Why Your Pharmacist Can’t Tell You That a $20 Prescription Could Cost Only $8

Why Your Pharmacist Can’t Tell You That a $20 Prescription Could Cost Only $8

WASHINGTON — As consumers face rapidly rising drug costs, states across the country are moving to block “gag clauses” that prohibit pharmacists from telling customers that they could save money by paying cash for prescription drugs rather than using their health insurance.

Many pharmacists have expressed frustration about such provisions in their contracts with the powerful companies that manage drug benefits for insurers and employers. The clauses force the pharmacists to remain silent as, for example, a consumer pays $125 under her insurance plan for an influenza drug that would have cost $100 if purchased with cash.

Much of the difference often goes to the drug benefit managers.

Federal and state officials say they share the pharmacists’ concerns, and they have started taking action. At least five states have adopted laws to make sure pharmacists can inform patients about less costly ways to obtain their medicines, and at least a dozen others are considering legislation to prohibit gag clauses, according to the National Conference of State Legislatures.

Senator Susan Collins, Republican of Maine, said that after meeting recently with a group of pharmacists in her state, she was “outraged” to learn about the gag orders.

Click here to continue reading on the New York Times Website.

10 Things to Know About Your New Medicare Card

10 Things to Know About Your New Medicare Card

Background: As dictated by 2015 legislation, the Social Security Administration (SSA) will begin the roll-out of new Medicare cards without the use of Social Security numbers. This is help prevent identity theft as Medicare has used Social Security numbers since its inception on your Medicare cards.

The following list is from Centers for Medicare and Medicaid services (CMS).

  1. Mailing takes time. Your card may arrive at a different time than your friend’s or neighbor’s.
  2. Destroy your old Medicare card: Once you get your new Medicare card, destroy you old Medicare card and start using your new card right away.
  3. Guard you card: Only give your new Medicare number to doctors, pharmacists, other health care providers, your insurers, or people you trust to work with Medicare on you behalf.

Our comments: For some reason the CMS in its publication avoids mentioning insurance agents. When filling out an application for a Medicare supplement, Medicare advantage, or a Part D Rx plan, we must put down your Medicare number on the application.

  1. Your Medicare number in unique: Your care has a new number instead of your Social Security number. This new number is unique to you.
  2. Your new card is paper: Paper cards are easier for many providers to use and copy, and they save taxpayers a lot of money. Plus, you can print your own replacement card if your need one.

Our comments: Some people laminate their card. Technically, that may be a no-no, but obviously people do it anyway. For sure, make a photocopy of your new Medicare card. You could carry the copy with you and keep your government issued one safely at home.

  1. Keep you new care with you: Carry your new card and show it to your health care providers when you need care.

Our comments: The same as number five. We have seen some old paper cards so worn that they were virtually unreadable. There’s the wisdom in making a copy.

  1. Your doctor knows it’s coming: Doctors, other health care providers and facilities will ask you for your new Medicare care when you need care.
  2. You can find your number: If you forget your new card, you, your doctor or other health care provider may be able to look up you Medicare number online.

Our comments: Again, carry a copy or even multiple copies. Keep one in your car or other backup location. Since there is no SS# on the card, it will be virtually useless to an identity thief.

  1. Keep you Medicare advantage card: If you’re in a Medicare advantage Plan (like an HMO or PPO, your Medicare advantage Plan ID card is you main card for Medicate—you should still keep and use it whenever you need care. However, you also may be asked to show your new Medicare card, so you should carry this card, too.

Our comments: Back in 2006 when Medicare advantage plans ramped up, the companies were insistent that you SS numbers NOT be used on their ID cards.

  1. Help is available: If you don’t get your new Medicare card by April 2019, call 1-800-Medicare (1-800-633-4227). TTY users can call 1-877-486-2078. End of the CMS document

Avoid the Scammers: We have reprinted some of the tips from Ron Iverson concerning scammers. They are as follows:

First, scammers are calling Medicare recipients, sometimes identifying themselves as Medicare or “government” officials and telling them that the new cards are coming out, but that they will have to send $30-50 to get the new cards.  That is bogus—there is no charge for the new cards—and CMS/Medicare does not call people—it only uses the U.S. Postal Service to communicate.

