research into drugs which don’t make it to market.

                  It’s all very well saying that it’s not that expensive to bring a successful drug to market (I have my quibbles, but let it stand). What percentage of candidates make it through Stage III? From memory, it’s around 5% of candidates at best.

                  The majority of R&D spending is devoted to finding potential drugs, not bringing those drugs to market.

                • MPAVictoria

                  It does in fact. They are including that in their total cost by looking at the tax receipts from these companies. It is actually an ingenious way to get accurate info.

                • Here’s a summary of the Tufts rebuttal. If Tufts is right that these critiques aren’t citing prior rebuttals, then that’s a bit of a warning sign.

                  (Just to be clear: I certainly don’t endorse pharmaceutical pricing and if we are going to have companies producing and selling drugs, it’s going to require a hell of a lot of counter pressure to keep prices sane.

                  Personally, I suspect that nationalising drug development and maybe production is ultimately the right way to go. If you need some “start up culture” juice, you can do some sort of mixed mode with the post-patent situation be nationalisation.)

                • MPAVictoria

                  Worth pointing out that Tufts receives a big chunk of their funding from (surprise surprise) pharma companies.

                • sibusisodan

                  That’s not terribly responsive to the rebuttal.

                  Either their arguments are germane, or they aren’t. If they are a bunch of ink trying to obscure the issue, it should be possible to show that.

                  If their rebuttal is coherent and defensible, then the source of their funding is a secondary concern, at best.

                • Worth pointing out that Tufts receives a big chunk of their funding from (surprise surprise) pharma companies.

                  What sibusisodan said. The Centre seems reasonably transparent about their methods and funding.

                  Here’s another rebuttal (from a different source) of a key point:

                  The higher the interest rate used in capitalization, the larger is the multiple between out-of-pocket and capitalized costs. Light and Warburton argue (2011, p. 41) that the 11 percent interest rate used by the Tufts group was too high, given that U.S. Government Office of Management and Budget guidelines in 2003 called for applying a 3 percent interest rate in evaluating public capital outlays. This criticism is clearly wrong. Governments like the United States (at least up to the year 2012) financed their deficits with what were widely considered “risk-free” bonds that indeed often bore quite low interest rates. But the common stock with which corporations are financed is riskier and bears considerably higher implicit interest rates. Addressing this issue, finance experts advising the U.S. Office of Technology Assessment found (p. 67) that the cost of capital (i.e., the implicit interest rate) for established pharmaceutical companies in the 1980s and early 1990s was on the order of 8 to 10 percent after stripping away inflation premia. They found too that R&D-intensive activities were more risky than ordinary corporate investments, calling for interest rate premia on the order of 4.5 percentage points, or approximately 13 to 14 percent over-all. Recognizing this, the 11 percent implicit interest rate used by the Tufts group appeared consistent with broader knowledge and perhaps even conservative for the time period covered.

                  I point out these rebuttals not to adjudicate. I can’t seem to get the original article, but it seems that there’s genuine controversy not that it’s been “shown” that high R&D costs “are a myth” as you’ve claimed.

                  Indeed, you’ve made other, somewhat rash, claims:

                  This is the give away that you have been taken in by Pharma company propaganda. The vast majority of drug research is funded by the government or through charities not by big pharma companies.

                  So, the Tufts research is “propaganda” now? And, we rebutted (without acknowledgement) that a majority (to a large majority) of funding comes from industry. (And even if the ‘vast’ majority of funding wasn’t from industry, that doesn’t speak to *how big* the investment is.)

          • rea

            This site has detected that you are accessing it from United States.

            Unfortunately this site is only available from Great Britain.

            We apologise for any inconvenience.

            • That’s…weird. Thanks for the details. I’ll have to ping the folks I know at NICE.

              • cpinva

                “But the common stock with which corporations are financed is riskier and bears considerably higher implicit interest rates.”

                let me just shred this little bit of stupidity. full disclosure: I am CPA, I audit Fortune 500 companies here in the US, and take into account their foreign subsidiaries or parent holding companies. hence, Foreign Tax Credits & Transfer Pricing are in my area of purview. Transfer Pricing specifically is relevant to the issue at hand.

                Much of the R&D expenditures claimed by companies (and used to compute the R&D Credit) are paid to someone else, to do the actual work. much of them are paid to colleges & universities, to pay for either licensing rights, or the patent itself. overall, roughly 50% of all R&D costs, in the US, are paid directly by the Federal Gov’t, some in the form of grants for theoretical research, most for research leading to a specific product or process.

                companies do not issue additional shares of common stock, solely (or even ever) for the purpose of funding their ongoing research endeavors. conceivably, they might sell bonds (debt) to raise funds for research. I personally have never seen this, but then I haven’t seen the financial records of every company in the US either, so it is possible. unlikely, but possible.

                if they are working on a product that will, by its very nature, take off as soon as it hits the market, they’d be better off going to a bank and borrowing the money. the interest rate will be low, and they won’t have potentially millions in issuance fees to pay.

                a company like Pfizer budgets for ongoing research, out of operating income, like practically every other company on the planet does. issuing securities would be the exception to the rule.

                • Thanks for the insight!

                  Much of the R&D expenditures claimed by companies (and used to compute the R&D Credit) are paid to someone else, to do the actual work. much of them are paid to colleges & universities, to pay for either licensing rights, or the patent itself. overall, roughly 50% of all R&D costs, in the US, are paid directly by the Federal Gov’t, some in the form of grants for theoretical research, most for research leading to a specific product or process.

                  Sure and SBIRs, etc. But the Tufts research was aimed at direct costs to the companies and the discussed how they weren’t estimating the total social cost (i.e., all funding). Other papers suggest 60% of total funding comes from companies.

                  WRT the opportunity cost estimate, how would you do it? I don’t think they are saying that the actual funding mechanise would be stocks, just that if you are looking for a baseline estimate of opportunity cost, you can put the cash into a savings account or treasury bonds, or put it into the stock market, so these should be some sort of baseline. I don’t know how much that makes sense, but I believe that’s the general argument.

                  (A good chunk of the dispute seems to be over opportunity costs.)

