The Physical Costs

The Physical Costs

    The other day saw the completion of my physical, my first return visit in nearly three years, a schedule in keeping with my doctor's request to not have one done every year (for some, an annual physical is almost mandatory due to ongoing health conditions).  In my case, the visit was almost mandatory for had I passed the three year mark, I would have been dropped from his patient roles (something to keep in mind for those of you also not visiting your doc regularly), and since he no longer accepts new patients, would have left me out there searching for a new primary care physician (cue music: Mission Impossible).

    It's a good thing to have a physical workup now and then, your blood and urine samples given several days ahead of time, the results read back to you, usually with an EKG (good to at least have one electrocardiogram graph done so that there is a baseline record of your normal heart rhythm to compare should there be an emergency) and a colonoscopy (don't let the stories scare you...I've had two and have been consciously awake for both and felt no pain, none, nada; and remember, colon cancer is one of the easiest cancers to cure if caught early, and one of the most difficult to stop if caught late).  And if your doc is at all like mine, your lab results will be rattled off more or less like a calculus exam, the recognizable words (thyroid, liver, kidney) making sense, the almost-recognizable words somewhat making sense (glucose, potassium, albumin) but not the numbers or the rest of the words (hematocrit, MCH, AST, ALP, UKET).  A brief summation and explanation of the results, one of many, can be viewed as a PDF file from an article years ago in AARP's magazine, a magazine designed to help retired people and others understand a bit of life's abbreviations.

    While those results are rattled off, it's a good time to have your questions written down and ready to be asked about what might be bothering you.  Leg cramps, rashes that haven't healed, funny heart rhythms, trouble sleeping.  Whatever your questions, now is the time because once your doc leaves the room, it's like a magic show; somehow, there's a trick door somewhere and he or she disappears before you can jump off the table and say, "oh, I forgot to ask..."  It's also a good time to review your meds (if not done earlier) and perhaps mention to your doc that your co-pay has shot up into the world of unaffordability.  In my case, it was the EpiPen, that auto-injector of a dollar's worth of epinephrine that now costs the consumer $455.00 (the saver of allergic reactions, the EpiPen used to cost about a tenth that price with insurance, or about 20% of the price without insurance).  Credit Heather Bresch, the CEO of Mylan, the pharmaceutical company that purchased the semi-monopolistic rights of Epipen from Merck KGaA back in 2007.  She began an aggresive marketing campaign to worried schools and malls and airlines that an Epipen should be available to counter any severe allergic reaction, especially to something as common (now) as the once-rare peanut allergy (sales have jumped from $200 million in 2007 to +$1,000,000,000 last year).   Says a piece in Bloomberg Businessweek: (CEO Heather) Bresch, the daughter of Senator Joe Manchin (D-W.Va.), turned to Washington for help.  Along with patient groups, Mylan pushed for federal legislation encouraging states to stock epinephrine devices in schools.  In 2010 new federal guidelines said patients who had severe allergic reactions should be prescribed two epinephrine doses, and soon after Mylan stopped selling single pens in favor of twin-packs.  At the time, 35 percent of prescriptions were for single EpiPens.  The U.S. Food and Drug Administration had changed label rules to allow the devices to be marketed to anyone at risk, rather than only those who’d already had an anaphylaxis reaction.  “Those were both big events that we’ve started to capitalize on,” Bresch said in October 2011...In 2013, the year following the widely publicized death of a 7-year-old girl at a school in Virginia after an allergic reaction to peanuts, Congress passed legislation encouraging states to have epinephrine devices on hand in schools.  Now 47 states require or encourage schools to stock the devices.

    What happened with EpiPen is just another in a rather long list of drug price increases.  One of the most publicized was the purchase by former hedge fund manager, Martin Shkreli, of the drug Daraprim, "which treats a parasitic infection called toxoplasmosis that can be life-threatening to babies and people with AIDS," said a piece in The Week.  As the new CEO of Turing Pharmaceuticals, Shkreli* hiked the price 5500%; what once costs less than $14 was now $750 per pill  (Congress has barred the government from negotiating pharmaceutical prices so companies are free to set their own prices...and those running to other countries to purchase the same drugs --EpiPen sells for less than $88 in France-- are doing so illegally, again a law passed by Congress).  Adds the article: Nine of the 10 top drugmakers spend more on their TV ads and other marketing campaigns than they do on researching drugs.  Moreover, many new drugs are actually discovered by academic researchers operating on funding from the National Institutes of Health and then developed by drug companies into commercial products.  Big Pharma also has a profit margin of 20 to 30 percent — one of the highest profit margins of any industry.  Much of that profit goes to the companies' shareholders and executives — like Gilead Science's CEO, who pulled in more than $180 million in compensation in the same year that his company's $84,000-a-year Hepatitis C drug, Solvadi, hit the market.  Recently, many drugs companies have been dramatically increasing the price of drugs they didn't even create or develop...Shkreli's company, Turing, is one of several companies that have made a fortune by buying up the rights to older medicines for rare conditions and price-gouging people dependent on them. Daraprim, the drug it decided was now worth $750 a pill, has been on the market for 62 years and costs just $1 to make. Another company following this strategy is Valeant, which spends only 3 percent of its revenue on R&D, yet has raised the price of old diabetes pills, diuretics, and rheumatoid arthritis medicines by up to 800 percent.  

    There are many more cases, says Bloomberg Businessweek, the prices for doxycycline hyclate (common antibiotic) up 8,281%, albuterol sulfate (for asthma) up 4,014%, glycopyrrolate (used during surgery for irregular heartbeats) up 2,728% and on and on.  And generally, said another piece, those prices don't come back down, even for generic drugs: A survey conducted for Bloomberg of 3,700 formulations of generic hospital drugs found more than 400 have at least doubled in price since late 2007, including 50 that have gone up at least tenfold.  roughly 25 percent of all older hospital drugs have gone up faster than the rate of inflation during that period, according to the survey of average wholesale prices by DRX, a unit of Connecture that provides price comparison software for health plans.  It's all legal, and perhaps as the pharmaceutical industry might say, is how business is done in the U.S. (that and spending nearly $300 million on Congressional lobbying and campaign donations).

    But back to my physical (and yours, one hopes)...it worth checking up on your body, to make sure that your blood is steadily flowing at a speed of 3-4 miles per hour, your heart beating an average of 2.5 billion times to accomplish that, your lungs are still taking in an average of 2 gallons of air each minute, your eyes are blinking at a steady 10 times each minute, and your cells are making a new protein every 10 seconds.  You might even discover some of the new images of inside the body such as those from award-winning Anders Perrson using dual-energy CT scans (what??...but worth a peek to see what an implanted heart pump looks like to a surgeon).  But look at it this way, at least (again, one hopes) you're not hooked up to a machine in the hospital, the one regulating your saline drips and medicines and heart beats and pacemakers...those have apparently been hacked or are easily hacked and are sometimes able to be remotely controlled, in some cases, even while you're walking on the street (imagine having no control over the machine inside your chest)...but that story is for a different day.  


*About a month ago (December 15, 2015), Shkreli was arrested by the FBI on securities fraud charges during his days as a hedge fund manager; he has posted the $5 million bail and is awaiting trial...