Often people will require more than one type of drug, but low-dose diuretics are a common first-line treatment. At 12.5 to 25mg of hydrochlorothiazide, the most common diuretic, side effects tend to be milder than other drugs like beta-blockers (fatigue...it blocks the same receptors that adrenalin stimulates), ACE inhibitors (dry cough in ~10%), and calcium channel blockers (gingival hyperplasia, constipation, peripheral edema, etc.) No drug is for everyone - all can cause adverse effects or be contraindicated in some cases.
Partly it may be due to the fact that the newer drugs have a more obvious effect on blood pressure, even though this reduction is not proportional to the reduced risk of heart attack and stroke. (The old non-XL Adalat caused a sudden drop of blood pressure, resulting in a rebound effect and increased mortality. Alpha-blockers and atenolol have been found to be substantially worse than other treatments at the same level of BP reduction.)
Also, a lot of it has to do with all the free samples doctors receive for giving to patients. Guess which ones the drug reps are always talking about and handing out boxes of? Of course, if everyone else is doing it, then they can't just stop or they'll lose market share...
The NIH spends less than $30 billion per year, not all of which is for medical life-sciences research, so I'm not sure about your math. I guess spending more than Canada's total medical research budget on bioterrorism research alone is quite an accomplishment. Personally, I think both countries underfund medical research, and I agree with this guy
Drug companies could easily afford to sell their meds for less than Canadian prices if they slashed their marketing budgets. The price differences aren't that huge... More importantly, Canadian provincial plans will pay for the cost of the generic drug whose patent has expired, or a new type of drug which has been proven more effective, but if you want an evergreened version that costs three times as much because of the "Type R" sticker slapped on it - you can pay for it.
Also, consider this from JAMA:
"None of the first-line treatment strategies-blockers, angiotensin-converting enzyme (ACE) inhibitors, calcium channel blockers (CCBs), -blockers, and angiotensin receptor blockerswas significantly better than low-dose diuretics for any outcome."
The diuretics they refer to cost about a penny per pill. Some of the other treatments cost more than a dollar per pill.
In BC everyone has a deductible based on income... for non-seniors who make >$30000/year, when drug costs reach 3% of annual income Pharmacare pays 70%, and when at 4% of annual income Pharmacare pays 100%. (For people on expensive and long-term treatments, there is the option to spread out the deductible cost over the year.) Many "average" people with diabetes or high blood pressure will receive at least some coverage.
Even someone who makes six figures may get their drugs paid for if they are on extremely expensive treatments. There are also other types of coverage, such as pallative and mental health, which will pay 100% with no deductible needed for specific drugs.
Or is the grandparent referring to "college" using the Canadian meaning of the term - a community college, providing maybe a year or so of technical training? Ignoring the fact that they would have used previous versions during grade school, anyone with a university degree in any science who cannot figure out a word processor is a disgrace.
Do people actually take courses to get trained in that sort of thing? It was generally assumed that we would know how to use a word processor, e-mail (I'd never heard of Pine before, but it didn't take long to figure out), basic spreadsheet functions, connecting to a proxy server for Ovid searches, etc... or that we would go to a tutorial workshop in the library if we needed help. The only program I ever received training for was Zadall, for prescriptions, patient files, and billing. We don't use it anymore.
So this new version of Office means another high-cost license and a new file format (converting files and potential incompatibility), plus retraining costs and reliance on a closed-source vendor to provide patches in a timely manner?
Can it get any worse? How about some built-in adware? Does the EULA have a clause signing over the rights to the user's first bor--oh, forget it...
The 3D functions of the GPU are locked...you can't get any 3D acceleration in Linux. More importantly, re: it being a supercomputer, the last I heard it was being beaten in benchmarks by a G5. With code specially optimized for the vector processors, it may be very fast for specialized tasks, but currently its just a crippled PowerPC chip (no out-of-order execution).
It's probably not good for the waterblocks, but this isn't true: Hypochloric acid is a weak acid, which makes the hypochlorite ion a strong base
It's a weak base, since it exists in solution with its conjugate acid. Sort of like how sodium acetate is added as a buffer for acetic acid in salt&vinegar chips. *crunch*
Even with hardware that seems to be working perfectly fine, in the process of storing and repeatedly transferring stuff between different types of storage I've had errors crop up.
Sure, I could use archives with checksums or RAID, but it'd be nice if there was an option to sacrifice some speed and space on a single form of storage to improve the reliability without going to such cumbersome lengths.
What I'd like to see would be a filesystem that would look like a read-only FAT32 drive with hidden files or an extra partition to an OS that didn't support it, but to an OS with the correct driver would have error correction transparently built-in.
Being able to transparently divide files above 4gig and have them look like a single file to a supported OS would be gravy.
First, "almost nothing" is an extreme exaggeration. Most drug companies spent massive amounts on marketing, in some cases probably more than R&D, but R&D is hardly a minor expense. The fact that government money is being used for their benefit, instead of on developing "open-source" drugs or drugs patented by the government for royalty-free manufacture in-country, is another issue entirely.
