Martin Dyckman: EpiPen debacle demonstrates need for price controls

martin dyckman“Your money or your life,” a laugh line for the great comedian Jack Benny, must be the business model of the American pharmaceutical industry.

It’s time for a serious national discussion on establishing price controls over Big Pharma.

The latest provocation is the staggering increase in the price of the EpiPen, a necessity for people with life-threatening food and bee-sting allergies. The two-dose pack that cost about $100 in 2007 is priced at around $600 now.

A different company sells the same product in France for about $85.

The self-injecting device was originally developed for the U.S. military. The drug it contains, epinephrine, actually costs about $1 per dose to manufacture, according to Bloomberg Businessweek.

All this is why Heather Bresch, the CEO of patent holder Mylan Pharmaceuticals and the genius behind the price rise, has for the moment displaced the smirking Martin Shkreli as the public face of her ruthless industry.

It doesn’t help that image that her compensation swelled nearly eightfold, from some $2.5 million to nearly $19 million, while the EpiPen was becoming six times more expensive.

Or that the face of the customer who’s being told “your money or your life” is most often a schoolchild.

Even if there’s family insurance, most plans these days have enormous deductibles

And yes, Mylan is another of those companies that ran out on U.S. residency — in this case to the Netherlands — to reduce its taxes.

Unlike Shkreli, a corporate takeover rogue who skyjacked the price of a vital anti-parasitic drug for people with compromised immune systems, Bresch is a major figure in the pharmaceutical industry. In that respect, her profiteering is more significant, and more worrisome, than his.

Responding to a social media firestorm that yielded some 70,000 online signatures, 100,000 letters to Congress and serious attention in the media, Bresch announced Mylan will give some customers larger vouchers to buy EpiPens at discounted prices.

But those apparently aren’t available to people on Medicare, soldiers and veterans, and millions of others who have no insurance. That’s no substitute for reducing the base price to something reasonable.

Unless you’re one of those legendary folks who never get sick until they need the undertaker, you have had your own experiences with drug price sticker shocks. And if you’re on Medicare, it takes only a few of those to reach the coverage gap.

That Medicare or private insurance may cushion those sticker shocks is no excuse for them. Remember who’s paying for Medicare and for the insurance premiums.

In most cases, these outrageously priced drugs are sole-source products. Even when there are generic alternatives, Big Pharma has been ingenious about hyping those costs too.

Although there are many players in the industry, their individual control of specific drugs means that are, essentially, monopolies.

There are rivals to the EpiPen, but Mylan still controls about 85 percent of that market, according to Bloomberg. That’s a monopoly by any definition.

One factor is Mylan’s highly successful campaign to persuade schools to stock the device, with the encouragement of Congress and the Food and Drug Administration.

The so-called “discipline of the market” is an oxymoron in a monopoly market.

That’s why price controls would not only be appropriate, but also necessary.

Price control is a powerful weapon that should be used rarely, not least because it can backfire badly. Venezuela knows that now.

But there’s ample precedent in the United States for price controls in a monopolized industry that, like pharmaceuticals, is essential to life and health.

I’m speaking of the public utilities — electricity, gas and often water, in which effective competition would be wildly inefficient and costly.

The standard model for regulating utilities is to establish a reasonable rate of return on investment and operating expenses, and calculate allowable profit on that.

In Big Pharma’s case, companies should be entitled to credit for what they spend to develop and test new drugs. They might even spend more on the antibiotic research they presently shun as unprofitable. This is a grave issue because of the rapid evolution of antibiotic-resistant pathogens.

I didn’t mention advertising.

Ours is not only the country with the highest drug prices, but also the only one where manufacturers can spend millions advertising drugs you didn’t know you needed and for which the disclaimers — how they might sicken or even kill you — command more time and space than the alleged benefits.

Given how Big Pharma usually leads the pack in campaign spending and lobbying expenses, the prospects for price controls must be rated slight at best.

But I’d like to hear what Hillary Clinton has to say on this. She’s gotten nearly $1 million in Pharma money this election cycle. That’s more than anyone else.

It would be interesting also to hear from Sen. Joe Manchin, D-W.Va. Bresch is his daughter.

___

Martin Dyckman is a retired associate editor of the newspaper now known as the Tampa Bay Times. He lives in suburban Asheville, North Carolina.

