I’d had something like a cold for close on to a month, when it started causing my asthma to kick in. So I went to see my allergist. He suggested that I increase my routine meds that I take for allergies and asthma.
And then, on the off chance that the cause of all this was bacterial and not viral or merely allergies (and probably because I kept insisting that it was more than allergies, and that I was afraid to get near my new grandson), he prescribed an antibiotic. One I hadn’t heard of — Avelox.
“Is it expensive?” I asked.
“Tell you what,” he said, “let me see if I have some samples.”
So he went and rooted around the office, and came back with five individually wrapped pills. And when I say wrapped, I mean each pill was contained in one of those things with plastic on one side and foil on the other (you punch them out through the foil), and then in its own box.
Since it’s a one-a-day thing, that would get me through five days. But he wanted me to take it for 10 days.
So a couple of days later, I went to get it filled, and those five pills cost me $94.62. Which means each pill cost almost 19 dollars ($18.924, to be exact).
This is by no means the most expensive medication either I or a member of my family has taken. It just struck me that here’s something I’m just taking on the off chance that I have something it will help with. We’re not talking cancer or something like that.
In fact, there’s nothing particularly remarkable about a $19 pill today, really. Which is why I thought I’d take note of it. So that somebody 20 years from now can read this and laugh that I thought it was a lot of money. Just as I think how innocent we were in the early 80s, when we marveled that Tagamet cost a dollar a pill.
Oh, here’s the kicker — almost from the hour I took the first one, I’ve been feeling better. A lot better. I’m kind of tired feeling, but the sore throat and coughing and wheezing are gone. So… if you ask me, would I spend $19 a day for five or even 10 days to get over feeling the way I did?… I’d say yes.
But I thought I’d still make note of it.
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But what is you were poor and had to choose between the $19 pill and eating for a few days? Not something most of “rich” folks who write on Brad’s blog have to worry about but plenty of folks are faced with just that delimma.
But most likely a vastly cheaper generic antibiotic would have worked just as well, and there’s less of a risk that you are guinea pig–you know, all those new meds that 5 years later the class action lawyers are asking you if you took?
Now you know why health care is so expensive…we are over diagnosed, over tested, and over medicated. But I’m glad you feel better.
Kathryn, I proposed that option — asked, as I have a number of times in recent years, of different doctors — what about tetracycline? I took vast quantities of tetracycline for respiratory infections in my youth (which is why my teeth are stained an unbecoming color, from the inside out — tetracycline does that.
No, he said — and I’ve heard the same from other docs. Tetracycline just isn’t nearly as effective as these new meds.
I’m pretty sure that it wouldn’t have made me start feeling better within a day. (This made me feel better SO fast that I’d be suspicious of a placebo effect — if I had gone into it confident that I’d get better fast, but I wasn’t that confident.)
But, based on the last time I had it (maybe 20 years ago), it DOES have the virtue of being cheap.
Your doctor should have cultured a sample and determined what was called for. The placebo effect, the fact that your sickness ran its natural course, and that antibiotics have anti-inflammatory effects could account for your feeling better.
I didn’t post this to second-guess my doc, and now I guess I need to defend him. I’ve been seeing him for more than 20 years, and I don’t know that he ever prescribed an antibiotic before.
My only point is that I took this apparently efficacious medication, and it cost a lot.
Publix offers several antibiotics free. That’s where I went last time, and it was much faster (15 minute wait) and friendlier pharmacy service than I had ever experienced anywhere else. Cost for 15 pills: $0.
And Brad, your math could be more accurate: you got 10 pills (5 free) plus 5 for $94.62. Your cost per pill (take note, Bud) was about $9.46 (still not cheap).
Other docs at low-cost clinics dispense to the indigent based on need. Perhaps big-government and socialist types don’t want to tell each not tell each other the good stuff, because it hurts their bigger government agenda.
Did Kathryn go to law school or medical school? Does her doctor give her legal advice?
If you can’t afford to make a call because of the expensive pills, just go on welfare and your pills and cell phone (likely with a data plan) will be provided to you free of charge.
Just be careful with these newer antibiotics. The primary side effect can be tendon damage. My neighbor ruptured tendons in both elbows when she went on a strong antibiotic last year… so be careful about patting yourself on the back during the next ten days.
If the drug companies weren’t driven by a profit motive, do you think there would be as much advancement in pharmaceuticals?
Or should they just do it for the goodness of humanity?
I know – let’s have the government set up its own drug labs and let them compete with the private sector. Anyone want to go first as the guinea pig for a government created cancer drug?
But isn’t that the point–people don’t “second guess” their doctors, and we get antibiotic resistant bacteria and spiraling health costs.
Avelox is made by Bayer AG, a German country.
