American Healthcare continues to go backward

[cowboyinexile]

Amazing a billionaire with such a fundamental misunderstanding of economics. We don’t want to compete with India to have a plant making 9 cent pills. We want to dominate AI. We want to make better chips. We want to create high dollar luxury items.

You notice we aren’t fighting Germany or Luxembourg for these plants. Gee, I wonder why they are in India?

So what's the endgame?

The whole cabinet isn't a bunch of idiots. Its filled with yes men and people with their own agenda, but at some point someone is going to find a way to nudge him in a halfway intelligent direction. If random people on a message board can look at this and see instantly how its a bad idea, there has to be a couple of policy advisors paid to figure this out telling him the smart move with pharmaceuticals would be literally anything else.

 

[CowboyJD]

So what's the endgame?

The whole cabinet isn't a bunch of idiots. Its filled with yes men and people with their own agenda, but at some point someone is going to find a way to nudge him in a halfway intelligent direction. If random people on a message board can look at this and see instantly how its a bad idea, there has to be a couple of policy advisors paid to figure this out telling him the smart move with pharmaceuticals would be literally anything else.

When a policy advisor tells him something like that, the policy advisor gets fired immediately.

 

[steross]

When a policy advisor tells him something like that, the policy advisor gets fired immediately.

Bingo!!

What @cowboyinexile said was true for first Trump admin. Now it is all yes men. The “How it started…” thread is full of these people saying one thing a while back when honest and saying what Trump makes them say now.

 

[RxCowboy]

Amazing a billionaire with such a fundamental misunderstanding of economics. We don’t want to compete with India to have a plant making 9 cent pills. We want to dominate AI. We want to make better chips. We want to create high dollar luxury items.

I'm a clinical guy, not a pharm administration/economics guy. But this is just so damn easy to see through. It's like the administration doesn't know a pharmacist to ask "will this work?" Or the pharmacist they asked is MAGA-brained and simply said yes because that's what's expected.

You notice we aren’t fighting Germany or Luxembourg for these plants. Gee, I wonder why they are in India?

Only one reason, and it's the same reason they are in China, because they basically have slave labor.

 

[RxCowboy]

When a policy advisor tells him something like that, the policy advisor gets fired immediately.

 

[RxCowboy]

What he wants, to shift generic drug manufacturing from India and China, can’t happen regardless of how high he makes the tariffs. New plants would have to be built and said plants would have to meet all regulatory requirements. That means the startup costs would be extremely high, for generic drugs with very small margins.

All the tariffs will do is increase the cost of generic drugs.

Let me add a P.S. to this. All China and India have to do is ride out the term. People in the U.S. will pay higher prices for generic pharmaceuticals, but in 3.5 years there will be another administration and the tariffs will be rolled back. Also, in the meantime, we can't live without the generics even if it means paying higher prices for them. Sales won't change, only costs will. Whether or not those costs will be passed on to patients, or the pharmacies get squeezed, the PBM/insurance won't pay a dime of it, they'll still make their money. Finally, when the tariffs are rolled back the prices won't be. The increase in price will likely be permanent.

And China and India will most definitely just ride it out.

 

[RxCowboy]

We already spend $600 billion annually on prescriptions via Medicare and Medicaid. So sure let’s just double and triple that w tariffs.

It’s been a week and I’m worn smooth but if I’m pharma wouldn’t I just smile and wave bc they pass the cost onto consumers and in the end the Government pays out via Medicare and Medicaid while the private insurance raise their costs to cover the tariffs plus a little.

So now pharma has more money and so does insurance w which to buy more influence.

Who in this besides us gets screwed?

Not China and India, they ride it out.

Not the PBMs/insurance companies. We already have generics that are tier 3 and prior approval. There will be even more that are tier 3 and prior approval. PBMs are evil, btw. They are middle-middle men.

Pharmacies may get squeezed. Reimbursement on generics is already so low that independent pharmacies are struggling to survive, and the few Rite Aids that were left here in the midwest are now all gone.

Who's left? Patients. They will end up holding the bag. And that really pisses me off.

For about five minutes the administration realized that we subsidize the rest of the world by paying higher prices for prescription pharmaceuticals here in the US. I've been saying this for at least 20 years. I thought that something positive might happen. But it only lasted five minutes.

 

[RxCowboy]

I've spent my entire career helping the poor, underserved, and veterans. I love my work. But this could do me in.

 

[RxCowboy]

I caused great cognitive dissonance among antivax Trumpians simply by posting this picture on twitter...

 

[CptnQuirk]

Not China and India, they ride it out.

