Prescription drug costs are one of the fasted growing segments of healthcare. Have been for several years and concerns are dismissed as over-reactive and not understanding the true value of medications at reducing total healthcare costs. PHARMA is a strong lobbying group at state and federal levels and has been effective at minimizing any significant progress to reduce costs.

Limiting options of low cost drugs with patents has been an effective technique.

The clearest case is prescription drugs where we will spend over $440 billion this year for drugs that would likely sell for less than $80 billion in a free market.

Even if we decide these government granted monopolies are necessary, we could still make them shorter and weaker. In the last four decades, policy has gone in the opposite direction. We have made patents and copyrights both longer and stronger.

A category of drugs called protein pump inhibitors (PPI) is a good example of the inherent problems of our current drug marketplace. The original drug on the market Prilosec (omperizole) was replaced by the same company when its patent expired with a better more expensive drug Nexium - the purple pill. There have been a number of "me too drugs" introduced to the market as multiple companies try and grab some of the profits. The drugs were heavily promoted to be automatically prescribed in treatment protocols, made available as prescription and over-the counter-dosage forms and most studies are for short-term use.

Questions about appropriateness of long term use are starting to be raised.

The adverse outcomes associated with PPI use are serious, and each is independently associated with higher risk of mortality. Evidence from several small cohort studies of older adults who were recently discharged from the hospital or institutionalized in long-term care facilities suggests inconsistently that PPI use may be associated with increased risk of 1 year mortality.

PPI are widely used by millions of people for indications and durations that were never tested or approved; they are available over the counter (without prescription) in several countries and generally perceived as safe class of therapeutics. They are often overprescribed, rarely deprescribed and frequently started inappropriately during a hospital stay, and their use extended for long-term duration without appropriate medical indication.46–50 Results of nationally representative data from the National Health and Nutrition Examination Survey, where analyses were weighted to represent the US adult population, showed that the use of prescription PPI increased from 3.9% to 7.8% from 1999–2000 to 2011–2012, representing a doubling of prevalence ratio.45 Studies estimate that between 53% and 69% of PPI prescriptions are for inappropriate indications46 51 where benefits of PPI use may not justify the risks for many users.

Creative new ways to increase profits have been implemented.

You can walk into your local drugstore and buy a month’s supply of Aleve and Nexium for about $40. For Vimovo, the pharmacy billed my insurance company $3,252. This doesn’t mean the drug company ultimately gets paid that much. The pharmaceutical world is rife with rebates and side deals — all designed to elbow ahead of the competition.

Herrick, the health care economist, said Horizon cashed in by eliminating many of the barriers in the system that are meant to control costs. The company got patients on board by covering their out-of-pocket costs. It appealed to doctors by promoting the benefits to patients. And it did an end-run around chain pharmacies, which typically might suggest a lower-priced alternative, by steering prescriptions to pharmacists who would participate in their patient-assistance program.

Efforts to decrease prescription drug prices are probably mostly talk.

With a new administration in place, the pharmaceutical and health products industry spent $78 million in lobbying in the first quarter, a 14 percent increase over last year

Several of the proposals appear to reflect that industry influence. For example, the document directs the United States trade representative to conduct a study of price differences between the United States and other countries, and to review trade agreements that may need to be revised “to promote greater intellectual property protection and competition in the global market.”

Farm Report

This week I have been dealing with water issues.

Attended a member meeting for the irrigation district regarding future plans to decrease water loss from the ditches and leave more water in the river. The district is preparing to do a test project of piped pressurized water directly to the farms and ranches. Preparation is starting to happen for future decreases in water supplies.

The irrigation water is mapped to each square foot of land and it needs to usage requirements. The district takes aerial photos yearly to verify use. If not used for 4 years the irrigation district has the option of confiscating the water rights. A consistent amount of water is delivered daily for use. I can adjust the amount of water on any portion of land with water rights, but may not irrigate on the portions of the property without rights. This allows me to create different zones on my property to mimic different rainfall patterns.

A current picture of dry field with spring grasses that are now dormant and an irrigated field.

The trees in the picture are on non-irrigated land, downhill from a small ditch. Enough water seeps from the ditch and travels down for the aspens, apple tree and chinese elm to grow. The apple tree does produce a few apples every year.

A couple of acres are native dry land that are not grazed or traveled on with vehicles since I bought the property. The area containing native grasses, mosses and wild flowers area is slowly growing in size.

Mariposa lily stalks are not visible until close to the plant. The flower appears floating in the air at a distance.

Mariposa lily with bitterbrush background in dry land.

Wild yellow buckwheat in dry land.

Yarrow at the edge of the irrigated field

Six weeks growth since I last posted a picture. Coming to inspect the camera.