Monthly Archives: January 2017

My Special Snowflake

Back to bikes!

I’ve been training hard using TrainerRoad; more about that later. But long story short, it’s awesome; I’m closing out week 7 of 5 rides/week (around 8 hours total each week) with some very significant FTP gains. Highly recommended.

Also just want to brag: Only 1 missed workout, and that was because my knee was a little achy.

I have a build list together for my Fujin SL II, if anyone sees something that could potentially be optimized, let me know!


Headset: Chris King 1″ NTS
Crankset/BB: Lightning carbon, 165mm, no logo, 110bcd spider
Front der.: Shimano XTR Di2 M9070
Rear der.: Shimano XTR Di2 M9050
Display: XTR Di2
Wiring for Di2: Battery, charger, junction, wires
Shifters: Shimano XTR Di2
Cassette: KCNC titanium 11spd 11-42
Chain: KMC X11SL, gold x 3
Front rim: Velocity A23, 20″ (406), black
Fork: Monoblade, CF
Front hub: tbd
Front spokes: tbd
Front tire: Schwalbe Pro One 406×28
Tubeless: Tape, aluminium valve, sealant
Rear rim: NoTubes ZTR Crest Mk3, 26″ (559), 28h
Rear spokes: Pillar Megalite SS rainbow x 28
Rear nipples: Sapim aluminium
Rear tire: Compass Elk Pass 26″x1.25″
Rear tube: 26″ ultralight butyl
Rear hub: Tune Kong, 10×135, 28h
Rear skewer: something light
Chainrings: Powertap C2, 50/36
Chainring bolts: Titanium
Brakes: Trickstuff Picolo, pink, plus rotors
Grips: Extralite Hyper Grips
Light: Exposure Strada 1200
Light bracket: Custom, tbd tbc
Misc: Titanium upgrade for all fasteners as appropriate

Some Hard Truths: Profit, Pharma, and Your Healthcare

I promise that after this, no more semi-political posts.

I read today that our president-elect plans to “negotiate with pharmaceutical companies to get the best price.” Not a bad idea, although I’m not sure how exactly that is going to work in practice.

Here’s a fact, though: Only about 10% of the national healthcare dollar went to prescription drugs. In contrast, 33% went toward hospital care (in 2013, the latest data I could find offhand). With all the hype about drug prices, I bet you didn’t know that.

So if we want to reduce healthcare spending, the way to do it is to keep people out of the goddamn hospital in the first place. In other words, if DJT really wanted to cut costs, he’d launch a massive preventative healthcare initiative. Not negotiate the 9% spent on prescription drugs to 7% or whatever.

Anyway, I know everyone beats up on pharmaceutical companies for drug prices–and there are certainly a few egregious examples of some pretty shady practices. But that’s not what I’m going to talk about right now.

With that out of the way: Let’s face a few facts: The pharma industry, like any other industry, is driven by profit. But wait, you say, healthcare shouldn’t be driven by profit!

In an ideal world, that would be true. But without the profit motive, do you think you are going to get new, lifesaving treatments? If you think scientists at academic centers are spending their time developing new cancer treatments, you are (by and large) wrong. Basic science in the academic setting is exactly that: basic, fundamental work that in many cases has no application to human health, and in other cases won’t have an application for decades to come. It is absolutely necessary to lay foundations, but it rarely produces immediate benefits.

Let’s look at what happened in a specific therapeutic area when the profit motive disappeared. Hypertension. You know, high blood pressure. Almost everyone will have some degree of hypertension as they get older, and most of these people will require medications.

People tend to think of antihypertensives as relatively benign drugs, because a huge proportion of people, especially older people, are taking them. But here’s a sad fact: most of them have fairly significant side effects, and none are particularly effective. In fact, many (if not most) people ultimately require a stew of different medications to get blood pressure fully under control.

Up until about 2010, there was massive research and development into new antihypertensive medications. What happened around then, plus or minus 5 years? A bunch of widely used antihypertensives went off patent. Now they’re available for pennies per pill, instead of substantially more.

Okay, you say, that’s great! Cheap medications! But you know what else happened? The pace of development of new antihypertensives came to close to a standstill, at least relative to the pace before the profit motive mostly disappeared.

The end result? You’re going to be taking the same crappy, ineffective antihypertensives your parents or grandparents are taking right now. Maybe there will be a few new, better drugs. But if you were running a pharmaceutical company, would you spend hundreds of millions to develop a new antihypertensive, put it through clinical trials, and then release it into a market that has hundreds of drugs available for pennies a pill? Probably not.

Hope you enjoy your chlorthalidone and hydrochlorothiazide!

Now, back to my post on Trainer Road, which I’m sure is far more interesting on a bicycle blog!

John

 

A Brief Aside: Health Insurance

So…Republicans are gearing up to kill the ACA.

Now, I’m a Democrat, but the ACA has been an unmitigated disaster for my own personal healthcare. Before the ACA, I had wonderful PPO insurance from the Freelancer’s Union. It was <$400 a month, had a minimal deductible, reasonable copays, and no coinsurance.

Contrast with my situation today: For $950/month, I get a $2000 deductible, copays have tripled and–wait for it–$30,000 in coinsurance. If I’m doing my math right, that means that a major medical issue would cost me $11,400 (monthly premium), $2000 (deductible), and up to $30,000 in coinsurance, for a grand total of $43,400. It’s almost like not being insured at all!

Plus, it’s HMO insurance, which means that I have to go through my primary care provider every time I need anything, leading to massive delays in getting specialty healthcare if I need it. For example, between appointment delays and insurance delays, it took me months and thousands of dollars in healthcare costs just to go see an orthopedic surgeon for a simple corticosteroid injection. I could also count the massive loss in productive work time due to these delays, but I don’t even know how to calculate that.

I’m self-employed, so my insurance options are extremely limited in New York state. The plan I have is the absolute best available to the self-employed here. There are only 3 insurance companies offering plans on the exchange, none with more than a 2 stars out of 5 rating.

So, I ask, why would I care if Republicans kill the ACA? It has had a direct, very negative impact on my personal healthcare. I’m totally willing to pay more in taxes to support social programs–but when it comes to what amounts to taking away any option for decent healthcare, at any price, I can’t support that. The entire process of getting my neck injury treated was absolute hell. Given that my insurance covers so little, economics dictate that I am better off without it and saving for the inevitable medical emergency. Of course, then I have to pay a tax penalty.

Kill it. Kill it with fire.

PSA: Get your flu shot, 2016 edition

A brief digression from your regularly scheduled programming.

Those of you who know me know that I do a considerable amount of work on vaccines. In fact, I’d say that it is the work that I’m proudest of, and it is truly a privilege to work with people who develop and train on vaccines (plus they are some of my favorite clients!)

Among all the revolutions that have come over the past century in modern medicine, I think I can safely argue that–at least from a public health standpoint–vaccines have had the greatest impact on disease burden.

Although this post is about the flu shot, just a note: not vaccinating your kids is an antisocial act. In fact, New Paltz is in the middle of a mumps outbreak. Yes, mumps. Nobody should be getting mumps in 2017. Dear dimwits: Jenny McCarthy is not a reliable source for health information.

I got my flu shot last week. I had a day of lethargy that may or may not have been related to the shot, but certainly nothing that impacted my regular activities. If you are afraid of needles, I should note that the needles on most vaccines these days are so fine that you barely feel them. Really!

John

medicalwriter.net