patrick.net

Isn't marijuana a gateway drug to sugar (twinkies, Haagen Dasz, etc)?

curious2 says

No it isn't fair to people who are in pain that they are used as hostages with ransom paid to the medical industrial complex. You've been away lately but a big deal in the US now is the mandatory coverage for "preventive care" with no copay which means PhRMA is rolling out new patented contraceptives with hardly any testing, because it's more profitable than the old familiar Pill that went generic years ago; everyone is forced to pay PhRMA for the new patented ones, and the prescribers are coerced into prescribing them, and the patients who take them will discover the currently unknown side effects as they arise. No one ever said the law is fair, except you did just now and really I think it's because of the cognitive dissonance that would result from admitting you profit personally from an unfair law. It's profitable, not fair.

So where exactly in all this ramble is the part where people are "forced" to use on patent meds. Anyone can ask either their doctor or their pharmacist for generics. I do it.

bob2356 says

So where exactly in all this ramble is the part where people are "forced" to use on patent meds. Anyone can ask either their doctor or their pharmacist for generics.

Please read more carefully. Everyone is forced to PAY FOR patent meds. If you don't see how, read it again.

Yes, people who are knowledgeable can ask permission to buy something cheaper, and some doctors will grant that permission when requested. But, doctors are on a treadmill, caught between PhRMA, CME, and insurance; they need to prescribe profitably. They can easily think of reasons why a particular patient should have the patent drug, reciting claims presented in CME or touted by drug industry reps that visit the doctor's office, and it takes a rather confident patient to argue in that situation. In particular, the less educated patients are in a much weaker position. This may be one reason why education is the best predictor of longevity, not money and certainly not medical insurance.

As for asking the pharmacist, that usually doesn't work. In some states, if the doctor has allowed generic substitution, you can get a generic "equivalent" with the same active ingredient, if the pharmacy has one. (These may not actually be equivalent, and you are not allowed to compare generic manufacturers the way you can with OTC drugs.) You are never allowed to substitute a similar Rx drug with a different active ingredient the way you can with OTC drugs. For example, if you're shopping for OTC analgesics, you can choose freely among different active ingredients and multiple brands of each. You definitely can't do that with Rx analgesics. The discrepancy is part of why Americans, who pay the lowest prices in the world for OTC drugs, pay the highest prices in the world for Rx drugs. Again, the key to understanding the persistence of the system is to recognize that it's profitable, not fair.

freak80 says

sugar is addictive.

Definitely. Interestingly, even artificial sweeteners can set off a similar chain of events, with the consequence that people who switch to "diet" soda don't lose weight.

freak80 says

I ended up in the ER with a panic attack after starting out with Prozac.

Prescription drugs are a leading cause of emergency hospitalizations, in some age groups #1. That's part of why RomneyCare led to a 30% increase in emergency hospitalizations, after supporters promised that "preventive care" would lead to fewer. ("Preventive" CT scans in asymptomatic patients will lead to more hospitalizations, for cancer, but those will take longer to show up.) Funny how boosters of ObamneyCare recycled the same claim to advocate the same plan nationally, and the semi-"smart" people who trust commercial news (where literally a majority of the ads come from PhRMA) fell for it again. One might think the industry would need to come up with new lies at least to sell the same policy, but no, with enough lobbying $ they can get politicians to echo the same lies over and over again. The main difference between Rx drugs and illegal drugs is, Rx drugs are backed by a powerful "legitimate" industry that shares the "legitimate" $ with lobbyists and politicians, while illegal drugs are backed by a powerful illegal industry that launders its $ through money-center banks that share their "legitimate" $ with lobbyists and politicians. They are different categories, with the markups finding their way back to the politicians via different routes, but safety and efficacy are not really related to the political and financial categorization.

Wow! They like me! Right now, they really like me!!!

It's just division: dislikes / likes

That's all there is to it. Not very useful really, except as a kind of measure of how much people like your comments.

curious2 says

Please read more carefully. Everyone is forced to PAY FOR patent meds. If you don't see how, read it again.

