Archive for Ease and Disease

Another dose of karma

And the co-pay will make your hair stand on end:

Vyera Pharmaceuticals, formerly called Turing Pharmaceuticals, lost more than $1 million in the first quarter of 2018, according to financial documents obtained by STAT. Sales, driven by the $750-a-pill Daraprim, have been on the wane over the past two years, falling more than 14 percent in 2017 and on pace to drop another 7 percent in 2018.

The company gained notoriety in 2015 after [Martin] Shkreli, then CEO, acquired Daraprim, which treats a rare infection called toxoplasmosis, and raised the price more than 5,000 percent. Despite a public outcry, Shkreli claimed the move would bring in hundreds of millions of dollars a year in profits for the company’s shareholders and fund the development of new, better treatments for toxoplasmosis and other rare diseases.

But audited financial statements obtained by STAT show Vyera is nowhere near meeting either goal. The documents suggest Shkreli’s move was a short-term success: The Daraprim price hike helped Vyera achieve stellar gross margins, but the company’s expenses cut deeply into its net income. After turning small profits in 2016 and 2017, Vyera is now losing money. Daraprim sales are falling, and Vyera has laid off at least a handful of salespeople; expenses remain high.

Sales are falling? After a 5000-percent price hike? Who could have imagined such a thing?

U.S. prescriptions for Daraprim have consistently fallen over the past two years, from 427 in the first quarter of 2017 to just 107 in the first quarter of 2018, according to IQVIA, a pharma consultancy that tracks drug sales.

But it’s apparently not just the price:

A former employee said the company’s problems in part reflect a shrinking patient population.

Toxoplasmosis is a rare infection that largely affects patients with HIV. As HIV therapies gain wider use across the country, there are fewer and fewer patients who need Daraprim. That, coupled with the drug’s famously high price, has put a damper on sales, the former employee said.

“It’s a dying disease — which is a good thing — but it’s bad for the company,” said the former employee, who spoke on condition of anonymity so as not to violate an agreement with Vyera.

So not only does PharmaBro’s company languish in the market while he himself languishes in jail, but fewer people are getting sick. Karma scores the trifecta.

(Via Fark.)

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And just a hint of snake oil

Of course, you’re buying it for the fish:

Taking omega-3 fish oil supplements is often touted as a way simple way to protect your heart — but experts say the evidence that it does any good is flimsy at best. Cochrane researchers looked at trials in over 100,000 people and found little proof that it prevented heart disease.

They say the chance of getting any meaningful benefit from taking omega-3 is one in 1,000.

Eating oily fish, however, can still be recommended as part of a healthy diet.

The review mainly looked at supplements rather than omega-3 from eating fish. Experts still believe the latter is good for the heart as well as general health.

And something that smells like last month’s tuna had damned well better be good for the heart, right?

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Gravity never fails

It was 6:10 this morning. I know this because the digits on the old Timex alarm clock are entirely too bright, but the sun rose around 6:24, which meant that keeping the washcloth in front of the clock face was no longer necessary. I rolled over to get within reach of it.

And kept rolling.

And kept rolling.

And finally, I found myself on the floor: as the old broad said in that infamous commercial, “I’ve fallen and I can’t get up.”

Scraping along the floor, I managed to get to the phone and summon 911. (Lucky me, the fire department is only three blocks away.) One of them remembered me from the last time I’d hit the floor this hard.

At least now I know how I die: I pitch forward (or backwards, it hardly matters) out of reach of anything, and can’t propel myself at all. It will be a day or two, or more, before anyone even notices.

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Well, isn’t that specialist

The local VA Medical Center took care of brother James during his last couple of years; he’d rather come up here, he said, than take his chances with whatever Texas had to offer. He did mention, once or twice, that they seemed to be short of doctors, and it turns out he was right:

Under federal employment laws, no federal employee can have a higher salary than the president of the United States, who earns $400,000 per year. That poses challenges for VA hospitals seeking specialists.

Take, for example, cardiothoracic surgeons. The Oklahoma City VA hospital needs four but recently lost one, so they’re recruiting to fill the slot. The problem is that cardiothoracic surgeons can earn far more than $400,000 at private hospitals.

