JustCare

Category: Drugs and alcohol

  • Don’t trust TV drug ads

    Don’t trust TV drug ads

    Elisabeth Rosenthal writes for KFF Health News about why you should not trust drug ads on TV. Ignore the celebrity endorsements by Lady Gaga and others; they won’t tell you about a better less expensive drug. If our government were not in the pocket of the pharmaceutical corporations, it would ban all direct to consumer drug advertising as every country other than the US and New Zealand do.

    Pharmaceutical companies spend huge amounts of money to sway you to buy their drugs because their ads work really well, even when the ads promote drugs that are of little value. Indeed, pharmaceutical companies now spend more than $1 billion a month on these ads. They are among the biggest spenders of TV ads.

    The Clinton Administration is responsible for allowing these ads, which had been banned. The FDA thought it could somehow keep the drug companies from misleading people by saying ads could not be misleading and had to list side effects. Really?

    Rosenthal reports on University of Colorado professor Michael DiStefano’s recent study of best-selling drugs, which found that the pharmaceutical companies spent more on ads targeted to individuals, featuring drugs with fewer benefits, than on ads for doctors. DiStefano is concerned: “I worry that direct-to-consumer advertising can be used to drive demand for marginally effective drugs or for drugs with more affordable or more cost-effective alternatives.”

    Thankfully, five of the ten drugs that will have Medicare negotiated prices beginning in 2026, are drugs that the pharmaceutical corporations spent the most advertising to patients.

    The government’s legal challenges to PhRMA’s misleading ads, even by the former Trump Administration, are not easy to win. PhRMA claimed that a requirement to disclose a drug’s list price in an ad violated first amendment rights and prevailed.

    New FDA requirements sound great, but they are so vague and subjective as to be meaningless; moreover, the FDA cannot enforce them effectively. As of November 2023, PhRMA consumer ads must provide a “non-misleading net impression about the advertised drug.” Drug ads should be “clear, conspicuous, and neutral.”  “Audio or visual elements that might interfere with the consumer’s understanding” is not permitted and and anything in writing must be “easy to read.”

    The FDA does not require the pharmaceutical corporations to submit ads for approval before releasing them. The drug companies are expected to self-police. And, the FDA does not have the money or the power to hold pharmaceutical companies to account when they misled. Each year over the last five years, the FDA sent out an average of six “warning letters.” And, it’s not at all clear that the companies receiving those letters did anything about their misleading ads.

    The FDA now has a Bad Ad Program for physicians, The program trains them on misleading ads and gives them a hotline to call to report misleading ads: 855-RX-BADAD. Given the FDA’s limited resources and power, it’s hard to imagine that will do any good. The FTC apparently does not have the power to protect consumers from false and misleading drug ads.

    For the public health, Congress should ban these ads altogether.

    Here’s more from Just Care:

  • Aspirin is good at preventing blood clots post-surgery. Why don’t hospitals use it?

    Aspirin is good at preventing blood clots post-surgery. Why don’t hospitals use it?

    A recent study found that patients benefit as much from aspirin post-surgery as they do from costly and painful injectables. Both prevent blood clots in patients who have severely fractured a bone, but most hospitals continue to treat patients with the costly injectables. Researchers make the case that prescribing the injectables has serious health equity consequences in a Stat News op-ed and question provider behavior.

    Patients are burdened with far lower costs for aspirin than the low-molecular weight heparin injectables. And, it’s easier for them to take a pill than to get an injection. However, hospitals and physicians appear not to consider health equity issues or simple cost-effectiveness, for that matter, when they treat patients.

    The goal post bone-fracture surgery is to prevent clots, which keep blood from flowing in the lungs and can cause deadly embolisms. And, again, two aspirins a day work just as well as the painful injections into patients’ stomach wall twice a day for three or four weeks post surgery, even for high-risk patients. Moreover, six days of injections cost at least $70 and as much as $300, while the bottle of aspirin costs a few dollars.

    Health insurers will generally pay for the injectable drug even though the less costly aspirin alternative is just as good. But, the injectable drug drives up  patients’ out-of-pocket costs and members’ premiums. Moreover, people prescribed the injectable after their surgery post bone fracture often don’t take it, making it more likely that they will have a blood clot.

    Physicians do not appear to consider that lower-income people, in particular, often do not have the means–financial or social–to comply with the injectable regimen. Only about 15 percent of physicians prescribe aspirin directly after surgery to treat a bone fracture. Only about half of physicians prescribe aspirin to patients after they are discharged.

    At many hospitals, policies have not changed notwithstanding the results of the clinical study showing aspirin’s efficacy. It appears that the hospitals would benefit financially if they used aspirin and stopped using the injectables.