I read it again, I don't see it the first time, I still don't see it. Most people are already covered for contraceptives. Look it up, almost all employer insurance plans already cover contraception. Why would everyone suddenly change their contraception? Doesn't make sense. Trust me, doctors truly don't give a shit whether someone uses the pill or norplant or burning incense with chanting for contraception. The other seven items of affordable health care act womens preventative care don't involve drugs at all so they have no relevance.

curious2 says

Yes, people who are knowledgeable can ask permission to buy something cheaper, and some doctors will grant that permission when requested. But, doctors are on a treadmill, caught between PhRMA, CME, and insurance; they need to prescribe profitably.

Not any doctors I know. My wife the doctor is very curious how all this works. . So please give us the benefit of your extensive inside knowledge of how medical practices work. A couple free drug samples (that she and most doctors give to patients that they know have a hard time paying for meds) and the every other month rubber chicken dinner with power point presentation isn't exactly being in bondage to big pharma. She has never seen on patent drugs discussed at a CME course. She has never had an insurance company ask about prescriptions. Never, not once. She's spent years in practice and running her practice. I have spent years doing medical billing and medical practice management software for doctors offices, Neither of us has a clue what you are talking about when you say prescribe profitably. Enlighten us, starting with some type of description of your vast experience working day to day in the medical field.

No matter what she prescribes, on or off patent, there is zero affect on my wife's income from prescription drugs. So cognitive dissonance is not in play here. Nice try, but it ain't so joe.

bob2356 says

No matter what she prescribes, on or off patent, there is zero affect on my wife's income from prescription drugs.

People are under the impression that MD's make $$$$ from prescribing, which would be wonderful if it could happen. Then every MD would be outrageously wealthy and wouldn't have to worry about dumb stuff like ethics & sick people...

There are some MD's who participate in research and receive grants from big pharma, but imho most don't. So far as Bob's comment that samples are normally given out to people who can't afford, big pharma is giving out smaller amounts of samples for the normal stuff any more. They try to push the more expensive meds, so MD's don't have as much in their drug closet as they used to . It sucks.

The issue with the healthcare law is morals. Women are supposed to be demure little creatures who don't outwardly display their desire for sex (but are tigers in bed with the man that owns them), and should pop out babies like a pez dispenser.

Of course, if the man is gone or can't afford to pay for all of them thar babies, that's not our problem either. We need to cut back on welfare programs so that these "victims who are reliant on government handouts" can go out and get a fucking job. Leave the kids at home to watch each other, I guess.

I like that this conversation all started when I said I like to smoke weed.#120
Notice the tone here overall has become a bit more "mellow" than usual with out the usual "harsh" back and forth.

elliemae says

Women are supposed to be demure little creatures who don't outwardly display their desire for sex (but are tigers in bed with the man that owns them), and should pop out babies like a pez dispenser.

Ellie, I do not look at women that way.

thats cause your a 'freak'....

freak80 says

elliemae says

Women are supposed to be demure little creatures who don't outwardly display their desire for sex (but are tigers in bed with the man that owns them), and should pop out babies like a pez dispenser.

Ellie, I do not look at women that way.

SoftShell says

thats cause your a 'freak'....

I'm a Super Freak, Super Freak, I'm Super Freaky, YEAH!

bob2356 says

Not any doctors I know.

You can read more on ProPublica and even check some names if you like:

Dollars for Docs

Promotion of Prescription Drugs Through Payments and Gifts [including valuable trips and prizes, according to the Office of the Inspector General at HHS]

Lawsuits Say Pharma Illegally Paid Doctors to Push Their Drugs

drug companies pay $7 billion fines over illegal marketing [a fraction of what they made from it btw]

"Drug makers spent about $6.3 billion on marketing visits to doctors in 2009, the last year that such figures were available, according to IMS Health... [S]ome federal regulators and medical societies argue that drug makers are simply mining the data to identify and go after the doctors who would be most likely to prescribe the latest, most expensive brand-name medicines — driving up health care costs and exposing patients to newer drugs whose side effects may not yet be fully known."

After Sanctions, Doctors Get Drug Company Pay

This pattern has been so widely reported for so long that I wonder how long it's been since you've been in this country.

bob2356 says

Why would everyone suddenly change their contraception?

