You are so right - but I see it as only one peice of the puzzle. There are "seminars" in nice places, there are the millions of advertising dollars aimed at the public which often leads people to request specific (more expensive) medications, and many consumers only pay a small co-pay for their meds so they don't care about the costs. And how many tax dollars, directly or indirectly, have aided in the production of that medication? I suspect it is significant.

That's only one little drop in the bucket of why things are costing us so much.

My dd--who is an optician--recently gave me a coupon for free Crizal Avance non-glare coating that she received at a seminar she attended. (she's had her eyes corrected, so she no longer wears glasses and couldn't use the coupon.) Okay--so everyone there got one of these free coupons--that's the first point. And Avance is Crizal's most expensive coating. So I got my new glasses, used the coupon and saved $64 WHOLESALE (what are they charging retail for this coating?--dd doesn't sell it because it's too expensive to ask clients to pay for. She sells one of crizal's lower-priced lines--alonce, I think it is). Had the occasion last week to do a bit of night driving. Called DD up, and told her I didn't think the avance was any better than the lower-priced crizal I'd gotten on my last pair of glasses. She started laughing hysterically, saying, "Ding, ding, ding"--and then explained that alonce and avance are exactly the same, EXCEPT for the fact that avance has an extra ingredient to repel static cling. That makes no difference in your vision, of course. Basically the same product, but it probably costs between $30-50 more retail if your optician convinces you to get the more expensive coating. Didn't matter to me, since it was free with the coupon. But for someone paying? that's a big difference for nothing.

Well, guess I should add here, though--in all fairness--that these glasses DO seem to stay cleaner longer, not as much dust and stuff building up on them. So guess that's nice, but it's not strictly-speaking, necessary.

Back to your post--I hope you explained to the idiot who told you that that stuff comes out of the 'advertising' budget, where that budget comes from. Obviously, that's still a cost included in what patients are paying for product. When I used to work in a bakery, there was a medical rep (think she was involved with X-ray equipment, rather than drugs, but same principal, of course)--who came in every week, and purchased hundred $$$ worth of very expensive baked goods to take to her customers. I don't think what you're describing is isolated at all--happens all over. Although, the back door thing? I don't think that had any thing to do with the food being free--even if the office ordered lunch for themselves, it would be delivered to the back door--it's not appropriate to bring food through the waiting rooms, past the examining rooms. At least that's the practice in the area where I live.

Free lunches and sticky pads are just the tip of the ice berg.

Once when I had an antique shop, a young man had inherited a house, he took what he wanted and told me I could have anything and everything else I wanted.

No antiques, but we got some small appliances, a/c, etc., but there were a lot of papers. His mother, who had owned the home, was the ex -wife of a doctor. There were packet after packet of 'seminars' this doctor had been invited to attend. They were all in some resort area, and the attendees were given nice prizes just for showing up - the one I remember was a set of very expensive golf clubs.

My husband recently played golf with one of the new young doctors in town. The doctor was showing off his set of very expensive clubs. All the guys were really impressed and my husband asked him which drug company gave them to him. He asked, "how did you know"? He told the young doctor that he wasn't the first doctor he had played golf with over the years.

I once asked my husband's doctor if doctors got any 'rewards' for prescribing medications. He said, "why do you think a doctor will have a room full of paying customers, yet take the time to bring a drug rep in ahead of them?'

All this adds to the price of your drugs, but nothing adds to it like the lobbyists. There are a huge number of drug lobbyists in Washington.

Then, of course, who knows what the cost might be to get the FDA to be so friendly to some drugs that get on the market and shouldn't.

Alot of dr's offices and hospitals are now not allowed to take any items from drug reps.

The hospital I work for (very large) has instituted a policy where no one is even allowed to accept drug rep items (including pads of papers, pens, lunches ect). So, I have seen a lot of work being done to help consumers here.

Drug prices are expensive for numerous reasons though, so I am not sure if decreasing the seminars or free items our going to increase our costs. Not only that, drug companies can charge what they want for a drug. So even if they were not paying for advertising they don't have to transfer the cost saving to the consumer.

Oh, those drug commercials! Don't get me started on those! Drug companies shouldn't be allowed to advertise like that. Seems like most of the drugs they advertise are for depression, sleeplessness, impotence and incontinence, none of which I want a mental picture for the malady OR the remedy!

There's another thing that's happening in my community that makes me do a slow burn. A sleep center was built several years ago. I saw a letter written by one of the local doctors encouraging all the other doctors to invest in this sleep center. Can you say, "conflict of interest"? Now that it's built, every time you go to the doctor and complain about anything, they decide you need to go get a sleep test.

And while I'm on the subject, I also discovered that most of the medical profession in this area treat each other FOR FREE.

Stopping them from accepting visits and sticky pads is a step in the right direction. Also, I have heard doctors, themselves, complain about it.

I'm pretty sure, though, while eliminating any goodies may not lower the price - giving them out certainly does increase the costs.

The costs of lobbyists, however, is not a small thing.

Re - 'the sleep center'.

The scans and other great new technology for diagnoses are wonderful. I did wonder about the number of tests that might have been ordered when not needed, just because a doctor or clinic had invested a huge amount of money in one of these machines.

Medicene is a for profit business and certainly should be - I would just like to see that business operated in a more responsible and honorable way.

All good points. How about "moles" in hospitals reporting CONFIDENTIAL info to ATTORNEYS and the attorneys contacting the patient to see if they want to file a law suit? How about doctors not policing their own ranks - and resisting efforts from outsiders to do the same? How about billing statements so vague that the consumer can't really determine the accuracy of such - and the hospital getting paid for more than they actually did? How about repeated unnessecary procedures? The list can go on and on.

In the future, we will be hearing a lot about this nations health care. Our government will try to intervene so that everyone can have access to health care and can afford their medications - and it's going to have a big price tag. I'm sure there is no shortage of opinions as to the best way towards this lofty goal. I have no concrete ideas, myself. However, I do know that if this system "cleaned up it's act" and acted ethically and in the best interest of the consumer, things could be better than they are right now. I know this is not likely to happen because there is too much money to be made in health care, and it is too easy to defraud the system. So, as consumers we see our costs escalating or our services being cut (sometimes both).

