On Drugs

Today I received multiple emails urging me to voice my opposition to the “21st Century Cures bill.” Specifically opposed by Elizabeth Warren, it was passed by the House yesterday and is now headed for the Senate. Here’s one of the more level headed things written about it today.

So, here’s something that might concern you. This bill would specifically allow something called “off-label use” of drugs. More specifically, it allows drug manufacturers to mention these off label uses, rather than leave it to word of mouth among doctors. Critics call that “Fraud”, adding “If this bill passes, Big Pharma could market drugs as cures for all sorts of symptoms, not for the uses that were approved by the FDA. That sort of fraud puts people at risk.”

That’s simply not how it works.

Let me start with a common example that you or somebody you know might be familiar with. There’s a drug called Gabapentin, name brand Neurontin. It’s approved as an anti-seizure medication. The truth is, there are many better drugs for seizures, but Gabapentin is really good at controlling nerve pain (“neuropathy”). Many diabetics use this drug to control diabetic neuropathy (it’s cheaper than that stuff you see advertised on the TV, and has a longer track record for safety simply because it’s been around for years). So this bill would say that the makers of Gabapentin could run an ad saying doctors use this stuff all the time for neuropathy.

People like Elizabeth Warren who are calling this “fraud” think somebody should pay for a bunch of new research studies to prove what doctors and patients have known for years: this stuff works pretty well for something other than it’s original purpose.

The fact is that one out of five prescriptions written today is for an off label use — what critics are now calling “fraud” — and there are perfectly valid reasons for your doctor to write that prescription. In fact, if I can only get you to read one thing about this issue, let it be this peer reviewed article on the practice. Notice there’s an entire table of common off label uses, some of which are common sense (gee, morphine can treat severe pain in children, gotta do some studies on that one).

Of course heaven forbid we should address the fact that the United States is one of only two countries that allow drug manufacturers to market their products directly to consumers who — let me point this out — cannot purchase them without a prescription. Not complaining, it helps  my clients remember what some of those new meds do.

In Closing: bras; Greenwald pointing out reality again; 5 pre-screened articles by conservatives; a Home Depot employee in Alabama has virtual control of the underground economy in Venezuelaplease stick a fork in identity liberalism (it’s dead); and it’s been a long time since I’ve linked to anything in HuffPo, but it is still the economy, stupid.

Diet Research? It must be January.

Yes indeed, it’s the first week of the year, and that means millions of Americans are trying to shed between 5 and 500 pounds. Some scientists were even willing to stick their necks out there and say fructose is a culprit in weight gain (a culprit not the culprit). Check the archives and you will find me many times saying that every weight loss diet that works requires drastically reducing if not altogether eliminating added sugars.

So Loyola University wants to help you out. They’ve got what they think are the top 4 reasons diets fail. Let me save you some reading:

  1. Underestimating calorie intake (e.g. eating too damn much)
  2. Overestimating activity and calories burned (e.g. imagining that an amble around the mall is just like a 5 mile run)
  3. Poor timing of meals (the dreaded “starvation mode“)
  4. Inadequate sleep (having a job and other responsibilities)

Really? I’m on board with reasons 1 and 2, although I see them as two sides of one coin. But do they really think that sleep is a bigger issue than unrealistic expectations in the first place, or diet plans that are for whatever reason unsustainable? Do they think that eating at the wrong time is truly a bigger issue than unsupportive friends and family who –subtly or openly — undermine the dieter’s efforts?

Want to lose weight without torturing yourself? Try eating reasonable portions of real food: plenty of veggies; adequate protein; no sweets, no crap that comes out of a box, no food-like chemistry sets. Hey, it’s no dumber than the other diets you’ve tried over the years.

In Closing: free classes; Downtown Vegas and F15; maybe now somebody will ask banks to follow the law pretty please?; Onnabugeisha; ha!; conform or be called a terrorist; Malala; why oh why did Texas give him a second term?; more employment data than you probably want; somebody inform Scalia that 24 is not a documentary; the estate tax is not a wealth tax, it’s a wealth moving into the hands of someone who didn’t actually earn it tax; it turns out you need facts before you can figure out what to think about them; well that’s gonna have conservative panties in a wad; the Romney Loophole; is anybody surprised by this?; and I think Brent may have been playing Black Ops 2.

Well Isn’t That Interesting

Gee, isn’t it peculiar that right after a very close election in Wisconsin, a voting official with a history of not exactly doing things the proper way happens to find just enough votes for one particular candidate to avoid a required recount, against pretty much every rule of computer programming and common sense?

