Non-24 Sleeping Pill | $15,000 a Month

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[caption id="attachment_254" align="alignleft" width="150"] logo created by RKL[/caption] The cash price for a single month of Vanda Pharmaceuticals’ highly advertised “Non-24” sleeping pill averages $15,000.  This translates to $500 a night or $180,000 a year for basically a sleeping pill that targets the melatonin receptors in the brain.  A four month supply of melatonin readily available without a prescription at any grocery store or pharmacy costs about $6. This drug, more properly known as Hetlioz, gained FDA marketing approval in 2014.  That year the cost for one month of Hetlioz was an egregious $7500.  By 2017 it rose to in excess of $13,000 and surpassed $15,00 by early 2018. The “Non-24” pill sold as Hetlioz contains a molecule similar to but somewhat different from over-the-counter melatonin preparations.  For obvious reasons…
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Victoza Heart Disease Diabetes and Survival

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[caption id="attachment_254" align="alignleft" width="150"] logo created by RKL[/caption] Can Victoza favorably disrupt the unholy trinity of obesity, type 2 diabetes and heart disease?  Since most type 2 diabetics die of cardiovascular disease rather than elevated blood sugar, this question significantly impacts survival. Advertising claims suggest advantages for the injectable anti-diabetic drug Victoza in protecting the heart, stimulating weight loss and reducing the likelihood of death from cardiac events.  Are these based in reality or merely commercial entreaties from the drug maker looking to ensnare more customers? Among the results emphasized by the company are a statistically significant fall in death from cardiovascular causes from 1.6 in 100 patient-years down to 1.2.  Regarding death from any cause Victoza reduced the toll from 2.5 deaths in 100 patient-years to 2.1. While statistically…
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Prevagen – Save Your Money Instead

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[caption id="attachment_254" align="alignleft" width="150"] logo created by RKL[/caption] Considering Prevagen - save your money instead.  Want to think like a jellyfish – take Prevagen.  Tiresome repetitious televised commercials somehow link brain health, clearer thinking and a sharper mind to an amino acid present in jellyfish. This moderately expensive supplement at once claims to improve mental clarity while at the same moment noting “this product is not intended to diagnose, treat, cure or prevent any disease.” Studies supposedly demonstrating Prevagen’s benefits must be taken with the proverbial grain of salt.  These company sponsored “investigations” appear highly flawed, unscientific, unreliable and not published in any recognized peer review journal.  Apparently the company and its principals even played a dominant role in writing the papers. Evidence supporting for Prevagen stems from the Madison…
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Gabapentin Remains an Enigma

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[caption id="attachment_254" align="alignleft" width="150"] logo created by RKL[/caption] Gabapentin remains an enigma: one of the most widely prescribed and abused drugs yet one with relatively little scientific justification for its use.  Approved as an add on for partial seizures in adults and children, it gained a certain following for treatment of severe nerve pain following in the aftermath of shingles – post-herpetic neuralgia (PHN). Even for post-herpetic neuralgia, gabapentin fails to live up to expectations.  Only moderate quality evidence exists regarding this indication.  Unfortunately studies indicate only 15% of individuals benefit by a 50% reduction in pain compared to those receiving a placebo.  And typically the investigations lasted only two to three months in PHN where symptoms persist for months to years. Gabapentin finds a certain cache as therapy for…
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Linzess Targets Chronic Constipation

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[caption id="attachment_254" align="alignleft" width="150"] logo created by RKL[/caption] Linzess targets chronic constipation related to long term conditions of undetermined cause such as the Irritable Bowel Syndrome.  By definition this requires fewer than 3 bowel movements each week for at least 3 months.  Unfortunately this very expensive drug, whose price continues to steadily increase, provides only mild relief.  With a cash price in excess of $15 a day, the drug seems as likely to cause harm as benefit. Approximately 1 in 5 individuals receiving Linzess experience diarrhea which at times may be quite serious.  Especially among the more fragile this may lead to dehydration, low blood pressure, dizziness and possibly fainting episodes. Advertisements aimed at the general public suggest the drug offers major advances in combating constipation.  Studies however suggest Linzess…
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Metformin Treats Type 2 Diabetes