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Florida man survives lightning strike, spider, snake bites

Kyle Cook can’t decide whether he’s really unlucky or incredibly fortunate.

Over the past four years, the 31-year-old Florida man has survived a lightning strike, a bite by a venomous spider and — most recently — an attack by a rattlesnake in his backyard in Lakeland, southwest of Orlando.

“I need to get a (protective) bubble,” Cook told The Ledger.

His father, Mike Cook, sees it another way. “He’s a walking Murphy’s Law,” the elder Cook said. “I walk on the other side of the mall.”

On Aug. 11, the younger Cook was almost finished cutting the grass at his family’s rented house when he heard a loud rattling sound. First, he thought it was the buzzing of cicadas. Then, he thought the push mower might be making the noise, so he shut it off. That’s when he saw the snake coiled about 3 feet from his right foot. He estimated it was about 5 feet long and had a girth the size of a soda can.

After briefly freezing in fear, Cook said he moved his left foot back and stepped on a stick. The noise apparently provoked the snake, which struck his ankle.

He says it happened fast. “I didn’t even see it bite me,” Cook said. “I just screamed and ran to my wife.”

His wife, Sara, said she washed the wound and called the poison control hotline. She then drove him to the emergency room at a Lakeland hospital.

Cook, a self-professed “bigger guy,” said doctors told him the snake’s fangs didn’t penetrate beyond a layer of fatty tissue.

“They said the tissue saved my life because it didn’t allow (the venom) to go into the bloodstream,” he said. He said he spent one night in the hospital and received one dose of antivenin.

He’s still experiencing soreness and walks with a slight limp.

Reactions to snake bites can vary wildly, according to Dr. Alfred Aleguas, director of the Florida Poison Information Center in Tampa. He said an average of 11 venomous snakebites had been reported to the center in the past five years, including a high of 17 in 2013.

But back to Cook’s other tales of survival.

On Aug. 12, 2012, he was driving a sweeper truck for a construction crew. A storm approached, and the truck’s sweeper got stuck. He left the cab to free it as lightning struck about 10 feet away. Cook said the electricity moved through a puddle, up the sweeper’s metal bristles and reached his left hand. He said he was knocked backward about 6 feet and rendered unconscious for up to a minute.

“It was like Mike Tyson hitting me with a jackhammer in the jaw,” he recalled.

Doctors said he had a mild heart attack. He said he still suffers a combination of nerve pain and loss of sensation on his left side.

“Lightning scares me so bad now,” he said.

The spider bite happened in April, when he was working as a truck driver. He was sitting on a pallet when a recluse spider bit his left hand.

Not wanting to miss a paycheck, he kept working until his hand swelled and became extremely painful. He went to the hospital and doctors performed surgery to drain the buildup of toxins.

He still has limited use of his hand, and is unemployed because the company fired him due to his absences.

Even before the latest incidents, Cook said he’s had many misadventures. He once got bitten by an alligator that he “accidentally” caught while fishing. And he was bitten by his friend’s Burmese python, which he was trying to feed.

“It’s been a rough four years,” he said. “Maybe the higher up … is trying to get your attention that maybe something is going wrong. Or maybe I’ve simply been in the wrong place at the wrong time my whole life.”

Republished with permission of the Associated Press.

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Insurers warn Floridians to prepare for tropical storm

A tropical storm stands an excellent chance of hitting South Florida this weekend. An insurance industry group wants Floridians to start getting ready.

The Property Casualty Insurers Association of America on Wednesday recommended Floridians review their policies now, to make sure they’re covered against storm damage, or add coverage, if necessary.

“Flood insurance is not covered by your standard homeowners policy; however, additional coverage can be purchased through the National Flood Insurance Program or your insurance company,” said Logan McFaddin, PCI’s Florida regional manager. “Florida is unique in that some insurers are offering flood insurance coverage, unlike other states, so it’s important to contact your agent or company right away.”

There’s a caveat: “Just be aware that there is typically a 30-day waiting period between the date of purchase and when the actual flood coverage goes into effect,” she said.

A tropical disturbance — called Invest 99 — was situated in the Lesser Antilles as of midday Wednesday, moving on a track that forecasters believe could bring it within range of the Florida Keys and later could threaten the Gulf Coast.

“Invest” is short for “investigation,” meaning the National Hurricane Center is monitoring developments. If the system develops into a tropical depression or storm, it would be named Hermine.