When you can no longer trust your doctor and wonder whether he/she is milking you and/or your insurance company for every possible dollar then you are in a precarious position indeed. Technology is wonderful but it is an expensive thing for the patient if their doctor orders it for them more because he/she has invested in it than because he/she thinks the patient needs it.

I'm not sure I agree that medicine should be a for-profit business, with so many people's lives hanging in the balance, simply because the definition of the word "profit" is so vague. I do not believe a medical practice should be wildly profitable, and normally they are not. But the physician who owns that practice takes home a huge paycheck even if you don't count all the little "incentives". The practice that I worked in experienced a slight down-turn and so they laid off three employees, all long-term employees and all over the age of 50. The week after, one of our doctors pulled into his parking space in a brand new Lexus. How insensitive can one get?

Oh, and I probably should mention that I stated that the food was brought in by the back door not to mean they didn't want to be seen. They don't care if they are seen or not because they don't see that they're doing anything other than their jobs. I was thinking that some people would say, "I often am in my doctor's office around noon and I never see anyone bringing in food!" I just wanted them to be aware that they're more likely to notice the food being brought in if they're out in the parking lot than if they're sitting in the waiting room.

The point is, drugs are high because the drug companies pay so much for advertising, yet many people actually are told, and they believe, that the reason drugs are expensive is because of the cost of the research needed to develop them. This is a more palatable reason, after all, even if it is an out-and-out lie. Retired people struggle under the cost of their prescriptions. The Medicare drug plans are just another "for profit" enterprise. Elderly folks make a decision whether to eat or buy their meds every day. Meanwhile the doctor who prescribes those medications is sitting in his break room chewing on a free fajita and shaking his head about why Mr. Smith doesn't take his meds.

Doctors getting expensive vacations and golf clubs from drug companies ought to hang their heads in shame.

My DS has worked for 3 different large pharmaceutical companies as a sales representative.

He has a huge budget for 'comping' doctors & their staff. It's not just the lunches & give-a-ways like mouse pads. DH also takes doctors & nurses to expensive dinners & golf outings. In the summer, he arranges some type of weekend fun such as a whale watch for a group of doctors & their families or a pig roast with live bands & clowns/pony rides for the kids.

My DS always brings receptionists in his territory chocolate covered cherries. In the spring, he puts together gardening baskets for them. Sometimes, he shows up at their offices with fancy pastries. The budget for all of these perks is very large.

It works. That's why it's industry standard. Doctors write 'scripts for his drugs 'cause they remember who paid for dinner & those New York theater tickets. Also, my DS receives a substantial compensation package plus bonuses & the benefits include fantastic medical insurance coverage.

Sales has always been a highly compensated job. It takes a certain type of person to excel at sales. Not everybody is succesful. So, for those who are...the compensation is great. My DS picks his own hours (he works from a home office) & is through in time to pick-up the kids after school. He also gets 2-3 days off every month to study (they have to keep up with the science behind the drugs). DH studies in the evening after the kids are asleep & while DDIL is watching TV & then uses his study days off as extra vacation. At the first company he worked for just out of college...at his first annual sales meeting...the company had rented one of those blow-up rooms like they have at McDonalds for the kids only the company put tons of $100 bills in the room & then turned on the fan. The sales reps each got one minute inside & could keep all the $100 bills they could grab from the air or scoop off the floor. They also got into Disneyworld free for the entire week plus had cash from the company for extras inside the park. Free golf, extra fancy meals, show tickets, etc. In return, they had one day of meetings...the rest of the entire week was fun filled for the sales reps. And now you know why your blood pressure med costs so much!

I could go on & on...it's very lucrative to be a pharmaceutical sales rep (if you're good) but it's also stressful. The monthly/quarterly/annual sales quotas are never ending & management gets ugly if you have a bad month or quarter. They really keep the pressure high.

Of course it adds to the cost of drugs! But, on the other hand, the system is working for the pharmaceutical companies so they have little incentive to change. Seriously, you wouldn't believe how large these budgets are for 'comping' doctors & their staff.

/tricia

The market ... rules, remember?

It works by the "Golden Rule" ...

... he wot has the gold...

... rules.

Lacking gold ... power helps ...

... plus, usually, helps rake in the gold!

ole joyful

Well Tricia, that just makes me sick.

How can people be proud of what they do for a living when they know how all this trickles down? I suppose it doesn't matter to them how many people suffer, as long as they, themselves get to live in the lap of luxury. So is this what is meant by "The American Way"?

My MIL died probably because she didn't take her prescriptions. We didn't know until we found all the prescription slips in her house after the funeral. She was always complaining about how expensive her prescriptions were.

I will never be able to fill a prescription again without feeling angry.

It saddens me, too, that those who know about it just seem to be accepting it as "standard practice". This is what it's come to, then.

ilene,

Money makes the world go'round. That how capitalism works.

My DS is very proud of how he earns his living. He sells medical equipment now; but it's the same as the drug industry. He spends hundreds of hours doing community outreach for those people that have medical conditions his company's equipment aids. He spends more time teaching doctors how to use the equipment. He feels people live longer & healthier lives because of his company's products.

Yes, he earns a good living. Before he could obtain these jobs he first had to investment tens of thousands of dollars in his education (BS Biology & BS Chemistry) plus continuing education. Why should he not be well compensated if he's a success?

Doctors do not have the time nor the inclination to learn everything they need to know about every new drug or piece of equipment coming to market. They are maxed out caring for patients. Many rely on company representatives for assistance. Without the reps the doctors would not have as indepth of an understanding of what's available to help their patients as they do now. In return, the doctors write 'scripts or order equipment as appropriate for the particular patient. While their families are being entertained on that whale watch...DS talks to the doctors about the meds and/or equipment. Yep, they have their talk on a boat but it's no different than all of the American business that happens on a golf course!

Was your comment meant to imply that sales representatives should 'volunteer' their time & knowledge for goodwill? Corporate America, not just big pharma, is capitalistic...or at least it was until the government started bailing out every company with their hands out!

