Why many generic drugs become so expensive

The high cost of prescription drugs is great news. You hear on TV, in the doctor's office, and even in the election campaign. When you think of expensive drugs, you can think of new therapies for lung cancer or hepatitis C. But in fact, prices are also soaring for generic versions of some commonly prescribed drugs.

An article published last year in the New England Journal of Medicine reported that between 2012 and 2013, captopril - a generic drug used to treat hypertension and heart failure - increase in the price of 1 cent to 40 cents pill. During this same period, the cost of doxycycline, an older antibiotic, rose 6 cents to $ 3.36 per pill. 

Connecture, a company of information technology for health insurance, reports that while the price of most generic drugs remained constant between 2008 and 2015, nearly 400 increases over 1000% saw prices generic. At a time when 18% of the costs of prescription drugs are paid out of pocket and 8% of Americans do not take their medication reports to save money, these dramatic increases in generic prices placed a heavy burden on public health.

Why is your product going in the price? 
Most of us think of cheaper generic version of a brand name for a prescription alternative - and that is often the case. Pharmaceutical companies that manufacture generic drugs can sell at lower prices because they do not have to pay for research and development that brought the drug to market first.  

However, this advantage may take a backseat in situations like these, where competition is reduced or delayed, allowing generic manufacturers to increase their prices:

  * The marketing of certain generic drugs is so small it attracts several producers such as pyrimethamine (Daraprim), an ancient drug used to treat a parasitic infection called toxoplasmosis. GlaxoSmithKline has long been the only producer of pyrimethamine, but at a modest price. This August, however, Turing Pharmaceutical acquired the rights to the drug and operated its monopoly, the price increase of 5,000% (from $ 13.50 to $ 750 per pill).

  * In some cases, the number of producers of generic drug decreases due to a continuous wave of market consolidation within the pharmaceutical industry.

  * Unforeseen safety issues may limit the supply of a generic drug. Hikma Pharmaceuticals, for example, was forced to stop production of doxycycline in 2011 because of quality problems at its plant in New Jersey. The shortage led to an increase of 6,000% in the price of drugs.

  * It can be difficult and expensive for a manufacturer for a generic drug to market first. The average time to the Food and Drug Administration (FDA) for the treatment of an application for generic drugs was 42 months in 2014, compared to an average of eight months to apply for a new standard drugs.

  * A generic manufacturer must prove that his version of a drug product is equivalent to a "reference" existing on the market. When only one company produces a tightly controlled drug and distribution, it can be extremely difficult for other companies to provide reference samples for products.

What you can do 
While Congress, the FDA and other government agencies to explore possible solutions to prevent soaring prices of generic drugs, there are several steps you can take to limit the number of victims in your wallet.

First, when the doctor recommends a drug for you, ask about its cost. In some situations, another drug (cheaper) which has a similar mechanism of action could be safe and effective.

When this is not possible or desirable, you might be able to save money by purchasing generic drugs independent of their health insurance. Websites like GoodRx offer online tools to compare the real drug prices in your area. Discount drug programs or discounts can also help. Note that while these programs may provide some relief, which are often available only for a short period of time (most are not valid after one year), and which can undermine policies to reduce insurance costs - and therefore premiums - down.

Finally, use your voice to help keep this issue a political priority. If you experience a substantial increase in the price of generic drugs, tell your elected officials. 
By: Ameet Sarpatwari, JD, PhD

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Is it difficult to decide on the total knee replacement? Totally!

It is a very important decision: If knee surgery painful?

Many people say yes. In fact, each year about 700,000 people in the United States that the most common form of arthritis of the knee undergo knee replacement surgery.

But how does it work? This is a question which has been largely answered by asking people who have had the surgery if you are happy they did. Most say yes. But the search for high-quality surgical versus non-surgical has not been done so far ... treatments.

In the last New England Journal of Medicine issue, researchers in Denmark report the results of a study that randomly assigned 95 people considered eligible for surgery knee replacement surgery or continue with more conservative treatments such as Exercise and a diet to lose excess weight. Here's what they found:

* Those who have had the surgery had more pain relief and improved function one year later than those assigned to nonsurgical treatment.

* The function and quality of life were better in those who have undergone surgery.

Does this mean that surgery is good for most people with knee arthritis? Not necessarily. Here's why:

  * Those enrolled in this study were carefully selected - which included only 95 people of nearly 1,500 that were originally selected.

  * This study excluded those who had a sharp pain in the week prior to inclusion in the study.

  * Only people with osteoarthritis - the with age-related "wear and tear" arthritis - were included. People with other types, such as rheumatoid arthritis, are not eligible.

