September 2013 archive

Cross posted from The Stars Hollow Gazette

One of the biggest drivers of health care costs to the patient is medication. Pharmaceutical companies who hold the patents often make minor changes in the drug to gain a new patent and applying for a new patent on essentially the same drug. This is called “evergreening.” A paper in PLOS examined the economic impact of this practice:

The researchers identified prescriptions of eight follow-on drugs issued by hospital and community pharmacists in Geneva between 2000 and 2008. To analyze the impact of evergreening strategies on healthcare spending, they calculated the market share score (an indicator of market competitiveness) for all prescriptions of the originally patented (brand) drug, the follow-on drug, and generic versions of the drug. The researchers then used hospital and community databases to analyze the costs of replacing brand and/or follow-on drugs with a corresponding generic drug (when available) under three scenarios (1) replacing all brand drug prescriptions, (2) replacing all follow-on drug prescriptions, and (3) replacing both follow-on and brand prescriptions. [..]

Using these methods, the researchers found that over the study period, the number of patients receiving either a brand or follow-on drug increased from 56,686 patients in 2001 to 131,193 patients in 2008. The total cost for all studied drugs was €171.5 million, of which €103.2 million was for brand drugs, €41.1 million was for follow-on drugs, and €27.2 million was for generic drugs. Based on scenario 1 (all brand drugs being replaced by generics) and scenario 2 (all follow-on drugs being replaced by generics), over the study period, the healthcare system could have saved €15.9 million and €14.4 million in extra costs, respectively. The researchers also found some evidence that hospital prescribing patterns (through a restrictive drug formulary [RDF]) influenced prescribing in the community: over the study period, the influence of hospital prescription patterns on the community resulted in an extra cost of €503,600 (mainly attributable to two drugs, esomeprazole and escitalopram). However, this influence also resulted in some savings because of a generic drug listed in the hospital formulary: use of the generic version of the drug cetirizine resulted in savings of €7,700.

(emphasis mine).

In a post at his blog, law professor Jonathan Turley explains how President Barack Obama has yielded to the pressures of the pharmaceutical industry and pushed to block access the inexpensive generic drugs, demanding India, one of the world’s largest suppliers of generic drugs, block production of the low cost medications:

Millions of Americans struggle on a daily basis to afford medicine in the United States which is the highest in the world. Many seek affordable drugs by driving to Canada or seeking medicine (as well as medical care) in India. Yet, one of the first things that President Obama did in the new health care law was to cave to a demand by the powerful pharmaceutical lobby to drop provisions guaranteeing cheaper medicine. The lobby then got Congress to block two measures to guarantee affordable medicine. With billions at stake, Congress and the White House again yielded to the demands of this industry, which is sapping the life savings away of millions of families. Given this history, many are concerned about a meeting planned between Obama and the Prime Minister of India. Public interest groups object that Obama is threatening retaliation against India in the hopes of blocking one of the major alternatives for families in acquiring affordable medicine. Congress has also again responded to industry demands for pressure in India to change its laws and, as a result, raise the cost of medicine. Doctors Without Borders, a highly respected medical group, has denounced the effort of the Obama Administration as threatening basic health care for its own citizens and those around the world.

From Doctors Without Boarders press release:

On the eve of a meeting between US president Barack Obama and Indian prime minister Manmohan Singh at the White House, the international medical humanitarian organization Doctors Without Borders/Médecins Sans Frontières (MSF) today warned that India faces retaliatory political pressure from the US government and pharmaceutical industry for its efforts to legally limit abusive patenting practices and to increase access to affordable generic medicines.

Pharmaceutical companies are aggressively lobbying congress and the Obama administration in a broad campaign to press India into changing its intellectual property laws. India is a critical producer of affordable medicines, and competition among generic drug manufacturers there has brought down the price of medicines for HIV, TB, and cancer by more than 90 percent. [..]

The pharmaceutical lobby, led by Pfizer, is currently engaged in a concerted effort to pressure India to change its intellectual property laws. In June, 170 members of US congress wrote a letter to President Obama urging him to send a “strong signal” to India’s high-level officials about its intellectual property policies, and numerous congressional hearings have been held in the past year designed in part to criticize India’s robust defense of public health. Several interest groups have been created to lobby the US government about India’s policies and in early September, US congressional trade leaders requested that the US International Trade Commission initiate an official investigation on India’s intellectual property laws. [..]