    The insurers should have a role to play. After all, the insurers claim that they offer “value.” Why aren’t they insisting that aspirin is the most cost-effective treatment and refusing to cover the injectable drug post bone-fracture surgery? Are they somehow benefiting financially from patients taking the injectables?

    Here’s more from Just Care:

  • Medicare Part D drug coverage stunts are rampant

    Medicare Part D drug coverage stunts are rampant

    When it comes to Medicare Part D prescription drug coverage, one thing’s for sure: Medicare Part D coverage stunts will continue without an overhaul. Insurers have way too much room to drive up drug costs for enrollees in order to profit handsomely. Cheryl Clark reports for MedPage Today that Medicare Payment Advisory Commission (MedPac) Commissioners are surprised by the huge variation in generic drug prices and availability among different Part D drug plans. It’s no surprise, it’s the “free market” run amok.

    Commissioners considered why one generic drug can cost someone with Part D coverage $1.06 at one pharmacy and $102 at a different pharmacy, sometimes even the same pharmacy chain. What goes into generic drug pricing? Lots of unknown factors in addition to the cost of manufacturing and dispensing the drug and the pharmacy’s costs. (But, you can be sure it’s all about insurer profits.)

    About 20 percent of Medicare spending on prescription drugs is for generics, and generics represent about 90 percent of the drugs that Part D plans fill. Generics are costing more and more.

    Some basic generic drugs, including cardiovascular drugs, are just plain “out of stock.” The big PBMs can’t even say when they will have these drugs in stock. Is it a supply chain issue? (Editor’s note: A David Dayen story in TAP reveals that 323 drugs are in short supply, many more than in the past, endangering people’s health and lives.)

    MedPac Commissioners want to know more about Medicare Part D, as if we need to know more to fix a multi-headed drug cost problem. The biggest players have so much power that they can keep drugs off the market if that helps them financially. A while back, I reported on a story about CVS not selling certain generic drugs because they profited more from only making the brand-name alternatives available.

    “Tying arrangements” are another cog in the pharmaceutical supply and price wheel. These agreements allow drug wholesalers and pharmacies to set the amount of a brand-name drug discount to the amount of generic drugs a pharmacy buys and the price it pays. Wholesalers can then charge more for generic drugs and give bigger discounts on brand-name drugs.

    In addition, bigger pharmacy chains can bargain for lower costs than independent pharmacies. They can also pay less for the same drug from wholesalers. The manufacturers might be charging the same price for a drug, but the wholesalers do not.

    And, the Part D the insurers don’t help matters, designing formularies that benefit their bottom lines and often cost their enrollees more. For more on the challenges of getting your drugs covered through Part D, check out this post from last week.

    Bottom line: You cannot assume that you are getting your drugs at the lowest cost through your Part D drug plan. You need to shop around. Too often you can pay a lot less without using your insurance. One MedPac Commissioner explained that with “irrational drug prices … beneficiaries in the know have to strategize multiple means to access their meds. GoodRx over here and a mail order for Mark Cuban over there, a patient assistance program over there, and the many other methods that … bypass the local pharmacist.” Of course, those not in the know, often the most vulnerable, pay more than they should.

    The Commissioner expounds on the problem: “It’s bad enough that the plans can dramatically change what medicines they cover and what costs for each year with different utilization management tools. But then to have multiple sources of the least expensive drug is just too much for older adults and adults with disabilities.” What’s worse, as I understand it, Part D plans can change the medicines they cover and their costs throughout the year.

    Michael Chernew, MedPac Chair, appeared not to be aware of this longstanding issue with Medicare Part D drugs, both generic and brand-name. He suggested that it was challenging to determine a way to fix the problem, even though every other wealthy nation has done so through negotiated drug prices.

    Here’s more from Just Care:

  • How to treat a runny nose?

    How to treat a runny nose?

    Are you taking DayQuil or Sudafed PE for a runny nose? It’s probably time to stop. An FDA panel recently declared that the decongestant in many over-the-counter oral cold medicines doesn’t work, reports the American Academy of Family Physicians.

    The decongestant in many over-the-counter oral cold and allergy medicines that appears to be no more than a placebo is phenylephrine. It’s been around for many years now. And, you can find it in dozens of brand-name cold and allergy medicines you buy at the drugstore.

    It took the FDA more than three decades to come out with a ruling. Experts have been calling for the FDA to make a finding about the lack of efficacy since at least 1992, reports Christina Jewett for The New York Times.

