Why Do Americans Pay More for Prescription Drugs?
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Drug companies in the U.S. face few restraints on what to charge for their products. A bipartisan bill would penalize those companies that sell their drugs at higher prices than the average of the prices in other wealthy nations.
In the U.S., the price of Revlimid, a brand-name cancer drug, has been increasing for two decades. It now sells for nearly $1,000 a pill. In Europe, the price has been consistently lower — in some countries by two-thirds.
I started reporting on Revlimid after I was prescribed the drug following a diagnosis of multiple myeloma, an incurable blood cancer. Stunned by the high price, I found that the drugmaker, Celgene, had used Revlimid as its own personal piggy bank for more than a decade, raising the price in the U.S. whenever it saw fit.
Even with lower prices in Europe, Celgene still made a profit there, a former executive told Congress. That added to the more than $21 billion in net earnings the company made after Revlimid was introduced in 2005.
Of course, Revlimid isn’t the only drug with a price disparity. Americans pay more in general for prescription drugs than people in other wealthy countries. And costs keep going up, saddling patients with crippling debt or forcing them to choose between filling prescriptions or buying groceries. So why do we pay so much more? And is anything being done about it?
In most other wealthy countries, governments set a single price for a drug that is usually based on analysis of the therapeutic benefit of the medicine and what other countries pay. In the U.S., drug companies determine what to charge for their products with few restraints. Insurance companies can refuse to cover a drug to try to negotiate a lower price, but for some diseases like cancer, that poses a risk of public backlash. Cancer is a “very politically charged disease,” said Dr. Aaron Kesselheim, a Harvard Medical School professor who studies drug pricing and regulation. Some states also mandate that insurers cover certain cancer drugs.
Pharmaceutical companies have consistently argued that American drug prices reflect the cost of research and development. Americans may pay more, but they also benefit from having first-line access to cutting-edge treatments. (Celgene has since been acquired by Bristol Myers Squibb, which says its price for Revlimid, which it increased in the U.S. last year by 7%, “reflects the continued clinical benefit Revlimid brings to patients, along with other economic factors.”)
Dr. Hagop Kantarjian, a leukemia specialist at MD Anderson Cancer Center who studies drug pricing, said that pharmaceutical companies often overstate the cost of developing drugs and that many drug discoveries originate in hospital and academic labs funded through government grants. Funding from the U.S. National Institutes of Health contributed to all but two of the 356 drugs approved by the Food and Drug Administration from 2010 to 2019, according to a Bentley University study. Companies also don’t spend all their profits on innovation: The 14 largest drug companies in the world spent more on stock buybacks and dividend payments to investors than on research and development, according to a 2021 analysis by the U.S. House Oversight Committee.
One possible solution to bring down costs: tie American prices to what drugmakers charge in other wealthy countries. The Congressional Budget Office found last year that this would have the biggest impact on reducing costs of seven proposals it studied. It’s an idea with bipartisan support.
Sens. Josh Hawley, R-Mo., and Peter Welch, D-Vt., introduced a bill this week that would penalize pharmaceutical companies that sell their drugs at higher prices than the average of the prices in Canada, France, Germany, Japan, Italy and the United Kingdom. Companies that sell above the average would face civil penalties equal to 10 times the difference between the U.S. list price and the average price in those other countries.
President Donald Trump has advocated for similar actions. During his first term, he issued an executive order directing the Medicare program to employ a “most favored nation” approach in paying for drugs. The administration later developed a rule directing Medicare to select the lowest price from a basket of similar countries and make that the maximum amount the agency would pay for 50 drugs administered by doctors. A court blocked the rule from being implemented in the last days of the first administration.
Now, according to reports this week, the administration is pushing plans to tie Medicaid and Medicare prices to lower prices charged in other countries.
Linking U.S. prices to those in other countries is opposed by industry groups who say it would leave decisions on medications to the government rather than doctors and patients.
“Government price setting in any form is bad for American patients,” said Alex Schriver, a spokesperson for the Pharmaceutical Research and Manufacturers of America, an industry group. He said efforts should be focused on fixing “the flaws in the U.S. system,” including money that flows to intermediaries such as pharmacy benefit managers.
Some critics also warn so-called international reference pricing can be gamed and allows foreign governments to essentially set the value of medicines sold in the U.S.
The Trump administration is expected to announce drug pricing plans as early as next week, according to a report. The White House did not respond to a request for comment.
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The 7 Approaches To Pain Management
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More Than One Way To Kill Pain
This is Dr. Deepak Ravindran (MD, FRCA. FFPMRCA, EDRA. FIPP, DMSMed). He has decades of experience and is a specialist in acute and chronic pain management, anesthesia, musculoskeletal medicine, and lifestyle medicine.
A quick catch-up, first:
We’ve written about chronic pain management before:
Managing Chronic Pain (Realistically!)
As well as:
Science-Based Alternative Pain Relief
Dr. Ravindran’s approach
Dr. Ravindran takes a “trauma-informed care” approach to his professional practice, and recommends the same for others.
In a nutshell, this means starting from a position of not “what’s wrong with you?”, but rather “what happened to you?”.
This seemingly subtle shift is important, because it means actually dealing with a person’s issues, instead of “take one of these and call my secretary next month”. Read more:
Pain itself can be something of a many-headed hydra. Dr. Ravindran’s approach is equally many-headed; specifically, he has a 7-point plan:
Medications
Dr. Ravindran sees painkillers (and a collection of other drugs, like antidepressants and muscle relaxants) as a potential means to an end worth exploring, but he doesn’t expect them to be the best choice for everyone, and nor does he expect them to be a cure-all. Neither should we. He also advises being mindful of the drawbacks and potential complications of these drugs, too.
Interventions
Sometimes, surgery is the right choice. Sometimes it isn’t. Often, it will change a life—one way or the other. Similar to with medications, Dr. Ravindran is very averse to a “one size fits all” approach here. See also:
The Insider’s Guide To Making Hospital As Comfortable As Possible
Neuroscience and stress management
Often a lot of the distress of pain is not just the pain itself, but the fear associated with it. Will it get worse if I move wrong or eat the wrong thing? How long will it last? Will it ever get better? Will it get worse if I do nothing?. Dr. Ravindran advises tackling this, with the same level of importance as the pain itself. Here’s a good start:
Stress, And Building Psychological Resilience
Diet and the microbiome
Many chronic illnesses are heavily influenced by this, and Dr. Ravindran’s respect for lifestyle medicine comes into play here. While diet might not fix all our ills, it certainly can stop things from being a lot worse. Beyond the obvious “eat healthily” (Mediterranean diet being a good starting point for most people), he also advises doing elimination tests where appropriate, to screen out potential flare-up triggers. You also might consider:
Four Ways To Upgrade The Mediterranean Diet
Sleep
“Get good sleep” is easy advice for those who are not in agonizing pain that sometimes gets worse from staying in the same position for too long. Nevertheless, it is important, and foundational to good health. So it’s important to explore—whatever limitations one might realistically have—what can be done to improve it.
If you can only sleep for a short while at a time, you may get benefit from this previous main feature of ours:
How To Nap Like A Pro (No More “Sleep Hangovers”!)
Exercise and movement
The trick here is to move little and often; without overdoing it, but without permitting loss of mobility either. See also:
The Doctor Who Wants Us To Exercise Less, And Move More
Therapies of the mind and body
This is about taking a holistic approach to one’s wellness. In Dr. Ravindran’s words:
❝Mind-body therapies are often an extremely sensitive topic about which people hold very strong opinions and sometimes irrational beliefs.
Some, like reiki and spiritual therapy and homeopathy, have hardly any scientific evidence to back them up, while others like yoga, hypnosis, and meditation/mindfulness are mainstream techniques with many studies showing the benefits, but they all work for certain patients.❞
In other words: evidence-based is surely the best starting point, but if you feel inclined to try something else and it works for you, then it works for you. And that’s a win.
Want to know more?
You might like his book…
The Pain-Free Mindset: 7 Steps to Taking Control and Overcoming Chronic Pain
He also has a blog and a podcast.
Take care!
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I’m heading overseas. Do I really need travel vaccines?
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Australia is in its busiest month for short-term overseas travel. And there are so many things to consider when planning your trip. Unfortunately, it’s easy to overlook the importance of pre-travel vaccinations.