          • Most of the NICE site is accessible, at least from Spain, including the clinical guidance. I got a blocked message too from the linked page on Enbrel.

          • cpinva

            “The site you linked is not available in the US.”

            I ran into the same problem. odd that what appears to be a UK government site would only be available to users in the UK.

      • Apollo13

        That document suggests the NHS in England pays about £89 per prefilled 25mg syringe or £178.75 per 50mg prefilled syringe. The normal adult dose is 50mg a week. Thats about 117 and 236 USD at todays rates.

        Amazing what massive, centralised purchasing power can do.

        A British NHS patient would of course pay only £8.40 of that cost.

        • Superficial googling gives online UK prices between £26 and £50. That’s for direct sale, so bulk buying does not come into it. Other European prices seem to be in the same ballpark. You only get this extreme level of price gouging in the USA because you let Pharma get away with it. Bring on NICE. Because they aren’t.

          • Gareth

            Can’t help noticing that the EpiPen wasn’t invented in the UK.

            You only get this extreme level of price gouging in the USA because you let Pharma get away with it. Bring on NICE.

            I know it’s the actual acronym for that real-life organisation, but when you recommend NICE for improving health care, I think of the C. S. Lewis version. I’d prefer the $500 EpiPens.

            • ajay

              Can’t help noticing that the EpiPen wasn’t invented in the UK.

              Use of injected adrenaline (epinephrine) as a vasodilator to treat conditions such as asthma was pioneered in the 19th century by George Oliver, a doctor in Harrogate, England (which is in the UK) and Edward Schafer, professor of physiology at University College, London (which is also in the UK).

              I will concede that it took an American to come up with the idea of charging $600 for it.

              • N__B

                I will concede that it took an American to come up with the idea of charging $600 for it.

                We’re number one! We’re number one! We’re number one!

              • Gareth

                Sure, but it was the Americans who invented the emergency injection device. So, let’s say the US had the equivalent of NICE, allowed to strike hard bargins for medical device prices. Do you think that would make it more likely or less likely that any particular medical device would be invented?

                • ajay

                  Sure, but it was the Americans who invented the emergency injection device.

                  Whoops, no, wrong again Gareth! It was invented by Rhone-Poulenc-Rorer and Sanofi, both French companies! (France is not part of the USA.)

                • sibusisodan

                  Do you think that would make it more likely or less likely that any particular medical device would be invented?

                  Most invention is as a result of having to deal with ever tighter constraints of various kinds.

                  Being able to charge a crapload of money because you can is a driver of complacency, not innovation.

                • ajay

                  Most invention is as a result of having to deal with ever tighter constraints of various kinds.
                  Being able to charge a crapload of money because you can is a driver of complacency, not innovation.

                  A very good point. Also I can’t help thinking that anyone selling medical devices in the UK has basically one customer, the NHS. And the NHS has a policy that they will dump you the second someone comes up with a slightly cheaper or better way of doing what you do, no matter how many politicians you pay off and how many advertisements you run, and (in NICE) a large, politically insulated and well funded team for assessing how well you are doing it.

                  Now that sounds like an environment that promotes constant innovation…

                • you run, and (in NICE) a large, politically insulated and well funded team

                  Alas, they’ve been getting increasingly squeezed.

              • cpinva

                don’t forget, we have Shkreli too, who jacked up the price of a drug by something like 1,000%, just because he could.

            • What’s your actual objection to NICE’s decisions, apart from EVIL SOCIALISM? Contrary to popular American belief, Brits who have the money can spend it on any treatment they can find a doctor to prescribe. NICE’s edicts define the treatments that the NHS will pay for, taking account of value for money in QALYs. It has approved eculizumab for atypical haemolytic uremic syndrome, a rare blood condition, at a cost of £340,000 a year. Is there a long queue of patients looking for treatments that NICE won’t pay for? Homeopathy, healing crystals, and the like: sure. Expensive cancer drugs that add 3 months to the unpleasant end of your life? Not so much. Of course, no American health insurance company would ever dream of not coughing up for eculizumab, whatever the price.

              • In That Hideous Strength, NICE stands for National Institute for Coordinated Experiments. No relation to the real world NICE :)

                • It was a very bad joke. NICE’s reputation is “hard as nails”, and they work at it.

              • MacK

                Not the treatments the NHS will pay for, the ones it MUST pay for.

                • What is the distinction in practice? Is there, for instance, a standard procedure by which an NHS doctor can make a case to some NHS panel to pay for a medicine that is not in the “MUST pay for” category, such that if he makes the case successfully they WILL pay for it?

                • ajay

                  I’m not sure there is a distinction – if a doctor prescribes treatment X, and it’s on NICE’s list, then the NHS will and must pay (well, the patient pays a little bit and the NHS pays the rest). If it’s not on NICE’s list, the NHS won’t pay – though your doctor can appeal to the local NHS Clinical Commissioning Group on the grounds that X will help in your specific case, and the CCG may decide to fund it.

                  NICE, remember, does more than just “this drug won’t work”. It does “this drug works fine, but we can get the same result at half the price with another drug, so we aren’t approving it for NHS funding”. It certainly doesn’t do “this drug or device is safe and legal to use in the UK” – that’s a separate entity, the Medical and Healthcare Regulatory Agency. (Like the FDA, I suppose.)

                  So your doctor could say “Lee should have drug X” and NICE could come back and say “meh, you could have the same results at half the cost with drug Y, give Lee that instead”, and then your doctor can say “ah, but in Lee’s case I don’t think Y will work; can you pay for X instead?”

                • (well, the patient pays a little bit and the NHS pays the rest)

                  According to ALL THE SIGNS at the pharmacy, we are NOT PAYING FOR THE DRUGS!!!! we are paying a “service fee”. (Even though they always ask “Do you pay for your prescription.”)

                  I don’t know that it’s that different than any formulary. It can be challenging to get insurance to cover stuff not in their formulary or for off label use. Not always impossible, though.

      • sparks

        I am fortunate I’m not in need of biologicals for RA. My meds are expensive enough already.

  • JMP

    So they’ve been basically pulling the same shit as Martin Shkreli, but by being quiet and a bit gradual with their gouging it’s gone unnoticed until now.