  * Although the improvement of those receiving surgery was greater than in the non-surgical group, both groups improved. And the difference between them was not great.

  * Severe side effects or complications were more frequent in the surgery group. For example, three of the 50 people who have had surgery (against none in the non-surgical group) developed blood clots that require treatment with anticoagulants. These clots can cause dangerous complications, potentially fatal.

  * This study only lasted a year, so he can not tell us what kind of treatment is best in the long run. This is important because osteoarthritis, and the impact of major surgery, can affect the pain and function for decades.

If you have osteoarthritis of the knee, talk to your doctor about your treatment options. Surgery may be a good choice if your symptoms are bothersome, other treatments have failed, and your overall health is good enough to support the operation. However, personal preferences are very important. For example:

 * How your arthritis affects you? An avid walker can take a different decision to undergo knee surgery that a person who is less active.

 * How do you feel about the risks? All surgery comes with a high potential for complications, such as infection or bleeding. Some people are more focused on the potential improvement provided by the operation, while others are more concerned about the risks.

 * Do you have other conditions or on medications that may make riskier than average surgery?

 * How do you feel about the necessary weeks of rehabilitation after surgery?

We still easy if the knee replacement surgery is best for people with osteoarthritis answer. This study helps. But preferences objectives, personal health and lifestyle are more important.
By: Robert Shmerling, MD

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Experts say that no amount of alcohol is safe during pregnancy

Let's face it: pregnancy is difficult. Yes, it is ultimately a wonderful thing to bring a baby into the world. But the process does not always feel so wonderful; accompanied by nausea, fatigue, stomach fat and uncomfortable varicose veins are not the things that are asked pregnant women to stop smoking. As the sushi; Swordfish; eggnog; Some soft cheeses; this extra cup of coffee; for smokers, cigarettes; and alcohol.

For some women, it is difficult to stop drinking completely. It can be tempting, especially on special occasions or in restaurants where everyone is drinking, to have a teensy-tiny glass of wine. After all, how much damage can a glass of wine?

But here's the problem: we do not know the answer to that. This means that to be safe, pregnant women should not drink alcohol at all. This is the conclusion of a clinical report just published by the American Academy of Pediatrics.

This is what we know: the alcohol is dangerous to the developing fetus. It can cause problems with the baby's growth. It can affect the kidneys, heart, muscles, eyes and ears. But what is more worrying is that it can affect the brain in a variety of ways - causing smaller and actually physically different, for a learning pattern and behavior.

The most serious form of damage is called fetal alcohol syndrome, or FAS. Babies born with this condition are smaller than other babies have distinctive facial features (small eyes, a thin upper lip, flat to the skin between the nose and the mouth instead of the usual chants), and effects on the brain. Occasional consumption at a party is unlikely to cause FAS; often occur when mothers drink at least a moderate amount of alcohol during pregnancy.

But what researchers have been finding is that there may be softer, more subtle effects of small amounts of alcohol. A study of 31,000 pregnancies found a risk for developmental problems when women had one alcoholic drink per day. And because some of the learning and behavior problems will not become clear until years after his birth, it is likely that even small amounts of alcohol have an effect. In fact, some experts believe the Disorder Fetal Alcohol Spectrum (a broad term that encompasses all the possible negative effects of fetal alcohol syndrome) affects up to 5% of all children.

About half of all women of childbearing age drink alcohol drink from sporadic to heavy drinking. Some of the damage caused by alcohol passes before women realize they are pregnant. Although most women cut or stop once they know they expect, over 7.6% of alcohol consumption continued - and 1.4% report binge drinking.

There is no time during pregnancy when it is "safe" to drink either. Yes, most organs are formed in the first quarter. But the baby grows and changes, and the brain develops during pregnancy. Alcohol can still hurt.

So do not risk it. Give your baby the best chance for the best life possible. If you are pregnant or could become pregnant, choose sparkling water instead. Nine months can seem like an eternity, but it is not.

If you do not think you can stop drinking for nine months, talk to your doctor. We can help you.
By: Claire McCarthy, MD
 

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Stress busting medicine mind body reduces the need for health care

This week, Harvard researchers reported a powerful way to keep the doctor away. And it is not an apple a day or a new drug - is a life skill called resilience. It is the adult equivalent of hitting a hedge on his first bike trip without training wheels, shaking the leaves and dirt from your hair, and think, "Well, it was not too bad I will try again. ".

