Comments on: The Bounce http://crookedtimber.org/2008/10/14/the-bounce/ Out of the crooked timber of humanity, no straight thing was ever made Sun, 22 Nov 2009 04:42:59 -0800 http://wordpress.org/?v=2.8.6 hourly 1 By: DHN http://crookedtimber.org/2008/10/14/the-bounce/comment-page-1/#comment-255926 DHN Fri, 17 Oct 2008 21:44:28 +0000 http://crookedtimber.org/?p=8115#comment-255926 The original question was why these drugs are so expensive. I'm kind of surprised that commenters on this site aren't economically literate enough to see that there are two main answers: 1. The manufacturer has a monopoly (called a patent). 2. Third-party payment (health insurance) separates most consumers from the cost. The price almost certainly will go down when the patent expires. There are lots of generic manufacturers that are not part of the "Big Pharma" club. Consider the plunging prices of drugs like Zocor (simvastatin) and Ambien (zolpidem since the patent expired. The only reasons the price wouldn't go down are (a) if there is insufficient demand to justify capital investment necessary to manufacture and distribute the drug or (b) if the manufacturing process itself is too expensive. And if either of those is true, then the drug isn't overpriced. But they probably aren't true, or the manufacturer would not be putting out the new version that Laura describes. The original question was why these drugs are so expensive. I’m kind of surprised that commenters on this site aren’t economically literate enough to see that there are two main answers:

1. The manufacturer has a monopoly (called a patent).

2. Third-party payment (health insurance) separates most consumers from the cost.

The price almost certainly will go down when the patent expires. There are lots of generic manufacturers that are not part of the “Big Pharma” club. Consider the plunging prices of drugs like Zocor (simvastatin) and Ambien (zolpidem since the patent expired. The only reasons the price wouldn’t go down are (a) if there is insufficient demand to justify capital investment necessary to manufacture and distribute the drug or (b) if the manufacturing process itself is too expensive. And if either of those is true, then the drug isn’t overpriced. But they probably aren’t true, or the manufacturer would not be putting out the new version that Laura describes.

]]> By: David http://crookedtimber.org/2008/10/14/the-bounce/comment-page-1/#comment-255916 David Fri, 17 Oct 2008 20:51:38 +0000 http://crookedtimber.org/?p=8115#comment-255916 I am a headache physician and frequently come across patients who report that a drug that once worked now no longer does (tachyphylaxis). Sometimes I suspect that the patient's headaches have actually worsened overall making the drug no longer effective. In cases where this doesn't hold, often returning to an old drug that used to work is effective. The tolerance (or whatever change has produced the lack of effect) has now worn off and the old drug works again! Also, we commonly use medications with different mechanisms of action (such as triptans + NSAIDS + anti-nauseants) together for better efficacy if one alone is not sufficient. I am a headache physician and frequently come across patients who report that a drug that once worked now no longer does (tachyphylaxis). Sometimes I suspect that the patient’s headaches have actually worsened overall making the drug no longer effective. In cases where this doesn’t hold, often returning to an old drug that used to work is effective. The tolerance (or whatever change has produced the lack of effect) has now worn off and the old drug works again!

Also, we commonly use medications with different mechanisms of action (such as triptans + NSAIDS + anti-nauseants) together for better efficacy if one alone is not sufficient.

]]> By: coco http://crookedtimber.org/2008/10/14/the-bounce/comment-page-1/#comment-255781 coco Fri, 17 Oct 2008 06:54:32 +0000 http://crookedtimber.org/?p=8115#comment-255781 ah, for me the triptans were a sort of devil's bargain. every triptan i tried was effective but accompanied by a couple of hours of extreme pain and disorientation. so, with every migraine i had the option of either slogging 10+ hours with moderate-to-severe migraine pain or 2 hours of excruciating triptan pain. in most cases, it was less debilitating to just deal with the migraine. medical marijuana ftw ah, for me the triptans were a sort of devil’s bargain. every triptan i tried was effective but accompanied by a couple of hours of extreme pain and disorientation. so, with every migraine i had the option of either slogging 10+ hours with moderate-to-severe migraine pain or 2 hours of excruciating triptan pain. in most cases, it was less debilitating to just deal with the migraine.