    • Vance Maverick

      Shkreli himself is calling them vultures.

      • Warren Terra

        Don’t give him any credit, or the attention he so clearly craves. He’s trolling. He’s not necessarily wrong in this instance (I haven’t followed the link), but he’s still scum, and he’s still trolling.

        • sparks

          They should rename raising prices in multiples per pill “shkrelis”. There will be fractional shkrelis as well, for those who raise <100% each year.

          Disclosure: I have been a victim of this in the 1990s.

    • Warren Terra

      Shrekli jumped the price, what, 55-fold overnight, which got everyone’s attention.

      These people are much more clever, and apparently raised the price 20% every year. If you can afford $50 one year, you can afford $60 the next, and may not even complain, or even not notice – but they do that every year, and the price is going to double every 4 years, go up sixfold in a decade.

  • efgoldman

    CBS did a story on this last week, but didn’t have the balls (probably their legal department didn’t) to call it monopoly price gouging in so many words.

    mrs efgoldman is allergic to bee stings, and the pen probably saved her life a few years ago – she injected herself then waited quietly for the EMTs.

    One of my daughter’s best friends growing up got stung at our house when she was about twelve. She didn’t know she was allergic until she started showing signs of anaphylaxis. mrs efg used her own pen to inject the girl, which kept her stable while we called her parents and the ambulance.

    This is just bullshit, In my world it would be prosecutable, but in my world drug monopolies wouldn’t be allowed.

    ETA: The pens used to be covered under the bottom tier copay. In our area now they’re all around $600, give or take 20 bucks.

  • AMK

    Epi-pens have been around for a fairly long time (my brother had one starting in the mid 90s), the market is huge, and the stuff is simple to make. Why aren’t there generic versions?

    • efgoldman

      Good goddamned question. And why did the other firm stop making it?

      • heckblazer

        Apparently making an injector that can pass muster with the FDA is really difficult.

        • Sebastian_h

          When you see an easy to make medical product skyrocket in price when it should be out of patent, you can guarantee that the FDA has done something stupid. But we can’t say things like “regulatory capture” or “over-regulated” around here. ;)

          • Murc

            The hell are you talking about? Erik in particular talks about regulatory capture all the time.

            • so-in-so

              Plus “regulatory capture” and “over regulated” are pretty much on opposite ends of the spectrum.

              • njorl

                Not necessarily. Established businesses with low unit costs like raising regulatory burdens in order to raise the initial fixed costs of getting into a business.

      • cpinva

        “Why aren’t there generic versions?”

        my guess would be that the company got the patent extended. same thing with Oxycontin & Viagra, both of which have been around for decades.

        “And why did the other firm stop making it?”

        possibly they entered an agreement whereby they get paid a big chunk of cash to not make them.

    • scott_theotherone

      I just read an article in the past few days about someone who’s attempting to manufacture a generic version, and said it—if I recall correctly—that it shouldn’t cost more than $50. (Not sure whether that would be the price or the cost.)

      At least half my social circle is made up of hardcore conservatives. I also know an awful lot of families where at least one person needs to carry an epi-pen around. I would not be at all surprised if they put their political beliefs to the side and cheered whole-heartedly (or at least didn’t offer a peep of dissent) if the government decided to nationalize the production of epi-pens.

      This is beyond bullshit.

      • earl

        You’re delusional.

        An aunt and uncle are retired and listen to Rush on the radio, fox the rest of the day (particularly Hannity and O’Reilly). Their son, my cousin, has an asthmatic son who ends up in the ER 1-3 times a year because he can’t breathe. Ambulance / treatment / etc runs $10k or more without insurance. Pre-Obamacare, individual insurance would take one look at that kid and say hell no, not at any price.

        When obamacare passed, cousin and I got into a giant argument with aunt/uncle because it meant even if cousin lost his job, he could still get his son insured. Aunt/Uncle insisted that any insurance company would take the kid and he’d be easy to insure on the private markets. They’re delusional, and nothing we could say (including mentioning the unemployment stint where cousin had to buy very expensive cobra) could change their minds.

        Evidence / actual experience simply didn’t count because Fox News Says.

        • so-in-so

          The number of RWers who will claim that the price increases are BECAUSE of “Obamacare” will probably approach 100%.

        • scott_theotherone

          Maybe so. The Plural of Anecdote is Not Data and so on. But, as I said, a far larger percentage of my social circle is made up of hardcore conservatives. I’m talking about the kinds of people who go and picket abortion clinics. And I know of at least two such mothers who have kids with serious health issues (one has two kids with diabetes, one has a kid with Down’s) that were leading their families into bankruptcy…until the hated gay muslim Kenyan usurper passed that horrific affront to dignity, morality, democracy and capitalism and oh hey lookit that saved their families thousands and thousands of dollars per year. They still hate Democrats and liebruls and Obummber, but they’ve admitted it’s completely changed their views on the way health care is run in this country.

          Are they the only two moms likely to feel that way? I guess it’s possible.

        • efgoldman

          Their son, my cousin, has an asthmatic son who ends up in the ER 1-3 times a year because he can’t breathe.

          mrs efgoldman has asthma. [That she grew up in a smoker’s house and smoked, herself, until we met didn’t help.]
          It was 2-4 ER trips a year, a home nebulizer, and multiple inhalers.
          Maybe 30 years ago, one of her docs started her on a daily oral med (pill) accolate (zafirlukast). She’s basically had no symptoms since – although she’s a little more bronchitis and pneumonia prone.
          It’s covered by insurance, I think bottom tier. I don’t understand why it’s not more widely prescribed.

      • twbb

        “I would not be at all surprised if they put their political beliefs to the side and cheered whole-heartedly (or at least didn’t offer a peep of dissent) if the government decided to nationalize the production of epi-pens.”

        You mean, they’d cheer whole-heartedly if the government fixed the massive price increases caused by the Kenyan usurper’s dastardly plan to make rural and suburban white voters slave away to give lazy, criminal black people concierge medical service.

    • earl

      What’s wrong with, eg, Adrenaclick? $150 at Walmart / Sams Club according to goodrx.

