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Medical Forum / General / Cardiology / October 2004Niacin and cholesterol
<an open letter to the Wall Street Journal> Letters Editor, The Wall Street Journal 26 October, 2004 Dear Editor: I should like to turn Dr. Kross' argument (Letters to the Editor, 26 Oct) back on himself, in that recommendations like his also contribute to rising health-care costs. His notion that statin drugs are a "cheap" way to lower one's LDLs is fine for keeping certain profits high, but is not so good for the consumer. On the approval of an open-minded MD, I started taking 1500 mg/day of plain, cheap nicotinic acid, a.k.a. niacin or vitamin B3. Ninety days later, I had lowered my total cholesterol to 172 from 244, and my LDL cholesterol to 84 from 178, all for about 15 cents a day. Those levels are actually a bit low, and have since backed off the niacin to 1000 mg/day. Instead of inspiring terror in pharmaceutical companies and orthodox medicine, I would suggest that such success stories as mine be taken as a strong hint to rethink market strategies and look for profit streams elsewhere. The groundswell of well-informed patients and nutritional medicine's coming of age are going to shut down certain market segments whether the current players like it or not. <signed, etc...> NB comparison: based on survey of Canadian-pharmacy and mail-order vitamin suppliers: daily dose of Lipitor: $1.40-2.00 per day, depending on strength, say 10-40 mg/day daily dose of nicotinic acid: $0.11-0.16 per day, 1000-1500 mg/day <do the math, folks. Apologise for the crossposts Hello Alexs Thank you for taking the time both to write this letter and to post it here. I agree with your point of view and hope to see more such posts from you. Niacin is not generally used for those with normal triglycerides and there are others who should not use it, or would have difficulty using it and would require careful monitoring. Listed here are contraindications and cautions for niacin use: http://www.pdrhealth.com/drug_info/nmdrugprofiles/nutsupdrugs/nia_0184.shtml Zee > <an open letter to the Wall Street Journal> > [quoted text clipped - 28 lines] > > <do the math, folks. Apologise for the crossposts> Good post! I too have had very good results with niacin. It only costs about 7 cents per day for 3000 mg (purchased in bulk at CostCo). FWIW, the current issue of the New Yorker (Oct. 25th) has an article about prescription drug costs. The main conclusion of the article is that the rising overall costs of prescription drugs are not caused so much by increasing costs of the drugs, as by the increasing volumes of prescriptions. Simply put, more people are being prescribed more drugs than ever before. We're a nation of pill-poppers, and somebody has to pay the bills. We also are influenced by the advertising, so folks with heartburn whose primary problem is that they eat too much sh*t every day go to their doctor and ask for a prescription for Nexium, because they saw it advertised on TV. Of course, they could just eat a better diet, which would cost $0. Failing that, they could get a prescription for generic Prilosec (very inexpensive). But, no...they saw it on TV and the doc will prescribe it, and the insurance company will pay for it. And then they whine when their co-pays go up. And yet, we think of ourselves as a nation of self-sufficient, rugged individuals (LOL). GG >We also are influenced by the advertising, so folks with heartburn whose >primary problem is that they eat too much sh*t every day go to their doctor [quoted text clipped - 5 lines] >yet, we think of ourselves as a nation of self-sufficient, rugged >individuals (LOL). I have battled GERD for years. Prilosec was the only durg that worked for me--I tried Pepcid, Zantac, etc.. I used to get Prilosec by Rx, and was pleased when it went OTC. My doctor prescribed another drug in that same class--but it didn't work for me. So I went back to taking Prilosec daily. When I went for a visit to the doctor last week, he said he didn't think that he could write me a Rx for Prilosec. I told him not to bother, as it only costs about $20.00 per month OTC. He told me that if Prilosec works, just keep taking it.... Mark > >We also are influenced by the advertising, so folks with heartburn whose > >primary problem is that they eat too much sh*t every day go to their doctor [quoted text clipped - 18 lines] > > Mark Sounds like Prilosec is working well for you...that's good. Unfortunately, too many people are being duped into taking the virtually identical