DULL BORING GENERIC

Did you know that Boring, Oregon and Dull, Scotland – yes these are real localities- have bonded to promote tourism?

There is a slight difference in size but neither is a metropolis. Boring’s population is about 8000; Dull north of Glasgow has 20 houses and 80 residents. Dull has no sidewalks to take in at night.

I hope that my little rants about the state of health care are neither “dull” or “boring” but informative.

One of the health care scams being promulgated on the public is the half truth that generics and brand name drugs are equal; implied is that there is no difference except cost.

Those who are seeking all routes in lowering the costs especially the insurance companies and government in their benefit programs are the protagonists for generic use.  The drug chains like them because even though there is a great difference in retail price their profit margins for the generic are much better.

It would be un-American the to legislated limits on percent markups over costs on medicines and procedures excluding the professional component.  Yet everyone approves of mandated fee schedules by Insurers as well as Medicare and Medicaid which are often below the breakeven point in a practice. Obviously that means that an equitable income cannot be reached.

To get back to the generics; the blanket statement that all generics and brand name drugs are equal is false.

All medicines with the same chemical formulation have the same active ingredient. Milligram to milligram they are the same. But, the standard of variation in therapeutic potency which may depend on actual amount of active ingredient in the tablet or capsule of medicine differs for brand name drugs and their generics.

Even if the chemical formula for a drug is the same there can be a variation in therapeutically response. This can be applicable to identical brand name drugs as well as generics.  This can have no relationship to any manufacturing variations in the amount of “drug” in the pill.

One of the most famous examples year ago had to do with two brand name levothyroxin products; Synthroid and Levoxol. Too many physicians’ surprise it turned out that the two brands were not interchangeable; a switch from one to the other resulted in a therapeutic difference in the patient. The possibility of this happening with generics is greater.

The brand name drugs are held to a narrow variation range in amount of the active ingredient in the tablets. The generic manufactures are permitted greater variation above or below the stated amount. There also is difference in the fillers that must be taken into account.

This is from MedicineNets description of the drug:

GENERIC NAME: levothyroxine sodium

BRAND NAME: Synthroid, Levoxyl, Levothroid, Unithroid, Tirosint, Levo-T

DRUG CLASS AND MECHANISM: Levothyroxine is a synthetic (man-made) version of the principle thyroid hormone, thyroxine (T4) that is made and released by the thyroid gland. Thyroid hormone increases the metabolic rate of cells of all tissues in the body. In the fetus and newborn, thyroid hormone is important for the growth and development of all tissues including bones and the brain. In adults, thyroid hormone helps to maintain brain function, utilization of food, and body temperature, among other effects.

GENERIC AVAILABLE: Yes. Generic and branded tablets of levothyroxine may differ: in the amount of levothyroxine they contain, in the absorption of the levothyroxine into the body, and the distribution of levothyroxine throughout the body.

This means that ingestion of 1 mg of generic levothyroxine may not have the same effect on the body as 1 mg of another generic or branded levothyroxine. Practically speaking, this means that when changing between levothyroxine manufactured by different pharmaceutical companies, a change in dose may be necessary to maintain the desired effect or to prevent toxicity. When switching between brands or generics, it is important to ensure that both preparations are equivalent or to check blood thyroid levels weekly.

One of the compounding problems with generics is that the pharmacy May change manufacturers due to a better price without notification to the consumer.

This problem is applicable to all medicines. Recently the FDA approved generic alternatives for an effective anti-glaucoma eye drops. Ophthalmologists have reported variations in eye pressure which had been stable for years. It is possible that damage could happen to an unsuspecting patient who knew his medicine was controlling his disease.

The point that I am making is that there always is a chance that a switch to a generic will mean that the impact on your body may change. This does not mean that you should not use generics but be advised that not all will respond exactly like your brand drug. If you are on a generic and doing well stick with it but check the manufactures name to be sure that there has not been a change in you medicine.   

POTPOURRI on HEALTH CARE

Today is the last Friday before the August Council meetings; and the Special Primary for the vacant Senate seat. Preseason pro-football starts tonight; yes there was the Hall of Fame game last weekend. Congress is on vacation; some will claim that it is always on vacation or doing nothing.

It is the time for a break from the above; a day for some unrelated tid-bits about Health Care and the effect on you. This potpourri is not going to attack “Obama Care” but note some unrelated Ozonian matters in Health Care.