      • AMK

        …..its marketing operation, apparently. Never heard of it, but glad it exists.

      • twbb

        I was going to propose a complicated, time-consuming statutory change to a number of federal laws, but I think earl just solved the problem a little more easily.

      • searcher

        It’s hilarious that Walmart can use its giant marketshare to negotiate lower drug prices to benefit consumers and the US government can’t.

        And that the group that wants the USG to be able to hates Walmart for leaning on their supply chain the way they do, and that the group that thinks free market Walmart can do no ill doesn’t want the USG to do the exact same thing…

        • Pat

          The US government has had its hands tied by law. Guess which political party made sure that happened?

          • so-in-so

            Oooh, oooh; could it be the same one that assured us years ago that for-profit medical care wold be so much better run and more affordable?

  • RPorrofatto

    My wife has several chronic ailments and we’ve come up against the new pharmonopoly game often. Just a short list:
    – Donnatal: Formerly $40 for a 30 day supply, now $900. No new formulation, or R&D, just a monopoly.

    – Rifaxamin: Once an inexpensive pill to treat traveler’s diarrhea ($30/30 days), it got a new indication for hepatic encephalopathy and just got another new indication for IBS. Without any new research or development cost, the pill now sells for $900 to $1700 for a 30 day supply, depending on the dosage. You can still get it in Europe for about $1 a pill. (Because of the new indications, it’s protected by the FDA from generic formulations for several years.)

    – Oracea: $425/30 days. It’s repackaged doxycycline at 40mg, which you can get in 50mg for about $$30 to $150. (Even generic doxycycline, which used to cost pennies per pill, jumps sometimes now to $5 per pill.)
    It’s kind of like life arbitrage for these greedy fucks.

    These are just a few of the ones we know personally — I’m sure there are thousands of similar stories out there.

  • delazeur

    You know you’re shady when 1-800-LAW-FIRM is breathing down your neck.

    But for people with worse insurance and/or more strained circumstances this could be a serious hardship, and I can see people taking the risk of going without one. It’s a serious problem.

    I know a lot of people who would be completely unable to get one without insurance. Even at the old price of $100 this would be an issue.

  • StellaB

    In 2012, the cash price for a hormone patch to treat menopause symptoms was $85 per month, currently the cash price is $145 per month, but I pay a $70 copay. A manufacturing problem forced me to switch to a different version from another manufacturer which is not covered by insurance at $195 per month. I sent the prescription to Canada where I was able to purchase the same drug, manufactured in the same factory, for $38 per month. Estrogen and progesterone have been on the market for more than a half century.

  • infovore

    Gizmodo has an update with a reaction from Mylan. It contains this:

    With changes in the healthcare insurance landscape, an increasing number of people and families are enrolled in high deductible health plans, and deductible amounts continue to rise.

    A cynical reading of this is that they expected to get away with the price increases because people’s insurance would effectively hide the costs from the users of these pens. And they would have gotten away with it if not for these meddling kids high deductibles. But the high deductibles are themselves in part a reaction to these kinds of price increases, where given the premiums they can ask, insurance companies have to pass on more of the costs.

    • Warren Terra

      Obviously, none of that response has the slightest to do with what price the company charges; that’s all about what part of the price is paid by the consumer. Mylan remains responsible for charging too much, however that cost is being shared.

      • infovore

        Yes, it is striking how that response treats Mylan’s price increases as a brute fact, something that needs neither excuse nor explanation. (Unless that was in a part not quoted by Gizmodo.)

    • DAS

      I read it more as “we had to raise prices because Obamacare”.

      Health insurance companies pulled this stunt more explicitly back when HRC was trying to reform health insurance: whenever a health insurance company did something venal, they’d say something like “we are making these changes in anticipation of anticipated changes in health insurance rules and regulations; we need to be ready to be immediately compliant with whatever so-called reforms happen”. It was b.s., but it, along with those commercials, managed to convince a huge segment of the populace that Hillary Clinton personally destroyed their medical benefits.

      A benefits company that advertises on our radio stations here is doing something similar with the ACA: they are claiming that it’s so hard for businesses to comply with the overly complicated ACA that they need the services of the benefits company. I actually know someone in the tech industry that has a company that sells software that helps businesses with regulatory compliance: he has a similar pitch but has drunk his own kool-aid about the Obama admin.

      I’m sure Mylan has drunk its own kool aid as well.

      • Philip

        $900/bottle kool aid. Very classy kool aid.

        • cpinva

          the BEST Kool-Aid!

  • MacK

    Some resteraunteurs I know wanted to keep Epipens in the first aid kit and include it in staff mandatory first aid training but were put off by the liability problems around Mylan’s short shelf lifeing of the pens (in part to force replacement) and high cost.

    • Philip

      Yeah. I (probably) won’t die from a reaction, so half the time my pens are expired.

  • N__B

    C-suite capitalists still haven’t learned that the most successful parasites don’t even let their hosts know they exist.

  • DrDick

    There is absolutely nothing that for profit healthcare cannot screw up royally.

    • MPAVictoria

      Bingo

    • Mike B.

      Right, and that is the problem. Mylan exists to make a profit, and as a publicly traded company, they are supposed to maximize profits for their shareholders. If they’re not breaking any laws, they’re doing what they’re ‘supposed’ to be doing, by the logic of the system (and a company that refuses to do so might be out of business). We should move away from allowing companies to charge whatever they want for lifesaving drugs, because if it’s ‘your money or your life,’ you’ll pay whatever you have to (and are able to). Also, allowing these large profits encourages companies to cheat, minimizing the risks of their drugs and exaggerating the benefits. Patents are not the only way to finance drug development.

      • GeorgeBurnsWasRight

        Don’t forget that investors want companies to keep increasing their profit level. On mature technology, there’s only so much that can be done to cut costs, so eventually the company has to keep raising prices to keep increasing profits unless they can increase sales steadily.

      • JR in WV

        We still watch the evening news pretty often, no cable available, no sat dish feasible, broadcast is it for us.

        The commercials for pharma are amazing. Recently there was a whole set of ads for a new chemo for [long scientific lung cancer name] that “offers you a chance for longer life”… now who won’t pay everything they’ve got for that? Ask your oncologist today!! Hurray; huzzah!