Consider this:
“A United States patent application was submitted on June 30, 1989, for Avelox (moxifloxacin hydrochloride),[1] but it was not until 1999 (ten years later) that Avelox was approved by the U.S. Food and Drug Administration (FDA) for use in the United States to treat severe and life threatening bacterial infections.[2]”
How much of that $19 do you think is the sunk cost of trying to meet FDA regulations over a period of 10 years? How much of that $19 is covering the cost of drugs that failed to be approved?
R&D isn’t cheap.
I second-guess my doctors all the time. But not in this case, since I was the one who kept talking up the case for an antibiotic.
After 50 some-odd years as an expert patient, I can tell when there’s something other than allergies going on.
My point, once again, is that some people need this drugs, whether you think I did or not. And they cost $19 a pill (not $9.46 — they didn’t jack up the price for five because I’d gotten five free).
And I’m blaming neither my doctor nor my pharmacist (both of whom have done yeoman’s work in helping me contain costs over the years). I’m just saying that pills can easily cost $19 now. For those keeping score.
@Kathryn – I get my legal advice from my doctor, and vice-versa.
Brad – Sucks to your assmar!
Doug, you only see one side of this picture. Pharmacutical companies don’t necessarily create new AND effective drugs because of profit motive. Sometimes they create new AND rather useless drugs because of the profit motive. The useless drugs are tauted as better when often they are just a new spin on an old drug. Profit can motivate to do great things or it can just be a source of greed. Why is it that folks like Doug are so dismissive of the greed angle?
Here’s the thing I’d say to all my conservative friends. Given the big victory in Wisconsin and by big tobacco in California it’s pretty clear that conservatisim is winning. And they’ve been winning for some time. We can argue about whether money is the big factor in this winning streak but nevertheless it is clear that policies favoring conservative ideas have been on the ascendance for many years now. And the result for the American people? Health care costs continue to soar. Health care outcomes continue to plummet as our ranking vs the rest of the world plummets. College costs are becoming unbearable. Tax rates for the wealthy are at a decades long low. Eduction achievement scores compared to the rest of the world are way down. Income distribution is skewed (in favor of the very rich) to the point of many third world countries. So when is all these benefits from conservative policy suppossed to kick in?
The regulars have become so predictable I could almost write everyone’s response to this story. Doug will always make this about the virtues of capitalism. Silence will show how government gets in the way of progress. Kathryn will provide the female angle. SDII will offer up some irrelevant comment. Brad will get frustrated and try to keep everyone on track. And of course bud will provide the pragmatic, sensible, common sense and correct answer. 🙂
@Steven Davis: First off, I no longer practice law, but when I did, I welcomed input from clients. Practicing law is not an oracle, where you input facts and it spits out law. There’s a lot of opinion in it, and there’s also the fact that one is counseling clients–they make the choices of how to act, and often want to know the probable consequences of doing so.
Medicine is even more of an art, I’m told by actual doctors. My doctors welcome input from me and we are partners in my medical care. I am intelligent and highly motivated to learn, and read widely in medical areas–after all, who cares more than I about my health? This winter, for example, I had occasion to decide jointly with my doctors whether a CAT scan was warranted, which antibiotics to choose–there are often several different types that can be chosen, with different side effects. Cipro has the potential, as Doug notes, to result in ruptured tendons. Flagyl makes me sick as a dog and wish for the original ailment. Augmentin, on the other hand, has none of these side effects and is equally indicated for my particular ailment. Now, if you don’t exercise, you are not at much risk of a ruptured tendon, and if you don’t have the touchiest G-I system, Flagyl might not be unduly unpleasant for you….
@Bud
Where do you think the U.S. would be WITHOUT the virtues of capitalism? Do you want a U.S. without high tech companies, pharmaceutical companies, entertainment and sports?
I suppose we could all work for the government and have an economy like Communist Russia back in the day.
The problem with your views, bud, is that you want everyone else to strive for mediocrity.
bud – So why do you bother commenting? The regulars that you names all know what your anti-military, anti-success, make everyone equal regardless of effort comment you’re going to post.
bud – I take exception to your statement that conservative principles are winning. If that were the case we wouldn’t have enormous deficits and an ever-expanding government on all levels.
It would be more truthful to say: “While the wind and sand of socialism continue to erode the gears of productive society, conservatives in Wisconsin were able to temporarily staunch the flow.”
I don’t always practice law, but when I do, I also dispense medical advice.
http://dosequis.com/
Doug this is where we have a serious disconnect. I don’t dis capitalism nor do I ignore it’s virtues. What I do do is address the imperfections of pure, unabridged captialism. Greed exists and if unfettered capitalism results in a monopolistic or oligopolistic industry that greed can result in serious spillover costs that can result in all kinds of problems ranging from pollution to worker exploitation to a runaway banking system to ineffictive and even dangerous drugs. Why is that so difficult to understand?
bud – I take exception to your statement that conservative principles are winning. If that were the case we wouldn’t have enormous deficits and an ever-expanding government on all levels.