Good thing there’s paper ballots. Somebody better pick those up before the mysterious fire. You never know when a mysterious fire can happen. You might be experiencing one right now!

In closing: the contents of Notorious B.I.G.’s pockets when he died; have a Koch and a smile; escaped leopard menaces children; blast from the past; Fox News through history; stop coddling the kids, they know better; yeah, because clearly Eric Holder has nothing important to do; it’s never been about deficit reduction (go ahead! shut the government down! but stop paying the worthless congresscreeps who got us here!); on the middle class; How to tell if your neighbor is cooking up explosives; what’s that doing in this century?; Detroit; the truth about how California reduced malpractice costs; make sure you are both on the mortgage; I doubt this seriously (did anybody bother to compare cost-with-coupon to cost of store brand?); stop tweeting ads; earthquake art; whistleblowers; and a cat with a gun.

Interest Rates Must Go Up

Just about 5 years ago, I wrote this:

It is my theory that beneath certain levels, low interest rates do not stimulate the economy. There are several factors which combine to this result: First, when rates are very low, there is no incentive for lenders to extend credit to individuals and companies. Since the available rate of return is so low, they would rather take the sure thing on government bonds. Housing lending has continued partly because there is a real asset involved, and partly because such loans can be sold to aggregators such as Fannie Mae. [edit: this was before the housing bubble burst; the last sentence isn’t entirely true any more.]

Second, when interest rates are very low, corporate borrowers — who are supposed to be goaded into action by super low rates — are mindful that the Powers That Be feel the economy is lousy. It is a bad idea to incur debts and invest in infrastructure when the economy is lousy. What will the stockholders say? What cash they do have they will sit on until the moment is right [edit: leaving them in a position to, say, buy out a competitor who imprudently overspent]. After all, if the economy is lousy, they may well need the cash cushion. As for loans, they will wait for some kind of signal that things are improving — an increase in interest rates, maybe — before calling for cash.

Finally, the third leg of the economic table, Joe and Jane Average do not experience added liquidity. While the banks are more than happy to lend them money for concrete things like houses and cars, the banks are reluctant to lend them cash for things that have a lasting impact on the economy. They can’t get cash to start a business (or to help along their existing business) because it’s too risky — for the bank, that is.

Here we are, 5 years later. The Fed Funds Rate has been 0-0.25% for two years. That means banks are able to borrow essentially free money, and have been for two years! Mortgage rates did rise this week, after 12 weeks of declines and record lows, including the lowest rates since this data has been tracked. Under traditional economic theory, all kinds of growth should be stimulated!

So where’s the jobs that should be created by all this stimulation? Oh, right.

The truth is that monetary policy can’t fix what’s really wrong with our economy: banks and businesses we won’t admit are really failing; a workforce that can neither take advantage of job opportunities in other regions nor start small businesses because their houses have lost so much value as to leave them underwater; businesses that pay millions upon millions to executives and stockholders while paying as little as possible to laborers here, overseas, and/or illegal; tax and regulatory policies that encourage bad corporate behavior; a still-broken health insurance system that discourages hiring and will soon force all of us to pay tribute to profitable insurance companies; a failure to manufacture much of anything that somebody somewhere in the world would want.

But it gets worse. Those super low interest rates create one more problem for our economy. It punishes people who are trying to prudently save money for retirement, college, or just a rainy day. A side effect of this is that the Social Security Trust Fund is also getting low rates on their investments — which directly impacts the future of the system and gives future seniors a double-whammy even if they do everything “right.” Further, the low interest rates encourage people (and the government) to borrow money they might have a hard time paying back. While this might boost the economy in the short run, in the long run it’s just a longer bit of rope with which to hang.

Interest rates must rise. Bernanke must stop hiding the fact that some banks are already busted without effectively no-interest loans from the Fed. Institutions that are not solvent or are “too big to fail” must be broken up and turned into organizations that serve their customers. Investors must own up to the fact that their Mortgage Based Securities are worth no more than 70% of the face value and allow homes to be properly valued. Tax code must encourage corporations to spend money instead of hoarding it. And there must be incentives to hiring people here for decent wages, and better yet making something here that can be sold and exported. Let’s stop pretending we can build an economy on cheap credit and lattes.

In Closing: pants; T-shirts; it’s more intellectually honest than Megan’s Law; school reform hasn’t done much for learning; people with a prescription for painkillers might have painkillers in the house; and am I the only person with a tape measure in her bag?