        Shouldn’t be legal to advertise drugs of any sort, from chemo to beer. Anything addictive, like gamboling with games of chance, should be non-advertisable. And you should have to prove with double-blind research done by anonymous research consulting company that your product isn’t addictive before being allowed to sell it via media.

  • MPAVictoria

    Just wanted to point out that the people making these decisions have names and addresses. Direct action may be a very effective way to prevent this kind of gouging. What if these people were confronted with angry crowds everywhere they went? What if they couldn’t sleep at night because of the yelling outside their homes from parents who had lost children as a direct result of their price hikes? If they couldn’t go to a movie without being taunted and questioned?

    These people have names and addresses…

    • JL

      I’m rather concerned about the idea of using doxxing, given its ugly history, the lack of control that anyone doing it has over just how escalated people get when they respond to the call, and the fact that it often paints a target on innocent people (e.g. the children of the person being targeted, or the people who now live at the address that was associated with the targeted person but the targeted person moved six months ago).

      I’ve been doxxed. Fortunately, someone misspelled the name of my then-street. But you know…I’d rather keep it to direct action at Mylan offices.

      • MPAVictoria

        I am sorry for your experiences. However there are times when direct action is necessary. This is one of those times. The rich need to be afraid to do this kind of thing.

        • Nick never Nick

          That’s kind of an obvious response, isn’t it? Do you think anyone stalks or doxes someone on the Internet thinking “This is not one of those times when direct action is necessary”?

          If you want to discredit your cause, by all means start harassing and frightening the families of pharma company executives, most of whom will have no writ at all over drug pricing.

          • MPAVictoria

            “If you want to discredit your cause, by all means start harassing and frightening the families of pharma company executives, most of whom will have no writ at all over drug pricing.”

            You don’t think that the executives of this company have a personal responsibility here? Really?

            • Nick never Nick

              I don’t think the HR executive has a personal responsibility over the price of an epi-pen. I don’t think the R&D executive has a personal responsibility over the price of an epi-pen. There are many, many people who work high up in companies that don’t have responsibility over pricing.

              But more to the point of your original comment — you think that the families and children of pharma companies have a personal responsibility here? You think that people who move into the house where a pharma company exec used to live have a direct responsibility here? You think their subletters have a direct responsibility here? You think people with identical names as them have a direct responsibility here? Really?

              • JR in WV

                The executives who do make these decisions are deciding that the lives of people are less important than their bonus checks. They are literally willing for people to die to maintain higher prices to boost their stock price and their annual bonus.

                So I think direct action against their companies is almost morally required if your family is affected. Those opting to undertake direct action have the same level of responsibility to not affect directly people not associated with the pharma company willing for people to die for their increased stock price, but, yes, the HR people and R&D people are complicit.

                They could work for a University or Federal lab, or even strike against immoral acts by their company. But when they do none of those things, they say they are OK with people dying for their bonus check to stay large.

              • MPAVictoria

                Ah okay just to be clear here I am not advocating picketing outside of the house of Bill from Human resources. I am talking about the CEO and a few other senior executives. The people who make the decisions.

                • Nick never Nick

                  And one problem with your approach has already been illustrated: JR in WV doesn’t agree, and considers every employee of the pharma company directly culpable for positively acquiescing in killing people for money. And that’s just after this post being up for 2-3 hours with a limited range of viewers — who knows how many similar nutcases would come out of the woodwork, and who knows what they’d do, if you actually had a direct action campaign against the company’s employees?

                • cpinva

                  “who knows how many similar nutcases would come out of the woodwork, and who knows what they’d do, if you actually had a direct action campaign against the company’s employees?”

                  personally, I’m thinking pitchforks, lit torches and dusting off those old guillotines, lubing them up, sharpening the blade and rolling them down to the town square. or, class action suits against the company officers and boards of directors, holding them personally responsible for deaths resulting from their price gouging. think of all the new friends they’ll make in prison. heck, they might even learn a useful trade.

        • infovore

          I’m old enough (and from the right part of the world) that this talk of direct action makes me a bit queasy.

          • cpinva

            sorry about that, but I fail to see any correlation with suggested direct protest against a specific group of companies.

            “Good luck with that, The Mylan CEO is the daughter of Sen. Joe Manchin.”

            one of the more useless democrats in the senate.

      • Philip

        +1, and I’m sorry that it’s happened to you.

    • fledermaus

      Good luck with that, The Mylan CEO is the daughter of Sen. Joe Manchin.

    • aidian

      Several years ago, as I was watching Michael Moore’s Sicko, it recounted the story of this family where an insurance company’s denial of coverage had doomed the husband to essentially certain death. It was a compelling story. I felt a lot of sympathy.

      I also felt that if it was my wife who was essentially being murdered by an insurance company, I’d start killing the entire C-level. I’d feel absolutely obligated to do so. And I’ll bet I could get through most of them before they got me. I’m kinda surprised this sort of thing doesn’t happen on at least a semi-regular basis.

  • sherm

    Not looking forward to having to stock up for every care provider when its time for back to school in a couple of weeks. We provide two for the school (classroom and nurse) and one for the after care program in addition to the ones we keep for ourselves. Fortunately, we have never had to use one on our son, but that’ll certainly change as he gets older and pushes boundaries. Nut allergies really suck, and the sufferers seem to receive little regard from restaurants, bakeries and food manufacturers.

    • Murc

      Nut allergies really suck, and the sufferers seem to receive little regard from restaurants, bakeries and food manufacturers.

      Nut allergies and dairy allergies.

      Restaurants don’t seem to understand “no, this isn’t lactose intolerance, this is an allergy. Don’t use a pan that’s been coated repeatedly in butter all damn night. She’ll die.”

      • DAS

        I am so glad that (knock wood) my dairy allergy is no longer so severe. It was a pain in the neck to deal with. I still get people who think I’m lactose intolerant (which I am not: every so often there is a product with lactose and/or milk fat but no other milk derived ingredients — i.e. nothing that would have any trace of residual casein in it — so I know I can digest lactose almost perfectly … I did once eat a whole bag of lactose containing salt & vinegar potato chips after not having anything with lactose for a couple of month, after which I did have some lactose intolerance symptoms).