"part of the reason is that drug stores make more money selling drugs that cost more"
I'm not sure about the US, but this isn't true in Canada - we just make the dispensing fee. (Any markup isn't paid for by Pharmacare, so this just results is pissed-off customers. The exception is for IA, which pays a meagre markup on prescribed OTC meds - not covered at all by other drug plans - instead of a dispensing fee.)
A way that seems to work reasonably well in BC is the concept of LCA drugs - "Lowest Cost Alternative"...the government will pay for the cheapest drug in a class (eg, a generic, instead of an evergreened super-duper ultra-extended-release form).
"Ritalin is very profitable because it is a treatment." And dextroamphetamine is a cure?!
"Treatment of stomach ulcers"
The treatment(s) you are talking about is for H. Pylori, and pretty much all of the regimens - there are several - involve a PPI, like Losec. I think I might of read one somewhere involving H2 blockers, but I've never seen that in practice, and it probably wouldn't work very well. I've never heard of a regimen not using acid reduction therapy to heal the ulcer. (Plus, pure antibiotic therapy would do nothing to help heal ulcers due to NSAIDs, etc.)
"blatant kickbacks that medical companies give Doctors and Pharmacists"
Both COX-2 inhibitors and regular NSAIDs can increase the risk of heart attacks. Rofecoxib (Vioxx) had a slightly higher than average risk, celecoxib (Celebrex) has slightly less risk. Ordinary Advil is probably about as risky as Vioxx was.
"A great deal of thinking will need to be done. There will be, and have been, suggestions that all these drugs, including over the counter analgesics, should be withdrawn. But in both these large studies half the patients were present or former users of NSAIDs or coxibs. Alternatives are few, with problems of their own."
Consider that the "alternatives" are acetaminophen (liver damage with high doses) and Flintstones chewable morphine...
I got a huge spiral 150W-equivalent "Marathon" CFL bulb from Home Depot for my kitchen (the fixture is a big white globe, so there's plenty of room)...it works great, but it does use 45W.
They don't have any problems getting illegal aliens to work for them. Heck, they can even work them seven days a week and lock them in overnight. It's not like they're slaves, so it's a-okay, right?
I replaced the four incandescent lights in my bathroom with CFLs... they quickly became yellow and dim, and they all died within the year. The same thing happened to the replacements . I'm guessing the moisture was too much for them, though the fixture design probably isn't helpful either. (It seems to trap moisture and heat.) CFLs elsewhere seem to last forever, though the older ones seem to be yellower than the new ones...maybe the old ones I got were just of a cheaper make, though.
You should probably just replace the bulb in the staircase with a (long life) incandescent bulb. (Or a halogen bulb meant for a regular light socket, like this...they last longer and give nicer light than incandescents, but are more expensive and not any more efficient.) With the small spike in power when turning the CFL on, and only using it for a few minutes a day, you probably aren't saving any power versus other bulbs, just wearing out the ballast.
Yeah, some very good ideas in the parent post. Another variation would be to set the gas furnace to a temperature a little lower than comfortable, and have a few cheap little electric heaters for where you need them. (A parabolic dish infrared heater can also be very nice - toasty! - and is very efficient, but usually only does a good job of heating the person it is directed at.)
After all, if the actual cost/BTU of heating with electricity is possibly cheaper than gas where you live, then using fewer BTUs by heating less of your house is definitely be cheaper.
It is one thing to show respect for someone's religious beliefs, but it is another thing to accept a paper with references such as "[1] Divine inspiration" and "[2] Genesis 1:2".
Slashdot Mirror
Partly it may be due to the fact that the newer drugs have a more obvious effect on blood pressure, even though this reduction is not proportional to the reduced risk of heart attack and stroke. (The old non-XL Adalat caused a sudden drop of blood pressure, resulting in a rebound effect and increased mortality. Alpha-blockers and atenolol have been found to be substantially worse than other treatments at the same level of BP reduction.)
Also, a lot of it has to do with all the free samples doctors receive for giving to patients. Guess which ones the drug reps are always talking about and handing out boxes of? Of course, if everyone else is doing it, then they can't just stop or they'll lose market share...
The NIH spends less than $30 billion per year, not all of which is for medical life-sciences research, so I'm not sure about your math. I guess spending more than Canada's total medical research budget on bioterrorism research alone is quite an accomplishment. Personally, I think both countries underfund medical research, and I agree with this guy
Lowest Cost Alternative
Also, consider this from JAMA: "None of the first-line treatment strategies-blockers, angiotensin-converting enzyme (ACE) inhibitors, calcium channel blockers (CCBs), -blockers, and angiotensin receptor blockerswas significantly better than low-dose diuretics for any outcome."
The diuretics they refer to cost about a penny per pill. Some of the other treatments cost more than a dollar per pill.
Even someone who makes six figures may get their drugs paid for if they are on extremely expensive treatments. There are also other types of coverage, such as pallative and mental health, which will pay 100% with no deductible needed for specific drugs.