-Silence
Exactly my point. All those problems (and more) are the result of failed conservative policies.
@bud
There is no “pure, unabridged” capitalism in effect. Every transaction is taxed, regulated, or influenced by government. The affluent pay the majority of tax revenues.
Give me some examples of pure capitalism in effect in the U.S. Name one company that exhibits that behavior — it can’t be a publicly traded company because the company would be owned by the shareholders and monitored by the SEC.
100% pure capitalism doesn’t exist, nor should it. But what comes pretty close is the illegal recreational drug market. Marijuana is produced by a great variety of large and small entreprenuers in a largely unregulated environment. The product is distrubuted down to the end user in what seems like an arbitrary manner but is in fact quite efficient. And the market is effective in setting a consistent price based on certain quality criteria (really good s***, sells for more). Large and small producers alike can sell in this market for the established price. Competition is pretty much perfect with no large producers able to significantly affect the price. And it works pretty well with zero regulation in play.
Unfortunately that type of black market environment is not possible in most industries given the effects of economies of scale that tend to favor large companies. Herein lies the problem. Unregulated the large companies become too big to fail as per the banks and car companies. Or they can do great social harm such as the nuclear industry if that was left unregulated. Just look at the upheaval caused by Enron.
So yes, in many industries with few economies of scale market forces are enough to ensure good outcomes. In those cases government interference can do more harm than good. A good example of that is the taxicab industry where government conveys unnatural monopolies. But in a growing number of important industries the market is just not an adequate mechanism to police itself. That’s where government has an affirmitive duty to step in.
Doug,
does internet gambling count? I don’t know. Just asking.
Here’s the kicker: Brad said, “So… if you ask me, would I spend $19 a day for five or even 10 days to get over feeling the way I did?… I’d say yes.”
Some corporate person has (at their own expense, as far as we know) gone to the trouble to develop a product that improves Brad’s life. They developed it, and they own it. They can ask Brad to pay whatever they want, and if he thinks its a good tradeoff – he’ll pay it. He doesn’t have a right to it, but you have two parties willingly entering into a contract to exchange money for feeling a certain way. Until the regulators or the insurance companies get involved, it’s pretty much pure capitalism.
Having a 1963 Jaguar XKE Series I drop head coupe with the 3.8 litre six cylinder engine would improve my life, but until I’m willing to pay the seller’s price for one, I don’t have any right to it. Maybe there’s a program that can assist? Jaguaraid, anyone?
@ Silence. ha. ha.
Pointing out the basic facts that antibiotics should only be used when needed, and using the oldest effective ones isn’t medical advice. It’s called scientifically justified reality. We wouldn’t have super bugs if people would not have taken antibiotics they didn’t need and then not follow a full course of treatment.
I rarely have taken antibiotics, yet I am just as susceptible to MRSA as all you over-users.
@bud – hate to disagree with you all day but:
1) large producers and distribution networks do affect the prices of street drugs. Why do you think we refer to them as “Cartels”. They absolutely develop economies of scale.
2) Car companies, utilities and pharmaceutical companies utilize regulation as a significant barrier to entry. In the early days of the industry, everyone with a bicycle shop, carriage works or blacksmith’s shop was trying to turn out cars – and did. Nowadays, the costs required to certify crashworthiness, meet CAFE requirements, and engineer a decent product run into the tens of millions. How many automobile start ups can you think of? Delorean? Tesla? Fisker? You have to have many, many, many millions, and even then, it’s a longshot. And there’s no “unregulation” about it.
3) Government conveyed monopolies are some of the worst kind. There’s a good arguement for public water & power utilities being highly regulated, of course. I doubt it should extend anymore to cable TV, telephone or ISP’s. Taxicabs are regulated in an obscene manner, the Post Office could probably break even if congress would get out of the way, Amtrak has been a perennial loser. I can’t think of any others at the moment.
4) Deregulation has worked wonders for air travellers. Not so much for the airlines, but nowadays airfare is way cheaper and more accessible to a broader population than it used to be. Of course we are now all flying cattle car…
I’d say that deregulation has worked pretty much every time it’s been tried, with Enron as the major exception.
@Bud
But where are the monopolies? One of the worst monopolies for a long time was the cable industry — highly regulated by the government. It was only when competition from “greed” driven capitalists running Directv and DishNetwork that forced them to become more more price competitive and offer more services.