The second technique is for the scammer to say that he has a Medicare Advantage Prescription Drug Plan available, but then request personal Medicare information so that the new plan can be utilized.  This is also bogus.  Whatever you do, do not fall for this.  Medicare information is personal, and the scammers simply use it for other nefarious activities.

So, we don’t know when or how the scammers will spring into operation in your area, but if you receive one of these calls, just hang up and report the activity with a call to 1-800-Medicare (800-633-4227).  And…above all, do not feel pressured to respond to any of these calls—the scammers are well-trained in intimidation and persistency.  Don’t fall for it. End

Gary Taubes ‘The Case Against Sugar’ Part 4

Gary Taubes ‘The Case Against Sugar’ Part 4

Transcription of Gary Taubes’ YouTube video, The Case Against Sugar, by Elizabeth Reedy

Key takeaways from Part 3

  • Sugar is like a drug that shows no immediate side effects.
  • Taubes made several references to the connection between consuming sugar and pleasure with this telling statement: . . . once the drug became identified with pleasure, how long before it would be used to celebrate birthdays, a soccer game, good grades in school?
  • As sugar became more available in Europe, it was added to all sorts of concoctions. Later in the U.S., sugar was added to the original Coca-Cola formula to mask the bitterness of cocaine and caffeine.

Begin at 49:31

The removal of cocaine in the first years of the 20th century seemed to have little influence on Coca-Cola’s ability to become, as one journalist described it later, “The sublimated essence of all that America stands for, the single most widely distributed product on the planet and the second most recognizable word on the earth, with okay being the first.”

It’s not a coincidence that John Pemberton, the inventor of Coca-Cola, had a morphine addiction that he’d acquired after being wounded in the Civil War. Coca-Cola is one of several patented medicines he invented to help wean him off of the harder drug. [Quoting Pemberton] “Like Coca, Kola enables its partakers to undergo long fast and fatigue,” read one article in 1884. “Two drugs, so closely related in their psychological properties cannot fail to command early universal attention.”

As for tobacco, sugar was and still is a critical ingredient in the American blended-tobacco cigarette, the first of which was Camel, introduced by R. J. Reynolds in 1913. It’s this “marriage of tobacco and sugar,” as a sugar-industry report described it in 1950, that makes for the “mild” experience of smoking cigarettes as compared with cigars and, perhaps more important, makes it possible for most of us to inhale cigarette smoke and draw it deep into our lungs.

It’s the “inhalibility” of American blended cigarettes that made them so powerfully addictive—as well as so potently carcinogenic—and that drove the explosion in cigarette smoking in the U.S.  and Europe in the first half of the 20th century, and the rest of the world shortly thereafter, and, of course, the lung-cancer epidemics that have accompanied it.

Here’s an interesting story. About fifteen years ago I read a book called Sugar Blues. Do any of you remember that? William Dufty, Gloria Swanson’s husband, wrote this book. In this book he talks about sugar and tobacco, and about how the sugar in the tobacco leaves is critical to the success of the American cigarette.

For years after that, I tried to confirm that story and I just couldn’t find any evidence to do it. Two things happened. The internet grew and grew, and more and more sources of evidence got scanned into the computer, and you could search through them.

I had gotten a grant from the Robert Wood Johnson Foundation to write this book on sugar, and part of the grant was to uncover what was the sugar industry’s influence on science in the 70s. I could feel it in the research that in the same way they discover planets by seeing the influence of another planet.

Also, back in 2011 I was lecturing at a bookstore in Denver. I had done nothing on the book, I had completely stalled. I had started my not-for-profit instead. After the lecture, this woman, Kristen Kerns, comes up to me and she says she’s a dentist there in Denver. She works in a lower-class clinic, and she deals with diabetics with terrible teeth all day long.

She read my book Good Calories, Bad Calories, and she became obsessed with it. Then she went to a lecture on dentistry and chronic disease, and she heard a speaker from the American Diabetes Association say that they didn’t know why diabetics had such poor teeth. Kristen was horrified, and she started investigating the sugar industry.

She used Google and she found a cache of sugar industry documents which were from a defunct sugar industry company that had gone out of business and donated its archives to Colorado State University. Then she drove up to Fort Collins, and she started looking through the boxes. She pulled out the first one and it was labeled “Confidential. Sugar industry documents.”