Did you know in an attempt to assure that the Insurance companies made low premium insurance available; part of Obama care act puts a so called Cadillac Tax on high benefit expensive group insurance no matter who was responsible for the premium.

Among some of the too late recognized fall outs was that Congressional members and their staffs with their golden policies (paid by us) were also subject to that provision the extra cost being born by the policy holder.

The solution; by administrative order they are going to be exempt from that provision of the law.

Another unrecognized negative impact of this law will serious affect the economic well being of municipalities in which their union contracts require the offering of top grade Health Care cover all policies. The City and to a lesser extent the policy holder will have to pay the additional charges resulting from the surtax.  

The money will have to come from some place. Aside from the fact that in most political units one of the largest budget items is the mandated insurance coverage; the budgets will have to be reworked to cover that un-anticipated expense. That will be reflected in a major property tax increase.

Even the premium on the anticipated bare bones mandated insurance is going to need adjustment. Premiums are based by actuarial studies of possible costs.  The ages of the policy holders are an important factor. With the law dumping a large number of High Risk into the pool the overall risk element will be greatly increased which will result in an increase in insurance costs.

The resulting increase in costs and the relatively low penalty cost will persuade the young and healthy not to get insurance. This will lower the number of low risk members in the pool. There must be an increase in premiums due to a higher risk pool.

Did you know that two hospitals in Brooklyn are in bankruptcy and closing? This is a large part due to hospitals that are serving a large Medicaid population are under reimbursed for services rendered. 

Moreover since that type medical population tends to either abuse ER services or by not following instructions have increased re-admissions for which the hospital will be penalized for poor performance; the institutions will receive reduced payment from the already inadequate schedule    

Some more rants about the destruction of our health care system due to governmental intrusion that believes that limiting costs is more important than real quality care to follow over the weekend.

THE CHARTER REPORT

One of the pluses from attending the Charter Study Commission interview meetings was the education received by listening to the opinions of others. 

I was honored by being asked to be the first interviewee; and the only person who had no City Hall ties. Most of my original points except three were consistent with the Commission’s final document.

Of the three that were different; one, because of the often adversary Mayor Spokesperson position of the Corporation Counsel; I had suggested separate legal representation for Administration and Council.

Other interviewees opined that such roles could lead to more litigious action between the two bodies, I began to agree that the Corporation Counsel did not represent the Mayor, or the Council, but the City itself. He had to be neutral.

This change in my view has been enhanced by the present Corporation Counsel. There are several factors that will help in the future. Under the present Charter the Corporation Counsel is appointed by the Mayor and the Counsel’s term is concurrent with the Mayor’s. The Commission has  recommended  that the Counsel be given the same protection that the City Administrator an Department Directors have; If the Mayor fired them, the Council had by a 2/3 rd majority the right to

As other interviewees opined that such roles could lead to more litigious action between the two bodies, I began to agree that the Corporation Counsel did not represent the Mayor, or the Council, but the City itself. He had to be neutral.

This change in my view has been enhanced by the present Corporation Counsel David L. Minchello. He has assumed an impartial position since first becoming acting Corporation Counsel. He is representing the "Corporation" which is the Chartered City.

There are several factors that will help in the future. Under the present Charter the Corporation Counsel is appointed by the Mayor and the Counsel’s term is concurrent with the Mayor’s. The Commission has  recommended  that the Counsel be given the same protection that the City Administrator and Department Directors have; If the Mayor fired them, the Council had by a 2/3 rd majority the right to override the dismissal.

There is no provision in the Charter that the Corporation (Municipal) Counsel must be full time.  Indeed if he/she is not 100% depended on the position for their livelihood there is less chance of the Counsel’s being the Mayor’s advocate at Council meetings.

The second place where I differed from the final document was that I felt the present ward structure was not representative of the ethnic mix in the Council. 40% of the City’s population is Hispanic. Hispanic representation on the Council is 0.

I advocated a restructure into 6 wards and only 1(or 3) at large Council person. If that was not possible the present four wards should be redrawn so that the population contained in the 1^st and 4^th wards be equal to that in the 2^nd and 3rd. At present there are almost 2000 less voters in 1&4.

Changes off this magnitude would probably require Referendum voting, and I think the Commissions’ position of not going that route is correct.