medical marijuana ftw

]]> By: matt http://crookedtimber.org/2008/10/14/the-bounce/comment-page-1/#comment-255551 matt Thu, 16 Oct 2008 13:03:57 +0000 http://crookedtimber.org/?p=8115#comment-255551 Also, the injections work w/in seconds- really great stuff. But, the case for carrying them around is bit big to fit in your pocket so you'd need a bag or purse or jacket or something, and, as noted, at least w/ my insurance company they make you pay the same amount for 2 injections (they come in sets of two) as for 9 pills, so I almost always use a pill, even if it will mean suffering for a half hour to an hour. (Unless you are _really_ afraid of needles there' s no need to be afraid of the injections- it's a little mechanism, just pops right in, you can't hardly feel it, and you don't see the needle until it's all done. It's easy to use but there is sometimes a bit of bleeding- small enough to stop, but enough to stain your clothes if you don't watch for it.) Also, the injections work w/in seconds- really great stuff. But, the case for carrying them around is bit big to fit in your pocket so you’d need a bag or purse or jacket or something, and, as noted, at least w/ my insurance company they make you pay the same amount for 2 injections (they come in sets of two) as for 9 pills, so I almost always use a pill, even if it will mean suffering for a half hour to an hour. (Unless you are really afraid of needles there’ s no need to be afraid of the injections- it’s a little mechanism, just pops right in, you can’t hardly feel it, and you don’t see the needle until it’s all done. It’s easy to use but there is sometimes a bit of bleeding- small enough to stop, but enough to stain your clothes if you don’t watch for it.)

]]> By: Maria http://crookedtimber.org/2008/10/14/the-bounce/comment-page-1/#comment-255491 Maria Thu, 16 Oct 2008 04:56:27 +0000 http://crookedtimber.org/?p=8115#comment-255491 It can work that fast, if you've got the pills that melt in your mouth. It seems a shame to miss the light show, though. It can work that fast, if you’ve got the pills that melt in your mouth. It seems a shame to miss the light show, though.

]]> By: Brett Bellmore http://crookedtimber.org/2008/10/14/the-bounce/comment-page-1/#comment-255478 Brett Bellmore Thu, 16 Oct 2008 02:09:34 +0000 http://crookedtimber.org/?p=8115#comment-255478 I get the fun "ocular" migraines; Don't particularly hurt, I just go blind, and spend a half hour or so watching the kaleidoscope. If I understand right, it's the exact same mechanism, just a slightly different part of the brain effected. On the bright side, I can see it coming with a few minutes warning, (My vision starts getting pixilated.) so I've got time to pull over to the side of the road. On the down side, I have to be careful how closely I look at brightly lit, sparkly objects, prolonged exposure will trigger an attack. (I'd never make it as a jeweler!) Might be worth getting some triptans once the price drops, if the effect is fast enough that I could pop a pill, and stop the attack before I'm totally blind. Does it work that fast if you've got one right at hand when the attack starts? I get the fun “ocular” migraines; Don’t particularly hurt, I just go blind, and spend a half hour or so watching the kaleidoscope. If I understand right, it’s the exact same mechanism, just a slightly different part of the brain effected. On the bright side, I can see it coming with a few minutes warning, (My vision starts getting pixilated.) so I’ve got time to pull over to the side of the road. On the down side, I have to be careful how closely I look at brightly lit, sparkly objects, prolonged exposure will trigger an attack. (I’d never make it as a jeweler!)

Might be worth getting some triptans once the price drops, if the effect is fast enough that I could pop a pill, and stop the attack before I’m totally blind. Does it work that fast if you’ve got one right at hand when the attack starts?

]]> By: Jay http://crookedtimber.org/2008/10/14/the-bounce/comment-page-1/#comment-255472 Jay Thu, 16 Oct 2008 00:27:03 +0000 http://crookedtimber.org/?p=8115#comment-255472 @John, could you direct me to some passages to that effect (“Nietzsche spoke of illness in a philosophical way, as though it were a metaphor”)? While I was working on my Ph.D. thesis, I had to engage Nietzsche’s writings on rhetoric and figurative language at some point, and I smell something really interesting here. Some kind of reversed Sontag, actually. @John, could you direct me to some passages to that effect (“Nietzsche spoke of illness in a philosophical way, as though it were a metaphor”)?

While I was working on my Ph.D. thesis, I had to engage Nietzsche’s writings on rhetoric and figurative language at some point, and I smell something really interesting here. Some kind of reversed Sontag, actually.

]]> By: Jay http://crookedtimber.org/2008/10/14/the-bounce/comment-page-1/#comment-255471 Jay Thu, 16 Oct 2008 00:12:59 +0000 http://crookedtimber.org/?p=8115#comment-255471 Thanks Katherine, now I see. I <i>was</i> kind of wondering, but I didn’t want to rule it out... My writing and reading skills often need a day or two to fully recover from a migraine attack, and during that period I can muddle things up quite beautifully. Thanks Katherine, now I see. I was kind of wondering, but I didn’t want to rule it out… My writing and reading skills often need a day or two to fully recover from a migraine attack, and during that period I can muddle things up quite beautifully.

