This blog features information about the political campaign nationally and in the state of Pennsylvania. it will discuss congressional races western PA, but it won't restrict comments to those jurisdictions. On many occasions, it will feature humor, but its main purpose is to "cut the legs off" political jihad. This is a site for political grown-ups of all ages.

Location: Ambridge, Pennsylvania, United States

I have a Ph.D. from the University of Rochester (English and American Literature). I taught for 10 years at various educational institutions (Univ. of Rochester, my alma mater, College of William and Mary, and University of Georgia, where I was also Asst. Ed. of the Georgia Review. Later, I worked as a speechwriter and "thinker" at various large companies, including Phillips Petroleum, Gulf Oil, Aetna, Merck (consultant), and Eli Lilly (consultant), among many others. I'm a full-time writer and political commentator/analyst. Favorite company: AudioTech Business Books. Favorite female: my wife, Patricia Ann Maloney. Favorite politcal candidate: Diana Lynn Irey (PA's 12th congressional district)

Monday, January 08, 2007

Avandia(R) & Lipitor(R): How I Cut Health Care Costs by $4 Billion

Did I really cut American health care costs by a whopping $4 billion? Nope.

Could I suggest a very practical way of doing just that? Yep, absolutely, and I'll do so in this column.

Note that I'm not a medical doctor, and I can't offer advice on which particular medicine you should be taking. All I can do is suggest that you talk in an informed way to your own doctor about what products make medical and economic sense for you.

The cost of health care is wildly out of control, and the pharmaceutical industry is one of the causes. Doctors prescribe -- and patients and/or their insurers pay for -- various drugs that provide few, if any, benefits over much lower-priced alternatives.

Spending more than necessary on health care has some very bad consequences. It raises the cost of health insurance and limits the number of dollars that you can spend on other needs.

I learned this in a very personal way when I was taking Avandia, a medication to treat Type 2 ("adult onset") diabetes by lowering glucose (blood-sugar) counts. My monthly cost for 30 days of 8 mg. Avandia was just over $168.00, and I took it for about 9 months.

Doing that used up my insurance coverage under Medicare Plan D. That meant I soon had to pay out-of-pocket for my drugs, including Avandia.

When I moved to Ambridge, PA, my new doctor -- the wonderful Kathleen Osten -- suggested I try an older diabetes drug, Metformin (the generic name for Glucophage). Metformin worked very well, and I've been taking it for several months.

Its cost isn't $168.00 monthly, but rather $8.00. At Wal-Mart, the current cost for Metformin is $4.00. Lucky me.

But, you might ask, isn't Avandia a much better drug? Its manufacturer, GlaxoSmithKline, would certainly claim Avandia is far superior. At a retail cost 20-times as much as Metformin, Avandia should be an amazing medication, but it's not.

The layperson's version of the The Physician's Desk Reference indicates that people with Type 2 diabetes AND kidney problems should choose Avandia and not choose Metformin. However, what about people who have Type 2 diabetes but don't have kidney difficulties?

Here's what a major clinical study told doctors to say about Avandia compared with Metformin and Glyburide (another low-cost diabetes med): "Explain to patients who ask that this study found that the oral antidiabetes drug Avandia (rosiglitazone) was better than either Glucophage (metformin) or Diabeta (glyburide) at delaying time to failure of monotherapy [use of one drug alone] in patients with type 2 diabetes. Explain that Avandia is more expensive than either Glucophage or Diabeta, and that Avandia is associated with higher risk for weight gain, fluid retention, and congestive heart failure than the other drugs."

Also, Dr. David M. Nathan, M.D., of Harvard and director the Diabetes Center at Massachusetts General Hospital, said in the New England Journal of Medicine (NEJM) that the seeming advantages of Avandia in the study were "of questionable clinical significance." He added, ". . . [M]etformin remains the logical choice when initiating pharmacotherapy for type 2 diabetes."

You can read more about the Avandia study, Dr. Nathan, and the NEJM piece at

Essentially, the study suggests that many people on expensive Avandia could do equally well on low-cost Metformin or Glyburide. The worldwide sales of Avandia drug exceed $1.3 billion, roughly two-thirds of those revenues coming from diabetes-ridden America.

If half the Americans on Avandia switched to Metformin or Glyburide, the savings would approach $400 million per year in the U.S. It should happen, but it probably won't.

The maker of Avandia touts the drug relentlessly. It certainly won't emphasize the negative results of the recent study or the insights of an expert like Dr. Nathan. Instead, GlaxoSmithKline will continue peddling its over-priced drug and a depressingly high number of doctors will continue prescribing it.

The human assumption -- and doctors are of course very human -- is that if something costs more, it must be better. Granted, in health care, you might cure a headache with $50,000 worth of brain surgery, but it's probably best to try first aspirin or Tylenol priced at about five cents.

Granted, some patients -- especially those with kidney disorders -- should continue taking Avandia (or its even more expensive alternative, Actos). But many of those buying Avandia aren't significantly benefiting from it, and their purchases are adding unnecessary costs to the health care system.

Where's the other $3.6 billion in health care savings that I mentioned earlier? It comes from weaning millions of American away from the world's largest selling medication, Lipitor, an anti-cholesterol drug produced (and expensively promoted) by Pfizer. I'll deal with it tomorrow


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