Archive for Ease and Disease

Gouge potatoes

What we’re looking at here:

Insulin aspart was approved for medical use in the United States in 2000. In the United Kingdom it costs the NHS about £ 1.89 per 100 units as of 2019. In the United States the wholesale cost of this amount is about 30 USD. In 2016 it was the 87th most prescribed medication in the United States with more than 8 million prescriptions. Manufacturing involves yeast, which have had the gene for insulin aspart put into their genome. These yeast than make the insulin, which is harvested from the bioreactor.

The most recent NADAC says $35 or so, if they can get it for you wholesale. Which, of course, they can’t:

Senate Bill 1019 would permit a pharmacist to dispense this stuff without a prescription in case of emergency; I’m not quite sure how this is going to affect routine refills, but the bill has arrived at the House after passing the Senate 46-0.

(With thanks to Dan Lovejoy.)

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Gratuitous gratuity

More than just a mere tip:

The family got together for lunch on Saturday at The Imperial restaurant in downtown Portland. With a name like that, and the fact that they take reservations, I was a afraid it might be expensive, but it wasn’t too awful. $150 for six, with coffee, no alcohol. Because there were six of us, the bill included the tip. It also contained a 3% wellness charge. I have no idea where that came from.

I was curious enough to try to track that down, and:

From the DOC restaurant menu: A 3% health and wellness charge will be added to each check to provide health insurance and living wages for all our staff. Thank you!

Which, I suppose, might be preferable to just jacking up the price and not explaining why. Judging by the comments on that second link, though, a lot of people would prefer the jackage.

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This spud’s for you

I hadn’t heard this before:

Truth be told, I’m not entirely sure I’m hearing it now.

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Tons of money, stat

So why is it that we spend more on health care than pretty much everyone else on the planet? One theory:

Perhaps because we think we like to think we are sick and we like spending money on doctors and lab work and drugs. Perhaps because we are willing to spend the money and the medical establishment is willing to take it. In any case, I suspect it’s just our mindset: charge on until we are stopped, and then bust down the barricade and charge on some more… Crazy people run up bigger medical bills, and we Americans might be the craziest of all.

I dunno, but I suspect most of our health care dollars are spent on old people, and a lot of that is spent on people who are not even mentally with us anymore. It is easy to foist unnecessary treatments on people who are barely aware of what’s going on. But hey, Medicare will pay for it, so it gets done.

Certainly the medical establishment doesn’t go out of its way to keep from taking our money.

And then I look at the doctor’s office, which includes three actual medical personnel and four people who push paper, and I am no longer surprised.

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What is Stage Four?

“The thing to note about Stage Four,” said Christopher Hitchens, “is that there is no Stage Five.”

Alex Trebek, host of Jeopardy! v2.0 since its debut in 1984 (Art Fleming did the 1.0 version through the 1960s and 1970s), isn’t going to let Stage Four get him down:

“Now, just like 50,000 other people in the United States each year, this week I was diagnosed with Stage 4 pancreatic cancer,” he said. “Now normally, the prognosis for this is not very encouraging, but I’m going to fight this, and I’m going to keep working.

“And with the love and support of my family and friends and with the help of your prayers, also, I plan to beat the low survival rate statistics for this disease,” he said.

He then joked that he has to keep working due to contractual obligations.

“Truth told, I have to! Because under the terms of my contract, I have to host Jeopardy! for three more years! So help me. Keep the faith and we’ll win. We’ll get it done.”

It’s hard to imagine Trebek not working. For that matter, it’s hard for Trebek to imagine Trebek not working:

In 2018, while being interviewed by Harvey Levin on Fox News, Trebek floated the idea of retirement, saying the odds of him leaving Jeopardy! in 2020 were 50/50 “and a little less”. He added that he might continue if he is “not making too many mistakes” but would make an “intelligent decision” as to when he should give up the emcee role. However, in October that year, he signed a new contract to continue as host through 2022.

He’d had a few health issues before, but heck, the man is 78 years old. In the meantime, I’m guessing he’ll take Thoughts and Prayers for $1000.

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Harshing your melanoma

A drug that seems to work against skin cancer? As Glenn Reynolds would say, “Faster, please”:

For people with the deadly skin cancer melanoma, one dose of the drug Keytruda before surgery might stop the cancer in its tracks, according to a groundbreaking new study.