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[caption id="attachment_254" align="alignleft" width="150"] logo created by RKL[/caption] Metformin or Glucophage ranks as the first choice in treating Type 2 Diabetes when diet and exercise fail.  This drug remains one of the true bargains in American medicine – especially in diabetes care - typically costing less than $30 a month. Of course the main issue in Type 2 Diabetes remains excess body fat.  Cure by weight loss would be preferable to treatment by pill or injection.  Metformin offers the opportunity to decrease blood sugar without the risk of hypoglycemia when prescribed as the sole agent. Unfortunately as time progresses, most overweight individuals continue to add extra pounds which requires supplemental therapy.  Metformin may be combined with most other classes of anti-diabetic therapy. Metformin functions by altering a number of metabolic…
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Wellbutrin | Bupropion | Antidepressant

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[caption id="attachment_254" align="alignleft" width="150"] logo created by RKL[/caption] Originally marketed by its brand name Wellbutrin, most people receive the far less expensive generic bupropion.  The drug remains one of the most frequently prescribed anti-depressants capitalizing on the widespread perception it causes fewer side effects.  Arguably less weight gain and fatigue occur with bupropion than with other anti-depressants.  Additionally it may alleviate some of the sexual dysfunction associated with members of the SSRI family such as Prozac, Zoloft and Celexa. While physicians tend to champion one anti-depressant over another, statistics fail to reveal substantial difference between drugs commonly utilized to combat the disorder.  Due to individual sensitivity, some people may respond more favorably to one drug or experience fewer side effects compared to other options.  Interestingly for the majority of people,…
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Nuplazid Adverse Reactions

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Potentially severe adverse reactions including death warrant reconsideration of Nuplazid.  The drug continues to be heavily promoted to the public on television commercials and to the profession in journal advertisements.  Unfortunately Nuplazid offers few benefits compared to the major risk of complications.  Marketed as a breakthrough therapy to combat the hallucinations and delusions associated with Parkinson’s Disease, it barely surpassed the merits of an inactive placebo.  Except the placebo was neither associated with death nor did it cost anywhere near the staggering $30,000 a year commanded by Nuplazid.   During Nuplazid’s short time on the market, the Food and Drug Association Adverse Events Reporting System or FARES received more than 5700 reports of problems associated with the drug.  This included more than 1800 serious reactions and 712 deaths.  Although FARES…
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Trulicity | Expensive Diabetes Treatment

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Trulicity represents an expensive add-on treatment to assist in controlling type 2 diabetes.  Only one shot of Trulicity every 7 days is standard in addition to routine diabetes therapy.  The cost for one month of Trulicity for a cash paying patient averages about $800. A battle is brewing between Trulicity and a closely related competitor - Victoza.  Both activate the GLP-1 receptor which leads to greater insulin release and decrease in a hormone, glucagon, that counteracts the action of insulin.  In the process emptying of the stomach is slowed which results in reduced appetite and then the possibility of weight loss. Side effects tend to be mild but relatively common.  Among the most frequent are nausea in up to 20%, vomiting in 10%, diarrhea in 10% and abdominal pain in…
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SeroVital | A Growth Hormone Booster?

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  The question is whether SeroVital really boost growth hormone and if so does it matter?  Containing a smaller amount of amino acids than in a bite of steak, chicken or salmon, this supposed human growth hormone booster makes preposterous appearing claims based on extraordinarily shaky evidence. While using such enticing catch-phrases as anti-aging, breakthrough and fountain of youth, the packaging promotes SeroVital to increase lean muscle mass, reduce wrinkles and more. A $100 investment buys one month of product but at best the “increase” in growth hormone raises it only into the low normal range. Ingredients include small amounts of lysine, arginine and several other trace compounds in amounts dwarfed by those in the American diet.  While marketing hype suggests special benefits for these supplements, it seems difficult to…
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