    Sudafed PE, TheraFlu, Vicks NyQuil Sinex Nighttime Sinus Relief and Benadryl Allergy Plus Congestion are just a few of the common oral cold remedies that include phenylephrine. Shockingly, phenylephrine is more popular than any other oral decongestant in the United States. It led to just under $2 billion in sales last year.

    If phenylephrine worked, it would keep down the swelling in your nose. But, when you take it orally, most of it does not travel to your nose. So, it cannot end your congestion; your nose remains stuffy.

    The FDA nows says that oral phenylephrine cannot be categorized as generally safe and effective since it is definitely not effective. As a result, manufacturers of decongestants with oral phenylephrine might have to pull their cold medicines that include it from store shelves. The FDA has not ruled on that yet.

    Phenylephrine has side effects, including  headaches, inability to sleep and agita. It can also sometimes increase blood pressure.

    Note: Phenylephrine sprays do work because they travel directly to your nasal passages. Moreover, many of the products containing oral phenylephrine contain other products that can help with cold and allergy symptoms.

    Here’s more from Just Care:

  • Five ways to ensure the people you love are safe and healthy 

    Five ways to ensure the people you love are safe and healthy 

    At least once a year, every caregiver should engage the older people they love in what can be difficult conversations. No child looks forward to being a parent to her mom or dad; no one wants to have to speak with a spouse about exercising more, rethinking a medication regimen or considering stopping driving.  But, that’s often what needs to happen. Here are five ways you can help ensure the people you love are safe and healthy.

    1. Make sure they get an annual flu shot.  This should be easy since often the local pharmacy will administer the shot.  The shot minimizes the risk that older adults will develop flu-related health problems, including pneumonia and worsening chronic conditions. [Editor’s note: Also make sure they get their Covid-19 vaccine and booster shots.]
    1. Check out what drugs they are taking.  And, make a list of them, along with the names and phone numbers of their doctors, both for yourself and for their wallets.  If they keep the list on them, and you have a backup copy, it will help ensure their doctors are best prepared to treat them.
    1. Ask them about painkiller prescriptions they take as well as over the counter drugs, like Tylenol.  Too much acetaminophen can be dangerous. Prescription painkillers, such as Percocet or Vicodin, can be even more dangerous, particularly if mixed with alcohol, tranquilizers or other drugs.
    1. Try to nudge them to exercise. A brisk walk can reduce the likelihood of stroke and help prolong their lives. If they are not inclined to move, ask them what might get them out of the house.  Sometimes, a companion can make all the difference.  Anything they can do to move their bodies is great, including in hospital. Sometimes, showing them some easy exercises can work.  You can find simple balance exercises that the National Institutes on Health recommends here. For information about free and low-cost exercise programs in your community, visit the eldercare locator.
    1. Talk to them about driving if they are still driving. Many people can drive all their lives.  But, both mental and physical reflexes can weaken as you age.  The National Institute on Aging offers great advice on when and how you can help someone you love decide to stop driving.

    And, if you need help motivating them to change an unhealthy behavior, here are six tips that could help.

    Of course, there’s more you can do, including making their homes easier and safer to live in: for example, make sure floor surfaces are smooth to reduce the likelihood of tripping, install ramps and  raise toilet seats. More on that in a separate post.

    (This post was originally published on April 10, 2015.)

    Here’s more from Just Care:

  • Herbal remedies, including supplements, can cause serious harm

    Herbal remedies, including supplements, can cause serious harm

    More than 150 million Americans take dietary supplements and herbal remedies. Most of them fail to realize that herbal remedies and supplements, can cause serious harm, even death. Kaiser Health News reports on one woman’s death from taking a mulberry leaf supplement.

    In December 2021, Lori McClintock, Congressman Tom McClintock’s wife, died after consuming an herb from a white mulberry tree that people tend to think is safe and use to treat diabetes, obesity and high cholesterol. There’s evidence that this herb lowers blood sugar levels. McClintock was 61.

    Dehydration resulting from gastroenteritis was the cause of death for McClintock, according to the coroner’s report. Gastroenteritis inflames the stomach and intestines. In McClintock’s case, eating mulberry leaf caused the
    gastroenteritis.

    The autopsy report did not say whether Lori McClintock took a white mulberry leaf dietary supplement, drank tea brewed from the mulberry leaf or ate fresh or dried leaves. But, it did find a piece of white mulberry leaf in her stomach.

    Rep. McClinton said his wife had been dieting and going to the gym to lose weight. She had complained of an upset stomach the day before she died. Side effects of the white mulberry leaf include nausea and diarrhea.

