The EpiPen ripoff

The EpiPen is an injection device that comes pre-loaded with epinephrine (adrenaline). It’s used as an emergency treatment for severe allergies. People with severe allergies keep them on hand—as do schools and camps. They need to be replaced every year.

Here’s why the EpiPen is a ripoff: 

• In 2004, an EpiPen cost $50 (pack of two).
• The pharmaceutical company Mylan acquired the EpiPen in 2007 and began raising prices.
• Now Mylan is charging $600 (pack of two).
• The drug itself, costs just $1.00.
• Mylan holds the patent for the auto-injector.
• Mylan has a monopoly on the market; two competitors have dropped out.
• Mylan has moved their headquarters to the Netherlands to reduce taxes.
• The chief executive “earned” $19 million in 2015.

$600 for this?

 In response to the outcry, Mylan says it will offer a “generic” version for $300. What? A generic injector? They’re old injector model? The medicine itself will not change. Makes no sense to me.

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Homeostasis: How your body keeps in balance--or not

Our bodies continually seek to keep everything in balance—a condition called homeostasis. For example, we maintain an internal temperature of around 98.6 degrees no matter the outside temperature. Our bodies can also maintain an acid/alkali balance as well as levels of fluid, glucose, and calcium. In general, these balancing activities are the result of hormonal triggers.

All very nice. But stress can throw a monkey wrench into our nicely balanced systems. When stressed, our bodies release hormones such as cortisol and adrenalin to facilitate our “fight or flight” responses. While these reactions might come in handy for fighting off a predator, they result in wear and tear on our bodies. Specifically, high blood pressure (hypertension) is a normal response to chronic stress. Over time, adrenaline and cortisol tighten blood vessels and cause salt retention, conditions that can lead to long-term changes such as arterial wall thickening. Thickened arterial walls increase the blood pressure set point. Our bodies adapt to the higher set point and work to maintain it.

 Populations dealing with racism, poverty, fractured families, and joblessness are extremely stress-prone. In fact, high blood pressure disproportionately affects blacks, especially in poor communities. (American blacks have hypertension at a much higher rates than West Africans). Anyone with an increased and continuous need for vigilance—ready to flee or fight—is especially vulnerable to hypertension. But other stressors can have the same effect. In the U.K. studies of postal workers showed that people at the lowest level of the Civil Service occupational hierarchy—people with little job control and more financial instability—had nearly twice the death rate than that of administrators.

A new term, allostasis, has been coined as an alternative to the word homeostasis. While homeostasis is about preserving constancy, allostasis is about adapting to external circumstances, allowing for fluctuations in response to changing demands, including social circumstances. In the words of cardiologist Sandeep Jauhar, my source for this information, “Allostasis is a politically sophisticated theory of human physiology.” It also explains many modern chronic diseases.

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More useless surgeries

Last week I discussed surgery for meniscus tears, which many studies have proven to be useless. Here are more useless surgeries:

• Spinal fusion ("welding" together adjacent vertebrae)
• Vertebroplasty/Kyphoplasty (injecting a sort of cement into the spine to shore it up)
• Appendectomy (removing the appendix; apparently most can be avoided by antibiotic treatment)
• Coronary stenting (placing a tube inside an artery to open it up)
• Shoulder surgery for impingement (removing a bit of bone from the outer end of the shoulder blade where arm bone “impinges”)
• Ruptured Achilles’ tendon surgery (wearing a boot works just as well)
• Many fracture surgeries (if the bones are roughly aligned, they will heal themselves)

There are actually many more useless surgeries. My principle source for this information is Ian Harris, MD, PhD—an Australian orthopedic surgeon and professor of orthopedic surgery who directs a research unit that focuses on surgical outcomes. He admits to performing surgery that doesn’t work. Sometimes, he says, “If a patient complains enough, one of the easiest ways of satisfying them is to operate.” The title of his book, by the way, is Surgery, the Ultimate Placebo. If we expect a treatment to work, it is more likely to be perceived as working.

Dr. David Kallmes of the Mayo Clinic, believes that doctors continue to do some of these operations because insurers pay and because doctors remember their own patients who seemed better afterward. “I think there is a placebo effect not only on patients but on doctors.”

Not everything can be fixed.

For an introduction to this blog, see I Just Say No; for a list of blog topics, click the Topics tab.

Your torn meniscus and mine

I have a “shredded” meniscus. (The meniscus is the cartilage in your knee that serves as a shock absorber in your kneed.) I’d been having pain when I bent my knee certain ways. My chiropractor said my tibia and fibula were misaligned. He would re-align the bones, but it made no difference. I finally had an MRI, which showed the meniscus tears. In my case, the pain was caused by the fluid that accumulates as a result of the irritation and inflammation.

My treatment, so far, has been cortisone shots to the knee—two of them, three months apart. They have helped quite a bit. The orthopedic surgeon who treated me believes surgery is a better solution. I question that. 

At least five different high-quality randomized controlled trials show that meniscus surgery is next to useless. Nevertheless, about 400,000 middle-aged and older Americans a year have it. The thing is, there is no clear relationship between knee pain and meniscus tears. In fact, most people over forty have a meniscus tear and most do not have pain. I’m pretty sure my left knee, which doesn’t hurt, is probably just as bad. When people undergo the surgery and report feeling better, the result is due to the placebo effect.

When I suggested to my doc that he drain the fluid, he said it would just come back. I think he's right about that. But I could do it myself! I have discovered, on YouTube, people who do such things--stick themselves with needles to drain the fluid! One man, who has had his knee drained twice by a doctor, starts with three shots of tequila. See for yourself: https://www.youtube.com/watch?v=aPhBE1bscpE  I recommend skipping the tequila-drinking portion. Actually, you might want to skip the whole thing. EEEW!

My knee pain isn’t all that bad and it doesn’t hurt to walk. For me, it helps to know what was causing the problem.

For an introduction to this blog, see I Just Say No; for a list of blog topics, click the Topics tab.