She tells me this story after my talk, and my eyes light up like the big bad wolf. It scared the hell out of me. I was like, “I want everything you’ve got, put it in my book and take credit for it.” I learned that Kristen’s sense of humor was different than mine. Anyway, we ended up working together. We did a cover story for Mother Jones, which helped Kristen get a job at UCSF as a researcher.

If you read the New York Times, you’ll see she has a couple of front-page stories based on her research. I also talk about her research in the book, and I’m proud to have played a role in her life, though I still regret having scared her so much that first day.

One of the documents that Kristen found is this document written by a sugar industry executive in 1954 called “The Marriage of Sugar and Tobacco.” So, after World War II, the sugar industry and all of America starts going on a diet, in part because artificial sweeteners become readily available and allowed people to cut calories. People were arguing that sugar is fattening.

The sugar industry sees the writing on the wall even then, and they realize they have to start diversifying their products. They have to find other products that they could be using, and they are proud of the fact that, in 1954, sugar has played such a major role in the tobacco industry. They’re bragging about it in this document, and they had no reason to think that it wasn’t a great thing. It was more American capitalism at work.

And so, it’s all laid out in this document, including the references to FDA reports and the names of tobacco company executives who could confirm it. This didn’t really fit into my book because my book is about heart disease and diabetes, not the role of sugar and tobacco. But how could I leave it out?

At one point I had a chapter called The Marriage of Sugar and Tobacco, and I’d given it the number two and a half. Have any of you seen the movie Being John Malkovich? There was a… Well, this chapter ended up being Chapter 3. My editor doesn’t have the same sense of humor I do, either.

The other interesting thing is that this had actually been covered by a brilliant historian of science at Stanford, Robert Proctor, who had written a 700-page exposé of the sugar industry called Golden Holocaust that is relentlessly reported.

He wrote it based on the tobacco industry documents, and he came upon this article in the tobacco industry documents. So it doesn’t really fit into his book, but he wrote about it anyway, probably because it’s such an amazing story about the role of sugar and tobacco.

I was still able to get the scoop in this book, first of all because Robert Proctor’s book is 700 pages long, and it’s hard to get through. I find myself talking about other people’s books, other people’s set of good calories and bad calories. It’s good but it’s long. Anyway, a little more reading and then we’ll go to Q & A’s.

Unlike alcohol, which was the only commonly available psychoactive substance in the Old World until sugar, nicotine and caffeine arrived on the scene. The latter three had at least some stimulating properties and so offered a very different experience, one that was more conductive to the labor of everyday life.

These were the “eighteenth-century equivalent of uppers,” writes the Scottish historian Niall Ferguson. “Taken together, the new drugs gave English society an almighty hit. The Empire, it might be said, was built on a huge sugar, caffeine and nicotine rush—a rush nearly everyone could experience.”

Sugar, more than anything, seems to have made life worth living (as it still does) for so many, particularly those whose lives were absent from the kind of pleasures that relative wealth and daily hours of leisure might otherwise provide.

As early as the twelfth century, one contemporary chronicler of the Crusades, Albert of Aachen, was describing merely the opportunity to sample the sugar from the cane that the Crusaders found growing in the fields of what are now Israel and Lebanon as in and of itself “some compensation for the sufferings they had endured.” “The pilgrims,” he wrote, “could not get enough of its sweetness.”

As sugar, tea, and coffee instigated the transformation of daily life in Europe and the Americas in the seventeenth and eighteenth centuries, they became the indulgence that the laboring classes could afford; by the 1870s, they had come to be considered necessities of life.

During periods of economic hardship, as the British physician and researcher Edward Smith observed at the time, the British poor would sacrifice the nutritious items of their diet before they’d cut back on the sugar they consumed.

In nutritional terms,” suggested three British researchers in 1970 in an analysis of the results of Smith’s survey, “it would have been better if some of the money spent on sugar had been diverted to buy bread and potatoes, since this would have given them very many more calories for the same money, as well as providing some protein, vitamins and minerals, which sugar lacks entirely.