    No one has reported a death from consuming white mulberry leaf in the last 10 years, according to the American Association of Poison Control Centers. Of the 148 reported cases of accidental consumption, only one needed follow-up medical care. Since 2004, the FDA has received only two reports of people who got sick from the mulberry leaf; one or both of them needed hospitalization.

    Supplement manufacturers can include all sorts of ingredients in their products. And, these ingredients can be harmful on their own or cause harmful interactions with medications you are taking. What’s worse is that the FDA does not subject supplements to the kinds of safety testing that prescription drugs and over-the-counter medicines are subject to.

    Four in five Americans use supplements. Notwithstanding the risks supplements pose, it’s a $54 billion market in the US. No one tracks the number of supplement products on the market, but the FDA estimates 40,000-80,000.

    Sen. Richard Durbin (D-Ill.) and Sen. Mike Braun (R-Ind.) have introduced legislation to strengthen oversight of dietary supplements. They want to require supplement manufacturers to register with the FDA and publicly list all ingredients in their products. The dietary supplement industry, for its part, is opposed. Moreover, it wants you to believe that the white mulberry leaf supplement was not responsible for McClintock’s death, suggesting that any number of things might have caused her dehydration.

    Here’s more from Just Care:

  • Should you be taking aspirin every day?

    Should you be taking aspirin every day?

    When it comes to health care, everyone needs options tailored to their particular needs. That’s the beauty of traditional Medicare–it is one size fits all, working for everyone, so long as they have supplemental coverage. It’s also why the US Preventive Services Task Force’s recommendation against the use of daily aspirin for most people does not apply to everyone. Should you be taking aspirin every day?

    As reported in Just Care last week, the USPSTF recently recommended against the use of daily low-dose aspirin for most people because it determined that the risk of internal bleeding was greater than the benefits. However, that recommendation is the rule, for which there are likely exceptions. Andrew Chan, the director of cancer epidemiology at the Mass. General Cancer Center and a professor at Harvard Medical School, believes that powerful evidence indicates that low-dose aspirin can be effective in preventing colorectal cancer.

    Chan argues that the USPSTF is wrong to suggest that the evidence of the benefits of low-dose daily aspirin use is inconclusive when it comes to colorectal cancer. Chan’s research team found that people can benefit from taking aspirin if they start before they turn 70 and ward off colorectal cancer. If they start at 70, the data indicates that it might be too late to ward off cancer.

    Chan appreciates that there are serious risks of internal bleeding for some people who take low-dose aspirin daily. The key is to identify those people and make sure that they are not prescribed daily aspirin use. At the same time, Chan believes that low-dose aspirin can have beneficial anticancer effects for some people. It’s important to understand who can benefit.

    Science is evolving so it will likely be possible to understand a lot more about the population who benefits from taking daily aspirin and the population whose health is endangered from daily aspirin intake. Chan would like to see studies that identify biomarkers or another molecular factor that is able to calibrate risks and benefits of aspirin for particular individuals. He says that preventive medicine should be looking into this.

    Here’s more from Just Care:

  • Avoid opioids to treat dental pain

    Avoid opioids to treat dental pain

    Teresa Carr writes for Consumer Reports on the best drugs to treat dental pain. Hint: Avoid opioids. Percocet, Oxycontin, Codeine, and Vicodin are highly addictive and, for the most part, not as good at relieving pain as over-the-counter medicines. Advil and Motrin (ibuprofen) and Aleve (naproxen) are often more effective and come with fewer side effects.

    People continue to die of opioid overdoses. In fact, last year, 31 percent more people died of an opioid overdose than in 2019. The Sackler family just settled a major lawsuit against Purdue for its responsibility in fueling the opioid crisis, essentially promoting opioids as safe pain relief when over-the-counter medicines would be as effective and non-addictive.

    Back in July, several state attorneys general settled a lawsuit against a series of companies that distribute prescription drugs, including McKesson, Cardinal Health and AmerisourceBergen. Johnson & Johnson was also a defendant. They had been charged with significant responsibility for the opioid epidemic in the US. Interestingly, the health insurers, who claim to “manage” people’s care, got off easy, even though the buck stopped with them–they could have denied coverage for opioids except in the most limited of circumstances, as insurers in Germany did.

    Many people do not realize that dentists have been one of the biggest prescribers of opioids. They have also been far more responsible for opioid overdoses–two and a half times more responsible–than other prescribers of opioids, according to one recent analysis published in the American Journal of Preventive Medicine. (N.B. Keep in mind that sometimes dentists perform costly dental procedures that you might not need. Dental fraud is more common than you might think. So, try to get a second opinion before getting dental surgery.)