      • MacK

        My friends the restauranteurs – the ones who want to be able to keep Epipens would beg to differ.

        The chef explained to someone who said “I can’t stand X, so I tell the server I have an allergy” the scale of the problem.

        Nuts are present in a huge number of foods, including pre-prepared foods. When someone announces they have an allergy, at least in her restaurant, the food has to be cooked completely separately. That means that all utensils, boards, pots and pans for each dish need to be specially cleaned again before they are used, a separate line established away from all the other cooking going on in the kitchen and a separate cook detailed to make that one meal. And severe nut allergies are a huge problem because they can never be absolutely confident that say oil that is supposed to be nut-free is absolutely nut free, and chefs regularly exchange horror stories about reliable brands that had nut contamination.

        The problem as she points out is that there are (a) preferences (b) dislikes, (c) aversions (serious nausea), (d) intolerance which can range from mild to severe (think gluten intolerance to celiac disease, one might make you fart, the other puts you in the hospital), (e) allergies. The problem restaurants are having is a growing number of customers showing up simply claiming intolerance and/or allergies that are dubious – without any idea of the scale of the chaos that ensues when someone shows up and announces they have an allergy to a common ingredient, like dairy, or gluten. It’s hard to get waitstaff to take some of the claims seriously when they are often being made improperly.

        So you get people claiming allergies for what are not, and it too is a problem.

        • Murc

          To be fair, the reason customers started adopting this strategy is because they’d voice severe dislikes as a preference, and restaurants would completely ignore them. People feel, reasonably, that if they’re paying for a meal, and a restaurant is going to at least seemingly acquiesce to special requests of that nature, they should get what they’re asking for. So they went “fuck it” and started saying “I have an allergy.” Because that way you don’t find out two hours later when your intestinal track starts to inform you that you’re going to be spending the next day repeatedly on the toilet with a burning arsehole that they used those goddamn peppers you asked them not to use after all.

          I am sympathetic to the position restauranteurs are in, because people are so damn price-sensitive and aren’t willing, to, say pay for a kitchen to be 10-20% overstaffed on a normal night so that when abnormal situations arise they can be dealt with with alacrity. They want it all and they want it cheap. But, well. “Give me what I ordered, or don’t let me order it” seems like a low bar to clear.

          • MacK

            To be fair – a restaurant loses money on every meal that needs special preparation – and someone who goes into a high end Italian and announces no-gluten is basically “taking the piss.”

            However, the issues that I was in part responding to is the idea that it is as easy for a restaurant to accommodate a customer with a food allergy as it is for that persons family to deal with it at home. It is in fact extraordinary difficult and expensive to deal with it because dairy for example, or nuts – and indeed garlic and onions (I know someone with that diagnosed problem) are pretty ubiquitous in commercial kitchens. So making a special meal with not trace of a common ingredient is in fact a huge issue, and massively increases cost. But a good restauranteur does it because it is the right thing to do. To be blunt though there is a decided tone of “f*ck you” ingratitude on the one hand in a “how hard can it be” comment (answer f*cking hard) and a – hey the restaurant is to blame.

            As for “they won’t take instruction” so I yell allergy … again if you really dislike something sometimes you need to order a food that does not contain it. It shows a privileged cluelessness of someone who has never had to work in a commercial kitchen to not understand that some instruction on food are really very difficult to execute in a line kitchen trying to serve 60 covers in an hour. As in a sort of privileged dickishness – they are my servants for the night (or more I rented a slave.) To then call a dislike an allergy, that is being an incandescent asshole – making it truly tough for people with genuine allergies that they need to be addressed, and at the same time taking advantage of the goodwill of a restaurant towards those with real allergies.

            And I’m sorry a lot of this intolerance stuff is fashionable posing – which is in turn serious because it undermines the position of the genuine.

            • Murc

              To be fair – a restaurant loses money on every meal that needs special preparation

              Yeah, and that’s a real conundrum, because there’s tension between slapping “no substitutions” on the menu and annoying people (taking a financial hit) or accommodating them (and taking a financial hit.) You’re sort of screwed either way.

              – and someone who goes into a high end Italian and announces no-gluten is basically “taking the piss.”

              This ain’t true. I can think of a number of classic Italian chicken dishes that are quite delicious and can be easily made gluten-free. That’s just off the top of my head. People who are gluten-intoletant might want to enjoy a nice dish of chicken cacciatore made by a pro.

              However, the issues that I was in part responding to is the idea that it is as easy for a restaurant to accommodate a customer with a food allergy as it is for that persons family to deal with it at home.

              Oh, yes. That’s kind of an idiotic idea for people to have. Of course it isn’t as easy for a restaurant to deal with it as it is for you at home.

              My sister-in-law has a dairy allergy. My brother and her feel, and I agree with them, that they’re meeting restaurants halfway on that by making reservations and informing the establishment when they do that they’re bringing someone with a dairy allergy.

              As for “they won’t take instruction” so I yell allergy … again if you really dislike something sometimes you need to order a food that does not contain it. It shows a privileged cluelessness of someone who has never had to work in a commercial kitchen to not understand that some instruction on food are really very difficult to execute in a line kitchen trying to serve 60 covers in an hour.

              I kind of feel like the restaurant also has a responsibility here, tho. If they feel they have to run on a no-leeway, anything-that-disrupts-the-line-puts-us-into-the-red margin in order to survive (and many, of course, do need to run like that) you need to actually say “no” to your customers. Customers do have an obligation as decent people to not request something ridiculous like “the chicken breast must be raw in the center and burnt black on the outside, served on a plate that’s been in a freezer for ten minutes, the pasta should be a mix of al dente penne and slightly overcooked fusilli” but restaurants also need to say “no” instead of “yes, but we won’t actually do that.”

              I used to follow a lot of waiter stories blogs, tumblrs, and twitters, and I had to stop because a fair few of them had shit like “they asked me if dish Y included ingredient X and I said ‘no’ because I just didn’t feel like running back to the kitchen” and “they asked for decaf and I gave them regular” and “they asked for soy milk in their latter but I put regular milk in, that’ll show that skinny bitch” stories running through them constantly.