President Trump, so far, has not been actually collecting his salary from the Treasury — he’s been donating it — but that doesn’t make any difference as far as the law is concerned.

One workaround is federal contracts, which can exceed the $400,000 limit. For ophthalmologists, the VA contracts with the Dean McGee Eye Institute at a cost of $600,000. That includes overhead expenses it wouldn’t have to pay if it could hire its own ophthalmologists.

Director Wade Vlosich says it is what it is:

“It is just the way it goes at a VA hospital, because we’ll never reach that salary level for those doctors. So, no, it doesn’t worry me,” Vlosich said. “Areas that worry me are filling inpatient hospital positions, primary care positions and then some of the hard-to-recruit nursing positions, and engineers. Those are really the ones that keep me up at night.”

For what it’s worth, the first psychotherapist I saw this decade moved out of a group practice and into a VA slot. I have no idea how much she was making at either place.

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Manage this, pal

This will last, I suspect, for about five years after it’s proven worthless, after which the Next Big Thing will be proclaimed:

It’s been maybe 20 years since I first read that “pain management” was the most important aspect of health care that the medical profession was overlooking. That quickly became a fad, and now it’s an unhealthy obsession, as the opioid crisis demonstrates. The fact is, these fads cause all manner of damage not just in medicine but in pretty much every human endeavor — education, politics, economics — and it needs to stop.

Everyone hates opioids except for the people who use them. Most of the pills are off-patent and are therefore dirt cheap, which means no windfalls for Big Pharma. And your “pain-management” regimens seem to be based on the dubious premise that physical pain is somehow good for your immortal soul, a proposition I would hate to try to defend before the Almighty. I’m not at all enthusiastic about the therapeutic properties of marijuana, but I suspect that thousands of Oklahomans, myself included, voted for its legalization simply to spit in the eye of the Drug Warriors.

Oh, and if you want to see political fads in action, watch the so-called “Resistance,” which has an attention span of about 96 hours. Families split up at the Mexican border? That was last week. This week, Mr. Justice Kennedy retires, and it’s just a matter of days before women are turned into brood mares at the behest of the New Gilead. Expect something marginally less stale to take over the media by Tuesday.

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Destined to end badly

Although it’s clear who dropped the ball:

An Arizona woman has said she was left “in tears and humiliated” after a staff member at US pharmacy chain Walgreens refused to give her prescription medication to end her pregnancy — even though her doctor had said she would ultimately have a miscarriage.

Nicole Mone had discovered at a doctor’s appointment on Tuesday that her baby was not developing normally.

Knowing her two-month pregnancy would not run to term, she was given a choice to end it through a surgical procedure or prescription medication, and chose the latter.

When she went to a Walgreens in the city of Peoria to get her prescription, she says a pharmacist refused to serve her on moral grounds — a stance which is within the company’s rules.

She told the BBC the staff member was “very short, not compassionate at all.”

This is not a reference to the guy’s height.

“I stood at the mercy of this pharmacist explaining my situation in front of my 7-year-old and five customers standing behind, only to be denied because of his ethical beliefs,” she wrote on Facebook and Instagram.

“I get it, we all have our beliefs. But what he failed to understand is, this isn’t the situation I had hoped for — this isn’t something I wanted. This is something I have zero control over. He has no idea what it’s like to want nothing more than to carry a child to full term and be unable to do so.”

And apparently this wasn’t handled according to Walgreens policy, which the company describes as follows:

Which, it appears, is not what happened:

Ms Mone said that did not reflect her experience, however, as the pharmacist “could have just passed me on to the lady that was standing next to him” — which she says did not happen.

Instead, the prescription was transferred to another Walgreens store. Ms Mone picked it up there after seeking her doctor’s help to ensure the second pharmacy would give it to her.

My idea of “in a timely manner” does not include having to go several miles to another store.

Ms Mone, after talking to Walgreens corporate, has filed a complaint with the Arizona State Board of Pharmacy.

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When I’m sixty-five

I have received something like three dozen Medicare-related mailings in the last month or so, and nowhere did I read anything quite so sensible as this:

If you are an older senior citizen and can no longer take care of yourself and need Long-Term Care, but the government says there is no nursing home care available for you, what do you do?