Why do you think PhRMA spends so much on DTC advertising? The #1 complaint of general practitioners is patients lying to get prescriptions for drugs they saw on TV but that would be bad for them. If they are "preventive" (i.e. mandatory with no copay) then everybody has to pay for the "free" drugs. Even if established patients stick to the old products, every year millions of new patients enter a market where everything is "new and improved."

And then you have the "preventive care" full body CT scans for asymptomatic patients:

"What's new is that CT is being marketed as a preventive or proactive health care measure to healthy individuals who have no symptoms of disease. [There are] No Proven Benefits for Healthy People."

As a friend put it, it's an investment in future patients. Cancer patients.

Call it Crazy says

What if you did it comparing "likes" versus total posts... wouldn't that give you a ratio on how much the poster's overall comments are "liked"?

Yes, if I did it starting from the time I instituted the "like" thing. The forum existed for years before that, so those earlier comments shouldn't count I guess.

APOCALYPSEFUCK is Shostakovich | 23.5593

Ergo, Apocalypsefuck is both troll and anti-troll. If he ever encounters himself, he will annihilate himself liberating vast quantities of gamma radiation.

Just goes to show that you can't say anything important without offending someone.

Dan8267 says

Ergo, Apocalypsefuck is both troll and anti-troll. If he ever encounters himself, he will annihilate himself liberating vast quantities of gamma radiation.

So - if AF attacks himself, he would beat himself off?

(ellie never, ever misses an opportunity for a good masturbation joke)

curious2 says

This pattern has been so widely reported for so long that I wonder how long it's been since you've been in this country.

What pattern do you see here exactly? There are 3 reports that there are doctors are paid to speak for drug companies. So what, shilling for the drug companies isn't prescribing to patients. I notice any mention of the number of doctors involved is very lacking. There aren't a lot and I've never met one. The hhs report is from 1991 for christ sakes. Almost everything mentioned in it hasn't been allowed for 10 years or more. Try to focus on what is actually happening in today's world, not what happened 2 decades ago. The other 2 are about how drug companies data mine to make more focused pitches to doctors. That's news? Drug companies are marketing, shocking to hear that I tell you, just shocking. So how does any of this relate to your concept of profitable prescribing? Where in any of this does it show what doctors prescribe has any affect what they earn?

curious2 says

The #1 complaint of general practitioners is patients lying to get prescriptions for drugs they saw on TV but that would be bad for them.

Ding, ding, ding. Wow, you finally got a winner after all that. Yes THE BIGGEST PROBLEM is drug companies advertising to consumers. It should have never been allowed. Patients demand what they have seen advertised. Doctors go along if it isn't counterproductive. Why not, patients are the customer. If they want to spend a lot on drugs that won't do any better job than cheaper drugs then that's their right. This goes directly against your assertion that doctors are forcing expensive pharma on poor unwilling uninformed patients to line their pockets. What you are saying is patients are sophisticated enough to mis describe their symptoms to get expensive drugs they want because they saw them advertised, but are so unsophisticated they can't say hey doc could you to prescribe a generic if they want to pay less. Which is it, you can't have it both ways.

So again how does this amount to profitable prescribing? Where is the profit for the doctor in any of this short of owning pharma stock or working for a drug company? I used to do a lot of practice management/accounting work and I don't understand how it's done. Explain the accounting ins and outs of "profitable prescribing" in an average practice to me instead of throwing up a lot of basically irrelevant articles. Debits and credits I understand.

Sorry I missed the part where you talked about how you acquired all your extensive day to day experience in the operation of physicians practices. Could you post it again perhaps.

Since you are so curious, I've been overseas 5 years. As hard as it is for the average American to understand even in the wilds of uncivilized countries like NZ there is mail service, phones, emails, even "gasp" internet. Even harder to believe, you can get on a jet plane and go back sometimes. I do keep up with what people are doing in the states. My wife spends 2-3 weeks a year at conferences in the states and spends a lot of time asking about what is going on. Keeping up on what is happening in medicine and practice management is of great interest for when we return.

Maybe you should give up on this whole profitable prescribing collusion idea and look at real problems. Start with doctors that refer to labs and diagnostic centers they have ownership in. Now that's a conflict of interest and pretty unethical in my opinion but it's legal in most states. Or why the area's that have the most doctors per capita have the highest medical cost per capita. Didn't you say licensing more doctors would make costs go down? Doesn't look like that works out in real life. So many real problems yet you are fixated on one that isn't.