]]> By: John Emerson http://crookedtimber.org/2008/10/14/the-bounce/comment-page-1/#comment-255469 John Emerson Wed, 15 Oct 2008 23:44:38 +0000 http://crookedtimber.org/?p=8115#comment-255469 Nietzsche spoke of illness in a philosophical way, as though it were a metaphor, but I he had debilitating headaches plus insomnia. And I think that he spoke of the time immediately after a bad episode as being his most creative time. So maybe Nietzsche's generalizations about sickness and genius should be interpreted in terms of him and his specific disease. Nietzsche spoke of illness in a philosophical way, as though it were a metaphor, but I he had debilitating headaches plus insomnia. And I think that he spoke of the time immediately after a bad episode as being his most creative time. So maybe Nietzsche’s generalizations about sickness and genius should be interpreted in terms of him and his specific disease.

]]> By: Katherine http://crookedtimber.org/2008/10/14/the-bounce/comment-page-1/#comment-255465 Katherine Wed, 15 Oct 2008 22:45:39 +0000 http://crookedtimber.org/?p=8115#comment-255465 I think itwas gdr @ #18 suggesting that Laura was a dupe, not you Jay. I think itwas gdr @ #18 suggesting that Laura was a dupe, not you Jay.

]]> By: Carrie K http://crookedtimber.org/2008/10/14/the-bounce/comment-page-1/#comment-255449 Carrie K Wed, 15 Oct 2008 20:12:51 +0000 http://crookedtimber.org/?p=8115#comment-255449 Scientific American had an interesting article on migraines in their August issue. http://www.sciam.com/article.cfm?id=why-migraines-strike I live in fear that Maxalt MLT won't work for me one of these days. Scientific American had an interesting article on migraines in their August issue. http://www.sciam.com/article.cfm?id=why-migraines-strike

I live in fear that Maxalt MLT won’t work for me one of these days.

]]> By: Jay http://crookedtimber.org/2008/10/14/the-bounce/comment-page-1/#comment-255428 Jay Wed, 15 Oct 2008 18:15:03 +0000 http://crookedtimber.org/?p=8115#comment-255428 Laura, I apologize for not expressing myself clearly enough, leaving room for misunderstandings. Of course I never doubted in any way that people develop a resistance to triptans. It’s only that I didn’t have a clue as to why that would be so, and I sincerely wanted to know. Laura, I apologize for not expressing myself clearly enough, leaving room for misunderstandings. Of course I never doubted in any way that people develop a resistance to triptans. It’s only that I didn’t have a clue as to why that would be so, and I sincerely wanted to know.

]]> By: Maria http://crookedtimber.org/2008/10/14/the-bounce/comment-page-1/#comment-255409 Maria Wed, 15 Oct 2008 16:52:05 +0000 http://crookedtimber.org/?p=8115#comment-255409 Thank you Glen (and Jay). This is what I love about CT - you write a breezy little post and the next thing you know, our far cleverer contributors have done something helpful and beautiful with it. And yes, Mollymooly is definitely the winner. Thank you Glen (and Jay). This is what I love about CT - you write a breezy little post and the next thing you know, our far cleverer contributors have done something helpful and beautiful with it.

And yes, Mollymooly is definitely the winner.

]]> By: Laura http://crookedtimber.org/2008/10/14/the-bounce/comment-page-1/#comment-255383 Laura Wed, 15 Oct 2008 15:32:07 +0000 http://crookedtimber.org/?p=8115#comment-255383 Yes, Glen, thank you for defending my honor against charges of being a dupe. On a tangent, isn't that counter-flooding response to the serotonin flood essentially the same reason MDMA (ecstacy) isn't a very good regular hobby? Yes, Glen, thank you for defending my honor against charges of being a dupe.

On a tangent, isn’t that counter-flooding response to the serotonin flood essentially the same reason MDMA (ecstacy) isn’t a very good regular hobby?

]]> By: Jay http://crookedtimber.org/2008/10/14/the-bounce/comment-page-1/#comment-255382 Jay Wed, 15 Oct 2008 15:18:23 +0000 http://crookedtimber.org/?p=8115#comment-255382 Glen, thank you! For explaining this succinctly and intelligibly, and for taking the time! :-) Glen, thank you! For explaining this succinctly and intelligibly, and for taking the time! :-)

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