That’s particularly the case for those visiting friends and relatives, who are less likely to get vaccinated before leaving the country. Unfortunately, this is also the group at greater risk compared to other travellers.
That’s because they generally stay longer, are more likely to travel to rural areas, eat or drink local or untreated food and water, and have closer contact with the local population.
Maria Korneeva/Getty Why are travel vaccines important?
Although infectious diseases exist everywhere, in some destinations there is a higher risk of becoming sick.
This can be due to tropical climates, the quality of water and sanitation, and insects or animals that carry diseases. This is alongside declining vaccination rates in children and low vaccine uptake in adults (for instance, for the flu vaccine) globally.
Getting sick overseas can at best, interrupt your holiday plans, or at worst, lead to serious illness and having to navigate foreign health systems.
Which vaccines should I think about?
The first group of vaccines are routine ones, not specific to travel (for example, the measles or flu vaccine).
The next group are specific to the risk of infectious disease where you’re travelling (for example, typhoid vaccine) or related to a person’s health or planned activities.
Finally, some vaccines might be required by law (for example, a yellow fever vaccine, or vaccines for travellers to Mecca). These will require evidence you’ve had them for entry to some countries.
Measles
Measles is a highly infectious virus that can cause severe illness. It can transmit easily in public spaces such as shopping centres or on aeroplanes.
There are outbreaks globally. This includes in Australia, where cases are mainly linked to people returning from overseas, including from popular holiday destinations in Southeast Asia.
So ensure you’re vaccinated with two doses of the measles vaccine. You may not know if you had two doses as a child. So you should check your vaccine records or with your GP. If you’re still unsure, it’s safe to have another dose, particularly if you’re planning to travel overseas.
Measles vaccines are given to children in Australia at one year of age, but young infants are at highest risk of severe disease and death. That is why Australia currently provides an extra, free measles vaccine for infants from six months of age if they are going overseas.
The flu
Flu remains one of the most common causes of infection in travellers. Most people know they should get a flu vaccine during autumn or winter.
However, the vaccine best protects against disease for about three to four months. So another dose is recommended for people heading into the Northern Hemisphere winter.
Hepatitis A
Hepatitis A is a viral infection of the liver. It spreads through contaminated food or water, or through contact with an infected person. It’s common in many parts of the world.
A vaccine is available that can be given from one year of age. Two doses, given at least six months apart, provides lifetime protection against disease.
Typhoid
Typhoid is a bacterial disease that can cause high fevers and abdominal pain. Complications such as brain inflammation occur in 10-15% of people.
It is most commonly acquired in people travelling to Asia and sub-Saharan Africa. Typhoid, like hepatitis A, is spread through contaminated food and water.
There are two types of typhoid vaccines: an injection (which can be given from two years of age and is safe in people who are immunocompromised) and an oral vaccine (for people over six years of age).
Rabies
Rabies is caused by a virus that spreads when an infected animal bites or scratches. Dogs are the main carrier of the virus, but any mammal can be infected, including bats, monkeys and cats. Rabies is almost always fatal.
People who are bitten or scratched by a land mammal overseas or bat anywhere need urgent treatment (called “post-exposure prophylaxis”) to prevent getting rabies.
This treatment needs to given as soon as possible after the bite or scratch. But access overseas can be difficult, particularly in remote areas.
Rabies vaccination before you travel can reduce the need for this post-exposure prophylaxis or can simplify your treatment if you’re bitten or scratched by an infected animal.
So a two- or three-visit vaccination course is recommended before travel.
Other vaccines
Other vaccines include those against:
- mosquito-borne diseases yellow fever and Japanese encephalitis.
- cholera, a cause of severe diarrhoea
- mpox, which is recommended for sexually active gay, bisexual or other men who have sex with men. It is also recommended for anyone (regardless of sexual orientation or gender identity) who is planning overseas travel with the intention of having sex with sex workers or in a country where a type of the virus known as clade I is circulating.
How do I find out more?
See your GP or a travel doctor to find out how to stay healthy on your trip, including which vaccines are recommended for you. This will be based on your travel destinations, planned activities, and baseline health. Many vaccines are also available at pharmacies.