This exchange does not relate directly to the OT but I do appreciate learning more about the subject so I will reply.

bob2356 says

why the area's that have the most doctors per capita have the highest medical cost per capita. Didn't you say licensing more doctors would make costs go down?

You seem to be confusing correlation and causation. In a free market, increasing the supply will reduce the price, all else being equal. But, in a distorted market with restricted supply (AMA cartel etc.) and artificially inflated demand (PhRMA ads on TV, mandatory insurance), many distortions can happen. A market that has a large population of sick people who watch TV all day may attract more doctors who prescribe the pills advertised on TV, resulting in higher costs. You didn't mention specific areas, but it's easy to guess that retirement destinations in Florida would have high concentrations of doctors and high costs. That doesn't change the fact that making it easier for doctors to get licensed (e.g. foreign doctors immigrating) or stay licensed (e.g. doctors retiring because they're tired of CME and other regulatory overhead) would reduce prices.

You react negatively to articles; I enjoyed these two dueling blog posts so you might prefer their candor and wit:

http://www.sciencebasedmedicine.org/index.php/bought-and-sold/

http://pharmamkting.blogspot.com/2011/05/physicians-are-concerned-about-pharma.html

Also this academic paper reports on the same issue:

http://www.scu.edu/ethics/publications/submitted/morreim/prescribing.html

Nevertheless, professionally edited newspapers continue to report the same pattern connecting prescriptions and PhRMA payments:

http://articles.courant.com/2012-07-30/health/hc-doctor-prescribers-20120730_1_second-highest-prescriber-top-medicaid-prescribers-pharmaceutical-companies

Sometimes the physicians sell the drugs directly, eliminating the added step of kickbacks:

http://www.nytimes.com/2012/07/12/business/some-physicians-making-millions-selling-drugs.html?pagewanted=all&_moc.semityn.www

Other times, it's kickbacks:

http://www.usatoday.com/money/industries/health/drugs/story/2012-07-02/glaxosmithkline-pleads-guilty-3B-fine-illicit-promotion-prescription-drugs/55979616/1

I certainly agree there are other problems, and I do not fixate on this one. It's just that you keep asking about this one, so the exchange gets more words on the page. I'm also concerned about doctors losing their independence because most of them are working directly or indirectly for insurance companies, e.g. 70% work for hospitals or large practice groups, which the largest insurers are buying. And we have exchanged comments before about C-T scans being marketed to healthy people as "preventive care" despite there being no benefits to anyone other than the revenue recipients.

I am surprised that APOCALYPSEFUCK is Shostakovich is ignored so much. Half of the fun of reading this blog are his posts about the coming cannibal anarchy. Hell I enjoy reading his posts.

thenuttyneutron says

Half of the fun of reading this blog are [AF's] posts about the coming cannibal anarchy.

I agree, and in fact there may be a real estate opportunity: AF fans should look into real estate in AF's neighborhood, so we can all band together to defend against the zombies.

Cloud has gone. Soon to return as drizzle, no doubt.

The Trolls are coming. The Trolls are coming.

Politicofact says

The Trolls are coming. The Trolls are coming.

Call it Crazy says

I would be careful... when you point out these negative FACTS about Obama's record, they don't like that here..... your posts will get deleted by the forum Nazi....

Fuck you.

I don't delete anyone for posting facts, just for relentless racist infantile propoganda.

Please post a picture of Obama in a grass skirt or as an evil clown so I can blow your account away in clean conscience.

Bumped for posterity. Imagine how wonderfully ordinary and sanguine this place would be had Patrick followed through on his threats. The housing bubble was a real and legitimate issue that deserved all the attention it got.

As the bubble resolved, most other sites went out with a bang as formerly priced out people bought and moved on with their lives. This site, unable to recognize that it was over changed focus and went out with a (cockeyed arm, obamas the devil, murica is doomed) whimper.

The world is interesting because of the competing narratives.

APOCALYPSEFUCKisShostikovitch says

I went to user list and sorted by likes and clearly AF is the most loved persona on PatNet.

I agree with your conclusion, but not your reasoning. Counting likes and dislikes is meaningless because fanboys will like every post in their clique and dislike every post by someone in an opposing clique.