In fact, however, we find that a taste for the sweetness of sugar tends to become fixed. The choice to eat almost as much sugar as they used to do, while substantially reducing the amount of meat, reinforces our belief that people develop a liking for sugar that becomes difficult to resist or overcome.”

Sugar was “an ideal substance,” says Mintz. “It served to make a busy life seem less so; in the pause it refreshes, it eased the changes back and forth from work to rest; it provided swifter sensations of fullness or satisfaction than complex carbohydrates did; it combined easily with many other foods, in some of which it was also used (tea and biscuit, coffee and bun, chocolate and jam-smeared bread)…. No wonder the rich and powerful liked it so much, and no wonder the poor learned to love it.”

What Oscar Wilde wrote about cigarettes in 1891, when that indulgence was about to explode in popularity and availability, might also be said about sugar: It is “the perfect pleasure. It is exquisite, and it leaves one unsatisfied. What more can one want?

Thank you. I think I’ll leave it at that. Thank you.

Q&A: One man from the audience asks if we would be healthier or less healthy by using artificial sweeteners instead of sugar. Taubes’ response is that the science is inconclusive. He cited studies where the researchers use lean college students as guinea pigs to see how artificial sweeteners affects them. He says that those results may have different outcomes for middle-aged people, and especially those with medical issues.

My Comments: I was intrigued by Taubes’ comments about the use of sugar along with nicotine and caffeine as the “uppers” of the 17th-18th centuries in Europe and America. They helped to give people a lift from the drudgeries of a hard life. I wonder if things aren’t all that much different in the 21st century.

Rebecca, for example, looks forward to her morning and afternoon coffee breaks at her office. That’s time to get a cup of sweetened coffee and a Danish or some other pastry that a colleague brought to their office. End

The Hacking of the American Mind—Report #3

The Hacking of the American Mind—Report Number 3

by Robert H Lustig, MD, MSL

Synopsis of Report #2

Two quotes from Lustig well sums up his account so far.

No pleasure means no happiness. Pleasure is the straw that stirs the drink. Happiness is the drink. Anxiety melts the ice cubes. We all need reward, because reward keep anxiety at bay . . . for a short time.

When taken to the extreme, these two pathways can take you to the highest mountain or the lowest valley—addiction, depression, and just plain misery. The science in Part 2 and 3 says so.

Pleasure and happiness are interrelated, and there has to be a proper balance. If all pleasure is removed from a person’s living, his/her zest for life is gone.

Chapter 3: Desire and Dopamine, Pleasure and Opioids

Lustig is a university trained medical doctor. He’s also an endocrinologist, and his writing is on a university level with almost the expectation that his reader can grasp the technical terminology that he uses. As I mentioned before, understanding some of his technical stuff is stretching my brain. I will do my best to interpret it for you.

Lustig starts out by reminding us that reward is a strong driver of human emotion. He uses several paragraphs to explain this in greater detail. His summation is as follows:

Reward is first and foremost. Reward is the end. And sometimes reward literally becomes your end. Because one reward is never enough. When one reward becomes the primary goal, overwhelming all else, the end consequence is addiction—perhaps the nadir (the lowest point) of unhappiness. Therefore, understanding the inner working of reward is paramount to any discussion of personal or societal benefit or detriment.

My Comments: Lustig is spot on when he says, “becomes your end.” I have two cousins that predeceased their parents due to booze and drugs. Their reward was their end.

I have witnessed several people so addicted to their refined carbohydrates that they are dying a slow death of degenerative diseases, meaning obesity, diabetes, heart attacks and strokes. They’re still consuming their sweets, and gradually losing the battle with ever increasing doses of insulin. It’s akin to the person with emphysema that continues to smoke.

Continuing: Lustig says that the reward pathway is basic to survival. If our parents hadn’t enjoyed sex, we might not have been reading this text. He says that scientists have now learned how the reward pathways work and how they can be manipulated for both good and bad.

From hereon out, the chapter gets very technical. Please feel free to read it in its entirety if you care to delve into the intricate details.

Lustig says that we can distill the discussion down to the trigger of the pathway: dopamine:

…Virtually all pleasurable activities (sex, drugs, alcohol, food, gambling, shopping, the internet) employ the dopamine pathway in the brain to generate the motivation. But too much dopamine starts the downward spiral toward misery (my emphasis). If you can put “-aholic” on the end of the word (alcoholic, shopaholic, chocaholic, sexaholic) then the dopamine pathway is in play.

