The High Cost Of Drugs

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No reasonable person would begrudge pharmaceutical companies a fair return on their investment in research, development, and distribution of life-prolonging drugs. But when these companies jointly start raising prices on competing drugs just because they can, serious ethical and political issues are raised. The New York Times reports-

A group of new drugs is promising to prolong the lives and relieve the symptoms of men with advanced prostate cancer, but could also add billions of dollars to the nation’s medical bills.

“What a great time it is in prostate cancer,” Dr. Daniel J. George of the Duke Cancer Institute proclaimed earlier this month at the annual meeting of the American Society of Clinical Oncology.

And it’s a great time for the drug makers, with several drugs competing to fill a niche for longer-term survival. Analysts estimate that some of the new drugs, particularly Dendreon’s Provenge and Johnson & Johnson’s Zytiga, could reach annual sales of $1 billion or even much more.

The recently approved drugs and most of those in development are for cases in which the disease has spread beyond the prostate gland and is no longer held in check by hormone therapy.

Men with that late-stage cancer had a median survival of about a year and a half using docetaxel. The new drugs each added two to five months to median survival when tested in clinical trials. Doctors say that men taking more than one of the drugs in succession would be expected to live more than two years.

But the price of these drugs has already stirred concerns about the costs of care among patients, providers and insurers. For example, Provenge costs $93,000 for a course of treatment, while Zytiga costs about $5,000 a month. Another of the new drugs, Sanofi’s Jevtana, costs about $8,000 every three weeks.

With other pricey drugs on the way, said Joel Sendek, an analyst at Lazard, “We could be talking easily $500,000 per patient or more over the course of therapy, which I don’t think the system can afford, especially since 80 percent of the patients are on Medicare.”

Still, for now, one company’s price is prompting the next one to follow suit.

“The pricing environment is encouraging and getting better for us,” Andrew Kay, the chief executive of Algeta, told securities analysts earlier this month, after announcing that his company’s experimental drug had extended median survival nearly three months in a clinical trial.

Mr. Kay said he had initially thought that his company, which is based in Norway, would charge about $25,000 for a typical course of treatment with the drug, Alpharadin. But with the rival drug Jevtana costing about $50,000, Algeta and its partner, Bayer, are considering a higher price

The Trouble With Internet Filter Bubbles

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One of my favorite Yes songs, back in the day, was “Don’t Surround Yourself With Yourself”. Although the lyrics meandered a bit, the title seemed a worthy piece of advice. Unfortunately, for various reasons (including, of course, targeted marketing and advertising), internet search engines – and social networking sites like facebook – are increasingly surrounding each of us with what they “think” we want, and burying or even filtering out search results they “think” we’ll find irrelevant. Eli Pariser, author of The Filter Bubble: What the Internet is hiding from you, would like you to seriously consider the possible long-term consequences of this growing trend. Here’s a ten minute talk he gave on the subject-

Thanks to Laura Knaapen for publicizing this video via a discussion list at my University.

Wisconsin Legislature Delegates More Authority To Governor Walker While Stifling Dissent

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Here’s a report from Rick Ungar’s blog “The Policy Page” over at, of all places, the conservative outlet forbes.com that, if true, paints a disturbing picture of a legislative branch that is abdicating its responsibilities while both muzzling dissent and empowering an increasingly dictatorial governor-

What’s a governor to do when he has a big agenda but little tolerance for the nagging voice of the people?

He either loads up on the anti-acids and the aspirins, or he finds the peace and quiet he requires to bring his society-changing schemes to life by simply legislating away the annoyance of having to listen to the voice of the voters.

Apparently, Gov. Scott Walker has decided to skip the Maalox and go for the muzzle.

Last week, the Wisconsin legislature passed a new state budget granting Gov. Walker the power to slash the state’s Medicaid program by some $500 million. To ensure that the Governor and his subordinates could do their cutting without unwanted interference from Wisconsin voters and the pesky media, the legislature simply removed the obligation of the executive branch to hold hearings on any such cuts- leaving Walker free to do as he will without the requirement of public input.

Previously, as a result of the now infamous budget-repair bill passed earlier this year in the Badger State, the legislature had taken themselves out of the Medicaid cutting business by turning full responsibility for the same over to the Department of Health Services. By so doing, the legislature not only avoided the requirement of holding public hearings, but handed Walker total and complete control over how the state’s poor were to be treated.

However, even that over-the-top legislation held onto the requirement that Health Services hold their own public hearings on proposed alterations to Medicaid programs so that interested parties could make their feelings and voices heard.