Here’s what McFaddin recommended:

— Review your policy, especially the declarations page. Does it cover replacement costs or actual cash value for a loss?

— Inventory household items, photographing or videotaping them for documentation. Keep these records and your policy in a safe place.

— Keep the name, address and claims-reporting telephone number of your insurer handy, in a safe place.

— Deploy hurricane shutters or board your windows, and move vehicles and patio furniture indoors. Secure your boat.

— Keep any receipts for repairs so you can be reimbursed.

The Association offers additional recommendations and resources here.

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Florida A&M leader remains in limbo after trustee vote

The future of Florida A&M University President Elmira Mangum remains unclear.

University trustees narrowly rejected a proposal Wednesday to extend her current contract by one year. It’s the second time this summer trustees have refused to extend it and means she must leave by April 2017.

Trustees voted, however, to create a special committee to meet with Mangum and come up with a proposal to consider in September.

Mangum’s two years have been turbulent and marred by power struggles with trustees as the former Cornell University official grappled with the politics of running a public university in Florida. She was nearly fired in 2015.

Mangum was hired initially as a “change agent” who could help FAMU restore its reputation after the November 2011 hazing death of Marching 100 band member Robert Champion.

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Recordings capture chaos of Florida face-biting slayings

Florida sheriff’s deputies confronted chaos as they tried to subdue an attacker biting a victim’s face after stabbing and beating a couple to death in a random assault outside their home, recordings of radio transmissions released Tuesday show.

When a dispatcher asks the first Martin County deputy on the scene if she has the suspect controlled, she responds, “No sir, I have this guy wrapped around him and he is biting him.”

Sheriff William Snyder has said it took numerous deputies, jolts from a stun gun and a dog to pry 19-year-old college student Austin Harrouff off 59-year-old John Stevens in the Aug. 15 attack. Stevens’ 53-year-old wife, Michelle Mishcon, lay nearby.

At one point during the struggle, a garbled transmission that sounds like “Oh no” can be heard.

After Harrouff is finally subdued, the first deputy let out a plaintive sigh and then told dispatchers, “possible two ‘sevens,'” the agency’s code for dead people. Another deputy then asks for paramedics and crime scene technicians, adding “we need them in here now.” They also directed that an ambulance be sent across the street to the home of Jeff Fisher, a 47-year-old neighbor stabbed several times as he tried to rescue the couple. He has since been released from the hospital.

Harrouff remained hospitalized under guard Tuesday in critical but stable condition. Snyder said he will be charged with two counts of first-degree murder and one count of attempted first-degree murder upon his release.

The FBI is running tests to determine whether Harrouff, who had finished his first year at Florida State University and was home for the summer, was under the influence of hallucinogenic drugs such as flakka or bath salts, both of which have been linked to violent outbursts. But Snyder said there were no traces of common street drugs – including cocaine, marijuana and methamphetamine – in Harrouff’s system immediately after the attacks. There is also a possibility that Harrouff may have ingested caustic chemicals from the couple’s garage, Snyder said.

Harrouff told deputies as they arrested him that they would find no drugs in his system.

The toxicology reports will provide “a big piece of the unknown,” Snyder said.

What investigators do know is that Harrouff was having dinner with family about 4 miles from the couple’s house. Video surveillance from the restaurant shows him calmly walking out about 45 minutes before the attacks. Investigators said he apparently had words with his father. His mother later reported him missing, telling police he had been acting strangely for about a week before the attack.

The couple, who lived a short distance from Harrouff’s father, were known to sit in their garage with the door open, watching television.

Harrouff’s parents, Wade and Mina Harrouff, issued a statement last week expressing their condolences to the Stevens family and their apologies to Fisher.

Attorney Robert Watson, who is representing Harrouff, said last week that the student’s parents saw “indications of odd and unusual behavior” in him recently, but he declined to elaborate on possible mental health issues.

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Florida sheriff says face-biting FSU student may have ingested ‘caustic’ chemicals from the couple’s garage

The college student caught biting a victim’s face after stabbing and beating the man and his wife to death in a random attack may have ingested “caustic” chemicals from the couple’s garage, Martin County Sheriff Snyder said.

Snyder told news outlets that Austin Harrouff, 19, remains in critical but stable condition at a West Palm Beach hospital a week after the attack that killed John Stevens, 59, and Michelle Mishcon, 53, outside their home near Jupiter. Harrouff was taken into custody Aug 15.

Snyder has said he will be arrested on two counts of first-degree murder and one count of attempted murder as soon as he’s released from the hospital.

“It’s a typical garage, so there were solvents,” he told the Palm Beach Post. “There were things he could have consumed and that first night at the hospital, the hospital speculated based on what they were seeing in his body fluids, that perhaps he had ingested something caustic from the garage.”

The FBI is running tests to determine whether Harrouff, who had finished his first year at Florida State University and was home for the summer, was under the influence of either bath salts or a drug called flakka, both of which have been linked to violent outbursts. But Snyder said there were no traces of street drugs — including cocaine, marijuana and methamphetamine — in Harrouff’s system immediately after the attacks.

The toxicology reports will provide “a big piece of the unknown,” Snyder said.

What investigators do know is that Harrouff was having dinner with his parents about four miles from the couple’s house. Video surveillance from the restaurant shows him calmly walking out about 45 minutes before the attacks. Investigators said he apparently had words with his parents. His mother later reported him missing, telling police he had been acting strangely for about a week before the attack.

The couple, who lived a short distance from Harrouff’s father, were known to sit in their garage with the door open, watching television. Their bodies were found in the garage and driveway. Investigators say Harrouff also stabbed neighbor Jeff Fisher, who heard a commotion and tried to help.

Fisher has since been released from the hospital and is recovering from his wounds.

Harrouff’s parents, Wade and Mina Harrouff, issued a statement last week expressing their condolences to the Stevens family and their apologies to Fischer.

Attorney Robert Watson, who is representing Harrouff, said last week that the student’s parents saw “indications of odd and unusual behavior” in him recently, but he declined to elaborate on possible mental health issues.

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Father of toddler killed by alligator at Disney World reached into animal’s mouth to try and free his son

The father of a Nebraska toddler killed by an alligator at Walt Disney World last June reached into the animal’s mouth in an attempt to free his son’s head from the reptile’s jaw, according to a final report on the death released Monday by Florida’s wildlife agency.

The Florida Fish and Wildlife Conservation Commission report said that the 7-foot alligator bit 2-year-old Lane Graves‘ head as the boy bent down at the edge of a lagoon gathering sand for a sandcastle at Disney’s Grand Floridian Resort and that the boy died from a crushing bite and drowning.

Separately, the Orange County Sheriff’s Office released its report and ruled the death an accident. One witness, a 16-year-old tourist, said he was walking with his younger siblings on a beach-area walkway when he heard a scream from the lagoon and saw the alligator taking the boy away.

“The alligator first came in head first toward the beach but turned around once it had the child in its mouth and crawled back into the water headfirst,” Peter Courakos told deputies.

Several guests at the resort reported seeing the alligator swimming in the lagoon shortly before the attack.

Tourist Alfred Smith said he photographed the alligator from his hotel room balcony about an hour and a half before the attack. A short time before the attack, he said, he saw children playing in the ankle-deep water. He was heading out the door to warn them about the alligator when he heard Lane’s mother screaming, the wildlife agency report said.

Another tourist, Shawna Giacomini told investigators her two daughters saw the alligator five feet from shore about 45 minutes before the attack. The eldest daughter told a Disney employee about it, and that employee went to inform another Disney worker. The Giacominis went to a nearby store and when they returned the boy had been attacked, according to the wildlife agency’s report.

Disney lifeguard Christopher Tubbs told deputies that after the boy was snatched he saw Lane’s feet sticking out about 20 feet from shore.

“He saw the alligator start slash(ing) around and the shoes went under the water and the alligator began its death roll,” the sheriff’s office report said.

The wildlife agency’s report said Lane did nothing to provoke the alligator and that the death is classified as a predatory attack.

The alligator may have had a diminished fear of people by being in an area with lots of humans, and wildlife officials are still investigating if alligator feeding took place, according to the wildlife agency.

Lane’s parents have said publicly they don’t plan to sue Walt Disney World over the death.

After Lane’s death, Disney World made changes to limit possible visitor contact with alligators on the property.

Workers were building a stone wall around the lagoon and “No Fishing” signs were installed around waterfront areas. Fishing at Disney World was changed to be limited only to excursions.