You may opt for Medicare Part G.

The plan gives anyone 70 or older, a gun (Part G) and one bullet.

You may then shoot one worthless politician.

This means you will be sent to prison for the rest of your life where you will receive three meals a day, a roof over your head, central heating and air conditioning, cable TV, a library, and all the healthcare you need.

Then again, I’m still a few years away from seventy.

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Yet another soap opera

At least this person is, or has been, on meds: Cut a dvla car clamp off my car because I panicked that they where going to sieze it?

Basically I’m usually on antipsychotic medication due to anger problems & the past 3 months have been nothing but cursed, the doctor stopped my medication without warning and would not put them back on without trying to ‘bargain’ with me so I walked out and haven’t been taking medication which I need now, however I hadn’t realized my car wasn’t taxed and woke up to it being clamped about 3 weeks ago, I didn’t have enough money to pay the release fees and they said they will come back and take the car if it’s not payed so I panicked and someone from the street offered to cut it off and I let him and hid the car while I sorted the money out to pay, they then found the car last year and its impounded so I’ve decided I want to give the car up to them now because I need to sort out my medication but I’m scared to go to their office because I don’t want to get in trouble with the police? What do I do

The DVLA is to Britain what the DMV is to most US states. Which makes me wonder if the National Health decided they were spending too much money keeping this silly sod tranquilized.

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Thank you for your support

Provided, of course, you don’t have tusks:

I blame Lindsey Buckingham.

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Where things stand

And I don’t see them improving any time in the near future, either:

Lots of contributing factors — idiot customers, horrible summer heat, and ongoing bodily-function failures — and at best, only one of those is going away any time soon, if “soon” can be stretched to 90 days or so.

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Dreaming of full service

You may remember this from just about a tankful ago:

[L]ast month, when I pulled up to my usual filling station, did my usual painful exercise to get myself out of the car, and only then discovered that the card reader was inoperative. None of my cards would save me in this case. Rather than go through a second round of contortions, I pulled the Walking Appliance out of the back seat, wheeled myself into the store, and peeled off three twenties. This of course necessitated a second trip into the store to retrieve $17 or so in change, but it demonstrated pretty clearly who rules.

This week, I pulled up to a different station, closer to home and dealing in E0. (You want ethanol, you go to the beer display.) I did my usual painful exercise to get myself out of the car, and only then discovered that the card reader was inoperative. The Walking Appliance would not get me up the very steep path to the retail store. With a little help from passersby, I managed to get into the store proper and swipe $60 on the old Mastercard. Forty-five dollars later, another neighbor pointed out that at the far end of the building was an actual ramp, which up to that point I hadn’t noticed, and while I’ve lived around here for a decade and a half, I didn’t need a ramp for most of that time, which explains why I hadn’t noticed it.

Later this week, I assume the store will change that sixty-dollar debit to a forty-five-dollar debit.

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$911 a yard, or something like that

Tam pries open the bill for an ambulance trip, and perhaps wishes she hadn’t:

Literally a hundred times more than I’ve ever paid for an Uber going twice the distance. Hell, I could have Uber’d back and forth between Indianapolis and Lafayette every day for a couple of weeks for that money.

Next time, no matter how much I’m writhing on the floor and screaming in pain at 0300, just tap me behind the ear with a hammer and throw me in the car.

Undoubtedly this was discussed in a boardroom somewhere:

“How much would this trip cost via Uber or Lyft?”

The new kid begins, “Well, it varies with how busy they are. Something called surge pricing.”

“We can’t do that. Bad optics. Find the average and multiply it by 200.”

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Cold day in hell

Miracle cures abound in these days of ultra-modern medicine, but we’re still knocked flat by the common cold — for now, anyway:

UK scientists believe they may have found a way to combat the common cold.

Rather than attacking the virus itself, which comes in hundreds of versions, the treatment targets the human host. It blocks a key protein in the body’s cells that cold viruses normally hijack to self-replicate and spread.

This should stop any cold virus in its tracks if given early enough, lab studies suggest. Safety trials in people could start within two years.

How’s that again?

The Imperial College London researchers are working on making a form of the drug that can be inhaled, to reduce the chance of side-effects.