    The researchers found that dentists prescribed an opioid to more than one in four people, including teenagers, who received dental surgeries between 2011 and 2018. Millions of people who visited the dentist ended up filling opioid prescriptions. And, nearly six in 10,000 overdosed. The researchers posited that we would see 1,700 fewer opioid overdoses each year if dentists stopped prescribing opioids.

    People with Medicare often do not get to see a dentist because Medicare does not cover dental care and the costs can be prohibitive. But, Congress is working on legislation that is likely to add a dental benefit to Medicare. It should make it easier for older people and people with disabilities to see a dentist.

    When you go to the dentist, keep in mind that there’s generally no need for you to take opioids to relieve dental pain. Over-the-counter medicines are safer and as or more effective than opioids for the majority of people. Drugs like Advil and Aleve are able to keep your gums from swelling. And, Tylenol keeps you from feeling pain.

    Side effects from over-the-counter drugs are also fewer and milder than side effects from opioids. In addition to being addictive, opioids can cause drowsiness, constipation and nausea.

    Talk to your doctor about the drugs you need to relieve any pain you might have from dental care. Remember that even over-the-counter medicines should not be taken in excess. And, if an opioid is warranted because of the intensity of the pain from your dental procedure, make sure to limit your use to what’s needed. Generally, you should be over the harsh pain in two or three days and can then switch to Advil or Tylenol if you still need some pain relief.

    Here’s more from Just Care:

  • More than one in three older adults could be taking inappropriate drugs

    More than one in three older adults could be taking inappropriate drugs

    Should you be taking all the medications you are taking? With medicine, sometimes less is more.  Judith Garber writes for the Lown Institute on a new study in the Journal of the American Geriatrics Society, which finds that more than one in three older adults could be taking inappropriate drugs.

    At least once a year, you should take a bag with all your medicines, prescriptions, over-the-counter medications and supplements, to your doctor’s office to confirm that you should be taking them all. Or, in this time of Covid-19, take photos of all the bottles and share them with your doctor in a telehealth checkup.  Medicare covers telehealth. You might find that your doctor says you no longer need one or more of them or that there are some potentially harmful interactions from taking all of them.

    The data show that older adults often are taking a lot of medications that jeopardize their health. Most older adults take five or more medicines, including supplements and over-the-counter medicines. This increases the likelihood that they will end up in the emergency room or hospitalized.

    Researchers looked at the drug intake of 218 million older adults over a four-year period and found that more than one in three were prescribed a potentially inappropriate drug. There are a large number of possibly inappropriate drugs for older adults, including benzodiazepines, sedative hypnotics, skeletal muscle relaxants, and first generation (sedative) antihistamines.

    The researchers further found that certain types of people were at greater risk of taking potentially inappropriate drugs, including women, people with lower incomes, people with chronic conditions and people with poor mental health.

    Doctors should consider deprescribing certain medicines that can be particularly harmful to older adults. They include anti-cholinergic drugs, benzodiazepines, and proton pump inhibitors. If you are taking any of these medicines, talk to your doctor about whether you should continue to take them.

    Here’s more from Just Care:

  • Coronavirus: Why are older adults most at risk?

    Coronavirus: Why are older adults most at risk?

    You might be wondering why it is that older adults are most likely to be at risk if they get COVID-19. It’s largely about our immune systems. Veronique Greenwood reports for The New York Times on how our immune systems lose immune cells as we age, causing greater inflammation.

    With the novel coronavirus, the greatest worry is for people over 80. They are at literally hundreds of times’ greater risk of dying from COVID-19 than younger people. Part of the reason is that they tend to have more health conditions, so their systems are compromised and vulnerable.

    People over 80 are also at particular risk because of how our immune system evolves as it ages. We need our immune systems to trigger inflammation that harms or weakens the virus, but not to overreact. Our immune system can also address cells in our body that are damaged.

    But, as we age, our immune system is not able to do the work it once did, Instead, it is in a chronic alert state, overreacting. In addition, older cells appear to evolve as we age, and they release inflammatory substances, which can be harmful.

    Older adults are more likely to be frail as a result of these older cells that raise levels of immune proteins. Even 65-year olds who are healthy and not frail usually have higher immune protein levels.

    As Greenwood explains it, older people’s cells are in “inflammatory chaos,” making it harder to fight off a virus. Their immune systems are not likely to react to the virus as they would have when they were younger. Instead, too many immune messengers are activated, which can cause organ failure.

    So, how effective will a COVID-19 vaccine be for older people? Some people believe that vaccines do not always work as well for older people as for younger people because older people’s immune systems do not react as they once did. There is reason for concern that the COVID-19 vaccine will not work as well for older people.

    Here’s more from Just Care: