Category Archives: health insurance

End the War on Patients by Allergan Pharmaceuticals (or is it Actavis or is it Pfizer)

By Gary Pepper, M.D. you noticed that prices of prescription drugs including generics are skyrocketing? The public is being squeezed by the pharmaceutical industry to pay increasing prices for the same medications while inflation in other areas of the economy is all but absent. Some fairly simple answers exist as to why this is occurring and there is a need to do something to stop it. Continue reading

Share this post

How the Sunshine Act Will Save You Money

By Gary Pepper, M.D.

Offering Promotional Money

Have you noticed that medication costs are skyrocketing? Even if you don’t take medication these higher costs are passed along to you in your health insurance premiums. The recently enacted Sunshine Act will combat these economic forces but in ways you may not realize. The legislation requires pharmaceutical companies to report all payments made to doctors. Physicians receiving substantial amounts of money from these companies include “thought leaders” who are sponsored by the drug companies to lecture the nation’s doctors on newly approved medications. Continue reading

Share this post

New Diabetes Medications Cost 100 Times More than Established Treatments

by Gary Pepper, M.D.

“New is not always better.” This caution seems reasonable when considering the value of the recently approved medications for treatment of Type 2 (adult type) diabetes.  These drugs include three new classes of medication referred to as GLP-1 analogs, DPP-4 inhibitors and most recently SGLT-2 inhibitors. The focus of this discussion will be the most widely prescribed of the newcomers, the DPP-4 inhibitors.

The first thing consumers will notice about the new diabetes medications are their TV commercial friendly names,  Januvia, Onglyza, Tradjenta, and Nesina.  Mix these newcomer drugs together into a single pill with the venerable low cost generic metformin and the names becomes Janumet, Kombiglyze, Jentadueto, and Kazano.

The next thing a consumer will notice is the price tag. At the local pharmacy in Jupiter, Florida the retail prices of a 3 month supply of Januvia, Onglyza or Tradjenta are all about $1100.  A three month supply of the established generic drug, glipizide, is $9.99 and metformin is between zero and $41. Continue reading

Share this post

Pharmacies Label Armour Thyroid “Illegal” and Issue Therapeutic Warning


by Gary Pepper, M.D.

Early in May 2014 a patient being treated with Armour Thyroid (desiccated thyroid) for hypothyroidism reported that her pharmacy service would not refill her prescription for Armour Thyroid because it was an “illegal” drug. We were both very distressed to learn of this, but for different reasons. My patient was rightfully concerned that she might be receiving a wildly inappropriate medication, while I was concerned that I might not be able to prescribe a medication I knew to be extremely helpful and safe. Continue reading

Share this post

National Organizations Fail to Recognize New Approach for Treatment of Hypothyroidism

The 2013 guidelines issued by the American Association of Clinical Endocrinologists and the American Thyroid Association reiterated their long standing opinion that only a single hormone, T4 (Synthroid, levothyroxine) is advised for treatment of  hypothyroidism. These key organizations

Continue reading

Share this post

Why Emotions Trigger Food Cravings

The old saying, “The way to a man’s heart is through his stomach” implies there is a deep connection between emotions and eating. My guess is  no one is really surprised by this idea. Both men and woman can identify ways in which their mood and appetite are intertwined and it is no mere quirk of man’s personality that this is true.

Evolution tells us that we were born to eat. The earliest creatures in the world’s history were simple eating machines. Their bodies consisted of an entrance for food, a digestive tract and an exit for refuse. In order to become more efficient at getting food creatures developed a system to locate food and to move toward it. This system is known as a nervous system. The first creature to have this ability is the worm. Eventually the nervous system controlling the digestive system (enteric nervous system) began to sprout nodes which were early brains.  As time went on and the brain became better developed it split off from the nervous system that controlled the digestive tract. Everything that followed in evolution, has served the purpose of developing  increasingly efficient brains (central nervous system) for acquiring the fuel of life.

Another example of how deeply connected the gut and brain are, is to look at the development of the fetus. When a human fetus is still just a lump of jelly, the digestive  and nervous systems are one structure. Soon this organ splits into two, one to become our gastrointestinal tract and the other the brain and spinal cord (central nervous system). Even though they become physically separated the chemical signals used by the gut and nervous system remain virtually identical. These chemicals comprise the groups known as neurotransmitters and hormones.

The same chemicals in the digestive tract that cause the intestines to twist and convulse (peristalsis), in the brain stimulate the emotion of anxiety. This explains why people get “butterflies” in the stomach or diarrhea when they are nervous.  The brain chemicals involved in depression can cause constipation.  The syndrome of irritable bowel disease (IBS) with its cycles of diarrhea and constipation is thought to be a reflection of an emotional rollercoaster.  The chemical relationship between mood and appetite is even more complex but no less real. One of the most common side effect of mood altering drugs is increased appetite and weight gain. Just ask anyone who has been on an anti-depressant drug such as Prozac, Zoloft or Abilify.  The chemical in marihuana that gets people high is famous for triggering the eating binge called “the munchies”.

Appetite suppressant drugs often have effects on mood and can be the source of major side effects. One new generation of appetite suppressants being developed, Acomplia, failed to be approved by the FDA because it caused severe depression and suicidal thinking.

In the next part of this series we will look at ways we can influence the brain to control our appetite.

Share this post

What’s Fair is Fair: Health Care 2010

It’s hard to feel someone else’s pain. It doesn’t matter what political party or economic system you ascribe to, it’s just human nature to be unsympathetic if you don’t understand the pain someone else is experiencing. What does this have to do with health care reform in the U.S.?

Who in this country has the best, most comprehensive, most generous health care insurance? The answer is federal employees, including members of Congress. These are people who never suffer insecurity about getting the best health care for themselves and their families. I believe this is a key factor reducing the motivation of Congress to change our health care system. Likewise in our country, the well off are still getting the best health care available. In my experience, these are the people who are least sympathetic to healthcare reform.

It is being said that the President was “Un-American” in the way he achieved his goal of health care reform. I think it is Un-American to shrug in the face of 30 million uninsured citizens, or to accept a system where the companies offering health insurance are making billions of dollars in profit while denying coverage to those who need it the most.

As a physician I am sitting at ground zero in regards to the changes in healthcare just set into motion. I have not yet been able to analyze how these changes will effect the way I practice medicine, but I still applaud the great effort by our leaders to fix a healthcare system which is clearly broken.

Gary Pepper, M.D. , Editor-in-Chief,

Share this post

In This Political Season, Health Care Reform is a Business Issue

by John Hammergren

It would be easy, in this long run of important presidential primaries, to be convinced that the problems we have with our health care system can only be resolved through government action and the political process. After all, presidential candidates Hillary Clinton, Barack Obama, and John McCain have each made health care reform a central issue of their campaigns. Political races are all about emphasizing stark differences between positions. But I am encouraged by how much today’s political leaders recognize that our health care crisis – despite that word “care” – is fundamentally a business problem.

California Governor Arnold Schwarzenegger is one of those politicians who understands the urgency for reform. The health care company I lead, McKesson Corporation, turned 175 years old this year. To help us celebrate that proud milestone, Governor Schwarzenegger spoke passionately and convincingly about the opportunities we have before us to bring the health care industry to another level of excellence.

I believe he’s right. Historically, every twenty years or so, we have a debate in this country about health care reform. So what’s different now? We’ve enjoyed incredible advances in medical practice and technology over the last few decades. That’s one reason why overall costs have risen but it’s also why American health care, despite the criticism currently in vogue, is the envy of the world. On the other hand, with the best of intentions, the political solutions traditionally put forward to make health care cheaper and more accessible – like artificially capping costs, regulating the services providers offer and restricting consumer choice – have had the opposite effect. Nobody who runs a business is surprised about that. What computer maker or car dealer would worry about price, access or quality if there was no competition for the customer and no reward for distinctive service?

Business leaders across the country are keenly aware of these issues. I am a member of the Coalition to Advance Healthcare Reform, a group of more than 50 companies advocating solutions to the health care crisis. In regular conversations with top executives, I hear the same concerns frequently. First, because health care costs are soaring, our employer-based health insurance system is hurting American businesses and the economy. Every product or service an American company offers is more expensive than it should be because employee health care costs are added to the mix. In a global economy, this is making it harder to compete with companies abroad. Second, business leaders, with their background in competitive markets and customer service, look at our health care system and think, “What other industry could operate like this and survive?”

In most industries, top performing businesses excel by being the low cost producer, putting out the best product, and meeting or beating customer expectations. The market works because consumers are able to choose the services that meet their needs best. In the health care industry, costs are distorted by government interference in the market and quality differences are disguised by a lack of consumer information and choice. Moreover, while we can argue that “customer” is another word for patient, would the customer in any other market make critical decisions without concern for cost or quality and put up with the inconveniences, inefficiencies and high error rates of health care?

The three remaining presidential candidates understand that effective health care reform means preserving our enviable ability to innovate while making the health care industry more market-oriented and customer friendly. The stump speech talking points about access and cost containment don’t always highlight this. But if you view the details of their proposals, a different picture emerges. Each candidate’s agenda emphasizes business fundamentals like quality, transparency, and paying for outcomes. They also understand that the current health care information technology boom is about to revolutionize the way care is delivered, reducing medical errors and administrative waste while making efficiency, informed choice, lifelong care and customer-orientation the new paradigm.

What’s more, all three candidates see the same critical areas that need our most urgent attention. Chronic diseases account for most of our health care expenditures and require coordinated rather than episodic care. We need to incentivize and organize providers to manage long-term illnesses better. The fear of medical malpractice suits are driving up costs by encouraging unnecessary treatment. We need sensible reform to reduce the preponderance of defensive medicine. Quality of care and outcomes need to be the new measuring sticks by which we assess, select and pay providers for their health care services. We need greater transparency to give primary care physicians and health care consumers the ability to choose the best doctors, hospitals, insurance providers and technicians, while also creating industry-wide standards for the latest in best practice.

No matter which candidate prevails in November, the popular concerns we have about health care right now are going to evolve rapidly once the next administration begins. As a business leader, I support universal access through tax incentives and individual choice (not a de facto expansion of Medicare) because I believe that having everyone in the insurance pool is fundamental to reducing costs and creating a competitive insurance market. But as Governor Schwarzenegger learned when the California Senate Health Care Panel rejected a bill mandating health care for all state residents, sweeping reform is even more difficult when economic times are tough.

The will for reform is real and the political process is critical in building and maintaining the health care industry we deserve. But as the candidates for president realize, the kinds of forces that make American business so competitive can make health care work better, too. Higher quality, lower costs, greater transparency, and better customer service are not contradictory goals, they’re outcomes that go together. We don’t need to control the health care market through mandates and cost containment legislation, we need to unleash it by giving people the ability to make better informed choices. After all, health care is the one product all consumers need, guaranteed.

John Hammergren is CEO of McKesson Corporation, the Fortune 18 health care services leader. McKesson serves customers at every point of health care and is helping transform the industry into a modern, efficient, and quality-driven system. McKesson has seen industry-leading performance under Hammergren’s leadership. During his tenure, the company has more than doubled its revenues and experienced a cultural and business renewal. Hammergren is an HP board member and the recipient of numerous awards for leadership. He is the author of Skin in the Game: How Putting Yourself First Today Will Revolutionize Health Care Tomorrow.

Share this post