Do people actually take courses to get trained in that sort of thing? It was generally assumed that we would know how to use a word processor, e-mail (I'd never heard of Pine before, but it didn't take long to figure out), basic spreadsheet functions, connecting to a proxy server for Ovid searches, etc... or that we would go to a tutorial workshop in the library if we needed help. The only program I ever received training for was Zadall, for prescriptions, patient files, and billing. We don't use it anymore.
Can it get any worse? How about some built-in adware? Does the EULA have a clause signing over the rights to the user's first bor--oh, forget it...
299,792,458 m/s would be a much more appropriate number, though 3x10^8 m/s is good enough for tests :)
The 3D functions of the GPU are locked...you can't get any 3D acceleration in Linux. More importantly, re: it being a supercomputer, the last I heard it was being beaten in benchmarks by a G5. With code specially optimized for the vector processors, it may be very fast for specialized tasks, but currently its just a crippled PowerPC chip (no out-of-order execution).
Yeah, using a properly-protected radiator as a middle step should remove the risk without negating any benefits.
It's a weak base, since it exists in solution with its conjugate acid. Sort of like how sodium acetate is added as a buffer for acetic acid in salt&vinegar chips. *crunch*
Sure, I could use archives with checksums or RAID, but it'd be nice if there was an option to sacrifice some speed and space on a single form of storage to improve the reliability without going to such cumbersome lengths.
Being able to transparently divide files above 4gig and have them look like a single file to a supported OS would be gravy.
When the system requires skin contact and constant eye tracking or it shuts the car down...try not to blink.
"part of the reason is that drug stores make more money selling drugs that cost more"
I'm not sure about the US, but this isn't true in Canada - we just make the dispensing fee. (Any markup isn't paid for by Pharmacare, so this just results is pissed-off customers. The exception is for IA, which pays a meagre markup on prescribed OTC meds - not covered at all by other drug plans - instead of a dispensing fee.)
A way that seems to work reasonably well in BC is the concept of LCA drugs - "Lowest Cost Alternative"...the government will pay for the cheapest drug in a class (eg, a generic, instead of an evergreened super-duper ultra-extended-release form).
"Ritalin is very profitable because it is a treatment." And dextroamphetamine is a cure?!
"Treatment of stomach ulcers"
The treatment(s) you are talking about is for H. Pylori, and pretty much all of the regimens - there are several - involve a PPI, like Losec. I think I might of read one somewhere involving H2 blockers, but I've never seen that in practice, and it probably wouldn't work very well. I've never heard of a regimen not using acid reduction therapy to heal the ulcer. (Plus, pure antibiotic therapy would do nothing to help heal ulcers due to NSAIDs, etc.)
"blatant kickbacks that medical companies give Doctors and Pharmacists"
Where are my kickbacks? ;_;
I haven't seen that in Canada... were the twice a day Amoxi-Clav 875s not big enough? :-D
Charged particles! Computers! Together at laszxxz#@`.; NO CARRIER
From Bandolier:
"A great deal of thinking will need to be done. There will be, and have been, suggestions that all these drugs, including over the counter analgesics, should be withdrawn. But in both these large studies half the patients were present or former users of NSAIDs or coxibs. Alternatives are few, with problems of their own."
Consider that the "alternatives" are acetaminophen (liver damage with high doses) and Flintstones chewable morphine...
Hey, there are pretty pictures, too. Plus, I can think of 355 billion dollars spent a lot less wisely.
I got a huge spiral 150W-equivalent "Marathon" CFL bulb from Home Depot for my kitchen (the fixture is a big white globe, so there's plenty of room)...it works great, but it does use 45W.
They don't have any problems getting illegal aliens to work for them. Heck, they can even work them seven days a week and lock them in overnight. It's not like they're slaves, so it's a-okay, right?
I replaced the four incandescent lights in my bathroom with CFLs... they quickly became yellow and dim, and they all died within the year. The same thing happened to the replacements . I'm guessing the moisture was too much for them, though the fixture design probably isn't helpful either. (It seems to trap moisture and heat.) CFLs elsewhere seem to last forever, though the older ones seem to be yellower than the new ones...maybe the old ones I got were just of a cheaper make, though.
You should probably just replace the bulb in the staircase with a (long life) incandescent bulb. (Or a halogen bulb meant for a regular light socket, like this...they last longer and give nicer light than incandescents, but are more expensive and not any more efficient.) With the small spike in power when turning the CFL on, and only using it for a few minutes a day, you probably aren't saving any power versus other bulbs, just wearing out the ballast.
After all, if the actual cost/BTU of heating with electricity is possibly cheaper than gas where you live, then using fewer BTUs by heating less of your house is definitely be cheaper.
Wasn't one of the worst betrayals caused by a CIA agent's wife spending all his money? (And he passed a couple polygraph tests, too...)
It is one thing to show respect for someone's religious beliefs, but it is another thing to accept a paper with references such as "[1] Divine inspiration" and "[2] Genesis 1:2".