              Basically, don’t like to people because you assume they’re just posers. People can tell, and it fosters an unhealthy environment.

              • lmontheinternet

                I think we followed the same blogs. I call those people poisoners and no longer eat in restaurants because of them. It’s not worth the risk.

                Before anyone asks, I also don’t eat food prepared by one of my siblings because he doesn’t take my problems seriously either :P

          • David Allan Poe

            “Give me what I ordered, or don’t let me order it” seems like a low bar to clear.

            Haha. Never worked in the industry, I see.

            At minimum, the response to “I’m sorry, but we can’t accomodate this request,” is likely to be grumbling. At worst it will be a tantrum that ruins not only the diner’s night, but the server’s, the rest of the table’s, every other table’s within earshot, the kitchen’s, and probably the next-door neighbor’s.

            There is no excuse whatsoever for claiming an allergy when you do not have one. Allergy (or celiac) showing up on a ticket is a big deal. As MacK notes, kitchens take it seriously. There are few things more disheartening than spending a bunch of time and energy cooking around, say, a seafood “allergy”, only to have that person then tell their server that something cooked with fish stock is ok because they’re only “allergic” to big pieces of fish.

            Please, please, please do not lie to your restaurants.

            • sibusisodan

              If anybody is not yet aware of the Behind Closed Ovens blog on Kitchenette (since transposed to Wonkette), I urge you to read it for hilarity and frustration purposes.

              ‘I’m allergic to carbs, except for bread’ is the kind of thing which comes up often.

      • Dennis Orphen

        If a person is an alcoholic then they should stay away from the bars.

        • Murc

          What this has to do with the subject at hand I can’t begin to guess, unless you’re making the claim that people with food allergies and sensitivities don’t deserve to enjoy a professionally cooked meal in a restaurant.

          • Dennis Orphen

            I’m making the claim that they shouldn’t take risks that have severe, potentially fatal consequences unless they are willing to accept those consequences.

            • Or we could arrange society so that normal activities (such as going to a restaurant) undertaken with reasonable precautions (such as informing your server of dangerous allergies and being accepting perhaps some limitations) aren’t life threatening.

            • Murc

              By this logic I should be prepared to accept dying in a flaming wreck every time I step onto a plane.

            • MacK

              In a very sad event in Ireland recently a girl died of peanut allergy outside a pharmacy in central Dublin because the locum chemist did not know that in Ireland he had emergency prescribing rights and could have give the mother an Epipen – she was trying to get the child to an emergency room. I have a lot of sympathy, but they were in fact eating in a Thai/Chinese restaurant when the problem worse and the teenager and her mother both knew she had a peanut allergy, and she spooned a satay sauce on her food that was peanut based.

              A THAI RESTAURANT! That’s nearly suicidal with nut allergy.

              • Philip

                A THAI RESTAURANT! That’s nearly suicidal with nut allergy

                Depends. I have a bad peanut allergy, but for whatever reason it’s really only ingestion. Being *around* them is just like having a bad cold. As long as I’m careful about what I order, it’s usually not an issue (although I’m always paranoid the first few times I eat at a new Thai place, because some are careful about dishes that shouldn’t have peanut and some aren’t).

                ETA: I’m fortunate that I can do that, though. I have friends who have to be much more careful about it.

                • Origami Isopod

                  I would still be careful. Minor allergies can blow up into major ones without warning.

                  I was told this by an allergist once, after I’d reported to him that both pineapples and walnuts made the inside of my mouth itch. Fortunately I haven’t experienced a problem with either one since.

                • Philip

                  Definitely. I still carry an epipen, even though I’m not great about replacing expired ones. And I get a blood test done to check on it with my physical every few years, and fortunately it’s been slowly getting more mild for a while now.

              • sherm

                Not everybody knows that a satay sauce contains peanuts.

              • In a very sad event in Ireland recently a girl died of peanut allergy outside a pharmacy in central Dublin because the locum chemist did not know that in Ireland he had emergency prescribing rights and could have give the mother an Epipen – she was trying to get the child to an emergency room.

                Er…that seems like malpractice to me.

                • MacK

                  He was brought up on charges for malpractice

                • Ok! I’m somewhat relieved.

            • sherm

              I’m making the claim that they shouldn’t take risks that have severe, potentially fatal consequences unless they are willing to accept those consequences.
              Reply

              This is the asshole mentality that many possess which makes living in the world with a nut allergy more dangerous than it should be. Going out for dinner and picking up a cake at a bakery should not be life-threatening events.

              • Dennis Orphen

                I didn’t give them the allergy. I don’t want them to have the allergy. I don’t threaten people who go out for dinner or pick up a cake at a bakery.

                • Ooookay, this really seems to be stepping from contrarian to asshole.

                  You articulated a view which, roughly, implied “It’s entirely on people with nut allergies to avoid nuts, thus, they shouldn’t eat out or they should restrict themselves to a very limited range of options.”

                  That view, as policy, exactly makes living in the world with a nut allergy more dangerous than it easily can and definitely should be. That view, as a personal view, is rather assholish and unkind.

  • Murc

    You know, health care hasn’t been a big issue this election season for some reason (which ticks me off, because the ACA was a good starting point, not an end point) but if we somehow manage to take the House back, a robust public option whose implied, if not explicit, purpose is to undercut and destroy private insurers, or at least force them to behave better, needs to be on the table as an ACA add-on.

    Because we were all told back in 2010 that the ACA would be expanded and worked on further in the future, just like Social Security and Medicare were.

    • Anna in PDX

      I’ve seen some rhetoric, and I think the Dem platform has something, about the public option. I think the Dems have been talking about this, though of course press coverage is not ever about actual policy concerns but rather stupid horse-race navel-gazing.

      • Murc

        Oh, of course. “Hasn’t been a big issue” isn’t the same as “isn’t an issue at all.”

    • GeorgeBurnsWasRight

      And there were few if any questions about the environment during the primaries.