Nexium because it is heavily advertised. It costs around $120/month. And folks wonder why their health insurance costs are going up... GG Damn yer good! > <an open letter to the Wall Street Journal> > [quoted text clipped - 28 lines] > > <do the math, folks. Apologise for the crossposts> That's great but diet is tried first in controlling cholesterol levels and then meds are usually tried. In my case the next thing my doctor tried was niacin. I had severe headaches and could not tolerate it almost immediately. I tried many different statins but could not tolerate GI side effects of most until I came across Baycol. I was on it for about a year until it was pulled from the market and was forced to try other statins and again having trouble finding one I could tolerate. I finely found Altoprey AKA Lescol. It is expensive but as some people here say that all copycat drugs are the same is BS. My stomach can tell the difference. In my case the cost of the medicine had nothing to do we what I could tolerate and work with. If the drug costs a $1000 dollars a pill and it upsets my stomach then I would not take it. If a pill costs cents and it doesn't give me bad side effects and it works then I would take it. > <an open letter to the Wall Street Journal> > [quoted text clipped - 36 lines] > > <do the math, folks. Apologise for the crossposts> On my health care plan my statin, Pravachol, cost me $0.11 per day. OK. I did the math. Now what? L. > > <an open letter to the Wall Street Journal> > > [quoted text clipped - 40 lines] > > OK. I did the math. Now what? As you are surely aware, your Pravachol costs much more than $0.11 per day. Your employer and/or insurer are subsidizing the true costs (and people wonder why their health insurance costs keep going up). As a famous economist once said, "There's no such thing as a Free Lunch". GG "As you are surely aware, your Pravachol costs much more than $0.11 per day. Your employer and/or insurer are subsidizing the true costs (and people wonder why their health insurance costs keep going up). As a famous economist once said, "There's no such thing as a Free Lunch"." Insurance, when correctly done, is a bet that the sum of the customer's claims will not exceed what they charge. This is not a subsity but a pooling of risk. For each claim there are x people without claims. An employer may pick up the customer's side of the bet,ie. that their claims will exceed what they pay to be in the pool, or as is now so common the cost of the bet is split between the two. All do subsidise poor folk who can not afford to enter the betting pool. > "As you are surely aware, your Pravachol costs much more than $0.11 per > day. [quoted text clipped - 10 lines] > cost of the bet is split between the two. All do subsidise poor folk who > can not afford to enter the betting pool. big box pharmacy: no coverage. nicotinic acid...500/3.....one month.....$ 5.37 pravastatin......20mg......one month.....$40.91 generic rosuvastatin.....20mg......one month.....$63.25 atorvastatin.....20mg......one month.....$75.45 simvastatin......20mg......one month.....$48.76 Zee > "As you are surely aware, your Pravachol costs much more than $0.11 per > day. [quoted text clipped - 10 lines] > cost of the bet is split between the two. All do subsidise poor folk who > can not afford to enter the betting pool. The problem is, we've become a nation of pill-poppers. The overall rate of prescriptions is going up every year. This means the insurance companies are having to pay more and more, thus forcing them to increase their rates. Unfortunately, with the current plan, there is no incentive for folks to choose less expensive options for health care...if the $120/month Nexium "costs" me the same $10 co-pay as the $20/month Prilosec, why would I choose the less expensive one? GG > The overall rate of > prescriptions is going up every year. This means the insurance companies [quoted text clipped - 3 lines] > "costs" me the same $10 co-pay as the $20/month Prilosec, why would I choose > the less expensive one? Well you answered your own question in the first part of your comment. The costs to insurance companies keep going up. They don't want to lose out on any profit. They raise rates to maintain income. In a year or two you or your employer pay higher premiums because folks think they're getting something for next to nothing. There is incentive, it's just not well recognized.  