Earlier this year, Novartis lost a seven-year-battle to claim a patent on the salt form of the cancer drug imatinib, marketed as Gleevec. The Indian Supreme Court ruled that this new formulation did not meet the patentability requirement in Indian patent law, which limits the common pharmaceutical industry practice of “evergreening,” or extending drug patents on existing drugs in order to lengthen monopolies. [..]

These decisions by the Indian judiciary and government are compliant with all existing international law, including those rules outlined in the World Trade Organization Agreement on Trade Related Aspects of Intellectual Property (TRIPS) and the Doha Declaration on TRIPS and Public Health. Both defend access to existing medicines by allowing countries to use legal flexibilities such as patent oppositions and compulsory licenses to overcome intellectual property barriers. Nevertheless, some US pharmaceutical companies are crying foul, and wrongly accusing India’s patent system of not being consistent with TRIPS.

(all emphasis mine)

As Prof. Turley points out, India is forcing down the cost of drugs making life saving drugs available to millions. If Big Pharma is successful the impact will be life threatening to millions around the world.

Welcome to the Health and Fitness News, a weekly diary which is cross-posted from The Stars Hollow Gazette. It is open for discussion about health related issues including diet, exercise, health and health care issues, as well as, tips on what you can do when there is a medical emergency. Also an opportunity to share and exchange your favorite healthy recipes.

Questions are encouraged and I will answer to the best of my ability. If I can’t, I will try to steer you in the right direction. Naturally, I cannot give individual medical advice for personal health issues. I can give you information about medical conditions and the current treatments available.

You can now find past Health and Fitness News diaries here and on the right hand side of the Front Page.

This week I pulled out my miso and got to work on dishes other than soups. Mind you, I love miso soup; it’s one of my favorite things about eating in a Japanese restaurant. I used to make it a lot at home, too, especially in my early days of being a vegetarian when I was still obsessed with getting enough protein, because it is a good source. But I also love miso glazes on vegetables and on fish and I’ve used this healthy fermented food in salad dressings, dips and spreads.

The paste is made by fermenting grains and/or soybeans with salt and a fungus called kojikin. It is always salty and the light varieties – white (shiro), yellow, and some light brown varieties – are sweet as well. The mildest tasting misos are the white or shiro misos, which are made with rice, barley and a relatively small proportion of soybeans. The more soybeans that are used in miso, the darker and stronger it tastes. I worked with a light miso in this week’s recipes.

~Martha Rose Snulman~

Assumptions can be dangerous to people who are habitually marginalized.  One of the big assumptions that people make about the concept of “transgender” is that transgender is a subset of homosexual.  It is not.  I do not have data to turn to, but I have heard, as I shared in a diary last week, that about 1/4 of transgender people are gay or lesbian, 1/4 are heterosexual, 1/4 are bisexual and 1/4 are asexual.  

What exactly that says about the influence of the normalized control of gender and sexuality by our culture is something I’ll let other people discuss.

But the assumption has a large impact on the everyday lives of gender-variant people.  Even scientists studying sexually-transmitted diseases jump to the conclusion that transgender women are “men who have sex with men.”  And even direct evidence to the contrary often does not dissuade people from adopting the assumption.

Tonight I have two cases in point.

Cross posted from The Stars Hollow Gazette

This is your morning Open Thread. Pour your favorite beverage and review the past and comment on the future.

Find the past “On This Day in History” here.

September 27 is the 270th day of the year (271st in leap years) in the Gregorian calendar. There are 95 days remaining until the end of the year.

On this day in 1922, Jean-François Champollion deciphered the hieroglyphs of the Rosetta Stone with the help of groundwork laid by his predecessors: Athanasius Kircher, Silvestre de Sacy, Johan David Akerblad, Thomas Young, and William John Bankes. Champollion translated parts of the Rosetta Stone, showing that the Egyptian writing system was a combination of phonetic and ideographic signs.

Thomas Young was one of the first to attempt decipherment of the Egyptian hieroglyphs, basing his own work on the investigations of Swedish diplomat Akerblad, who built up a demotic  alphabet of 29 letters (15 turned out to be correct) and translated all personal names and other words in the Demotic part of the Rosetta Stone  in 1802. Akerblad however, wrongly believed that demotic was entirely phonetic or alphabetic. Young thought the same, and by 1814 he had completely translated the enchorial (which Champollion labeled Demotic as it is called today) text of the Rosetta Stone (he had a list with 86 demotic words). Young then studied the hieroglyphic alphabet and made some progress but failed to recognise that demotic and hieroglyphic texts were paraphrases and not simple translations. In 1823 he published an Account of the Recent Discoveries in Hieroglyphic Literature and Egyptian Antiquities. Some of Young’s conclusions appeared in the famous article Egypt he wrote for the 1818 edition of the Encyclopædia Britannica.