Keytruda (pembrolizumab) is a PD-1 inhibitor, an immunotherapy drug that triggers the body’s immune response to attack cancer cells. According to results of this study, the drug’s effects peak as early as seven days after treatment — much earlier than previously seen in other studies.

It even works on politicians:

Keytruda is the drug responsible for the remission of former President Jimmy Carter’s cancer in 2015. Carter, then 90, had melanoma that spread to his brain and liver. Treatment with Keytruda appears to have cured him.

And don’t ask the price:

The drug isn’t cheap, costing about $150,000 a year. Keytruda is covered by most insurance, including Medicare, but copays can be high, according to the Kaiser Family Foundation.

The surgical option, though, isn’t likely to be any less expensive.

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You got a lot of nerves

To me, the amazing thing about hand transplants is not that they work fairly well, but that they work at all: all those nerves have to be positioned just so. Anyone whose nerves have gone to hell will recognize this pattern:

When I read about these things, it takes me back to the decade in which I had nerve injuries in both my arms and suffered constant and often substantial neuropathic pain (I’ve described it here and elsewhere). I’m not comparing myself to these patients (thank goodness). Nevertheless, I have had a fairly lengthy experience of nerve injury, and then a lengthy convalescence (a couple of years, actually) and rehab from nerve surgery, and am well aware of the dangers and difficulties inherent in rehabbing any nerve problem. Hand transplants involve a great deal more, of course. But they also involve the reconnection and growth of many nerves, and that takes a long long time.

In particular, the article recalled a dream I had a night or two after surgery on my right arm. I dreamed that my arm had been amputated and I’d been given another arm that was attached at the shoulder with clumsy, Frankensteinish stitches. At the time, my right arm was essentially unusable, and in tremendous pain. The rehab ended up being fraught with problems — I changed physical therapists about four times before I found one who knew how to help me — and my recovery took two to three years. It’s been about twenty years and I’m now about 85% to 90% better than I was before the surgery, which is practically miraculous and for which I’m very grateful. But a person doesn’t forget an experience like that.

Two and a half years following all that spinal stuff, I have to wonder if “recovery” means anything in my case. Pain has been mostly quieted, and I am grateful for that, but I still can’t walk more than a couple of steps. Since I tend to be a bit wobbly when standing still, I’m thinking that somewhere along the way I misplaced my equilibrium. At least I don’t dream about it.

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Adjusted for inflation?

Bernie is Not Pleased:

U.S. Senator Bernie Sanders sent a letter to Catalyst Pharmaceuticals on Monday asking it to justify its decision to charge $375,000 annually for a medication that for years has been available to patients for free.

The drug, Firdapse, is used to treat Lambert-Eaton Myasthenic Syndrome (LEMS), a rare neuromuscular disorder, according to the letter, made available to Reuters by the senator’s office. The disorder affects about one in 100,000 people in the United States.

The government is intensifying its scrutiny of the pharmaceutical industry and rising prescription drug prices, a top voter concern and a priority of President Donald Trump’s administration.

That word “free” actually means something in this case:

In the 1990s, doctors in the US, on behalf of Muscular Dystrophy Association, approached a small family-owned manufacturer of active pharmaceutical ingredients in New Jersey, Jacobus Pharmaceuticals, about manufacturing amifampridine [the generic name] so they could test it in clinical trials. Jacobus did so, and when the treatment turned out to be effective, Jacobus and the doctors were faced with a choice — invest in clinical trials to get FDA approval or give the drug away for free under a compassionate use program. Jacobus elected to give the drug away, and did so for about twenty years.

But that compassion stuff buys no yachts:

Catalyst anticipated that it could earn $300 to $900 million per year in sales for treatment of people with LEMS and other indications, and analysts anticipated the drug would be priced at around $100,000 in the US.

Fooled you, analysts.

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Fark blurb of the week

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Also, the clappers were clean

This I hadn’t heard of, but it seems to make sense:

Something Sentara Hospital has done is switch over as much as possible to copper-infused materials. Copper is naturally anti-bacterial, so this is just another weapon in the fight against in-house infections. There are fliers and signs and notices everywhere about it, explaining why the linens, towels and rags are all the color of chocolate milk. Even the tabletop of my bedside table was copper infused.