Signature"To know the world intimately is the beginning of caring." -- Ann Hayman Zwinger The answer using your example would be: to split the savings of using generic drugs with the consumer and ultimate payer. If Nexium cost insurance $120/month less 10 bucks that is $110 a month for the company to pay. Prilosec cost insurance $20/ month less 10 bucks or only ten dollars a month. If everyone uses Prilosec instead of Nexium will the insurance companies cut their prices because their expenses are less? Not likely Why not give the patient that takes Prilosec a cash rebate of fifty dollars each month for taking the inexpensive drug? Its no crazier than paying for Nexium if Prilosec works just as well. You might ban advertising of brand name medications as they are detrimental to the nations' health due to excessive cost. How many so-called wonder drugs are only wonderful because of the huge sums spent in advertising them to consumers and the gullible medical profession. . > The problem is, we've become a nation of pill-poppers. The overall rate of > prescriptions is going up every year. This means the insurance companies [quoted text clipped - 5 lines] > > GG >The answer using your example would be: to split the savings of using >generic drugs with the consumer and ultimate payer. If Nexium cost [quoted text clipped - 5 lines] >month for taking the inexpensive drug? Its no crazier than paying for >Nexium if Prilosec works just as well. Insurance companies are already steering consumers to take less expensive Rx drugs or go the OTC route. My plan covers 30 days worth of: Generics $10.00 Co-pay Brand Name $25.00 Co-pay Non-Formulary $50.00 Co-pay Prilosec is OTC, so no coverage at all. Nexium is a Non-Formulary, which requires prior approval by the insurance company before coverage. Then if they approve (which requires proof that other formulary drugs didn't work), they require periodic progress reports from the physician to get refills. 25 years ago, national magazines had alcohol and cigarette ads on every other page. Now there are ads for Rx drugs on those same pages. All those advertising dollars have to be recouped by the drug companies. Mark >"As you are surely aware, your Pravachol costs much more than $0.11 per >day. [quoted text clipped - 10 lines] >cost of the bet is split between the two. All do subsidise poor folk who >can not afford to enter the betting pool. Thanks Mark. That's a good way of looking at it, and justifies why I don't like insurance companies. They are just gamblers! :-) I take very good care of my property and have little cause to worry about it, so I refuse to pay the inflated premiums to cover folk who wander about in a daze leaving their property vulnerable to all sorts of risks. I know a professional "insurer" who had everything covered to the hilt and whenever he needed a newer and advanced model of something, he arranged a fire/accident/burglary and has profited handsomely from his many insurance escapades. He had a broker who chased around to find cover for him from the dwindling pool of companies who would look at him , until the broker ran out of options and dumped him. He now goes uninsured :-) No thanks! All pharmacy computer programs should tell the patient the real retail cash price of the prescription that they purchase. Most often only the patient's co-pay Rx price is printed on his receipt. No wonder they think a three hundred dollar Rx only costs twenty dollars! But everyone knows that a Rolex or a BMW cost a lot of money. > All pharmacy computer programs should tell the patient the real retail cash > price of the prescription that they purchase. Most often only the patient's > co-pay Rx price is printed on his receipt. No wonder they think a three > hundred dollar Rx only costs twenty dollars! But everyone knows that a Rolex > or a BMW cost a lot of money. Some how when government provides it for "free" that way of looking at it is lost. >> All pharmacy computer programs should tell the patient the real retail >cash [quoted text clipped - 7 lines] >Some how when government provides it for "free" that way of looking at it is >lost. Agree, which is why they have the full price printed on every drug prescribed in Australia. >All pharmacy computer programs should tell the patient the real retail cash >price of the prescription that they purchase. Most often only the patient's >co-pay Rx price is printed on his receipt. No wonder they think a three >hundred dollar Rx only costs twenty dollars! But everyone knows that a Rolex >or a BMW cost a lot of money. Every box of med prescribed here has the full price on the pharmacict's label |
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