Wednesday, October 18, 2017

Harvoni hi-jacking? :-O

I was sitting in the doctor's office one day -- and one of the drug company folks was sitting across from me waiting to speak to the doctor.  Then it hit me and I asked him: "If Harvoni ...

... [Gileads 99% cure of Hepatitis C which it sells in the US for $100,000 an 84 pill treatment] ...

... is worth so much why doesn't anybody knock off a truckload?  They must keep it somewhere.  Isn't the Mafia interested?"

Later a whole gamut of criminal enterprises opened up for me.  You could get a prescription and then hit the pharmacy when you knew it was there (burglary or robbery).  You could treat your self or sell it and ask for another prescription -- you "never got it."

Harvoni could be the smuggling enterprise dream.  You are not going to get life imprison for smuggling kilos of prescription drugs (I don't think).  84 pills weighs, what, about two ounces?  A couple of million dollars per kilo at US pharmacy prices -- maybe $200,000 on the street (dealing with legit buyers; not crime prone addicts).  Cost to manufacture: maybe $2,000 -- going by $150* a treatment for Sovaldi, the main ingredient.  No raids and no payoffs at the point of manufacture (India, China, Egypt?) -- and no guilty conscience: you're saving lives!  :-)

Organized crime would back off "you-deal-you-die" for it's "fellows."

Be like prohibition (except easier).  Cops may look the other way -- they won't want anybody to die.  Juries may not convict!
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Possible anti-pharmaceutical extortion TV ad:
I'm thinking of a scene I used to see on Seventh Avenue outside Madison Square Garden in the 70s.  Two money trucks parked, one at the curb, one catercorner in the next lane out, four guards come out of the building, one with two boxes (presumably money) on a hand truck, one just behind him to one side, another ten feet behind him to the other side and one trailing thirty feet back on the other, all guns drawn.

Well, you'd just need a little box with a dozen bottles of pills to go way over a million legit pharmacy smackolas with Harvoni.   You could film it being delivered to a drug fortress.  Once the opportunity for extreme profits knocking off sky high-priced prescription drugs, not just Harvoni, gets around you're going to have to safeguard them much more than, say, mere check cashing place dollars -- worth incomparably more.
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Another anti-medical murder angle:
Put up a countdown billboard showing how many years (11) and days before Hepatitis C can be wiped out in this country (now 3 years since it could have been wiped) -- simultaneous with Gilead's Harvoni patent running down (2028).

It is crazy to have a once-and-for-all cure for Hepatitis C and to have to wait fifteen years before taking actual advantage of it -- for lack of funds to pay Gilead's $300 billion(b) drug store price.  Which price Gilead will extract most of at $15 billion(b) a year anyway -- to treat the more active infections, many or most of which will have been contracted from today's 3,000,000 US uncured hosts.  

Crazy ironic because VA research started the cure on its way -- whence said VA researchers smelled money and took over same for themselves (took it all the way to Ireland actually for lower intellectual property taxes) -- the lead endocrinologist taking off a cool $446 million (almost enough to manufacture enough for all US patients)  when Gilead bought the patent for $11 billion in 2011.


 * * * * * * * * * * * *

The Tasmanian Hep C Buyers’ Club
Sophie Cousins    JULY 25, 2017

It works like this: If you’re a patient who doesn’t want to travel to India, you send Jefferys $1,000 along with an identification form and a prescription. Within 10 days you receive your generic Sovaldi or Harvoni, shipped from India.

If you can’t get a prescription (some countries prohibit doctors from prescribing generic medicines), a medical report showing that you have hepatitis C will suffice. Jefferys asks for a $200 fee for his service, but it’s optional. “I don’t want to profit from people’s sickness. There’s enough of that going on already, so I will remove my fee if you ask,” his website says.
 * * *
While Australia, Britain and the United States allow the personal importation of a three-month supply of medicines under certain regulations, some countries, like Canada, ban personal importation altogether.

Jefferys is reluctant to talk about his work with people in Canada. “From a legal point of view, I’m just facilitating people’s access to drugs,” he said. As for his methods, he said, “I cannot reveal all because some are illegal. I’m perfectly happy to break laws and get people treatment. You’re talking about people’s lives.”


Sunday, October 1, 2017

The restocking of American labor union density in 39 words

The restocking of American labor union density in 39 words:
If a state or local legislature passes a law that makes exercising freedom of association (e.g., organizing a labor union) possible where it would otherwise not be possible, then, Congressional preemption of labor law falls to the First Amendment.

Federal interference (preemption) with state legislation can pop up in the least likely places (and least practical).


Florida wanted 140 mph resistant cranes -- Congress thought 93 mph okay, years ago -- judiciary thought no lives endangered (off street; none lost to previous storms); probable property damage to cranes and structures not enough to let Florida do its own thinking.  No competing value somewhere else in the Constitution could save Florida from judges judging federal preemption.

Not so in every area.

A doctor on KevinMD blog griped that anti-trust laws bar doctors from combining to bargain fees with hospitals (unless employed there).  I opined (no expert on the specifics) that if doctors combined to bargain with a giant like Blue Cross, then, overall market power would be sufficiently balanced -- for the First Amendment to assert itself and protect doctors' combination -- disallowing not a matter of legislative choice.  (I got the general idea right anyway.)

For decades now, judicial interpretation has walled out state labor legislation under federal preemption until it precludes anything the NLRA(a) even so much as arguably protects or prohibits (Garmon); all arguments resolved solely by the NLRB(b) -- also almost anything that fits under the definition of the free play of economic forces affecting collective bargaining (Machinists), IOW almost anything not fitting under the definition of protected or prohibited.

Ironically, as decades of judicially discovered barriers to state intervention piled up, the number of union workers left under federal rules slid endlessly down.

Decades during which the initial intent of Congress to "encourage the practice and procedure of collective bargaining" -- was been lost to growing federal ineffectiveness and state law freeze out.

6% labor union density in private business (the 6% able to hang on by their own natural advantages; no help from Congress) equates to 20/10 blood pressure -- no difficulty diagnostically.  And it starves every other healthy democratic process.

For an all day read on uninvited judicial construction activity click below (97 page PDF, very readable, half is notes and if you only want to check out Garmon and Machinists you can do pp. 70-90).

Reforming Labor Law by Reforming Labor Law Preemption Doctrine to Allow the States to Make More Labor Relations Policy   by Henry H. Drummonds

Late dean of the Washington press corps, David Broder, told a novice reporter that when he came to D.C. fifty years earlier, all the lobbyists were labor.  I tell doctors that no matter what health system we originate or borrow it won't halt the financialization and crapification of US medicine -- unless we build a countervailing force, unless we restore healthy union density (for the whole country, not just doctors).

How to get (back) there in 30 words:
Constitutionally guaranteed freedom of association precludes Congress from disallowing state legislative protection of labor organizing for collective bargaining which legislation is a necessary condition for the exercise of that freedom.

"The ultimate sweetheart contract is no contract at all."