You might have to pay for some pre-travel vaccines. But this is usually a relatively small cost on top of what you’ve already spent on flights, accommodation and activities, and will mean less chance of disrupting your trip.
Archana Koirala, Paediatrician and Infectious Diseases Specialist; Clinical Researcher, University of Sydney; Anthea Katelaris, Public Health Physician and Conjoint Senior Lecturer in the School of Population Health, UNSW Sydney, and Phoebe Williams, Paediatrician & Infectious Diseases Physician; Senior Lecturer & NHMRC Fellow, Faculty of Medicine, University of Sydney
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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Saturated Fats & Lymphedema
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When it comes to lymphedema, what’s better than compression than compression garments and lymphatic drainage?
If you guessed “saturated fats”, then here is where we must disappoint you, because no, it’s rather the opposite—a diet low in saturated fats will ease lymphedema symptoms, while a diet high in saturated fats can bring on or worsen lymphedema.
But first, what is lymphedema?
More than one way to lymphedema
Lymphedema’s name literally means “lymphatic swelling”, and that’s exactly what it is.
First, know that lymphedema can be divided into primary and secondary lymphedema:
- Primary lymphedema = if you have a congenital genetic mutation that results in a malformed, and thus dysfunctional, lymphatic system
- Secondary lymphedema = you originally had a nicely working lymphatic system, which was then damaged by something else
The former is definitionally congenital.
Note: it’s not beyond the realm of possibility that such a genetic mutation could be acquired later by something that affects the genes (retrovirus, genotoxic substances, radiation, cancer, etc), but if this occurs, it would still be definitionally secondary lymphedema, because it occurred as a result of something damaging an initially normal, functional lymphatic system.
Secondary lymphedema usually comes about as a result of such things as cancer treatment, infection, or injury, including the typical progress of untreated lipedema.
Lipedema occurs mostly in women, mostly in times of hormonal change, with increasing risk as time goes by (so for example, puberty yields a lower risk than pregnancy, which yields a lower risk than menopause).
Lipedema’s name literally means “fat swelling”, and can easily be mistaken for obesity or, in its earlier stages, just pain old cellulite.
Rather than derail this article by going more deeply into lipedema, we’ll drop a link to our previous article on such: Watch Out For Lipedema
FABP4: a protein that’s sometimes not so fab after all
FABP4 is short for “fatty-acid-binding protein 4”.
You can probably guess what its job is.
Now, while this is a job that does need to be done, people with lymphedema (either kind) have nearly 3x as much of this protein, and inhibiting it (with a chemical inhibitor) results in a 50% reduction in lymphedema.
If you don’t have such chemical inhibitors in your kitchen, don’t worry, because a dietary intervention achieves very similar results—at least, in animal experiments so far, but in this case it’s highly unlikely that the results won’t translate to human patients, it’s just that that science has yet to be done, to be sure.
Specifically, per the most recent research by Dr. Karina Gomes et al., switching to a diet high in saturated fats brought on or worsened lymphedema (as mentioned up top), and/but importantly, switching to a diet low in saturated fats reversed these effects.
You can read this study in full, here: Saturated fatty acids induce lipotoxicity in lymphatic endothelial cells contributing to secondary lymphedema development
Want to learn more?
Check out:
- Nutrition To Combat Lymphedema & Lipedema ← this is a bit older, so it doesn’t mention the saturated fat connection, but has some other good pointers
- Can Saturated Fats Be Healthy? ← yes, albeit in very small portions, and only certain kinds, and certainly not butter, cream, or fatty meat (fish have their place, though!)
- Butter vs Plant Oils: What The Latest Evidence Shows ← this was a topic of some debate in the US earlier this year (2025, at time of writing), but the science quite clear
Enjoy!
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After 50, These 3 Habits Slow Aging The Most
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Will Harlow, the over-50s specialist physio, advises:
The Big Three
It doesn’t take a lot of time per week:
1) Resistance training (2–3 sessions per week): builds strength and muscle, which lowers risk of cancer, diabetes, and heart disease. Just two 20-minute routines per week are enough. Example routine: Monday (push): goblet sit-to-stand, chair press, shoulder press; Thursday (pull): Romanian deadlift, dumbbell row, reverse lunge. Do 10–20 reps per exercise, 3 sets each, 1–2 minutes rest, and increase reps or resistance gradually.