I'm sorry about your grandma. If she couldn't afford her medications...every pharma company has programs that provide free meds to those in need. The pharma companies advertise those programs a lot, at least in my area. Not an evening goes by that I don't see at least a couple of them. In fact, I'm watching CNBC right now & Astra Zenica just aired a commercial advertising their drug assistance program. I sincerely wish her doctor, or pharmacist, would have helped her receive the medications prescribed.

Research is expensive & many trial drugs fail. Those that make it to market have to fund all research. It's a huge industry involving billions of dollars annually. There is no one single answer to the high cost of medications/equipment. Certainly, allowing negotiations between the government & industry will help but that won't stop the 'comps doctors receive as inducement to 'script one company's drug over another company's. That part is capatilistic competition.

/tricia

"It saddens me, too, that those who know about it just seem to be accepting it as "standard practice". This is what it's come to, then"

Oh, come on!

This is how the 'selling' business works... and it has worked that way for decades.
There is no "This is what it's come to, then"... this is how it has been as long as salesmen have pushed their wares. This is not new and not unique to the pharma business.

Guess you can be sad when you drive your car, use you furniture, wear your clothes.... there are perks and kick-backs there too, along with many others (like Mary Kay & Pampered Chef).

it's funny that the one hand-out that one one's mentioned are the drug samples...
'perk' budgets are, indeed bloated - but they include not just sticky buns and laser pens, but boxes of Zpac and other antibiotics, courses of Prednisone, a week's worth of Prozac, or Effexor in a cute little bottle, those scary purple Advair inhalers.

and since I've had health insurance that didn't include ANY scrips, let me tell you they sometimes made the difference between me getting meds, and me not getting meds.

of course, all of that just serves to make all of us, Dr's and patients alive more dependant on chemical solutions to what may not be a problem WITH a chemical solution...but we're practicing Western Medicine, here - the aim is to treat disease, not make people healthy.

When I say it should be 'for profit' - I mean those working in the healthcare profession deserve to make a living and a profit. If not, we would not have it. The profit should be because of their work, their services and their products - not kickbacks and corruption.

Believe me, there will be more profit made by these same people when we get national healthcare.

There is absolutely nothing wrong with sales reps in the drug industry. It is how new technology and medications get known. Information is one thing - going beyond that is quite another. It is wrong for the drug companies, it's wrong for the doctors. It is dangerous for the patients.

I disagree that doctors don't have time to learn about medications - that's a very frightening statement. If they don't know, they shouldn't prescribe it and I'm not sure a drug company's information should be the only one taken.

Due to a series of medical mistakes, my daughter in law could not nurse our youngest grandson. He couldn't tolerate iron in his formula - it was just that simple. The doctor, however, kept telling my son and his wife, the baby had a 'nervous stomach'. He gave the child some medication that made him quit breathing when he went to sleep.

Due to the my daughter in law's health, it was just a miracle that she noticed it. When it happened at first, she called the doctor and asked if it could be the medicene - he chided her as being over anxious. After it had happened several times, with someone staying awake with the baby, my son did some research on the internet. This was one of the possible side effects of the medication.

My son insisted the baby be put in the hospital with a monitor then told the doctor what he had learned. This doctor again argued. My son said, 'let's find a computer'. After the doctor had read the information, his only response was 'well, what do you know'. Not 'I'm sorry' or 'oh my goodness'.

The baby was in the hospital, on a monitor until all the medication had gotten out of his system, then had to wear a monitor for several months after just as a precaution.

That doctor could have killed my grandson because he didn't bother to do something as easy as an internet search on the medication he was prescribing.

Interesting thread. This country runs on capitalism. And yes, people need to be compensated for their efforts, even the drug reps :) But, and this needs to be clearly understood, physicians are the Gatekeepers to our health. If I need certain medications, treatments, tests, etc. I have to rely on a physician to direct me. I can't get some services/medicines without the MD. As such, they do need to be held to a much higher standard than currently exists. There should exist NO conflicts of interest such as accepting 'gifts', owning stock in pharmaceutical companies, etc.

Because of the very nature of medicine, they can't and shouldn't be compared to other sales models. It's not the same as buying a toaster or a car.

Well said, Ruffian. Thanks for posting.

Lady Texan, we do certainly have to be our own advocates. I can remember when people looked up to their doctor as their protector. I'm real proud of the pediatrician who saw after the health of my grandsons. We could talk about anything and I could express my doubts without him getting his back up. He's a great guy. Hope your sweet grandson is well now.

As for the others, none of you will ever convince me that this is the way this country should work. If somebody robs you every day does that make it more acceptable tomorrow, or do you finally get mad and say, "THAT'S ENOUGH!!" Free prescriptions are offered to people who can prove they're low income. But once again, the middle class is the hardest hit. They make too much money to qualify but not enough to pay for things right out of their pockets all the time. But why should I and everyone else have to pay $100 for a month's worth of pills whose price is artificially bloated because of indulgent advertising practices, regardless of how much money anyone makes? It ain't right. You don't line your pockets at the expense of sick people.

It's interesting that now people are breaking out the old "Research is Expensive" excuse. Heard it before. Believed it in the past. Before the knowledge of expensive meals, vacations, parties, gifts. And thank you, I'll feel sad if I want. --Ilene

Yes, you do need to be your own advocate - do your research, as the pharmacist, etc.

One of our rules, also, is never leave a loved one alone in the hospital.

Especially not in a VA hospital, apparently.

A woman I knew from church had to have her husband admitted to one, as they did not have any other insurance and he had a stroke. She could not stay with him because they were raising grandchildren and she went back and forth between them as best she could. I kept the kids as much as I could and I think some of our other church members did, too. This was back about eight years ago.

One day she found him black and blue. He told her an orderly had climbed on top of him in his bed and punched him repeatedly during the night. She reported it immediately but the story was that he was delirious and had just fallen out of his bed. She filed a complaint and the VA wrote a letter, a copy of which she received, saying she was hysterical due to being under pressure because of her husband's illness. There was no formal inquiry made. He later contracted a staph infection at this hospital, his temperature raged and he was never the same after. She had him transferred to another VA hospital where he died.