Not the PBMs/insurance companies. We already have generics that are tier 3 and prior approval. There will be even more that are tier 3 and prior approval. PBMs are evil, btw. They are middle-middle men.

Pharmacies may get squeezed. Reimbursement on generics is already so low that independent pharmacies are struggling to survive, and the few Rite Aids that were left here in the midwest are now all gone.

Who's left? Patients. They will end up holding the bag. And that really pisses me off.

For about five minutes the administration realized that we subsidize the rest of the world by paying higher prices for prescription pharmaceuticals here in the US. I've been saying this for at least 20 years. I thought that something positive might happen. But it only lasted five minutes.

Has anyone ran the tariff scenario past the best A.I. to see where the money comes from, where is goes and who pays for it all in the end?

 

[RxCowboy]

Has anyone ran the tariff scenario past the best A.I. to see where the money comes from, where is goes and who pays for it all in the end?

It comes from you, just like corporate taxes come from you. The only way to avoid paying higher prices because of the tariffs is to avoid buying the high tariff goods and services.

Even if somehow China and India were made to pay the tariffs on generic medications, do you think they are simply going to accept less profit? And if not, then how else are they going to maintain profits if not by adjusting prices for the tariffs?

And if we do build plants to manufacture a bunch of generics and hire Americans to make them, rather than the near slave labor in China and India, do you think the generics are going to cost the same as those from Asia? It simply isn’t possible for them to cost the same with the incredibly high start up costs.

What is the purpose of the tariffs? To correct a trade imbalance? To promote manufacturing in the US, protect US jobs? To stem the flow of fentanyl? He’s stated all these and more, and they can’t all be true at the same time.

 

[Stillwater Townie]

Let me add a P.S. to this. All China and India have to do is ride out the term. People in the U.S. will pay higher prices for generic pharmaceuticals, but in 3.5 years there will be another administration and the tariffs will be rolled back. Also, in the meantime, we can't live without the generics even if it means paying higher prices for them. Sales won't change, only costs will. Whether or not those costs will be passed on to patients, or the pharmacies get squeezed, the PBM/insurance won't pay a dime of it, they'll still make their money. Finally, when the tariffs are rolled back the prices won't be. The increase in price will likely be permanent.

And China and India will most definitely just ride it out.

And those two countries may be motivated more than ever to find new countries to market their drugs to.

Consider that paying tariffs on imported equipment needed to make drugs in new plants may be prohibitive, unless Trump wants to exempt or refund them. Also finding qualified workers to make drugs may be difficult. Maybe automation or robots could come in.

 

[RxCowboy]

And those two countries may be motivated more than ever to find new countries to market their drugs to.

Consider that paying tariffs on imported equipment needed to make drugs in new plants may be prohibitive, unless Trump wants to exempt or refund them. Also finding qualified workers to make drugs may be difficult. Maybe automation or robots could come in.

We are the biggest pharma market in the world, per capita.

 

[cowboyinexile]

We are the biggest pharma market in the world, per capita.

We do love our drugs.

 

[RxCowboy]

We do love our drugs.

Adverse drug effects cost the American healthcare system somewhere between $70-120 billion per year. That's billion with a B. Just imagine how many more people we could deliver healthcare to if we could cut that even by 10%. Think about that the next time you are at the pharmacy and handed a prescription and they ask you to sign that you don't need counseling without even telling you why you are signing.

Every patient I talk to as I am treating their diabetes I could through a list of adverse effects of each of the meds that I'm responsible for and ask them if they have any adverse effects. Every single patient I start on a new med I tell them about both the serious (e.g. pancreatitis) and common (e.g. nausea/vomiting, diarrhea) potential adverse effects, SO THAT THEY CAN HELP ME MONITOR FOR THEM.

OBRA 90 mandated that pharmacists counsel their patients about their medications. How did pharmacy respond? Two ways: 1) in pharmacy school we started teaching students how and why they need to do this, and 2) pharmacies started having patients sign that they don't need to do this.

The hypocrisy of my profession can be stunning.

 

[steross]

Adverse drug effects cost the American healthcare system somewhere between $70-120 billion per year. That's billion with a B. Just imagine how many more people we could deliver healthcare to if we could cut that even by 10%. Think about that the next time you are at the pharmacy and handed a prescription and they ask you to sign that you don't need counseling without even telling you why you are signing.

Every patient I talk to as I am treating their diabetes I could through a list of adverse effects of each of the meds that I'm responsible for and ask them if they have any adverse effects. Every single patient I start on a new med I tell them about both the serious (e.g. pancreatitis) and common (e.g. nausea/vomiting, diarrhea) potential adverse effects, SO THAT THEY CAN HELP ME MONITOR FOR THEM.