In the lab, it worked within minutes of being applied to human lung cells, targeting a human protein called NMT… All strains of cold virus need this human protein to make new copies of themselves.

In the US, availability will presumably be contingent upon whether the drug can be used to manufacture other drugs; were there a way to make meth out of meatballs, American drug warriors would ban spaghetti.

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Reversion to form

“Have you had this before?” the doctor asked, pretending to shuffle through the 800 or so pages of my file folder.

“I have,” I said.

“Well, you’ve got it again.”

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A dog-paddle of sorts

He can’t help it, he was born this way:

A remark from Vetbook, a sort of wiki for veterinarians:

In most cases, euthanasia is not recommended as restoration of normal movement eventually occurs as the pup grows, provided the walking surfaces are firm such as carpet, grass, soil, etc.

There’s a lot to be said for not recommending euthanasia.

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We said your time was up

And $DEITYdamnit, we meant it:

Alfie Evans, a British toddler with a degenerative brain condition whose parents lost a legal battle to keep him on life support at a Vatican hospital, was mourned with balloons set free in the sky and prayers from the pope after he died Saturday weeks shy of his second birthday.

Much of the criticism of the National Health Service came from the United States; while Twitter would not permit the topic to be listed as “trending” because of course they wouldn’t, American tweeters were keen to point out that It Can’t Happen Here.

One might not want to be too sure about that:

Orwell would be proud: QALY (quality of life years) criteria are how the death panels the NICE (National Institute for Health and Care Excellence) decides if you should live or die.

and with the growing “elderly” population (and fewer kids/immigrants to support them by their taxes) you can see how this cost control idea could rapidly expand to active killing of the old, senile, and those denied treatment.

But before you point fingers at the UK, maybe you should read about the “futile care” law in Texas that has gotten little publicity. From Wikipedia:

“The Texas Advance Directives Act (1999), also known as the Texas Futile Care Law, describes certain provisions that are now Chapter 166 of the Texas Health & Safety Code. Controversy over these provisions mainly centers on Section 166.046, Subsection (e), which allows a health care facility to discontinue life-sustaining treatment ten days after giving written notice if the continuation of life-sustaining treatment is considered futile care by the treating medical team.”

Unlike the UK, if the family wants to, they can move the patient and pay their bills.

Or they can ask the hospital “ethics committee” to decide. The problem being that most “bioethics” types already believe in the “QALY” mindset, so good luck to you fellah.

I assure you, my interest in this topic is not entirely academic; I am, after all, sixty-four years old.

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Please don’t clap

So it’s finally come to this:

A man in the UK has caught the world’s “worst-ever” case of super-gonorrhea.

He had a regular partner in the UK, but picked up the superbug after a sexual encounter with a woman in south-east Asia. Public Health England says it is the first time the infection cannot be cured with first choice antibiotics.

Health officials are now tracing any other sexual partners of the man, who has not been identified, in an attempt to contain the infection’s spread.

The main antibiotic treatment — a combination of azithromycin and ceftriaxone — has failed to treat the disease.

This is also the course of treatment recommended by the CDC in the US, although:

Treatment of patients with gonorrhea with the most effective therapy will limit the transmission of gonorrhea, prevent complications, and likely will slow emergence of resistance. However, resistance to cephalosporins, including ceftriaxone, is expected to emerge. Reinvestment in gonorrhea prevention and control is warranted. New treatment options for gonorrhea are urgently needed.

That was 2012. Didn’t take long for the bug to evolve resistance, did it?

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Busted cycle

During recent spates of insomnia, I assumed that my circadian rhythms were totally out of whack. I am currently not quite so sleep-deprived, but this old body persists in traveling to the beat of a different drum.

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Oh, by the way

A really dreadful gurney-side manner, this is:

Laura Cameron, then three months pregnant, tripped and fell in a parking lot and landed in the emergency room last May — her blood pressure was low and she was scared and in pain. She was flat on her back and plugged into a saline drip when a hospital employee approached her gurney to discuss how she would pay her hospital bill.

Though both Cameron, 28, and her husband, Keith, have insurance, the bill would likely come to about $830, the representative said. If that sounded unmanageable, she offered, they could take out a loan through a bank that had a partnership with the hospital.