My mom and dad felt towards their doctor as the closest thing to God. They followed his instructions to the letter and never questioned. And this guy was a quack. My mom had attacks in the night where she would wake up and said she felt like her blood was boiling. Her doctor prescribed something for her that made her start having periods again, at the age of 70. I begged them to go somewhere else, at least get a second opinion. They would not do it because they said they were afraid their doctor would be angry and would stop treating them. So several of my siblings went to see the doctor. My parents were SOOO upset at them for doing that! At their next appointment, the doctor patted my mom's hand and said, "Tell your children not to worry about you." She was later diagnosed with panic attacks, after emergency admission to the psych ward at the hospital, where a different doctor saw her.

The unfortunate thing is that many times people are too sick to be their own advocate and don't have family close enough to do so for them, especially when they are elderly.

You also have to do your homework. My DH had knee surgery on both knees this summer. We held off for a long time because we knew so many people who ended up with a staph infection. And that can be really an ordeal and can result in lots of pain and sometimes death. Every time we met someone who had had the surgery, we asked who did it and how did it work out. One surgeon's name kept popping up that we eventually went to. He did his surgery in a hospital owned by himself and other local doctors. He said it was the only way to ensure that staph infections would be kept to a minimum, since their rules were stricter than what was the standard. Now I might normally feel towards that like I do about the sleep center, but there's a difference between ownership that allows you to control quality and ownership that just represents an investment. Surgery went well, DH had excellent care, recovered quickly and is now pain free for the first time in years.

No one has mentioned the fact that R & D to make an effective drug probably costs millions of dollars. Plus testing, Plus lawsuits for those who have side effects.

I had a colleague years ago who was furious at a new government regulation that forbid manufacturers of vitamin and natural supplements from claiming to help certain conditions until there was proof to back it up. She said the supplements were great for people who couldn't afford other drugs. I pointed out that people with little money or education could spend a lot on "remedies" that weren't effective. She whined, "but those studies cost moooonnnneeey."

So the companies advertise relentlessly. I heard a fellow on the radio tell about taking his son to the doctor for a check-up before he started Kindergarten. The little tyke looked up at his father and asked, "Dad, shouldn't we ask the doctor about Cialis?"

Yes, R & D does cost money.

But should we consumers pay for the fact that 5 different companies want to spend tons of money researching some form of viagra? We will pay for it - if we purchase any product of those companies, or if we pay taxes - since we pay for drugs for those who are on programs through the government.

Having several different companies working on a life saving or very necessary drug is a good thing. To have them competing for yet another mood altering drug, or viagra type drug is a waste of our money.

I don't want supplements to make claims that can't be backed up. There is a world of quackery out there involving supplements, etc.

The fact is, though, those 'approved' drugs have harmed, maimed and killed many people in this country. How much money and education would one have to have to be able to keep tabs on all of their claims?

Again, if my son and daughter in law had not been so determined, my grandson would probably have died in his sleep - probably labelled as SIDS.

In many instances, we simply have to trust our government, the drug companies and our doctors. That is sometimes dangerous.

There is a law either already enacted or being enacted that doesn't allow people to sue a drug company, in state court, for an 'approved' drug.

That's frightening -

I have only recently started coming to this forum. Because I have a chronically ill daughter with 2 diseases, I read this post with much interest. I work for a company that sells to the companies (middlemen) who sell to all companies, including the pharma industry.

Below are new guidelines that might alleviate some of the practices that have been mentioned.

"In a move that carries great consequence for the ad specialty industry, the Pharmaceutical Research and Manufacturers of America (PhRMA) announced a revision to its industry code that prohibits the distribution of non-educational items to health-care professionals. In practice, it would ban the giving of pens, coffee mugs, notepads, magnets and scores of other branded "reminder items" that are routinely found in any doctor's office. The change becomes effective January 1, 2009. The revision one of many instituted by PhRMA Â is not a federal law but rather a recommended mandate, issued with the expectation that pharmaceutical companies will self-police themselves and comply."

My daughter's previous doctor actually had a pad for sales reps to sign in on where patients would see the receptionist.

When doctors give out free meds, they are getting a patient used to that particular medication. If it works, the doctor won't want to change anything and the free drug ends up being the purchased drug of choice. As far as free drugs from the drug companies, my daughter had desperately needed insulin and was able to get 5 free bottles, but that was a one-time deal and she could never request it again.

I am Canadian and after living in the States for 30 years, we finally moved back here so my daughter wouldn't have to worry about paying to see a doctor or if she ends up in the ICU. When we first went to the doctor's office, DD pointed out to me that there was not one marketing item with a drug company's name on it. There's also no ads on TV for drugs as far as I can tell. We get U.S. TV as well but I'm pretty sure I'm watching the U.S. programs when those ads come on.

Marie, that is a good sign but they don't mention expensive parties, meals, trips and non-branded items such as a set of golf clubs. I hope that's in there somewhere. That you don't see things like that in Canada is simply proof of how dramatically marketing jacks up the price of the drug. We all know how much cheaper Canadian drugs are and I have no doubt that this is why.

Yes, R&D is expensive and so is testing, but they don't do a very good job of testing here in the US. I can remember personally either myself or DH being quickly and quietly taken off three different drugs because other people were having serious reactions. And I took myself off one because of reactions I experienced that left me with permanent muscular spasm problems that my doctor denies could've been caused by that drug, even though my problem certainly seems similar to one of the side-effects listed. Maybe if they didn't spend so much money on advertising, they might have enough in the budget to spend on adequate testing and still make the drugs more affordable to all.

Free samples are wonderful and I'm totally in approval of that. They are great to use to see if you can tolerate the drug before actually having to lay out cash for them. Doctors in my area typically don't give you enough, however, so if they work well and you fill your prescription for the remainder, you still end up paying the same co-pay for less pills so the insurance company is the one who usually gets the break. Some doctors in my area do not give them out to their patients at all -- they donate them to a free clinic.