People tend to think that resilience is something the lucky and unlucky people are missing, but it's not true. It is a skill that can be learned. Anyone can build resilience to practice the relaxation response - a deep relaxation physiological state induced by practices such as rhythmic breathing, mindfulness meditation, yoga, tai chi, qi gong, or prayer. The relaxation response was described over 40 years ago by Dr. Herbert Benson, founder and director emeritus of the Benson-Henry Institute for Mind Body Medicine at Harvard-affiliated Massachusetts General Hospital (MGH).

The power of resilience is central to a study published this week in PLoS One by Benson and his colleagues at MGH. Those who graduated from a resistance program increase developed by the Benson-Henry Institute use health services significantly less in the year after the course compared to the previous year.

The resilience of the impact of training 
Benson-Henry has developed an eight-week course, called resilience Intervention Program (3RP) Relaxation for Endurance. To measure the effect of this program on the use of health services, the PLoS One study mined a rich database of information compiled by Partners HealthCare patient, a system that includes MGH Hospital Brigham and women and other health centers in the Boston area. The study compared the use of health care for more than 4,400 graduates 3RP Partners 13,150 patients who were not taking the 3RP courses. Within one year of training, the use of health services by 3RP graduates fell by 43%.

"We have shown in the past that worked in the laboratory and at the individual physiology, and now we can see that when you do good to people, they do not want to use both health care," says study leader Dr. James E. Stahl, formerly affiliated with the Benson-Henry Institute but now based at Dartmouth-Hitchcock Medical Center in New Hampshire.

The 3RP training was ultimately responsible for the decline in demand for medical care? This study can not prove beyond doubt, as only found statistical links. The researchers were careful to consider factors other than 3RP training that could affect the amount of health care people seek - including age, sex, race, education and income level. "Can you ever really delete it? I do not think anyone can be sure," says Dr. Stahl.

For policymakers, the study offers the possibility of safe and inexpensive way to help control the costs of health care are rising. But in fact, this study does not provide evidence to prove otherwise. For example, if a group 3RP failed tests and other services that otherwise would have improved your health? more research is needed before anyone can drop resilience training as a way to reduce costs. "As for the use is the first step towards measuring the costs," says Dr. Stahl.

You can strengthen the resilience without formal training 
For those of us who do not live in Boston and can not be part of the 3RP training, it is still possible to increase our resilience in a variety of ways. Resilience is partly to make meaningful connections with others, such as through volunteering, caring for aging parents and other service jobs.

In addition, the positive psychology research shows that having an optimistic outlook and a sense of connection, meaning and purpose in life contributes to resilience. This includes learning to identify and combat negative attitudes of daily life that can harm health.

"As fluoridation of its water or vaccinate yourself, they are ways to keep it healthy with, from a public health perspective, the minimum investment," says Dr. Stahl. "My opinion is that we should probably teach these skills in elementary school."
By: Daniel Pendick
 

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Heads Up Parents: A new study important information about life in adolescents Online

Let's face it: most parents do not know what their teenagers are doing online. According to a new study, even parents who think they know what is going missing more.

For the study, in partnership with CNN two researchers - Marion Underwood, University of Texas and Robert Faris, University of California, Davis - to study the life of social media 216 eighth graders in eight secondary schools of Georgia, Indiana, New Jersey, New York, Texas and Virginia.  

The researchers installed software that monitored what teens have been queuing for six months (with their permission) and had completed questionnaires adolescents and their parents at the beginning and end. Some highlights of the large study that all parents of teenagers should know:

13 are "intensely engaged with social media." It is not a surprise to anyone who has hung a 13 year old recently. About 63% of young people in the study were in Instagram, 34% were on Twitter, and 20% were on Facebook. On average, they publish four times a week. They also spend more time online than in the media; most of the time spent watching and reading what others do online.

FOMO (afraid to lose) is a great reason to get online. Teenagers see social networks as a way to connect with their peers and see what they do, and frequently check social media. One in five teens if anyone said anything to each other, which is sad - and one in three checks to see if your friends do not do anything without them. Although the most common reason for social media monitoring is boredom (80%), many adolescents see social media as the main way to know what your friends are doing.

There is a dark side to form: the study found that teens who spend a lot of "lurking" time online were more likely to experience anxiety - feel excluded, feel enough is not popular, upset by things that read or online dispute. Because ...

Online conflict is common. In the study, 42% of students reported a conflict - usually with a friend - at least once a month. There are also conflicts that arise when young people feel they have been excluded from society, and conflict often develops with friends online.

Adolescents view social networks as a barometer of popularity. For teenagers, especially teenagers, popularity is very important - and the supporters, "love", "tags", and comments may seem a quantifiable way to measure popularity.