I got hauled to the ER twice in 2016. The first time, an underling who came off like Truman Capote’s taller brother let me know that I was facing a hundred-dollar copay, and would I like to take care of that now? I was sufficiently conscious to nod assent, and dug out my debit card.

An hour later, part two of the Truman show: “They’re telling us you haven’t met your deductible yet this year.” I shrugged, handed over the plastic, and signed for a thousand. Shortly thereafter, I was wheeled to an actual room.

[P]romoting bank loans at hospitals and, particularly, emergency rooms raises concerns, experts say. For one thing, the cost estimates provided — likely based on a hospital’s list price — may be far higher than the negotiated rate ultimately paid by most insurers. Sick patients, like Cameron, may feel they have no choice but to sign up for a loan since they need treatment. And the quick loan process, usually with no credit check, means they may well be signing on for expenses they can ill afford to pay.

I suppose I was fortunate in that I actually had $1100 in the bank. Not everyone is in such a position.

Here’s an option I heartily endorse when possible:

If you should find yourself in hospital unexpectedly, and confronted with this sort of aggressive approach, I suggest you tell them to talk to your significant other, or ask them to wait until you’re in a proper mental and physical and emotional state to make such decisions. If they persist, tell them what they can do with the paperwork. After all, they’re in a place where it can be extracted once they’ve done that!

Damn straight.

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Those bloodsuckers must be around here somewhere

The story begins here:

In July of 2017, 13-year-old Olivia Goodreau was on vacation in Missouri with her family. While outside Olivia noticed a tick on her dog, Mo (short for Missouri). Olivia & her mom watched the tick start to burrow into Mo’s leg. They quickly found needle nose tweezers to properly remove the tick from Mo. As Olivia was removing the tick she asked her mom, “”s there an app that can show what ticks are around us?” That night Olivia looked online and found that currently there was no app to help track, report, and educate people about ticks. This gave Olivia the idea to create the TickTracker app to help keep everyone safe.

TickTracker development teamI understood. Forty-five (!) years before that, I was stationed at Fort Leonard Wood in Missouri, where, according to the popular jape of the times, the state flower is the rock and the state bird is the tick. God knows I saw plenty of both over the two seasons I spent there.

The LivLyme Foundation was set up to develop the app and aggregate user data. TickTracker is offered at no charge. And if you ask me, they ought to be selling some of these spiffy black caps worn by the development team.

(Dear Brad Paisley: would you be interested in lending your name to a Good Cause?)

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To go without the flow

First there was meth, and it was bad, and the powers that be were forced to admit that they couldn’t possibly make it any more illegal than it already was; desperate to appear to be doing something, they eventually hit on the idea of making pseudoephedrine (Sudafed and its friends) hard to come by, apparently reasoning that the way to foil thousands of methheads was to inconvenience millions whose heads were merely stuffed up.

Now comes phase two:

As part of the fight against the nation’s opioid epidemic, the US Food and Drug Administration said Tuesday, one common antidiarrheal drug should be given new packaging.

The agency is working with manufacturers to change the packaging of the drug loperamide to include blister packs and single-dose packaging, which could reduce the likelihood of overdose, according to FDA Commissioner Dr. Scott Gottlieb.

Loperamide, sold under brand names such as Imodium, is an over-the-counter opioid medication used to treat diarrhea. However, it is sometimes taken in large doses by those seeking to suppress symptoms of withdrawal from such other opioids as heroin. In such high doses, loperamide can lead to cardiac problems and even death, Gottlieb said in a statement Tuesday.

Because nobody, but nobody, would ever bother to punch a dozen pills out of a blister pack when the monkey’s on his back and laughing out loud.

(Sent me by Holly H.)

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You deserve to hurt

Sam Quinones, a former Los Angeles Times scribe who wrote the book Dreamland: The True Tale of America’s Opiate Epidemic, was in town this week to talk about our Dreadful Addiction, and this is some of what he said:

Quinones traced the origins of the epidemic to indiscriminate prescribing in the 1990s as doctors came to believe they were undertreating pain — an argument that had some merit. The problem began when pharmaceutical companies and some doctors underplayed the addictive potential of opioids, he said.

