So long as its safe. Almost always, these things don't pan out... or at least the first molecular iteration. That's the primary reason medicine is so expensive.
> That's the primary reason medicine is so expensive.
My aim isn't to make a long thread out of the topic but: while I'd agree it's one reason, I'd dispute it's primary. Demand for medicine is pretty inelastic, meaning there is generally a lot of power on the supply side to set high prices. Then you have the dynamics between health insurers and providers, the burdens of regulation and liability for adverse effects, the tendency to focus research and marketing on novel [patentable] remedies over potentially cheaper ones, and the tendency to focus on remedy over prevention. It's fairly difficult to pick a primary reason.
The reason they have so much power on the supply side is that what they do is incredibly painstaking and expensive. I agree the system sucks.
Sublingual Toradol is available from pharmacies in Mexico. I fly to San Diego every five years, take the tram to the border and walk across to Tijuana to stock up. Toradol is an NSAID they give you via injection in the emergency room for chronic pain and headaches. By mouth it tends to cause GI bleeding worse than any other NSAID. A number of people died before they restricted the pill to five days consecutive use. Dissolving Toradol under your tongue bypasses the GI tract, making sublingual Toradol much safer. I carry a pill pack of four pills in my wallet, and having a pain medication as effective as morphine without sedation in my pocket at all times seriously improves my quality of life. There is something I can DO when my chronic pain flares up enough that it starts to get to me.
In the US the Sprix nasal inhaler is the functional equivalent of sublingual Toradol. I've read the research papers on both medications and I compared the charts for pharmacokinetics and pharmacodynamics and... the curves are virtually identical. They have the same impact on the body, both delivery mechanisms are equally effective in safety terms.
Sublingual Toradol is generic - the original papers on it are from the 80s. The Sprix is a patented delivery mechanism... wait for it...
* A dose of subligual Toradol in a Tijuana pharmacy: $0.25
* A single dose Sprix nasal inhaler from a US pharmacy: $25 last I checked. Only indicated for severe migraines.
That's a price multiple of 100x, as in one hundred times for a functionally equivalent medication. Last time I went to Tijuana the murder rate had multiplied by 10x since the last time I was there, so I went to the pharmacy right at the border. The price per dose was $0.50 there, but its cheaper if you go downtown. It isn't a counterfeited medication, so you don't have to worry about that. I wish more pain patients had access to sublingual Toradol. If a drug company wanted to improve chronic pain care, they could fund clinical trials in the US and get the medication approved. It will never happen in the states. Pure greed is the ONLY reason.
Actually, there's a lot more research on sublingual Toradol since I last checked: https://pubmed.ncbi.nlm.nih.gov/?term=%22sublingual+toradol%... See the sublingual film work? No reason for that instead of a pill except you can patent it. BOOM. BURN IT ALL DOWN.
I don't think we disagree but I find it interesting that you state: "...what they do is incredibly painstaking and expensive"
And later proceed to explain an example of two different patents based on a drug from the 80s improving nothing but changing just enough to patent it and sell it for 100x the generic.
I was wondering just about this, if hormone replacement therapy is really that safe, as one can imagine the natural drop in its levels with age may not necessarily be pathological itself, but a protection mechanism. Like the ageing body were an old boiler you can't just do a overhaul, so as the pipes rust, you turn the pressure down, to keep it operating it within a safe envelope. HRT then would be like an unwitting intern trying to improve the system by cranking the settings up back to the level of a brand new one.
Evolution doesn’t work this way. Everything that happens to an organism past the standard age range of reproduction has 0 effect on natural selection. There is no system affecting “graceful decline” of body systems in some protective way for things that happen past 35 in women and maybe 45 in men.
But yes, as a HRT user myself (age 38), I do see it as replacing the fluids in my car to make it operate like when it was peak tuned at age 22.
That is absolutely not true. Even genetic variants from your father that are not inherited by you still influence your chances of survival and how likely you are to pass your genes to an offspring. Imagine your dad has a rare genetic variant, which you don't inherit, that means he is likely to be dead by age 50. Your fitness will be lower as you will lack a father during your childhood.
See this famous study: The nature of nurture: Effects of parental genotypes. Science, 359, 424-428 (2018). doi:10.1126/science.aan6877. The summary literally states:
"Genetic variants in parents may affect the fitness of their offspring, even if the child does not carry the allele. This indirect effect is referred to as genetic nurture. Kong et al. used data from genome-wide association studies of educational attainment to construct polygenic scores for parents that only considered the nontransmitted alleles."
What are your tested free-T levels after HRT? 500, 800, 1000? Age 38: That is pretty early, in my experience, unless you are using it as "HET" (hormone enhancement therapy) for bodybuilding -- basically, medical doctor-approved anabolic steroids.
Simplifying a lot, once you age, your cells have accumulated lots of genetic and epigenetic defects, so they are more likely to become cancerous if you let them divide quickly.
Besides, you have less lymphocytes looking for carcinogenic cells, as your immune system is older.