I have felt that the present 3 Department structure is too artificial and unwieldy. The Commission seems to agree on this but once again felt that the present structure retention outweighed the costs of a Referendum vote.

Therefore they suggested a revision of that portion of the organizational structure to retain the present Departments with an updating of their name. But they also added a provision that the Council by Ordinance could add up to 3 more Departments.

The added provision for a Charter Study every 12 years is a well thought out plan. The Charter should be a living document not a fossil.

The suggestion for a Legislative Aid for the Council is a good one. 

I believe there should be an addition to the Mayor's duties a requirement to attend Council meetings in an Ex-Officio position. At present the Mayor is considered a guest. The Mayor  should be afforded the privilege of the floor in accordance with the Council's rules. 

ABOUT REV.COUNCILWOMAN

Chick here for copy of the NNO flyer:  http://www.plainfield.com/docs2013/NNO2013-flyer-A.pdf#page=1

Councilwoman Rev. would be as acceptable as Councilman Dr..  Dr. Councilman Joe Blow ?

POOR SUBSTITUTE

An apology to my readers for not having a:”meaningful blog” today. Part of the problem is that there has been such a sudden profusion of subjects and material that merit discussion and amplification that 

I cannot focus on one single topic.

Nationally there is the reaction to a major terrorist threat. Although it is believe that the target(s) are overseas, one cannot rule out a “leaked” diversionary plot to hide some major incident in the USA.

Nationally there has been a splurge of random acts of “murdering” innocent unsuspecting civilians.  In Pennsylvania a “homeless “man killed six by shooting through the wall of the building holding the Council meeting. In California a man deliberately drove his car onto the Boardwalk” killing at least one person.  

Then there is the A-Rod and MLB nonsense in which he is penalized as he should probably be although there were no positive tests. On the other hand' Baseball is treating him proportionally out of line with the penalties given others. The lawyers will make out like bandits.

There has been a flurry of activity in the local sphere. The Charter Study Commission has submitted its report which must be read. The Mayor with acts like she is running for a political office with two last moment public affairs in the past few days.

Apparently, according to the flier for the City’s NNO there has already been a Charter Change. Among the sponsors is Rev. Councilwoman Tracey L. Brown. Are we mixing church and State?

Busy two days ahead with “social” visits two health care providers today and tomorrow. However I may write a blog later today.

CHARTER COMMISISON REPORT First Glance

The Charter Study Commission has delivered its report as required by law to the City Clerk's Office. AJ has posted a copy on email to those on his list.

A preliminary scan shows no earth shaking recommendations other than clearly  defining the role of the Corporation Counsel as the City's legal resource not the Mayor's spokesperson or personal attorney which seem to often to be Williamson's' role.

Also there is a recommendation that the Council not the Mayor appoint the City Clerk.A third change is to rename the City Administrator as the Business Administrator which is more descriptive of his "job".

(8am 8/6/13). The lack of efficiencies of the Charter mandated 3 Department structure is recognized. Rather than mandate a change or increase in the number of Departments; provision is included to permit up to 3 new additional Departments by Ordinance or  reformation of present Departments

There are language changes to bring the Charter into conformity with State Laws.

Most important rather than going the expensive and time consuming Referendum route there is the recommendation that changes be made by Ordinances which have to be submitted to the Legislature for approval by 2/3 majority. Since none are controversial that should be no problem.

Although their task is not yet complete we Plainfielders should  all express our gratitude to those five dedicated citizens who accomplished without compensation this arduous work.

NATIONAL NIGHT OUT PUBLICITY

August the 3rd I posted my blog MEDIATATION  bemoaning the loss of  viable print news media. 

Today's (8/5/13) Courier is a good example  of why non-metropolitan news papers are becoming extinct. 

The Front page news Story about Tuesday's "National Night Out" continues on the 2nd page listing various communities planned celebration. 

Not only is Plainfield's reported in one of the shortest paragraphs; but only the Johny-come- lately even unpublicised on the City site is noted. Mayor's and NAACP sponsored event is mentioned. Totally ignored is previous announced event sponsored by FOSH and Netherwood Heights Association at the Leland Ave park.

This event was planned when the city gave no indication that there would be anything official in the city. I was under the impression that Freeholder Chairperson Linda  Carter for years one of the  proponents of this annual event had acknowledge this celebration.

Why should or would anyone in Plainfield subscribe to a paper that treats Plainfield with disdain?