OBRA 90 mandated that pharmacists counsel their patients about their medications. How did pharmacy respond? Two ways: 1) in pharmacy school we started teaching students how and why they need to do this, and 2) pharmacies started having patients sign that they don't need to do this.

The hypocrisy of my profession can be stunning.

I'm sure you see this also, it is common at the VA, but not specific to the VA. There are people out there on 20-40 medications a day.

Then they come in with a new symptom or worsening of a chronic symptom, and we hand them yet another drug for the new symptom. If you mention getting rid of a few of them, some patients react like you are telling them to get rid of a pet. But I sometimes wonder if we took those people and said, "We are going to allow the 5 most critical meds. All else must go. We will see how you are and add back only if a very clear, serious objective indication." I would bet the vast majority would feel better.

 

[RxCowboy]

I'm sure you see this also, it is common at the VA, but not specific to the VA. There are people out there on 20-40 medications a day.

Then they come in with a new symptom or worsening of a chronic symptom, and we hand them yet another drug for the new symptom. If you mention getting rid of a few of them, some patients react like you are telling them to get rid of a pet. But I sometimes wonder if we took those people and said, "We are going to allow the 5 most critical meds. All else must go. We will see how you are and add back only if a very clear, serious objective indication." I would bet the vast majority would feel better.

It is more common at the VA than on the outside. When I was at the Lawton VA I used to get what we now call "deprescribing" consults. I would simply go through lists of meds and get rid of some. The most common thing I found was that a medication was prescribed for a side effect of another medication and the medication that had caused the side effect had been discontinued, but the medication for the side effect was not. Or, a medication had been prescribed for a symptom that had long since resolved and the medication was simply renewed... forever. Then there were the patients on three medications for the same thing, and it's still uncontrolled... none of them were working. Get rid of all three and try something else.

Yes, absolutely, if we get people off of craploads of unnecessary medications and onto effective medications they will feel better.

OTOH, I got a Teams message from a PA on Thursday. She said she had a diabetic patient that was on metformin 250 mg/day, minimal dose. The Pharm.D. who worked with her told her that 250 mg/day isn't a glycemic control dose and that she should increase it to 500 mg/day. I asked what the A1c was? 6.6. Why the freak increase the dose in a patient that's well controlled and there is no potential benefit but only increases the risk of side effects? That's the opposite of clinical pharmacy. I told the PA to tell the Pharm.D. exactly that, "Why the freak increase the dose in a patient that's well controlled and there is no potential benefit but only increases the risk of side effects?"

Not a glycemic control dose... I have patients on 0.25 mg/day of Ozempic with A1cs in the 6's. 0.25 mg/week isn't supposed to be a glycemic control dose, it's a starter dose to let people build tolerance to the GI side effects. But if it works then why change it?

Sometimes my profession really pisses me off. There's a job out there to do and we're not doing it. We could actually make people healthier, that is if we didn't behave like morons.

Maybe I'm just feeling old and cranky this morning.

 

[RxCowboy]

 

[RxCowboy]

You’re referring to the 2008 study co-authored by Anthony S. Fauci, along with David M. Morens and Jeffery K. Taubenberger, published in The Journal of Infectious Diseases. In that paper, the researchers examined lung tissue from 58 autopsies and reviewed data from over 8,000 additional autopsies to investigate the main cause of death during the 1918–1919 Spanish flu pandemic. Their key finding: the majority of deaths were due to secondary bacterial pneumonia following influenza infection, not the virus acting alone .

Dr. Fauci himself summarized it succinctly: “In essence, the virus landed the first blow while bacteria delivered the knockout punch” .

To clarify a critical misconception: the study does not blame mask-wearing for influenza deaths. That claim is entirely false. The paper contains no mention of masks whatsoever, and multiple fact-checking outlets have debunked the narrative that Fauci attributed Spanish flu fatalities to mask usage .

Summary:

• Title (approximate): Predominant Role of Bacterial Pneumonia as a Cause of Death in Pandemic Influenza: Implications for Pandemic Influenza Preparedness (2008).
• Main conclusion: Most deaths in the 1918–1919 pandemic were caused by bacterial pneumonia following viral damage—not the influenza virus alone.
• No reference to masks—any claim otherwise is a misinterpretation or fabrication.

Let me know if you’d like a more detailed breakdown of the study’s methodology, its implications for pandemic preparedness, or how these findings influence modern responses to influenza.

 

[steross]

View attachment 13304

If only there was a simple way to diagnose pneumonia that takes about two minutes and costs a few bucks (ignoring Us health care insanity) so that we didn't have an "unobserved" pandemic.