Viagra -- don't get me started on that one. I, too, think there ought to be a couple of categories of drugs, at least, that would differentiate life-saving from what some perceive as enhancements to the quality of life. I myself don't perceive Viagra, Cialis or any of those other brands available now to be worth the risk of the side-effects. There may be a few men out there that truly need the product, I don't know.... But certainly the malady this drug promises to "cure" might be less needed if there wasn't such a trend for men to discard the woman who was his high school sweetheart for one who wasn't even born yet when he graduated from college. And now this version that can be taken once a day! I certainly can't speak for all women, but with me being 62 and DH 66, it wouldn't be very long at all before I'd be flushing those pills and substituting them for saccharin tablets or something!

Ladytexan - I agree totally with you about non-prescription supplements. I have taken a few in the past. Some people swear by them, but I have not experienced any big breakthrough with regards to my health by taking any of the things I have tried. They can be quite expensive and of course if you have insurance that covers drugs, the supplements are not part of this package and therefore you pay out of your pocket. The biggest claim they make is that, even if they do you no good, they do you no harm. However, if you research the herb that is the active ingredient, many times there will be a warning that too much can kill you. Digitalis, Feverfew, Ephedra, Fen-Phen, for instance. Since soil fertility plays a big role in how potent herbs are, I can see how this could become a big problem. There is also a trend in "miracle cures" experienced by taking mega-doses of vitamins, especially the B-vitamins, that I'm not sure is anything more than "Snake oil promotion".

Where our health is involved, and our money, too, I think we have the right to expect and demand credibility, honesty, integrity, and a sense of what the Hippocratic Oath promises. By the way, I Googled Hippocratic Oath and read it. If doctors still take that oath when they graduate med school, then they have departed from it when their profitability hangs in the balance.

Until things change, I think I'm going to insist that my doctor only write prescriptions for me and my family that can be obtained in it's generic form. At least that way there will be no motivation for my doctor to write a prescription that we do not need. And the drug does not get offered in generic until it has paid for it's "research and development" (*snicker*)-- which includes using the general public as guinea pigs, apparently -- so we might have a better chance to escape that this way. Will we miss out on some "break-thru" drug? Probably. But since sometimes the side-effects are worse than they malady they are developed to treat, I think I'll take my chances. And obviously we can no longer trust our doctor to have our best interests at heart (if we ever could) so I'm going to be giving almost anything he recommends "the old fish-eye". As far as the pharmaceutical companies are concerned, they've ruined any credibility they had with their behavior and that won't come back until laws are passed to make it illegal to fleece sick Americans.

And I am no longer sad that it has come to this. I'm seriously HACKED OFF! --Ilene

Ilene,

I do hope that stop the free seminars to the Bahamas, etc.

My DIL has benefitted from some free drug programs. Her doctor got her totally free medications for quite a while. I really helped their budget. Now, whether she could do without some of the medication she takes or not, that's another story. I can't make that decision for her.

I do take supplements and vitamins. I don't take the 'cures'. I try to work with my body and help it cure itself. I think the good Lord designed us to do that and the more we can just help the body, the better off we are.
It takes reading, studying, and for me - asking my daughter. She spends a lot of time delving into this.
I don't take anything extraordinary. I absolutely think anything can harm you, if you aren't careful.

I was re-reading this post and I thought to post a tip that I use myself. I have prescription coverage through my health insurance. My co-pay is $10 for a 30 day supply. The pharmacy will charge me $10 for 30 pills. If I tell them that I am paying cash, I get 100 pills for $9.99. It doesn't seem right, but this is just another symptom of our messed up system.

Wal-Mart does this too. If a person is not using insurance, I think only for generics, one can get a 90-day refill for $10. If one is using insurance, the normal co-pays apply, and it can get complicated. And expensive.

Our Walmart has a special price for generics too, but only certain ones and they don't happen to be the ones DH takes. Generics are not inflated by advertising and the cost of courting the doctor, which is why, apparently, they cost so much less.

I'm not sure how your insurance plan works, Ruffian, but the last insurance I had that provided a drug card did not work that way at all. In fact, if the prescription is written for 30 pills, the only way you can get 90 is if the pharmacist calls the doctor and gets the prescription changed. I know there are some pills that insurance companies will ONLY pay for a 30-day supply at a time, and they watch the calendar. If you try to refill the prescription even one day before they think you should, they will not cover it. So apparently ways you can save on your prescriptions vary wildly across the country and depends upon what the drug is, and requires each person who takes medication to do their own (time consuming) research. DH gets his by mail now, and uses generics, and that saves a lot of money.

When you have insurance, the drug is always less expensive because the insurance company negotiates with the pharmacy for a better price. When you see, on the paperwork you get with your prescription, "Your insurance saved you $XXX", that doesn't mean that your insurance company paid that amount for you. They negotiated the price down and then they paid the remainder, up to your co-pay.

Every year, employers are notified by the insurance companies that there will be a rate increase. It grows larger and larger each year. Why do you think this is? Certainly health care costs are spiraling for all sorts of reasons but the cost of drugs figures in there. Which brings me to the original question as to why we're all sitting still for having to pay for some doctor's golf clubs and expensive vacations through the cost of our prescriptions. Either we pay it, or our insurance company does. If our insurance company pays for it, we pay for it several times over in the end. It just isn't that obvious to us.

The last place I worked, the insurance premiums got so high that my employer could no longer afford them. They had to change insurance companies to get a lower rate. Since they had three people who had surgery for breast cancer that previous year, there were several insurance companies that wouldn't even quote them. They ended up with a bare-bones insurance policy and a "payroll savings plan". Better than nothing, but still expensive, nonetheless, and no drug coverage.

When businesses employ people with health problems and they have already cost the insurance company more than they have taken in, the insurance company is quick to point out that this is why the premiums have increased. So that employer looks at the "unhealthy" employees with new eyes and begins to weigh whether they're worth keeping. If they've been there a long time and are paid more than newer employees, this is another red flag. When it becomes necessary to lay someone off, those people are the first to go. They usually can't afford to pay the COBRA premium and nobody else wants to insure them so they end up without insurance coverage at all. Then the first major illness they have throws them into poverty.

Now, let's say you are middle income. You either don't have insurance or you have one with no drug plan. You don't qualify for free medication because you "make too much money". Your pharmacy won't negotiate with an individual. So wouldn't you, then, be paying the full load for the golf clubs and vacations, PLUS the loss of revenue because of negotiations with other people's insurance companies, PLUS the free prescriptions given to low-income people? These things have to be paid for somehow.