Apparently, the whole democracy thing turned out to be more trouble than it was worth in Wisconsin.

In the new budget, the legislature not only continues their own dismissal from the process – thereby continuing to abdicate the responsibility entrusted to them by their constituents – but have now opted to drop the requirement that public hearings be held by the Department of Health Services.

To further make clear just who is in complete control of Wisconsin’s government, the legislature added that the exemption from having to allow the public into the discussion is to be kept in place for the remainder of the Governor Walker’s term.

Aloha Friday Flower

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Here’s a cute little flower (all of one inch across) that I found growing along the Kuliouou trail on Oahu, just above the ironwood forest, taken with my iPhone 4 camera-

I Hate To Say ‘I Told You So’…

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I really do hate to say ‘I told you so’, because the fact that I was right in my previous post about Wisconsin’s Open Meetings law means thats my take-home pay is about to be cut 8-10%, thanks to Scott Walker’s union-busting “Budget Repair” bill, which balances the budget on the backs of public employees (regardless of whether they have been members of unions with bargaining rights or, like me and other UW professors, not so). While I was on vacation, I read that Dane County Judge Maryann Sumi had struck down the bill on the grounds that in passing it, the Republicans violated at least the spirit of the Open Meetings law, and perhaps even its letter (having given less than two hours notice, and having granted only limited access to the meeting after that). Although I agreed with her that the Republicans had violated at least the spirit of the law, it seemed to me that the law itself contained a loophole regarding legislative rules that allowed them to do so legally. Hoping that Judge Sumi might explain some aspect of the law or of the Senate’s legislative rules that I had missed, I read her decision with interest, but I had the distinct impression that she had downplayed the power of the loophole. Unfortunately, the Wisconsin Supreme Court today agreed 4-3 with my interpretation. As the New York Times reports-

The decision ended, at least for now, lingering questions about when and whether the cuts would take effect, but it also underscored the state’s partisan divide, which seems to grow wider by the day. The ruling was 4 to 3, split along what many viewed as the court’s predictable conservative-liberal line.

The majority of the justices concluded that a lower court was wrong when it found that the Legislature had forced through the cuts in collective bargaining without giving sufficient notice — 24 hours — under the state’s open-meetings requirements.

In its written decision, the court cited the importance of the separation of powers, and said the Legislature had not violated the state’s Constitution when it relied on its “interpretation of its own rules of proceeding” and gave slightly less than two hours’ notice before meeting and voting. In the end, the provision passed without the attendance of any of the Senate’s 14 Democrats.

The Isthmus adds to its story on the issue the following remark from Democratic Senator Barca-

“The Supreme Court is saying the legislature is above the law,” he said.

Barca suggested the best recourse would be passing a constitutional amendment ensuring openness in the legislature.

The collective bargaining law will officially take effect once published by Secretary of State Doug LaFollette, after which time the legislation is likely to see legal challenges, this time on its merits, rather than procedure.

The point that I made in my previous post is that not only does the Supreme Court say that the legislature is above the Open Meetings law, the legislature wrote the law so as to insure that it is above the law. No doubt there will be a challenge to the law’s legal merits from an injured party, but I doubt that any such challenge will be successful. As I stated in my previous post, this is a political issue to be decided at the polls, not a legal one.

Bring on the recall elections.

Recall Elections: The Plot Thickens

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Well, I was gone only two and a half weeks, but during that time a number of developments occurred regarding the upcoming Wisconsin state senate recall elections. By now you’ve probably heard that, as the Associated Press reports, Republicans plan to field fake democratic candidates to force time-conuming and money-wasting primary elections. So far, the reaction to such shenanigans - including editorials in such centrist media as The Oshkosh Northwestern – has been loud and negative. It will be interesting to see if the Republican party backs down on this.

In the meantime, it has been fascinating to see the number of “King State Senate” signs that have sprouted like so many mushrooms on the lawns of my usually politically quiet – indeed, even Republican – Oshkosh neighborhood. Before I left, there was hardly a one. Now they outnumber the Hooper signs by at least 5-to-1.

I wonder: will the fake primaries give Hooper time to get his up?

Where I’ve Been Lately

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Cheryl and I spent a couple of weeks on Oahu for some much needed R+R. Here’s a couple of photos taken during a hike on one of the many trails that criss-cross the rain forest on Tantalus, a hill behind Honolulu-

Hawaiian Flowers

Hawaiian flowers growing on Tantalus

Banyan Tree

Banyan tree (with me underneath for scale) - photo by Keith Boutte