Saturday, October 22, 2016

Even More Things Which make me Say "Huh?"

       Even more things which make me go "Huh?"

        Saturday morning, 7:30 am news. A man's pet Emu was scared by a dog and ran away. It took a significant number of bodies and time to recapture the bird. Now the real question: Why the hell would someone keep a 125 pound, 5 1/2 foot tall,  "can kick you to death" flightless bird in an urban setting?  The eggs are relatively inedible, the bird has a brain about the size of its eyeball, and is rated by breeders as being "dumber than a turkey!" In fact, Smithsonian recently pronounced the Emu as (officially, I guess) the "dumbest bird in the world," That's a really stupid bird and, it seems to me, a reasonably poor  choice for a pet.


        Nest question. here's a hypothetical scenario. President George W. Bush, while President, went to Africa several times. At least twice, African heads of state donated various sums in kind or in gifts to the President which he gratefully accepted and then regifted to non-profit causes. Was anybody irate about this? Woodrow Wilson received (and kept) a limousine. Ronald Reagan received , kept and, after leaving the White House,  lived in, a $2.5 million house in Bel Air, CA.  Where's the outrage?   

        On the other hand, Hillary Clinton, while serving as Secretary of State, visited Morocco,  a friendly and  critical ally  in Northern Africa,  and gave a speech. The King, richer than God, as a symbol of  good relations between our nations,  gave a large monetary gift - not to her, not to her family, but to a charitable  foundation which is one of the most highly vetted and respected  charities in America, far more productive and efficient than the Red Cross, or even St. Jude's Children's Hospital.  The Clinton Foundation sponsors programs in public health, economic development, women’s rights and climate change.  Its work has been praised, including efforts to lower the price of AIDS medication and distribute it to children. The foundation and the Clinton Global Initiative have helped more than 435 million people in 180 countries. The secretary herself, and her husband, also gave over $1 million in each of several years to this charity, while receiving absolutely zero compensation whatsoever,  from it. Donald Trump is outraged.  It makes my head hurt.

       As a footnote, Trump has actively solicited contributions to his own charitable foundation,  from private citizens and corporations as well. Recent reporting on the Trump Foundation,  has centered on Mr. Trump’s repeated use of foundation money to make donations that simultaneously helped him solve a personal or business problem.  A recent Florida  lawsuit  was eventually settled with Mr. Trump agreeing to donate $100,000 to charity, but the donation came from the Trump Foundation instead of Mr. Trump himself. Using charity money to satisfy a personal lawsuit is typically considered to be self-dealing, an illegal use of nonprofit foundation funds. In more recent years, it appears that the major beneficiary of the Trump Foundation has been....Trump! Mr. Trump’s foundation does not show up on the charity registers in many states,  because the foundation  has, numerous times,  not complied with non-profit regulations. Again, it makes my head hurt.

        "Be an energy voter - it's not a partisan issue",  proclaims a recent commercial featuring a cast of paid actors portraying the spectrum  of American citizens. Of course, it absolutely is a partisan issue, and all you need to do to prove it is look at the energy barons in America and where their political support lies. Start with the Koch Brothers, Republican mega donors. Their $9.250,000  in lobbying alone, is a good indicator. While you're beginning to believe that they really care about you, consider this:

       Two of the world's largest energy companies, Royal Dutch/Shell and BP, are majority owned and controlled outside the US. One wonders how much Congressional "bang" they get for their $7.43 million bucks in direct lobbying? What we do know is that energy lobbying contributions show a 30 to 1 ratio in favor of fossil fuels (you know, CO2, acid rain, global warming and all that stuff ?)  Collectively, oil and gas alone fed the coffers of all Congressional  lobbying recipients a staggering $1.8 billion!   Statistically, about 70% of Petroleum/ gas industry  lobbying goes to Republicans. As unbalanced  as that seems, it pales next to mining (coal) interests, in which case over  90% of lobbying donations ("bribes" carries such an unpleasant connotation, doesn't it?) go to Republicans.  If you still believe "being an energy voter" isn't partisan, I can't help you.


        In a somewhat related vein, at least conceptually, candidates Clinton and Sanders both have made repeated calls for modifying a  2006 Bush administration "gift" to the Pharma industry. To get the Medicare part D act passed, over rather strenuous objection  by the Big Pharma industry, the  bill was altered to include a provision that Medicare would never negotiate drug prices. Understand, this means that while Insurance companies and The Veteran's Administration can, and do, pay less for drugs by negotiating with suppliers, Medicare costs (and the co-pays of recipients) are set by Big Pharma with zero regard for anything but profit.

        Let's reiterate, using a current example: Mylan Pharmaceuticals' recent 500% price hike to ($600) of its patented "Epi-pen" was met with significant outrage, to the point that Mylan lowered the price (with a coupon issued by them) to "only" $300.  Of course in the UK, Mylan sells the identical item (at a profit) for about $69. The Veteran's administration also pays less, because they are able to negotiate price, as do major US  health insurers - except Medicare. So who gets hurt? To some degree, all users do, since the actual value of the drug in an Epi-pen is less than $2.00!   The sad part is that those hurt worst are those least able to afford it. Those with health insurance will undoubtedly see an increase in their co-pay but, if they can afford insurance in the first place, will probably be all right. However, those without insurance or on Medicare will pay full price, and those with Part D will still pay a larger co-pay based on the full retail drug cost.