While I'm on the subject, those Medicare Drug Plans for senior citizens are a farce -- a money-making plan for the insurance companies. It might save the individual a little, but mostly it's because the insurance companies negotiate for a lower cost on the drug. What they actually pay towards the prescription itself is only a pittance. Which is why they're even willing to do this -- taking in a premium each month while the person pays out of pocket for their prescription costs for the first few months until they reach a certain dollar amount, then "coverage" until they reach "the donut hole". Then they're paying out of pocket again AND still paying a premium every month. Just another opportunity for somebody to make money at the expense of sick people. All this while they bemoan the fact that so many senior citizens have not signed up and "taken advantage of this valuable service". *Snort!*

When we were in the States and on Blue Cross/Blue Shield, we'd receive a letter each year with a list of prescriptions that they wouldn't cover any more. Some were now over the counter, which ended up costing quite a bit more than on the insurance. But that just forced people to switch to another medicine the insurance covered. THis is just one industry feeding another.

Remember all that running around, flying, holding meetings, appearing on TV, etc. there was recently all over the U.S.A. ...

... just to choose the candidates for which party ...

... who then spent many more months, and millions more of dollars ...

... running for the political office to which s/he aspired?

How much do you think all of that cost?

All paid for by the respective candidates, right?

With some income provided by their individual friends, right?

Yeah ... right!

And whom do you think helped pick up the tab for all of that baloney?

The guys who do all of that "research" to find new drugs helped many of them pay for part of it.

And then add a little wrinkle to an old drug, just prior to the expiry of the patent ...

... to allow it to be patented again.

Keeping the generic makers at bay for a longer period.

Good wishes for demanding of your drug copmapnies that they act more responsibly ...

... as responsible citizens, helping other citizens ...

... the ones suffering from a variety of diseases, troubles and pains ... some of them so severe that they could not work, resulting in income, to pay for the expensive drugs.

Artificially expensified ones, as outlined above.

ole joyful

In trying to keep my post short, I don't think I explained things right. If a doctor writes a prescription for a years worth of pills, the pharmacist will fill it for the whole year if you don't go through a "plan." It is the "plans" that impose restrictions. For me, it is a one month supply at a time, three months for routine medications (if mail ordered).

The prescription that I had filled was $10/30 pills through my prescription drug coverage. If I did not use my drug coverage, it cost $9.99/100 pills. $10 was listed on the bag as both the cash price and prescription price if I had it filled through my insurance. A pharmacist told me that "you have one of those prescriptions that are cheaper to buy out of pocket." I have to beleive that this pharmacist was really on the ball and interested in the consumer. I still have pharmacy techs messing up my prescriptions because they can't understand why I would want to pay cash for this prescription and use my prescription card for others.

AS a follow-up, our local pharmacy is now promoting it's $4 prescriptions. This medication is included on the list. It will now cost $4/30 or $12/90. This is a 25% INCREASE!

Prescription drugs are so high simply because they can get it. I use any eye drop medecine it costs$50 with my insurance here. My brother lives in Texas near the Mexican border. He can get me the exact same eye drops for $7.50. Now I don,t mean a generic I mean the exact same drops produced at the same place by the same country.

iggie, a lot of people go across the border for medication and especially for dental care.

I know people who have have had dental work done over there. He also said it was almsot painless during the work, very little pain afterward and a quick healing time.

A friend's friend had dental work done in Mexico this year. After she returned to the States, she ended up getting an infection caused by the dental work and died.

I asked my Canadian doctor if he gets any free medications from the pharmaceutical companies. He said only 2 representatives do this but they offer the "odd" drugs that the others don't supply. He also implied that they are not following the rules when they do this.

This is a great informative thread.I've learned alot. I'd like to add that the world Health Organization rates the worlds health care systems by health care availability, cost for health care, The amount of health care accidents etc.
The US is rated #37 in the world. Cuba is #38. France is #1 and they have nationalized health
care. The US is #1 in the cost of health care.
This is something that really gets my goat. We are supposed to be a super power and would get as good a care in a third world like Cuba.

Sorry, I don't remember how Canada was rated.

That's #37 out of 191 countries as of 2000.

http://www.who.int/whr/2000/media_centre/press_release/en/index.html

Who knows what it is now....

Here's the ranking in chart form for the major players... including Canada

http://www.longwoods.com/articles/images/LR21RDeberT1.jpg

Marie, people can get things done here, too, and die.

DH and I did a lot of research before having total knee replacement done on his knees this summer. After hearing many stories, including knowing personally one man who died on the operating table and three who contracted staph infections -- one eventually died after suffering a lot of pain, another is still fighting it after three years, and the third is in the hospital awaiting work -- we settled on a doctor 50 miles away, with the surgery done in a hospital that is owned by this doctor and several of his peers. This doctor told us that since they own the hospital they have more say-so on how it is run, and one of the things that they insisted upon was lots of precautions being taken to prevent staph. It was tough making the trip and working things out, but all went well for DH and now he's walking around pain free. But we feel like he wouldn't have come out nearly as well if we had had it done locally.

One would think, wouldn't one, that if the US is #1 in the cost of healthcare, it should be #1 in the quality?

"One would think, wouldn't one, that if the US is #1 in the cost of healthcare, it should be #1 in the quality?"

Not really... not when so many patients insist on unnecessary tests and/or when doctors have to order unnecessary things to avoid lawsuits.

For every patient who sues unnecessarily, there are probably three or four patients who SHOULD sue and don't. I'd be more likely to sue my doctor for ordering unnecessary tests, if I knew that's what they were. But we're in the dark here, most of the time.

It has been my experience that the insurance companies are the ones who insist on several tests being run before they will pay for the procedure you actually need and that your doctor would've done right off the bat had he been allowed to do so. In the mean time you suffer needlessly, waiting for the procedure that will give you relief.