When Champollion, in 1822, published his translation of the hieroglyphs and the key to the grammatical system, Young and all others praised this work. Young had indicated in a letter to Gurney that he wished to see Champollion acknowledge that he had made use of Young’s earlier work in assisting his eventual deciphering of hieroglyphics. Champollion was unwilling to share the credit even though initially he had not recognized that hieroglyphics were phonetic. Young corrected him on this, and Champollion attempted to have an early article withdrawn once he realized his mistake. Strongly motivated by the political tensions of that time, the British supported Young and the French Champollion. Champollion completely translated the hieroglyphic grammar based in part upon the earlier work of others including Young. However, Champollion maintained that he alone had deciphered the hieroglyphs. After 1826, he did offer Young access to demotic manuscripts in the Louvre, when he was a curator. Baron Georges Cuvier (1825) credited Champollion’s work as an important aid in dating the Dendera Zodiac.

Cross posted from The Stars Hollow Gazette

In Shakespeare’s “Henry VI,” the character Dick the Butcher, a follower of the rebel Jack Cade, uttered the words, “The first thing we do, let’s kill all the lawyers.” If taken in the context of the play, the line, intended as a comedic aside, was actually a compliment to those lawyers who upheld the laws and protected society. Those words have taken on different meaning over the years and are now often used in reference to those lawyers who have twisted the laws to protect the corrupt and dishonest and, often as not, defend illegal wars and torture, as well as, circumvent the US Constitution. It has often been rephrased, as the title of this article, to fit a narrative, as in the case of “reforming” the NSA, “the first thing we do, is fire all the liars.”

Leading First Amendment lawyer, James Goodale, is the former general council to the New York Times and was the driving force behind the NYT‘s decision to publish the Pentagon Papers in 1971. He was instrumental in the winning strategy that resulted in the 6 – 3 Supreme Court ruling that the US government could not stop the Times from publishing the documents. In his opinion piece at The Guardian on the proposed reforming of the NSA, Prof. Goodale noted that President Barack Obama’s first concern should be to fire all the liars, starting with the Director of National Intelligence, James R Clapper and  General Keith Alexander, director of the National Security Agency, among others who have both blatantly lied to Congress.

NSA lawyers lied to secret Fisa court Judges John D Bates and Reggie B Walton. In recently released opinions, Bates said he had been lied to on three separate occasions and Walton said he had been lied to several times also.

But Clapper and Alexander have not been held in contempt of Congress. Nor have the Justice Department attorneys, who lied to Judges Walton and Bates, been disciplined. Part of the answer as to why this is so came out last week.

The Justice Department told USA Today that it had no intention of investigating the attorneys who lied to those judges. In the ordinary course, the Justice Department’s office of professional responsibility investigates the behavior of lawyers who have been subject to accusations such as those made by Judges Bates and Walton.

(emphasis mine)

You read that correctly, the Obama DOJ has no intention of investigating the attorneys who lied to Judges Bates and Walton

The Justice Department’s Office of Professional Responsibility routinely probes judges’ allegations that the department’s lawyers may have violated ethics rules that prohibit attorneys from misleading courts. Still, OPR said in response to a Freedom of Information Act request by USA TODAY that it had no record of ever having investigated – or even being made aware of – the scathing and, at the time, classified, critiques from the Foreign Intelligence Surveillance Court between 2009 and 2011.

Prof. Goodall also calls Pres. Obama’s statement in his August 9, 2013 address on the NSA that he would appoint experts to examine NSA practices, “reasonable” but points out that it doesn’t appear to be going anywhere:

Robert Atkinson, the president of the Information Technology and Innovation Foundation and an attendee, told the Guardian the he “did not hear much discussion” of changes to the bulk surveillance activities.

“My fear is it’s a simulacrum of meaningful reform,” said Sascha Meinrath, a vice president of the New America Foundation, an influential Washington think tank, and the director of the Open Technology Institute, who also attended. “Its function is to bleed off pressure, without getting to the meaningful reform.”