I noticed though (and it took me until the second night there to nail it down) that when I was laying in bed with my CPAP machine on, that there was a very faint odor. I finally realized that because of the copper, I constantly smelled just a whiff of blood. After three days I hadn’t gotten used to it.

A TV news report from that area:

Results published within The Journal of Hospital Infection shows results that Cupron infused copper in patient gowns, pillowcases, fitted and flat sheets, washcloths, bath towels, bath blankets and thermal blankets has helped drop infection rates at six Sentara hospitals in the Hampton Roads and North Carolina area.

The study published in November 2018 says that using the products by Cupron — a copper-based antimicrobial technology company — has significantly reduced occurrences of Clostridium difficile (C. diff) infections and infections caused by multi-drug resistant organisms (MDROs), including MRSA and VRE.

Impressive. And in the long run, I’d guess, possibly less expensive than the usual topical treatments.

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Don’t ever get sick

To misappropriate a line from J. B. S. Haldane, it’s not only more expensive than we imagine, it’s more expensive than we can imagine.

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A late arrival, one might say

A few days back, I wasted some time and space on the delusion held by some men to the effect that they think their junk is about to disappear. But weirder things than this actually happen:

Some children with a rare genetic condition appear female at birth but later develop a penis and testes around the time puberty begins. But what causes this to happen?

An article in BBC Magazine tells the story of some children in the Dominican Republic with this condition, who are known in the country as Guevedoces, which roughly translates to “penis at 12.” One child named Johnny was raised as a girl, but when he matured and neared puberty, he grew a penis and his testicles descended, according to the BBC.

Felicita apparently looked like any other girl until puberty kicked in. Enter Johnny.

Are these, then, trans men? After all, they were identified as female at birth. And I wonder if any of them decided, even after Mr. Johnson arrived, to continue to live as the girls they thought they were.

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This is not for you

There are wrong prescriptions, and there are really wrong prescriptions:

I’ve been prescribed a medication that isn’t covered (at all) by my medical insurance. Since it costs close to $1,500 per month at normal retail prices, there’s no way I can afford it; so the doctor who prescribed it signed me up with a specialty pharmacy, to see whether I qualified for a reduced price.

A few minutes ago I received a phone call from the pharmacy to confirm the information the doctor’s office had provided to them. All went well until, at the end of the call, the nice lady on the other end of the phone said, “You’ll be receiving your first prescription of (Drug X) next week.”

I hesitated, then said, “What medication was that, please?”

“(Drug X).”

“Er … I don’t recognize that name. Don’t you mean (Drug Y)?”

A brief pause, some background noises, and:

“You’re quite right; it should be (Drug Y). I’m afraid I mixed up your file with someone else’s. I’m sorry. I’ll correct it.”

I said, “Thank you – but what was the drug you were going to send me?”

With a quiver in her voice, she said, “It was hormone replacement therapy, to treat the menopause.”

Oops.

And now I feel sorry for those who actually need this drug and get to peel off eighteen grand a year for it.

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Excessive whiteness

It’s a tough life for an albino in Africa:

Albinism is a rare, hereditary condition that leads to a lack of pigmentation in the hair, skin and eyes. Without melanin in their skin, those with albinism are more vulnerable to the damaging effects of the sun.

In Africa, albinism is associated with many negative misconceptions and superstitions. As a result, many albinos suffer stigma, alienation and even physical abuse.

There’s no known cure, but at least the misconceptions and superstitions are being addressed:

The Albinism Society of Kenya have held a Mr and Miss Albinism beauty pageant in Nairobi to support those with the hereditary condition.

The pageant, called “Accept me, include me, I can,” included participants from Kenya, Tanzania and Uganda, and aimed to boost the confidence of young people with albinism.

And the winners are:

Emmanuel Silas Shedrack, 20, from Tanzania and Maryanne Muigai, 19, from Kenya were crowned the winners.

There were thirty contestants in all.

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This seems stressful

Rather a lot of us suffer from high blood pressure, and stories like this don’t make us feel any better:

For the third time in recent weeks, a blood pressure medication has been recalled because it may have been contaminated with an agent linked to cancer.

Sandoz, a generic pharmaceutical company that’s a division of the Novartis Group, said it’s voluntarily recalled losartan potassium hydrochlorothiazide tablets because the pills could contain the impurity N-nitrosodiethylamine (NDEA).