My Comments: I emphasized “misery” in that Lustig is so right with his analysis of too much dopamine. When he mentioned food, he didn’t elaborate, but you can bet your last dollar that he is referring to refined carbohydrates, meaning white flour and rice, sugars, and high fructose corn syrup, etc. I have a relative that is miserable because her choices of consuming alcohol and junk food have led her to type 2 diabetes, obesity, amputated toes, having a stroke, and now being confined to a wheelchair. All of this is for a person in her fifties!

Continuing: Lusting explains that our dopamine levels can be graded on a bell-shaped curve.  If a person doesn’t have enough dopamine, she will be lethargic and have little motivation for reward.

But if you’re already at the top of your bell-shaped curve, and you get that same dopamine boast, it can result in a transitional state that can quite unpleasant. Moreover, your current position on that bell-shaped curve can be changed by your experience with many forces, including stress and medicines.

Lustig cites two examples of being moved the wrong way on this bell curve. Number one is obesity. In a nutshell, obesity plays havoc with your dopamine system in very consistent ways. The obese person is already skewed to the right on the bell-shaped curve. An advertisement for Oreos, for example, can trigger a dopamine release, and now the person is overloaded with dopamine and has nowhere to go but down.

Worse, leptin is the hormone that tells our brains that we have had enough. It can get totally fouled up in the obese person’s brain* resulting in eating the second, third, and fourth pint of ice cream. The dopamine satisfaction continues to dwindle so he gets less and less reward from eating the ice cream. *Rather than referring the anatomical terminology for various parts of our brains, I’ll keep it simple and only use the word “brain.”

For a deeper understanding of how leptin works, Lustig references his book Fat Chance: Beating the odds against Sugar, Processed Food, and Disease. He also explains that some people have a genetic disposition for their obesity. Part of their brain can light up faster and quicker when they see a food commercial compared to people with normal weight.

My Comment: Lustig brings up the subject of food commercials. Where do you see most of these commercials? Of course, it’s on television. Please permit me to explain the power of advertising and how it plays around with our minds.

Let’s say Wilma Nesmeyer is 30 years old and has never touched alcohol in her life. She has her first taste of wine, only a few ounces, and she is already in a swooning state from the effects of what little alcohol was in that wine. It had an extraordinarily powerful effect on her. Just a small dose sent her reeling.

I don’t watch television, and I don’t have a TV in my home as my time is too valuable to passively sit and watch the screen. I’d rather be doing something more productive.

However, when I visit my sister-in-law who lives out-of-state, I’m exposed to the TV and its advertising. She’s a widow and has it on all the time. I ask her to turn it down or even off when I’m interacting with her. However, sometimes I’m forced to watch some of it.

I’m like Wilma. I literally feel the effects of how the advertising is working on my mind. One or two doses of it sends me reeling. It’s like, “Wow, what hit me; what’s pulling at my brain?” It like an assault on my mind. I certainly don’t like allowing someone to subliminally screw around with my emotions. I used to love eating Oreos, and seeing an Oreos commercial wants to trigger my dopamine response. In another era, it could have been the motivation to buy some. It’s incredibly powerful!

If you are trying to overcome your addiction to sugary, refined and processed foods, exposing yourself to advertising is like trying to put out the fire while at the same time fueling the flames. If you know you have a weakness here (most of us do), it’s best to minimize our exposure to advertising as much as possible.

Continuing: The second example that Lustig cites is estrogen. Simply put, rising estrogen means rising dopamine. He gives examples of how this can affect a woman’s moods.  She can be either focused and motivated, checking things off her to-do-lists, or on the verge of maiming her family member for forgetting to pick up the ice cream. For complete details, please refer to pages 50-51.

Get a Hit, Get a Rush

Lustig explains that there are three separate modes for the regulations of our dopamine levels.

(1) Synthesis: Dopamine is made in neurons of the ventral tegmental area (VTA) from the amino acid tyrosine, found in many foods. Ed: Examples are high-protein foods such as chicken, turkey, fish, milk, yogurt, cottage cheese, cheese, peanuts, almonds, pumpkin seeds, sesame seeds, lima beans, and avocados.