Interestingly, two groups of teenagers were more likely to experience distress were those using social media to try and increase its popularity and adolescents who feel attractive they do not get enough recognition through the media.

Parents do not really know what their children are doing. The document was signed a few examples of the disconnect between what parents have said and thought about the online behavior of their children and what is actually happening. The authors wrote: "Parents systematically underestimate the amount of emotion and their children experiencing negative behavior problems, and overestimated the amount of happiness and fun in their teens were in the process".

This does not mean that the online experience is mostly negative for youth. However, most young people said made them feel good, and that allowed them to connect and make new friends and find support.

In reality, teen life online is simply an extension of their offline life. The subjects are all the same. They simply are played in a different space, which can be both good - and dangerous. That is why it is so important that parents are involved. In fact, the study found that when parents were aware of what their children were doing online, their children were less likely to experience distress. 

The authors said that they agreed with the researcher Danah Boyd, who wrote in his 2014 book is not so easy: the social life of teenagers in the network:

    "What makes the secure digital street is when adolescents and adults collectively agree to open their eyes and listen, communicate and collaborate negotiate difficult situations. Adolescents need the freedom to move in the digital street, but also to know that caring adults are behind them and support them wherever they go The first step is to disable the tracking software then ask your children that they are doing when they are online - ... And why it is so important to them " That is very good advice.
By: Claire McCarthy,MD,

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The harmful effects of supplements that can be sent to the emergency room

For many people, a healthy lifestyle means more than eating a good diet and exercise - vitamins, nutritional supplements and complementary products are also part of the plan. But although there is much publicity about its potential benefits, there is less awareness of their potential adverse effects.

In fact, the use of these products can land in the emergency department.

A study published today in the New England Journal of Medicine found that the adverse effects of the supplements were responsible for an average of about 23,000 emergency department (ED) visits per year. That's a lot of something that is supposed to be good for you.

In this 10-year study, researchers analyzed data from 63 monitoring of hospital emergency departments to estimate the annual number of visits to emergency rooms related to the adverse effects of dietary supplements. The authors define 'food supplements' as herbal products or amino acids and micronutrients complementary or vitamin.  

Patients who visit the ED for symptoms related to supplement use were on average 32 years, and women account for over half of all visits. Just over 10% of these visits resulted in hospital admission, especially in adults over 65 years.

Weight loss products accounted for one quarter of all visits for a single product and women disproportionately affected, while men were more likely to suffer the adverse effects of products advertised for sexual enhancement and bodybuilding. Energy products increased up to another 10% of these visits.

Young adults are not the only ones affected. Many children under 4 years old have suffered allergic reactions or digestive symptoms (nausea, vomiting, abdominal pain) of unsupervised ingestion, accidental vitamins. Patients over 65 were more likely to have difficulty swallowing after taking vitamins or trace large pill.

Although study results are based on visits to emergency rooms annually estimated at a relatively small number of hospitals, reflecting the increased use of food supplements and micronutrients. These products are widely available without a prescription and are advertised as alternatives or supplements to pharmaceutical drugs prescribed in therapeutics. Consequently, dietary supplements or herbal are widely perceived as natural and safe. The latest figures indicate that more than 55,000 of these products available in the United States.

What you need to know before taking a supplement 
Although the Food and Drug Administration (FDA) is responsible for the supervision of food supplements, no safety testing or FDA approval required before a new supplement hits the market. In addition, it is not only the potential effects of the requirements of the list of undesirable packing dietary supplements nor are there rules for the maximum size of the pill (a clear risk to the elderly). 

Health care providers may also neglect to ask patients about using over-the-counter or herbal dietary supplements. Without this information, they can not recognize all the signs and symptoms of their patients may experience may be related to these products.

No doubt some dietary supplements can be beneficial. This is because these products contain active ingredients - interacting molecules on receptors in the body and cause physiological changes. However, because they contain active ingredients, they can also cause side effects such as high blood pressure, racing or irregular heartbeat, headache, dizziness, or gastrointestinal symptoms.

What is the safest approach to the use of these supplements? Staying healthy requires a multidimensional approach to self-care. You become aware and informed all supplements, if they are advertised as natural, herbal or no drugs - is part of that care.

If you take vitamins, supplements or herbal products, always read the safety labels included with the package. Ask a pharmacist, your doctor or nurse to check everything you need to make sure that the supplements will not cause damage, either alone or in combination with regularly prescribed or over-the-counter medicines. If you develop symptoms after taking a food supplement, stop and call your doctor.

By: Susan Farrell, MD.

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