2) Mobility work (10 minutes every morning): reduces pain, stiffness, and improves movement. Suggested bed-friendly routine: ankle pumps (2 min), hip flexion (1 min per side), knee rolls (2 min), book opener (1 min per side), assisted shoulder flexion (1 min per side).
3) Walking (increase steps or pace gradually): health and longevity benefits rise after about 6,000 daily steps, with diminishing returns past 12,000. Walking speed may be as important as step count. Track baseline for 2 weeks, then increase either steps or speed by a little each month.
For more on all of this plus visual demonstrations of exercises, enjoy:
Click Here If The Embedded Video Doesn’t Load Automatically!
Want to learn more?
You might also like:
These Top Few Things Make The Biggest Difference To Health ← on a different level, as “exercise” is one of the 5 things listed
Take care!
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Moore’s Clinically Oriented Anatomy – by Dr. Anne Argur & Dr. Arthur Dalley
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Imagine, if you will, Grey’s Anatomy but beautifully illustrated in color and formatted in a way that’s easy to read—both in terms of layout and searchability, and also in terms of how this book presents anatomy described in a practical, functional context, with summary boxes for each area, so that the primary concepts don’t get lost in the very many details.
(In contrast, if you have a copy of the famous Grey’s Anatomy, you’ll know it’s full of many pages of nothing but tiny dense text, a large amount of which is Latin, with occasional etchings by way of illustration)
Another way in which this does a lot better than the aforementioned seminal work is that it also describes and discusses very many common variations and abnormalities, both congenital and acquired, so that it’s not just a text of “what a theoretical person looks like inside”, but rather also reflects the diverse reality of the human form (we weren’t made identically in a production line, and so we can vary quite a bit).
The book is, of course, intended for students and practitioners of medicine and related fields, so what good is it to the lay person? Well, if you ask the average person where the gallbladder is and why we have one, they will gesture in the general direction of the abdomen, and sort of shrug sheepishly. You don’t have to be that person 🙂
Bottom line: if you’d like to know your acetabulum from your zygomatic arch, this is the best anatomy book this reviewer has yet seen.
Click here to check out Moore’s Clinically Oriented Anatomy, and prepare to be amazed!
PS: this one is expensive, but consider it a fair investment in your personal education, if you’re serious about it!
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Do You Believe In Magic? – by Dr. Paul Offit
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Here at 10almonds, we like to examine and present the science wherever it leads, so this book was an interesting read.
Dr. Offit, himself a much-decorated vaccine research scientist, and longtime enemy of the anti-vax crowd, takes aim at alternative therapies in general, looking at what does work (and how), and what doesn’t (and what harm it can cause).
The style of the book is largely polemic in tone, but there’s lots of well-qualified information and stats in here too. And certainly, if there are alternative therapies you’ve left unquestioned, this book will probably prompt questions, at the very least.
And science, of course, is about asking questions, and shouldn’t be afraid of such! Open-minded skepticism is a key starting point, while being unafraid to actually reach a conclusion of “this is probably [not] so”, when and if that’s where the evidence brings us. Then, question again when and if new evidence comes along.
To that end, Dr. Offit does an enthusiastic job of looking for answers, and presenting what he finds.
If the book has downsides, they are primarily twofold:
- He is a little quick to dismiss the benefits of a good healthy diet, supplemented or otherwise.
- His keenness here seems to step from a desire to ensure people don’t skip life-saving medical treatments in the hope that their diet will cure their cancer (or liver disease, or be it what it may), but in doing so, he throws out a lot of actually good science.
- He—strangely—lumps menopausal HRT in with alternative therapies, and does the exact same kind of anti-science scaremongering that he rails against in the rest of the book.
- In his defence, this book was published ten years ago, and he may have been influenced by a stack of headlines at the time, and a popular celebrity endorsement of HRT, which likely put him off it.
Bottom line: there’s something here to annoy everyone—which makes for stimulating reading.
Click here to check out Do You Believe In Magic, and expand your knowledge!
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- He is a little quick to dismiss the benefits of a good healthy diet, supplemented or otherwise.