Sandoz said the tablets are manufactured by Lek Pharmaceuticals in Slovenia and the impurity found is a probable carcinogen. However, it said, no issues have been reported concerning the affected tablets.

How times have changed. If you’re around my age, you may remember Sandoz as the developer of LSD, which was first marketed as a treatment for various mental ailments in 1947 under the name “Delysid.” Timothy Leary, at Harvard in the 1960s, began promoting the stuff for, um, nonprescription use. (Eric Burdon’s New Animals dropped a tune called “A Girl Named Sandoz” on the B-side of “When I Was Young”; it fooled no one.)

As it happens, this is the antihypertensive I take, though the stock I have on the shelf did not originate with Sandoz or its suppliers.

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Steps must be taken

The electorate wants things that look like solutions, even when they aren’t:

You might laugh but I remember the 1982 Tylenol thing and that is now why we’re all condemned, when we need a painkiller or OTC antihistamine out of a new box, to have to:

1. Pry the heavily-glued-shut box open

2. Remove the silly plastic “sleeve” that has been heat-shrunk onto the cap and neck of the bottle, and fewer of them have convenient tear-strips than they should. (“A pair of scissors, my kingdom for a pair of scissors” she cries, while searching the house mid-headache)

3. Punch through a “sealed for your protection” (the fig-leaf they put on foods is “sealed for freshness”) foil or foam capper

4. Dig out the cotton that’s stuffed in there, I presume to either keep the pills from breaking or to serve as a bit of a desiccant

All of this because an employee in the company poisoned some capsules … in which case all those things would not have prevented it.

Add several more steps if your remedy of choice has even the slightest resemblance to methamphetamine.

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What could be crueler?

Selma Blair, picture of youth. I first saw her as Cecile in Cruel Intentions, circa 1999; I realize that this was 19 years ago, and she was already 27 then, but the numbers inside my head don’t add up.

Selma Blair, sitting in the back seat

Selma Blair, taking a swim

Selma Blair, modeling something or other

But then there’s this:

https://www.instagram.com/p/BpKjP_7FnWQ/?utm_source=ig_web_button_share_sheet

The BBC reminds us:

There is no cure for MS, but treatment can help manage symptoms. This may include painkillers or drugs to reduce nerve inflammation, physical therapy to ease muscle stiffness, or medication to slow the condition’s progression.

Then again, life itself might well be an incurable disease of sorts.

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Hey, hey, we’re the munchies

There is, of course, a solution:

In case of emergency

The North Texas Poison Center is at 800-222-1222. As the sign says, The Pizza Guy is at 972-733-1222. Try not to mix them up.

(From reddit via Miss Cellania.)

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Paws to consider

Seeing yourself deteriorating — and retaining your sense of humor about it — to me seems only slightly short of miraculous:

The Internet is chock-full of cat videos. Among them there is one that gave us a chuckle a few years ago: a sullen cat pushing various objects off a table. And then came a day few weeks ago when I reached for a remote control sitting on the table right next to me. Rather than grabbing it, I pushed it off the table. It was impossible for me to pick it up with my right hand, which is now in a more-or-less permanently clenched fist.

Dee’s observation: You have now officially become a kitty.

We won’t ask him for a video. But:

Alas, she is right. But at least I don’t have to lick myself all over.

And he doesn’t quite sound sullen. (Yet.)

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The lowest form of cuisine

Circle K might not be your first choice for dinner:

No, not even QuikTrip.

Still, the person who’s never had so much as a 7-Elevem Slim Jim has had no opportunity to build up the kind of immunity our well-traveled road warriors count on.

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Miseries past

“Well, it sounds like you’ve been unhappy for a long time.”

“Honey, you have no idea.”

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Everything from here down

“Tell me where it hurts,” says the doctor.

“I think I just did.”

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This shouldn’t be about me

Arlo Guthrie:

“During these hard days and hard weeks, everybody always has it bad once in a while. You know, you have a bad time of it, and you always have a friend who says “Hey man, you ain’t got it that bad. Look at that guy.” And you at that guy, and he’s got it worse than you. And it makes you feel better that there’s somebody that’s got it worse than you.

“But think of the last guy. For one minute, think of the last guy. Nobody’s got it worse than that guy. Nobody in the whole world. That guy… he’s so alone in the world that he doesn’t even have a street to lay in for a truck to run him over. He’s out there with nothin’. Nothin’s happenin’ for that cat.”