I know there are Americans who are greedy and selfish and who run up costs for everyone else. But surely they have people like that in other countries that still manage to keep their medical and RX costs lower than we do .... most of us come from ancestors who were born in those same countries, it's hard to understand how being an American makes us any more prone to sue than we would've been had we stayed in France. Alors! (or some such French word)

I still maintain that you really should get what you pay for, not only in healthcare but everything. If you buy something and it isn't the good quality you were led to believe when you bought it, you can get your money back. Should be the same way in healthcare and prescriptions.

I do think lawsuits have had an effect on our healthcare - but I also agree that there are many out there who should sue and don't. Also, as with my Daughter in Law, the lawyers wouldn't take the case because 'there's just no money'. The doctor had had his insurance cancelled and both the doctor and hospital had a list of lawsuits pending and were broke.

So sometimes it's the worst ones who don't get sued.

Yes, you certainly can have medical treatment in this country and die from it. The figure is astounding - look it up.

My Daughter in Law got a very virulent staph infection in outpatient surgery. She almost died, they had told them to alert the family before they tried the last medication that might work - it did.

Of course, I haven't heard all the ins and outs of medical treatment in Mexico and would not suggest anyone do it unless they did research and was comfortable with it. It's just that I personally know two people who now got to Mexico for all their dental treatment, and have heard them talk of many others they know. My father always went to a doctor in Mexico - but he knew him personally.

I'm thinking with national healthcare, the ability to sue is greatly reduced. That would just be a guess for other countries - I'm pretty sure it would be here. There is the bill already the President wants or has passed that drug companies can be sued in state court for any harm they do.

I'm beginning to think the illusion of #1 is just that and we are slipping.

Look around at what our government(s) run and then ask youself if you really want them running our healthcare any more than they do.

Our education system is not good and we have been throwing obscene amounts of money at it for 40 years. The government, federal, has pretty much taken over our school system.

If you watch TV, you think our justice system is great - but how many of those who engineered the housing problems will ever be punished. Not many. Our government is making sure the big ones don't miss out on their big and I mean BIG bonuses. How many ended up the pokey or even lost money in the S & L scams? I'm talking big guys, we little ones lost.

The idea of being #1, may be propaganda. Don't get me wrong, it's my home, my country, but it needs fixing and I think the first thing we need is a good dose of honor and integrity.

Ladytexan, you are spot-on, as usual!

There is so much that needs fixing I just shudder to think of it all. So many dishonest politicians and officials that think anything's OK as long as they don't get caught. So much out-and-out fraud by those who can afford to hire slick attorneys. So much indulgence by large corporations. And our schools have become little more than 12-year babysitting programs -- I see disillusioned teachers all the time -- can't discipline, some of the kids are practically animals by the time they reach mid-high, disrupting class, making it impossible to teach, bullying the ones who are trying to get an education, in the halls and on the busses and sometimes right there in the classroom. If I had it all to do over again I'd home school. Kids graduate now knowing so little. Then they go off to college if they're lucky and so many of them party for at least the first two years.

I blame the real estate problems on the realtors and loan institutions. Sorry, folks, but when you get a commission on a sale you're going to want the highest sale price, it's just basic math. And greed. I bought my first home for $30,000. Lived in it for 20 years, kept the property well cared-for, and made improvements along the way, here and there. Worked by backside off to get it paid off early. Sold it for $75,000. Good for me, right? Not really. Had to pay almost all of that for another house in a near-by town that wasn't probably worth more than $30,000 considering all the work it ended up needing. My real-estate taxes doubled and my insurance company insisted on insuring it for $125,000, which is what they say it would cost to replace it. My situation is on a small scale as compared to other places, where you can't buy even a simple little frame home for less that a couple hundred thousand dollars. What's up with that? Of course the seller wants as much as the market will bear. But really. And the LOAN COMPANIES! Young couples taking on a debt of 100,000 on an ADJUSTABLE loan? That's the biggest rip-off in all history and it ought to be illegal. Then we have these individuals who buy a house on a loan that is structured to start out with low payments, with the payments increasing gradually with time -- the thinking being that the homeowner's income will increase with time. So the homeowner gets this bright idea to live in the house while the payment is low and then when it starts to climb, sell it at an appreciated price, thus actually living there for free and getting out of the loan before the payments get too high. Then the bottom falls out of the economy and they can't sell that house for any price. Not according to plan, huh? That's when they walk off from it, leave the keys in the mailbox. Banks need to go back to the conventional way of loaning money. Now many people can't even pay off their home early without paying some kind of penalty. Paying a PENALTY for paying off your debt ahead of time? Unreal. And folks, for heaven's sake, live within your means. If you don't plan to have 8 kids, do you really need 10 bedrooms? Fifty years ago, we only needed three bedrooms regardless of how many kids we had. All the boys in one bedroom. All the girls in another. If we fought, we were disciplined. I watch that home channel and I see so many couples say, "Well, we NEED a pool. We NEED two living areas. We NEED four bathrooms. We NEED granite counter-tops." (*snort*)

And the auto industry! The average car shouldn't cost as much as the average house did. It costs this much to build a car or truck because those auto workers make goooooood money and have great benefits. If we all made what those auto workers make, maybe we could afford to buy one of those vehicles every couple of years to keep them afloat. But we don't. And their company officials are paid outrageous salaries. So they want a bailout without wanting to change their ways. Wouldn't we all.

If politicians, corporations (including drug companies), physicians and banks cannot govern themselves with honor and integrity (and obviously they can't) then they need to be forced to do so somehow. I agree, being regulated by the Government is like getting a fox to guard the hen-house.

And that's something else that really gets my goat. When a bill is passed in the H of R, it shoudn't have other provisions tacked onto it as a way of getting enough votes. It should stand on it's own merit. If it doesn't get approved, then let those who voted against it be known and be accountable for it. It's just dirty to withhold your vote till they tack on something that will benefit you personally, or the state you come from, or some lobbyist who is paying you under the table. The founders of our country must be literally spinning in their graves.

It seems bizarre to me that medicine is a for-profit industry. Shouldn't people be going into it to help people, not to become rich? I don't begrudge doctors making a reasonable salary, but there are so many other people involved in the whole process that it just becomes ridiculously expensive. Our health care industry is just so messed up, I can't even conceive of how we might fix it.