Well, yeah, dependence does come with the package. But then:

“We began to believe that we were entitled to a life free of pain,” he said.

The more I repeat that, the worse it sounds. What say you?

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From the Something Must Be Done files

And this definitely qualifies as something:

Walmart is helping customers get rid of leftover opioids by giving them packets that turn the addictive painkillers into a useless gel.

The retail giant announced Wednesday that it will provide the packets free with opioid prescriptions filled at its 4,700 U.S. pharmacies.

The small packets, made by DisposeRX, contain a powder that is poured into prescription bottles. When mixed with warm water, the powder turns the pills into a biodegradable gel that can be thrown in the trash.

Research has shown that surgery patients often end up with leftover opioid painkillers and store the drugs improperly at home.

I dunno. I sort of sympathize with the Fark submitter, who asks: “But who has leftover opioids?”

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Just like it says

Still, it’s startling to see it in print on an actual product label:

Coprophagia remedy for dogs

And I suppose you really don’t want the dog in the picture to be grinning.

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When your brain hurts

Apparently there is now surgery to reduce migraines:

Surgical decompression of the peripheral sensory nerves around the skull can have a beneficial effect on the frequency, severity and duration of the migraine headaches. Surgery is performed as an outpatient procedure under local or (usually) general anesthesia and usually takes one to two hours. Some patients have multiple migraine triggers and surgery may take longer if the trigger sites are on different areas of the head. Surgery is not on the brain and we do not remove or go through the skull bones.

How well does this actually work?

Most studies have shown success rates above 70 percent, with roughly one-third of the patients experiencing total relief of their migraines. When successful, patients report an improvement in migraine frequency, duration, intensity and in health-related quality-of-life.

One thing’s for sure: I don’t know anyone with migraines who wouldn’t rather be someone without migraines.

(Via Finestkind Clinic and fish market.)

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One shot, so to speak

Two shots, if you’re doing both sides:

A transformative genetic treatment for a rare, inherited form of blindness will come with a price tag of of $425,000 per eye, or $850,000 for both, said Spark Therapeutics Inc., the tiny biotechnology company that is bringing the therapy to market.

Since Spark’s Luxturna was approved by the U.S. Food and Drug Administration last month, speculation over the price has grown as it became clear the therapy would be one of the first in a wave of medicines that yield remarkable results after a single treatment — and would carry a commensurate cost.

No quantity discounts, apparently.

Luxturna (Voretigene neparvovec) is one of those few pharmaceuticals for which the trade name and the generic name have roughly equal plausibility as a name for a minor Star Trek character.

There are admittedly not many patients for whom this stuff is indicated:

Leber’s congenital amaurosis, or biallelic RPE65-mediated inherited retinal disease, is an inherited disorder causing progressive blindness. Voretigene is the first treatment available for this condition. The gene therapy is not a cure for the condition, but substantially improves vision in those treated. It is given as a subretinal injection.

Now: is it worth $850,000 to not be blind anymore?

In an agreement with the Boston-area insurer Harvard Pilgrim Health Care, Spark will get the full price of treatment up front. If patients don’t get an immediate benefit — measured at 30 days, or a long term one — measured at 30 months, Spark will have to give some of the money back in a rebate.

There’s a new wrinkle.

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The reward for doing without

For certain values of “reward,” I suspect:

Prostate cancer is the most common cancer among men, hitting about one in eight at some point — with 43,000 UK cases each year.

Oxford University researchers studied 220,000 men aged 40 to 69 over six years.

They found those who had never had intercourse had a 47 per cent lower rate of the disease, dropping the risk to about one in 16.

Explaining why, lead researcher Prof Tim Key said: “Infections passed during sex, raising prostate cancer risk, could be a possibility.”

Out of any given sample of 220,000 men, 40 and above, how many are going to admit to having never had sex? Admittedly, university researchers are not likely to tell any of your friends at the pub, but this is a difficult thing to admit, unless you’re one of the Involuntary Celibates who have nothing else to distinguish themselves.

Dig a bit farther down, and there’s the answer:

Prof Key admitted: “It is a huge study but there were only about 20 cases of men who had never had sex.”

