The review published yesterday by Discovery Health “Medicine expenditure up by 26% in private healthcare industry” based on the Mediscor Medicines Review resonates with this week’s editorial from JAMA on Resolving Unreported Conflicts of Interest. Apart from anticancer therapy (which affects relatively few patients but is very costly), by far the two top drug costs to the private health system in RSA are antihypertensive and hypolipidemic drugs.
But why are these two groups of drugs 1/6th of local private medicines expenditure?
The reason is quite plainly vested interests- between prescribers, drug developers and retailers, for well-known reasons:
1. Modern western medicine rarely attempts to address the pathogenesis of disease – it takes too much effort by prescribers and patients to try to change diet and lifestyle. And the only “modern” drug that addresses the main causes of the common degenerative diseases – overweight, (pre) diabetes type 2, lipidemia, atheroma, thrombosis, hypertension, cancer, arthritis, dementia – is the antioxidant, insulin-sensitising, energising, nitric-oxide-promoter, antilipidemic, antithrombogenic, antihypertensive, anti-infertility, anti-PCOS, appetite-and-weight-suppressive, anticancer, and diabetes-preventing plant-derived metformin. This is the only prescription drug ever – with zero serious persisting adverse effects in appropriate dose – that has been shown (including in the only 20year randomized controlled trial ever) to actually reduce all major morbidity and all-cause mortality by over one-third.
2. Only new ie under-patent drugs are $billion dollar –a-year rainchecks in a $trillion dollar industry where only disease pays (not prevention- which keeps patients out of hospitals & specialist centres and off new drug) .
So the Disease Industry has correctly pinpointed overweight and hypertension as the two leading risk factors to bombard consumers with new drugs;
but has created the gigantic marketing ploy that these common lifestyle-diet problems need designer drugs: that
average mild to moderate hypertension must be treated by combinations of angiotensin-and adrenergic, and calcium-blockers – which do not reduce all-cause morbidity and mortality.;
and even average lipid levels by statins and now even the futile ezetimibe –which do not reduce all-cause morbidity and mortality;
and overweight-obesity by patented drugs like Orlistat and Rimonabant –which do not reduce all-cause morbidity and mortality ,
and type 2 diabetes by new sulphonylureas, glitazones and even more toxic and expensive injectables like gliptins- –which do not reduce all-cause morbidity and mortality .
But simple analysis of the hundreds of better-quality published studies and trials (not those ghost-written in glossy journals for drug companies to promote their products) shows that:
For average mild-to-moderate hypertension, no modern drugs (with many serious adverse effects) surpass for benefit the triple and zero-side-effect combination of lowdose reserpine plus lowdose coamiloretic- in RSA costing retail about R45 per 4 months ie about $2/month;
For average-risk overweight adults with or without lipidemia and diabetes, nothing surpasses the global benefits- major reduction in all-cause mortality and mortality- of metformin started in low dose eg 250mg/day and increased slowly to tolerance.
Obviously primary prevention for everyone includes a few grams a day of the essentials that deplete at all ages with longevity, the degrading food chain, pollution and stress – the natural ~50 replacement supplements of vitamins and minerals and the human biologicals EPA+DHA, CoQ10, arginince, carnitine, n-acetyl cysteine, alphalipoic acid, taurine, carnosine, MSM, chondroglucosamine, lutein, bioflavinoid, choline, inositol, 5HTP, GABA, melatonin, plus key plant supplements eg ginkgo, milk thistle, galega, gymnema, coleus etc;
all of which can be simply taken as a powder blend in water twice a day with a teasp of cod liver oil or a fish oil capsule;
at a global retail cost of as little as R100/$12 a month ( plus in older people, appropriate physiological human sex hormones).
So while there is some- but relatively little- competition between generics, the major saving in both cost, risks and prevention is between therapeutic equivalents eg lowdose coamilozide+reserpine, metformin, and other safe effective supplements – which are all that are needed for prevention and most treatment of all the major degenerative diseases of aging including osteoporosis (which agents Industry and their funded lobbyists- researchers, academics, regulators try persistently to denigrate if not actively suppress)- vs other newer- and heavily marketed classes of antihypertensives, appetite , lipidemia and osteoarthritis-osteoporosis suppressants.
This issue of promoting evidence-based best therapeutic equivalents is indeed blowing against the wind, the tsunami of $billion dollar adspend by Big Business to promote their designer labels. But all countries- while run by ruthless politician big business looking after their own interests – do pay some lip service to restraining the normative monopolistic and price-fixing racketeering that screws the man in the street- both in gross overpricing, and in massive tax evasion by big business, and in rigging of elections and tenders .
Our own Medical Schemes Council is in the process of open consultations about the revised necessary and approved drug lists for all diseases in the medical schemes industry. Hence urgent vigorous debate is urgently required – in all countries- before vested interests further strangle citizens’ choice of and access to both cheap old drugs to eg reverse the dropping of reserpine by bureaucrats in UK, Europe and state clinics here, and reverse the rising tide of suppression of the best prevention and treatment there is- the base of all modern medicines – minerals, vitamins and the numerous proven safe human and plant biologicals.
The trend by the FDA and EU and Big Business in RSA must be reversed, before they (in the interests of their own pockets filled with paybacks by Big Pharma) put all supplements totally on prescription by health professionals- the very people whose livelihood (including their shares in Big Pharma, med schemes and hospitals) depends on new quick-fix designer drugs which cure and prevent no chronic degenerative disease ie on avoiding effective doses and combinations of proven supplements.
As it is, the medical schemes in RSA are now compelled to pay for the services of witchdoctors (who admittedly probably kill far fewer people than do modern prescriptions and surgery for non-urgent conditions) yet these schemes- while insuring for profit people who persist in suicidal and homicidal smoking and alcohol and sexual behaviour- flatly refuse to pay for the best prevention there is – the supplements mentioned- because they are neither promoted by Big Pharma nor on prescription.
Numerous references are available under many keywords on this website below.