Lustig continues with a brief discussion of drugs that have been used to either decrease or increase dopamine levels.

(2) Action: This gets very technical. There are receptors for the dopamine that is produced our brains. If a person has fewer receptors, in part due to genetic reasons, it takes more dopamine to arrive at one’s optimal level. If a person has fewer receptors, then it takes more food intake to generate the reward, and that, of course, leads to weight gain. Put another way, this person needs more of a fix to generate the same level of reward as people without this particular genetic variation.

Lustig describes some of the uses for pharmaceutical drugs such as Risperdal, Zyprexa, and Abilify. They are used to enhance the effects of a person’s anti-depressant prescription. These drugs may be also used to treat ADHD, but they have their own side effects. These can be lack of motivation, walking around in a personality daze, and induce insulin resistance in the liver which leads to weight gain.

(3) Clearance: Remember, the synapses are the connecters between our nerves. The dopamine is like the electricity (electrons) flowing through the wires. The dopamine needs to be cleared out of the synapse, which occurs from one of two mechanisms.

The dopamine molecules can be recycled and used again. The dopamine transporter (DAT) transports and sucks dopamine back into the nerve terminal, removing it from the synapse and readying it for the next stimulus.

Lustig points out that cocaine and methamphetamine, in essence, fool the DATs into keeping more dopamine in the system. Now you know why they’re called uppers.

Dopamine molecules can be deactivated. The very technical explanation is on page 55.

Too Much of a Good Thing

Lustig cuts to the chase:

Recreational drugs such as cocaine are the quickest way to boost your dopamine. But drugs aren’t the only way to access reward, and drug use isn’t the only manifestation of a disordered reward pathway.

He explains that other behaviors can quickly can become addictive and specifically cites gambling. He mentions the excitement of the Kentucky Derby.

It generates the same dopamine rush, to different extents, as a ski run down a steep slope, a shopping spree . . . or a line of cocaine.

Lustig explains that dopamine is the just the gateway neurotransmitter or the trigger. He likens dopamine to sexual foreplay.

. . . the euphoria, the pleasure is mediated through another set of chemicals, the endogenous opioid peptides (EOPs) whose cell bodies are in the hypothalamus, the brain area that controls emotions. The most famous of these is beta-endorphin, the brain peptide with properties similar to morphine. It binds to the same opioid receptor as does morphine or heroin, generating the pleasure signal in the nucleus accumbens.

He explains that you can get there through the use of opioid drugs such as hydrocodone or OxyContin. Another way to get there is through your own beta-endorphin by vigorous exercise. This is known as the runner’s high.

There’s a problem here, just as there is with the over use of dopamine.

. . . [T]hose EOP receptors are also down-regulated with chronic exposure . . . although we’re not sure what happens to runners. . . . and when the opioid receptors down regulate, you go from wanting to needing. That’s the neuro-chemical equivalent of addiction.

If You Scratch You’ll Keep Itching

Lusting concludes this chapter by saying that the goal of reward is not in the motivation but rather it’s in the consummation. He says that activating these opioid receptors is where the action is.

Pleasure is the goal. Desire is the driver. Motivation drives the outward behavior, consummation is the inward expression of reward.

He recounts an incident when holed up in an old hot, muggy hotel in Paris when he had an itch for ice cream, and he satisfied that itch.

Reward comes in two phases. Motivation or desire triggers the dopamine. Consummation or pleasure comes from the endogenous opioid peptides (EOPs) delivered from parts of our brains.

Dopamine is the trigger and the EOPs are the bullets. You need both to fire the gun, unless someone fires the gun for you, like taking Demerol in the emergency room . .  . EOPs are designed to shut down further dopamine production.

If there is chronic over-stimulation, there is a reduction of dopamine receptors in the key area in our brains. This leads to needing more and more dopamine to get less and less of an effect. Lustig closes the chapter by saying that chronic stress impacts our dopamine more than anything else.

My Comments: Everything that Lustig has described in this chapter is how we are wired. It’s the human condition. What he hasn’t discussed, at least not yet, is how we can overcome this condition and not be controlled and driven by it. I’ll delve into this in the future. End.