It’s pretty predictable that there will be no meaningful reform coming from a committee comprised of intelligence insiders, former White House officials and Obama advisers.

Michael Morell, a former deputy CIA director, is a member, as is Richard Clarke, a White House counter-terrorism aide to three presidents. Cass Sunstein, a former White House regulatory staffer who is married to the new US ambassador to the United Nations; Geoffrey Stone, a University of Chicago law professor; and Peter Swire, a Georgia Tech professor and former aide to Obama and Bill Clinton, round out the panel.

Over at emptywheel, Marcy Wheeler pointed out a detail that Prof. Goodale missed:

In just its third open hearing this year, the Senate Intelligence Committee has arranged the following witnesses for tomorrow’s hearing on NSA’s spying.

   Senate Intelligence Committee Chairman Dianne Feinstein (D-Calif.) and Vice Chairman Saxby Chambliss (R-Ga.) today announced the committee will hold an open hearing to consider legislative changes to the Foreign Intelligence Surveillance Act, to include the NSA call records program, on Thursday, September 26, at 2 p.m.

   WHAT:  Public hearing on FISA, NSA call records

   WHO:

   Panel I

       Director of National Intelligence James Clapper

       National Security AgencyDirector General Keith Alexander

       Deputy Attorney General James Cole

   Panel II

       Ben Wittes, Brookings Institution

       Tim Edgar, Watson Institute for International Studies, Brown University

So DiFi’s idea of an “open hearing” is to invite two established liars. And for her non-governmental witnesses, one keeps declaring Congress NAKED! in the face of evidence the government lies to them, and the other tells fanciful stories about how much data NSA shares.

It’s like DiFi goes out of her way to find liars and their apologists to testify publicly. [..]

It’s DiFi’s committee. And if she wants every single open hearing to serve as a platform for accomplished liars, I guess that’s her prerogative.

But observers should be clear that’s the purpose of the hearings.

As Prof Goodale concludes, the culture of lying to the public and courts by the US intelligence community is nothing new but it lies with President Obama to force the NSA to change. The best place for that change would be to fire the liars, Clapper and Alexander. So far, it appears the president is not much interested in that solution.

Cross posted from The Stars Hollow Gazette

Iran’s new president Hassan Rouhani addressed the UN General Assembly taking a far more moderate and diplomatic course than his firebrand predecessor, Mahmoud Ahmadinejad. Propelled into office by a broad coalition of support from elites to students to former political prisoners, Mr. Rouhani has taken the West aback with his moderate and conciliatory approach to solving Iran’s problem’s with them and moving to resolve the differences over Iran’s nuclear energy program that resulted in crippling economic sanctions.

While the much anticipated meeting with US President Barack Obama did not take place, talks are scheduled for Thursday with Iran’s Foreign Minister, Mohammad Javad Zarif and US Secretary of State, John Kerry, the first ministerial talks between Tehran and Washington since the Islamic revolution in 1979. Despite the softening of the rhetoric by Iran and the outreach to repair the damage done by Ahmadinejad, there were still those who are not just wary but completely unconvinced with their own agenda. In any case, Pres. Rouhani was well received and has continued on his mission to repair Iran’s image. It is quite understandable that both sides are easing into this new relationship, one giant step, lots of baby steps towards better cooperation.

Iran’s new president treads middle ground in United Nations address

Breaking from his predecessor’s combative rhetoric, Hassan Rouhani spoke to concerns of both conservatives and liberals

With expectations so high, Hassan Rouhani’s speech to the general assembly was never going to be an easy one. In Iran, radicals will have listened intently to their new president, keen to ensure he wouldn’t be too soft on the west, especially the United States, Tehran’s sworn enemy since the 1979 Islamic revolution. After all, 34 years on, faithfuls still chant “death to America” every Friday after performing their weekly prayers.

Reformists, too, had pinned their hopes on Rouhani, expecting him to impress the world with a moderate voice, and to globally revamp Iran’s image, so badly hurt under eight years of Mahmoud Ahmadinejad. Being a moderate, an ultimate insider who has tried to bridge the gap between major factions of the Islamic republic, Rouhani succeeded in being just moderate enough – albeit judged by Iranian standards. He didn’t impress either group, nor did he particularly disappoint them. It was a speech that both sides seemed to agree was worth listening to.