The correct way to measure popularity is to calculate a popularity matrix based on likes/dislikes using the following algorithm.

1. Person A's opinion of person B is the number of likes of B by A minus the number of dislikes of B by A divided by the number of posts of B.

opinion(A, B) = (like(A, B) - dislike(A, B)) / postCount(B)

This value will be in the range [-1.0, +1.0].

2. The opinion of a set of users S of person B is the sum of the opinions of each member in S divided by the number of users in S.

opinion(S, B) = sum(opinion(S[i], B)) / order(S)

This value will also be in the range [-1.0, +1.0].

This formula works for any set of persons in the community including the entire community. So you can ask how the entire community feels about a person, and in most cases that will be neutral since most community members won't express an opinion of person B.

However, you can also ask who are the people who like B and who dislike him. For example, you can partition the community into groups based on the value of S[i] as it falls into the ranges
[-1.0, -0.5] venomously hate
(-0.5, -0.2] hate
(-0.2, -0.1] dislike
(-0.1, -0.01] disapprove
(-0.01, 0.01) neutral
[0.01, 0.1] approve
[0.1, 0.2) like
[0.2, 0.5) friends
[0.5, 1.0] harmony

If you partition the entire community based on the above criteria for all users B to form a set of partitions P, you can generate the cliques in your community by forming sets C where C[i] is a set formed by P in which includes persons who were in the same P[i] for many i's. Many can be throttled like 10% or 20%.

Come on, sbh. With CiC gone, you will be like Sherlock Holmes without Moriarty.

Call it Crazy says

We already have someone here that fits that description

http://www.youtube.com/embed/Cs4Gj7JsET4

*baited

dodgerfanjohn says

*baited

SBH's spelling was correct.

I am just a vessel of venomous love for all Mankind. That is why I am beloved of Patnet.

sbh says

after which I will still be here with no loss.

It was not the grandfather paradox we were talking about. :-)

APOCALYPSEFUCKisShostikovitch says

You loves me long time, PatNet!

I win!

You could stand for the Patnet Presidential elections.
I would like to know your stand on the following important issues:
1. How do you intend handling Kim Jon, when he tells us what movies we cannot watch?
2. How would you handle ISIS, the nice guys who take women for sex slaves?

Thank you Mr. President.

Call it Crazy says

What this means to me, honestly, is there are a bunch of liberals on here who find it neccesary to "dislike" everything posted by one of these guys.

Point taken: In all fairness, liberals are indeed the only ones with a knee-jerk "dislike" reflex here.

Dan8267 says

I think we can all admit that we come to PatNet solely to bitch at other users and get our daily recommended value of AF, and the later is the more enjoyable of the experiences.

sbh says

CDon says

the captain & CIC have somehow vaunted from under CLs 380 to well over 12K each, with CIC blowing the doors off everyone breeching the 14K dislike plateau.

Yeah, that's because shit stinks.

dodgerfanjohn says

*baited

I know you had to try, but usually you're better than this.

Hey, how come you guys, with your skills, are nowhere near the top? If I was you I would crawl into a hole and hope no one finds me.

APOCALYPSEFUCKisShostikovitch says

Strategist says

APOCALYPSEFUCKisShostikovitch says

You loves me long time, PatNet!

I win!

You could stand for the Patnet Presidential elections.

I would like to know your stand on the following important issues:

1. How do you intend handling Kim Jon, when he tells us what movies we cannot watch?

Log splitter! To the Kimfucks little head!

2. How would you handle ISIS, the nice guys who take women for sex slaves?

Log splitter! to the ISISfucks little gonads!

Thank you Mr. President.

I feel safer already.

Strategist says

If I was you I would crawl into a hole and hope no one finds me.

Leave your mother out of this.

Dan8267 says

Strategist says

If I was you I would crawl into a hole and hope no one finds me.

Leave your mother out of this.

It doesn't take make much to stoop to the gutter. But it takes class not to.

Top Trolls

Me.

sbh says

It doesn't take make much to stoop to the gutter. But it takes class not to.

Is that more of your crap we're supposed to believe? You can't keep up with your own mindlessness.

He who shows the most class, wins the game. I won. :)