I might have known.

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It was one of those nights

I’ve had more of these than I perhaps ought to admit:

I wake up cold — but sweating. I’d had nightmares again. My heart felt heavy in my chest, my limbs felt entirely useless. Every time I stood up I thought I was going to fall, and my brain was blank and numb. I hate this, I hate feeling like I’m getting somewhere with my health, and then one morning it completely takes me by surprise and pulls me back in.

The only advantage I’ve had in such matters is that I can sometimes see them coming. If I crash into bed at eleven and I’m still running full-tilt thought patters at twelve-thirty, I can pretty well assume that “Well, this night is ruined.”

There’s no telling what mood I’ll wake up in, and there’s no guarantee that mood will stick around all day.

After many years, I have become conditioned to expect, if not The Worst, something Worst-Adjacent.

Morning ablutions are supposed to take me half an hour. To get the time down that far, I have to make sure that I don’t fall down in the shower, because I have this morbid idea that this is how I die, despite having survived one already, and I have to do without socks, which take me longer to put on than anything else. (This latter may be troublesome come Tuesday, when it’s supposed to be somewhere around 5°F during the morning commute.) The fact that these conditions exist at all tells me that I’m a long, long way from being out of the woods.

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Our shareholders want Lamborghinis, goddamnit

Where have we heard this before?

Since 2013, the price of a 40-year-old, off-patent cancer drug in the U.S. has risen 1,400%, putting the life-extending medicine out of reach for some patients.

Introduced in 1976 to treat brain tumors and Hodgkin lymphoma, lomustine has no generic competition, giving seller NextSource Biotechnology LLC significant pricing power.

The U.S. Food and Drug Administration is seeking to encourage more competition for drugs like lomustine, one of at least 319 drugs for which U.S. patents have expired but which have no generic copies, according to a list the agency published earlier this month.

What makes this drug so suddenly expensive?

For many years, lomustine was marketed under the brand name CeeNU by Bristol-Myers Squibb Co., which charged about $50 a capsule for the highest dose, before selling the product in 2013.

Now, the same capsule costs about $768, after nine price increases by a little-known Miami startup, NextSource, which supplies lomustine in a deal with the drug’s new owner, manufacturer CordenPharma.

Not a lot of lomustine is sold, so it’s hard to blame BMS for selling the rights to the drug. What hasn’t happened, of course, is an increase in production costs:

Robert DiCrisci, chief executive of NextSource, said in a statement the company bases its pricing on product-development costs, regulatory-agency fees, and the benefit the treatment delivers to patients. The company provides discounts to uninsured patients and those with financial limitations, he said.

“Product-development costs?” Is he kidding? The most they’ve spent on this stuff is whatever it cost to change the name on the box and the cost of PR announcing the price increases.

I am persuaded that the major cause of price-gouging like this is the desire to make a killing before the Feds come down and sweep the last vestiges of the marketplace under the rug.

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Why, he’s no fun, he fell right over

I spent enough time in the hospital in 2016 to know I didn’t want to do it again in 2017. However, I am growing older and probably more fragile, so I’m not sure I’ll manage to do the same as 2018 looms. If I must, though, I hope I have this much brain activity going for me:

It’s a blank to me — my last memory ahead of time was laying on the table in the OR and having a nurse ask after my name and birth date, to which I replied,

“I was born on Roberta X and my name is twenty-eight May, nineteen hundred and…”

She laughed and looked at her clipboard. “Do you know why you’re here today?”

“If it doesn’t say ‘sinus surgery to open up the sphenoid, erthymoid and left maxillary sinuses, with a side of turbinate reduction as needed’ on your form, I think we should lock the doors, order pizza, and hang out for a couple of hours.”

The anesthesiologist thought that would be a good idea, if his snicker was any indication, but alas, the fancy anatomical Latin was what it said on the form the nurse was holding, so it was too late to change plans, and besides, the ENT surgeon was on her way and we’d never have got the doors locked in time. And you know surgeons — she probably would have wanted anchovies or blue cheese or something. Might as well get operated on instead.

“No anchovies? You’ve got the wrong man. I spell my name DANGER.”

Wut?

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