        Of course, as an industry, Big Pharma  fights to preserve their special status, which is:  As an industry which manufactures products which, for some consumers aren't "optional" but essential to survival, they remain largely unregulated in the marketplace. This is different from most other manufacturers and industries,  whose product consumers can choose to use (or not). Being unable to afford new Basketball shoes is, perhaps, annoying. Being unable to afford a drug which makes the difference between life and death is possibly fatal.

       How much does it cost to "buy" this protection and unique privilege by stopping adverse legislation?  Here's the situation  as it is today:  Large pharmaceutical firms are some of the most profitable companies in the world, and they spend a great deal  money on, besides advertising and hefty salaries for rich kid CEOs, lobbying Congress to stay that way.  While they would like for public perception to be that they reinvest most of these obscene profits on Research and Development, and  some profits are reinvested to fund research and clinical trials,  far more is now spent annually, by the biggest names in the business on media advertising. Hundreds of millions of dollars are also spent on political operations ("lobbying") every year. 

     The government has long provided  the pharmaceutical industry with  premium patent protections while leaving drug pricing up to the whims of the market. We, as  consumers in the United States, now pay some of the highest prices in the world for many life-saving drugs. Recent data  shows  that critical cancer medicines, for example, cost as much as 600 times more in the United States than other countries. The industry has a clear interest in maintaining the political status quo, and lobbying is the vehicle. In total, most recently compiled lobbying expenditures for the Pharma and medical supply  industries exceed $125 million  over  the last fiscal year!  That, however is relatively minor when compared to the $5 billion spent on advertising by Pharma alone.

        Although the pharmaceutical industry justifies routine overcharging by pointing to the huge, and, admittedly  uncertain, costs of research, the truth is that the government has historically taken, mainly through the efforts and auspices of the National Institute of Health, and continues to take, the greatest risks, and funds those risks with your and my tax dollars . Additional government grants flow to public and private  university efforts as well.

        Beginning in the 1930s, the NIH has invested close to $900 billion in the basic and applied research that formed both the pharmaceutical and biotechnology sectors, with private companies only getting seriously into the biotech game in the 1980s. Big Pharma, while of course contributing to innovation, has increasingly begun to back away  from the high-risk side of research and development, often letting small biotech companies and the NIH do most of the hard work. In fact, about  75% of so-called new molecular entities with priority rating (the most innovative drugs with the most promise) can be traced to NIH funding, while companies spend more on "me too" drugs (slight variations of existing ones.)

        Although the 1980 Bayh-Dole Act allowed publicly funded research to be patented, to facilitate commercialization, and in return allowed price caps,  successive administrations, worried about being seen to intervene in the free market, have never capped the price of even one drug!  

        Finally, because I'm getting tired of typing, allow me one glaring example of just how bad we're being ripped off  while Pharma profits soar: 

        We've all seen the TV ads for the "new, breakthrough" drug Harvoni, which is the first to actually cure Hepatitis "C".  Gilead Science, which retails the drug, didn't actually develop  it! They purchased the rights to the drug  (actually generically named sofosbuvir) and patented it in the US.  Here is the even more amazing reality: sofosbuvir was developed under the leadership of Prof. Raymond Schinazi, a  professor of biochemistry at Emory University. The U.S. Government heavily funded Prof. Schinazi’s research, with major grants from the National Institutes of Health (NIH) and support from the Veterans Administration.  Get this right. We (taxpayers) funded much of this drug's R&D cost. Gilead's cost was a combination of clinical trials expense and profit paid to the startup company that Dr. Schinazi formed to sell his brainchild. Gilead paid about  $11 billion to purchase the drug, of which $440 million went to the good doctor. In its first 10 months of  sales, Harvoni recovered Gilead's entire investment! Their patent protection will allow them to do so until 2028. Understand, this means somewhere around  50,000% profit annually on Harvoni for the next 12 years.

         According to researchers in the UK, the actual production costs of Sovaldi  (retail name in the UK and Europe) for the 12-week course is in the range of $68-$136. In fact, generic sofosbuvir is currently being marketed in India at $300 per treatment course, after India told Gilead to kiss their ass when they (Gilead) tried to patent it in India. In other words, the U.S. price-cost markup is roughly 1,000-to-1! So, how can Gilead Science charge $84,000 for a drug that costs less than $300 to produce? Well, for starters,  Gilead’s patent on sofosbuvir runs until 2028, giving it a monopoly in the U.S. market. Second, a range of Federal and state government programs  will cover the $84,000 for a sizeable number of patients. For those not covered by government programs, some will be covered by private insurance, a few will pay out of pocket, and still others will die because they lack coverage and can’t afford the treatment.  And of course that pesky law prohibiting Medicare from negotiating price.


Angry yet?

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