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movie theater seats

Florida man loses again in court over broken movie seat

An appeals court has decided not to revive a lawsuit filed after a man was hurt by a collapsing movie theater seat in Pensacola.

A three-judge panel of the 1st District Court of Appeal Monday unanimously agreed that a lower court was right to grant summary judgment against Isaac Simmons.

Summary judgments allow parties to win a case without a trial.

Simmons had filed suit as a product liability case. Wrong move, the courts said.

“(The) seating system is an integral part of the movie theater’s operation,” Monday’s opinion said. The “movie theater seating system was a structural improvement to real property and, thus, not a product.”

While watching a movie, the “seat that (Simmons) was sitting in broke due to a failure in the welding in the seat bottom, causing him to fall to the floor and suffer bodily harm that required surgical interventions,” according to the opinion.

Under product liability law, plaintiffs generally only have to prove they were hurt and those being sued are responsible.

The defendants in the case, including the seat manufacturer, argued “strict liability did not apply … pointing to undisputed evidence that the seating system was bolted to the concrete floor of the auditorium,” the opinion said.

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Tanning industry blames 10,000 salon closings on ‘Obamacare’

The tanning salon industry is feeling burned by “Obamacare.”

Business owners around the country say the little-noticed 10 percent tax on tanning in President Barack Obama‘s health care overhaul has crippled the industry, forcing the closing of nearly 10,000 of the more than 18,000 tanning salons in the U.S.

Experts say the industry is overstating the effects of the “tan tax” and that it has been hurt by other factors, too, including public health warnings about the dangers of tanning and the passage of laws in dozens of states restricting the use of tanning salons by minors.

Nevertheless, some salon owners say the health care overhaul will be on their minds on Election Day. Republicans have vowed to repeal “Obamacare” if they win the presidency and retain control of Congress.

“When I go to vote, I’m supporting candidates who are pro-business and who want less government involvement, less government regulation,” said Chris Sternberg, senior vice president of Sun Tan City, a Louisville, Kentucky-based chain with nearly 300 salons in 22 states.

The tax, similar to that imposed on tobacco, is meant to discourage a practice known to increase the risk of cancer. The American Cancer Society Cancer Action Network says those who use tanning beds before age 35 increase their lifetime risk of melanoma, the deadliest type of skin cancer, by 59 percent.

Congressional experts also projected the tax would raise about $2.7 billion to help expand health coverage for uninsured Americans, but the industry says it actually has raised just a fraction of that.

The industry has spent millions lobbying to repeal the tax, which it says destroyed 81,000 tanning jobs.

Kim Arnold, a business owner in upstate New York, said she and her husband had to close their third Tropical Tann location last August because of the tax.

“Customers would say, ‘I’m not paying that,'” she said. “I’d have people walk right out the door.”

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Face-biting FSU student/murder suspect dared deputies to test him for drugs

A FSU student caught biting a victim’s face after stabbing the man and his wife in a random attack dared deputies to test him for drugs, a Florida sheriff’s office spokeswoman said Saturday.

Nineteen-year-old Austin Harrouff told deputies, “Test me. You won’t find any drugs,” after deputies responded to the home of 59-year-old John Stevens and his 53-year-old wife, Michelle Mishcon, Martin County Sheriff’s Office spokeswoman Trisha Kukuva said in a statement.

The couple died Monday night after Harrouff attacked them and tried to bite off Stevens’ face.

The sheriff’s office says Harrouff will be charged with two counts of first-degree murder for the couple’s death, as well as attempted first-degree murder for the stabbing of the couple’s neighbor, Jeff Fisher, who suffered multiple wounds when he tried to intervene before calling 911.

The FBI is conducting toxicology tests at the agency’s lab in Quantico, Va. to determine if Harrouff was under the influence of any substances.

Hospital blood tests showed no signs of methamphetamine, cocaine, heroin or other common drugs; it will take longer to test for less common hallucinogenic drugs such as flakka or bath salts, whose abusers have been known to become suddenly and irrationally violent.

Harrouff currently is in stable condition at a hospital where he was taken for treatment after deputies had to use a police dog and a taser gun on him before he was subdued. The sheriff’s office says he was growling like a dog and had abnormal strengthen, requiring several deputies to pull him off Stevens.

Investigators have been unable to interview him because he is heavily medicated and on breathing tube, Kukuva said.

The Florida State student is expected to be released from the hospital next week, she said.

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