I've been lucky, in that I've had fairly decent health insurance coverage over the years. Prescription coverage is something of a problem, though...I take several drugs, some of which are expensive, and I spend a few hundred every month for my prescriptions. And lately, my insurance has started refusing to cover certain drugs if there are over the counter alternatives, especially for allergy medications. I'm sorry, but Zyrtec and Claritin do not work as well as Allegra 180, at least not for me! One month of generic Allegra is $100 -- I've had to resort to ordering it from Canada, where I can get the same exact thing, but get 3 months for $60. I know that technically it's illegal, but frankly, I don't care.

When the CEO's of your health insurance companies give themselves millions of dollars as Christmas bonuses, who do you think is profiting in healthcare? Why do you think health insurance is so expensive? These companies control the care you get, dictate to your doctors and control your treatment and medications while they pad their pockets. You are barking up the wrong tree when you blame the doctors.

Doctors can't run their practice without getting permission from your healthcare company. They won't get paid. On top of this, they have attorneys breathing down their backs looking for law suits. The ambulance chasers are always close by. Who pays for the doctors malpractice insurance? Who pays for their years of education? They do and have to spend years paying off all the loans. What other profession spends so many years of education to wind up being told how to run their business by a bunch of idiots from healthcare companies. These healthcare 'professionals' aren't even doctors. Yet they determine your treatment!

Doctors have to squeeze in so many patients a day to cover their expenses because insurance companies control how much they make. On top of this, they are supposed to have time to keep up with advances in medicine and learning about new drugs when they come out?? A lunch with a drug rep helps educate about new drugs. Free samples help many people.

Its the lawyers you see on the golf courses playing with the CEO's. Its the CEO's of the 'big three' flying in with their private jets to take the taxpayer money.

Just remember who saves your life, who cures your disease, who fixes your bones, and who brings your baby into the world.
I would also suggest you think about who really makes the 'big bucks' in this country. It ain't the doctors!

I hardly think physicians are in that bad a pinch. I see how the doctors in my community live. I see their expensive homes and cars, and how their children all go to the best schools. You're preaching to the choir in trying to remind us what doctors do for us. They do, indeed, however, "make the big bucks".

But how about if physicians, who are really supposed to be concerned with the health of their patients and who do know that some of their patients don't take the prescribed medication because they can't afford it, would outlaw drug reps giving them perks, such as has been fully discussed here? Someone can't spend outrageous amounts of money on you unless you agree to receive it. What if it became a practice that everyone looked down upon, as if it was the churlish act that it is? How about that Hipocratic Oath? If being a doctor wasn't profitable, we'd be experiencing a shortage of doctors, because nobody would go through the rigors they have to if it wasn't. We're not. But we are experiencing a shortage of nurses, because some doctors start feeling like they're God and they treat their nurses horribly and don't pay them what they should.

DH and I have been blessed with wonderful doctors, who act like they care about us and appear to have respect for their support staff. But they live very well. And I have seen first-hand that some doctors put on a good show and aren't nearly as kind and wonderful after the patients have gone home.

I personally do blame the health insurance companies, as well as the drug companies. They got themselves in a position of power and now we can't keep them out of our pockets. I remember when it was common to not have medical insurance. When people needed medical care it didn't cost nearly so much, in proportion to what they earned, in those days. If they couldn't write a check to pay the bill, they'd pay it off so much a month. If they happened to have insurance, the doctor billed a little more because of the paperwork involved. Now it's the other way around. If you don't have insurance, you get the bare basics of treatment because they assume you can't pay. And when they bill you, they bill the same amount that they would if you had insurance, except that they don't want to allow themselves to be negotiated down, as they are by the insurance companies. One doctor, when I tried to negotiate with him, told me if Medicare saw that he was charging people without insurance less than he was billing them for the same procedure, he could lose his right to bill Medicare. So you pay thousands more for your medical care (and your drugs) than you would if you had insurance, even if the insurance didn't pay a penny of the bill. Nowadays it's catastrophic if you have to go to the hospital and don't have medical insurance. When people started getting dental insurance we saw the same huge jump in the costs of dental care.

Medical insurance is like gambling. You're gambling that you will be sick and the insurance company is gambling that you won't, or that they can figure a way to get around having to pay. Apparently it's working for them, if they can afford to pay their executives huge bonuses, etc.

People are petrified of being caught without insurance now. Every year the insurance companies hike up the premiums, or reduce the coverage. At what point is it just better to be without coverage and take your chances? Lots of people are there, not always by choice.

"But we are experiencing a shortage of nurses, because some doctors start feeling like they're God and they treat their nurses horribly and don't pay them what they should."

I don't believe that is the reason.
Women nowadays have many more options than before. It used to be that you were a secretary, teacher, or nurse. Now the opportunities are endless.

There are less people entering the field and more demand than ever.
That's why there is a shortage.

And, at least in my area, doctors don't pay nurses -- the hospitals do.

In my area, there are many, many clinics owned by doctors and yes there are doctors who do pay their nurses and physician's assistants. There are even some hospitals owned by the doctors who perform their surgery there.

Perhaps you're right about women not entering the field because they have so many more options available to them. But I personally have known a couple of nurses who left the field because they found a different field where they were paid better, had less demanding hours and received more respect from their boss(es). And I'm sure more women (and men) would enter the nursing field to begin with if there was more motivation to do so.

Um, Jane, I wasn't complaining about the doctors -- as I said, I don't begrudge doctor's making a reasonable salary. I believe I said "there are so many other people involved in the whole process that it just becomes ridiculously expensive" -- I wholeheartedly agree with you that it's the insurance companies and all the other people involved with the health care process that has made it so expensive. So...no offense, but no need to get on the defensive regarding doctors, at least with me. That's not where I was going with my statement.

Another thing I didn't see mentioned above that adds to the high cost of healthcare in the USA having to do with "for profit" hospitals is that it not uncommon for them to order up a whole batch of unnecessary or expensive tests on a patient especially when they are assured the patients insurer will cover it.
Why do a simple cost effective X-ray when an expensive MRI will pad the bottom line yet give no better result in many cases.