      For the most part, campaigns mostly avoid talking about significant issues and prefer to focus on trivia. ISTM this is part of a feedback loop between the media and the voters to avoid anything that can’t fit on a bumper sticker.

  • njorl

    “…the company values profits more than the lives of millions of Americans.”

    That is the definition of the word “company”. (Definition of “for-profit corporation”, anyway)

  • Opdivo: touted as the chemo drug that will allow you to see your new grandchild. Fine print said an added 3.2 months of life compared to other chemo drugs[3.2 MONTHS]. WSJ says –at $12000 a dose , this is not really gonna work. Two weeks later , WSJ runs another article–it–Opdivo–does NOT work at all. Sorry you suckers.

    • mark

      Opdivo works in some types of cancers (biochemically described, not by organs like “lung cancer.”) The WSJ article that said it “doesn’t work” would have been reporting on a clinical trial where BMS tried it against a broad population to let them get cute with a label and sell a lot more. It and the Merck offering in that class are really a big step forward.

      The ridiculously high cost for a few months median survival is a genuine issue. But a few months median survival also means some people who didn’t beat the disease before, do now. This is one of the real problems driving the cost–people are willing to pay for the chance. If this sort of improvement could only be sold at $1000 a dose it wouldn’t be on the market now.

      FWIW I work in pharma but not on the above products (or for the companies.)

  • Karen24

    My husband is an insulin-dependent diabetic. The company that produces his injectible insulin has just jacked its price as well. This is a drug used mostly by kids to keep from dying painfully and quickly. The owners of this company are total bastards.

  • Nick never Nick

    This whole discussion is kind of pointless, in an American context. It’s not the company’s job to value the lives of millions of Americans, it’s to produce a product and sell it for a profit. The people who should value the lives of Americans are Americans. If they did, they’d set up a system that took care of things like this. They haven’t — what they’ve done is set up thousands of little micro-systems that carve out thousands of special situations: your life is valued if you fall into the various categories of ‘have insurance with low co-pays’ or ‘on Medicare’ or ‘rich’. That’s American culture, and it’s not quite right to blame companies for it.

    • Vance Maverick

      Would you agree that this state of affairs is bad? Is it OK if we talk about that?

      • Nick never Nick

        Yes, I do, and you may. I was thinking more about how pathetic it is that Americans have decided to let this issue fall from the realm of the public into the private, and are reduced to whining about the lack of morality of for-profit businesses.

        • Nick never Nick

          I regret using the word ‘whining’, my apologies. Grouchy day at work.

    • so-in-so

      NPR had a piece a month or so ago about the change in the 1970’s when Frioedman and some other economists opined that the problem with business was it didn’t prioritize shareholder returns highly enough. The claim is that we then went from the idea that a company that focused on running the business well would, by extension, generate profit for the shareholders to the idea that making the shareholder’s higher and higher profits should be the focus of the business, and whatever the business did to make those profits was kinda secondary. In the time since, business on the whole went from re-investing 50% of profits into “the business” and the other 50% to shareholders, to giving 70% to the shareholders and only 30% into business improvements. They interviewed an executive from the earlier pharma industry who said he really never thought about the stockholders at all in running the business, and actually gave them better returns than modern business does. I guess they like being stroked better than actually making money (if the story was correct).

      http://www.marketplace.org/2016/06/08/world/profit-shareholder-value

    • It’s not the company’s job to value the lives of millions of Americans, it’s to produce a product and sell it for a profit.

      That is, of course, one of the things we can, and do, dispute.

      The people who should value the lives of Americans are Americans.

      Surprisingly, some of the people involved with these companies are, in fact, Americans!

    • Murc

      It’s not the company’s job to value the lives of millions of Americans, it’s to produce a product and sell it for a profit.

      “The company” does not have a job. It doesn’t have agency. It does not, in a real sense, exist; it is a legal abstraction. It can’t make decisions or enforce them.

      “The company” is run by people. And I expect those people to not act like sociopaths, and I regard them as dirtbags and treat them accordingly when they do.

      • Nick never Nick

        I guess I think it’s strange that you find businesses sociopathic for not doing something that American society itself is not interested in doing.

        • Murc

          Businesses cannot be sociopathic. Businesses are legal abstractions. They can be neither virtuous nor evil.

          • DAS

            Isn’t that notions of good and evil are irrelevant to a business’s status part and parcel of businesses being, pretty much by definition, sociopathic?

            • Murc

              I don’t think so, because what I said applies to all institutions, not just businesses. Governments, social clubs, NGOs, etc.

              I do this myself, when I say “Institution X has done/should do this” or “Institution Y should be ashamed of itself” and suchly. And it’s convenient language, but it obscures the fact that none of those institutions are in fact capable of doing anything, because they’re simply organizational abstractions. People can make decisions and carry them out. Abstractions cannot.

        • wengler

          American society is made up of people that disagree about stuff. I have a lot of opinions and the man that runs the pharmaceutical company has a lot of opinions. The difference between him and me is that come election time he has millions to spend on the campaigns of the people he wants to win and then millions to spend on lobbyists after the campaign is over.

          All of that money gets him access and a seat at the table of policymaking. All of my opinions give me jack squat. And that guy that runs the pharmaceutical company has a lot of positive opinions on the way he can turn his lifesaving drug into a monopoly that can extract the maximum amount of return from the people it helps. He has agency. He is not a machine.

  • I was just put on Metformin for Type 2 diabetes. The standard 500mg tab is 3 bucks a month for 120 pills. The time-release variant is 720 bucks a month for 30. But, hey, free market!

    • Mike B.

      Well, if a government-enforced monopoly is involved, it’s hardly a ‘free market’. Not that I’m a big believer in free markets (which could hardly exist without government involvement anyway), but people who claim to support free markets often have no problem with copyrights and patents. Whatever the merits of these, they are a prime example of government intervention in a market, so it is not ‘free’.

      • Yes, because in a totally free market, everything would be vastly more expensive, because people who need life saving drugs will pay anything, or just do without and, you know, die.

  • This is nothing “new.” Ever heard of the Triangle Shirt Waist Factory (fire). Big bidness is always defaulting to screw the consumers.

    • Triangle had nothing to do with screwing consumers, but whatever.

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