Regulation creates barriers, barriers artificially keep prices up. Why do you think industries pay so much for lobbying efforts? It’s to a) get their cut of government spending or b) establish market conditions that protect their turf
Yeah, deregulating the banks investment choices was great, too, and mortgage lending, and student loans….
You mean the government isn’t involved in student loans or mortgages or setting interest rates? Someone better let FNMA, FMAC, FAFSA, and the Fed know… You cant get a student loan WITHOUT disclosing your assets to the government using one of the most braindead processes ever conceived.
I reckon that’s why the medicine and law field are called practices.
Government meddling in interest rates- specifically mortgage and student loan rates has arguably caused the bubbles or increases recently seen in housing prices and college tuition. It also contributed to loans being extended to people with, shall we say, less than reasonable credit. The rates being charged did not adequately reflect the risks involved.
I’d say that deregulation has worked pretty much every time it’s been tried, with Enron as the major exception.
-Silence
I didn’t have any major disagreement until you wrote that. Are you kidding?? Deregulation is what led to the disasterous bank industry meltdown. Defacto deregulation is what led to the BP disaster in the Gulf. Mining companies have skirted regulations, essentially deregulating that industry, and the result has been mining disasters. The airline deregulation has led to extremes in price differential among cities and very uncomfortable flights. Although safety regulations continue to keep that industry remarkably safe. Amtrak is competing against heavily subsidized highway and airline industries.
On the positive side regulation has made our vehicles far safer and cleaner. Given the track record of the callous auto industry that led to disasters like the exploding Pinto we should all be thankful that we have a well regulated auto industry.
Rather than worship at the alter of pure capitalism lets look at what doesn’t work and reform it. But lets not make ridiculous claims like “whenver deregulation is tried it almost always works”. That’s nonsense of the highest order.
@bud
Last week the Wall Street Journal did an analysis of the airline industry. After fuel and salaries, the third highest expense for a typical flight is taxes. I’d hate to see what a regulated industry would look like.
I don’t mock people who read Ayn Rand. I mock Ayn Rand. There’s a difference.
Or rather, George Takei mocked Ayn Rand, and I just thought it was funny…
@ bud – Not following regulations is one thing. Being deregulated is another. Coal companies can follow all of the regulations – and there are a lot – but they can still cut the tops off of mountains in WV. I don’t think that defacto deregulation had anything to do with the BP gulf spill. Human error, miscalculation, mistakes, some bad luck, and disaster, certainly. What regulation would have prevented that? Banks are still among the most regulated entities around, but they still fail. Regulation isn’t the cure-all.
Fannie Mae and Freddie Mac were nowhere near adequately regulated, and could make “liar loans” based on bogus appraisals, legally.
Fannie and Freddie both retained a lot of leeway from the days when their debts were guaranteed by the government – even after they became publicly held corporations and were no longer GSE’s. People (investors) figured that the government would bail them out if they got into trouble, and THEY WERE RIGHT! They’d have never gotten anywhere close to where they were without the implicit guarantees of their debt.
@Kathryn
What do you think the F in FMAC and FNMA stands for?
From the Freddie Mac website:
“Freddie Mac is operating under a conservatorship that began on September 6, 2008, conducting our business under the direction of the Federal Housing Finance Agency (FHFA).”
It’s the quasi-government aspect of those organizations that were partly to blame for the housing bubble. The government encouraged home buying for people who should never have bought homes.
@Doug– The US Postal Service is not a government entity. A conservatorship doesn’t mean identity.
Quasi-governmental is right.
The government should have been regulating capital markets, including and especially home loans, and didn’t. That’s why you got the huge market swings and distributional disparities of unbridled capitalism.
Some of us learned this after the Great Depression, and that’s why all those onerous regulations, like Glass-Steagall were implemented.
But the “job creators” hated the “red tape”
The GSE’s should never have been allowed to lobby congress.
I’m all for reinstating the various Glass-Steagall acts. Then we could go back to making bank shareholders doubly liable. We should also get rid of the FDIC – then depositors would pay attention to how the bank is lending and investing their money. Of course, nobody with a FICO score South of 800 would ever get a loan again, and mortgage terms would shorten up substantially, basically collapsing the housing market.
In fact, congress was constantly pushing banks to make loans to people with lower credit quality. Do you really want to discuss that?
Also, the USPS is an independent agency of the United States Government. Article 1, section 8, clause 7 of the Constitution of the US. “To establish post offices and post roads;”
http://www.law.cornell.edu/constitution/articlei#section8
The USPS is certainly a government entity no matter how they categorize it. It cannot run itself like a private business… otherwise thousands of tiny post offices would have been closed years ago. It has its own police force enforcing federal laws. Its board of directors is appointed by the President. Its employees participate in the federal government retirement system and healthcare system.
The reason the USPS is in such financial difficulty is BECAUSE of its ties to the government.