There are times when I have to remind myself that I’m not the last guy.

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Trojan horsing around

I mean, it’s not like they’re expensive or anything:

We have entered a sad, sad world of stupidity when the CDC has to issue a warning that one should not wash out a condom and reuse it. I only hope these losers are recycling their own rubbers and not random old ones they found tossed out at the park down by the river.

Maybe this will work:

No, we don’t.

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At least they’re consistent

The story is always the same. Only the locations change:

A Chipotle restaurant in Ohio has reopened as officials investigate reports of illnesses linked to the location.

The Delaware General Health District says it can’t confirm anything until lab tests are back. But Traci Whittaker, a spokeswoman for the health district says it has received dozens of calls from people reporting illnesses since Sunday, with many mentioning they ate at the Chipotle in Powell, Ohio.

I’m betting Jack Baruth is not one of them.

In a statement, Chipotle says it closed the store Monday “out of an abundance of caution” and that it’s cooperating with local health authorities. It said it implemented its food-safety-response protocols, which include replacing the food and a cleaning of the restaurant.

The closure comes as Chipotle Mexican Grill Inc. works to recover from a series of food scares that sent sales plunging.

This quip landed in one of my social-media timelines: “You can’t spell ‘Chipotle’ without E. coli.”

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I could have told you that

You didn’t ask me, of course. Still, it’s good to have corroboration:

Dr. Paul Kelley, a researcher at Oxford University, has scientifically corroborated the claim that nearly every worker to ever live has made: that it sucks to work before 10 AM. In an interview, Kelley said:

“Before the age of 55, the circadian rhythms of adults are completely out of sync with normal nine-to-five working hours, posing a “serious threat’ to performance, mood and mental health.”

I got news for you, Doc: said rhythms don’t necessarily realign themselves at 55.

“Staff are usually sleep deprived.” Kelley asserts. “We’ve got a sleep-deprived society. It is hugely damaging on the body’s systems because you are affecting physical emotional and performance systems in the body. Your liver and your heart have different patterns and you’re asking them to shift two or three hours. This is an international issue. Everybody is suffering and they don’t have to.”

I did fairly well on swing shift (3:30-midnight) in my thirties. Physically, anyway. (Socially, I was douchey.)

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Textile analysis

Anything that begins “What is it with society?” automatically earns the side-eye:

What is it with society? I have a form of vestiphobia according to my psychologist and so many people are not compassionate at all!?

I hate wearing clothing due to my body thermostat being out of wack and I’m allergic to certain kinds of fabric, but people are so uncomfortable being around someone that prefers not to wear anything and this greatly reduces my social life! Obviously in public there are laws that force me to be dressed, but why are people so uncomfortable with letting me be undressed in social situations where the public can’t see? It’s just crazy and not fair.

“Oh, you poor thing. Go ahead and take your clothes off.” — nobody ever.

Those of us who do without clothing when we can learned a long time ago that this was going to reduce our social lives; it’s unreasonable for us to expect that our naked bodies will always be welcomed with open arms. Yes, it would be nice if there was more social acceptance to be had; but it’s an issue we can’t force, and even if we could, we shouldn’t. I’m interpreting “social situations where the public can’t see” as “I answered the door nude, and they threatened to call the police.” And what he might read as “compassion,” I’m thinking might be closer to “Humor him, honey. He might do something drastic.”

There are friends I’ve had for two decades and more who, if they’re coming over, will call first so I have time to throw on something more than a robe. The deal is: they’re still friends. Our alleged vestiphobe would never comprehend such a thing.

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A definite C word

The Local Malcontent minces no words:

I got some sobering news from my various Cancer doctors this morning:

My PSA number has more than doubled since my last Lab work in March, 2018, from 3.61 on March 21, to 7.33 on July 6th.

I had been trying to get the recent results for 4 days, to compare and to chart my PSA’s rate of change. And this news is indeed very disturbing.

It’s not the number itself that’s high, apparently; it’s the rate of increase.

Rather a lot of people on the old blogroll have slid into the Next Life, some of them without much warning. I hate that. Nothing much I can do about it, except appeal to the Almighty, but I’m pretty emphatic about hating it.

(Seen first by McG.)

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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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