Health Buzz: State Health Rankings and Other News
Vermont Named Healthiest U.S. State; Louisiana Deemed Unhealthiest
Vermont is the healthiest U.S. state, while Louisiana is the least healthy, according to the 19th annual America’s Health Rankings report, issued by the United Health Foundation, the American Public Health Association, and the Partnership for Prevention advocacy group. The rankings are based on 22 health measures, including factors that affect a population’s future health and ones that measure health outcomes that have already occurred. It was the second year in a row that Vermont earned the healthiest distinction. The next healthiest states were Hawaii (second place), New Hampshire (third), Minnesota (fourth), and Utah (fifth). Mississippi, which ranked as the unhealthiest state last year, came in 49th this year; above Mississippi were South Carolina (48th), Tennessee (47th), and Texas (46th).
The report also says that attempts to improve the health of Americans are not making notable progress. About 1 in 4 Americans is considered obese, putting them at risk for such health problems as heart disease, stroke, high blood pressure, diabetes, and certain types of cancer.
In November, U.S. News‘s Deborah Kotz reported on a better way to screen for heart disease and named six statin-free approaches to reducing inflammation. Last month, Nancy Shute listed five ways to prevent diabetes in your teenage child.
Generic Drugs: Cheaper, Yes. Same Quality? Maybe Not
Generic drugs are significantly cheaper and, according to the Food and Drug Administration, are bioequivalent to the drugs they are patterned after. No surprise, therefore, that an analysis of 47 articles comparing brand and generic cardiovascular drugs, just published by researchers at Harvard in the Journal of the American Medical Association, showed similar clinical results. The findings were comforting, but, as the researchers noted, these were short-term evaluations, and many of the studies were supported by generic drug companies. Dr. Bernadine Healy reports.
The comparisons raise another uncertainty that was barely a consideration a decade ago: Unlike most patented and many brand-name drugs, the generics are far more likely to be made in factories in parts of the world like India that have cheap labor and overhead, as U.S. News‘s Nancy Shute has reported. China—which has suffered a string of manufacturing scandals, including one involving contaminated heparin that led to serious and deadly allergic reactions in the United States—is gearing up to become a major producer of generic drugs and is expected to offer even lower prices.
Earlier this year, U.S. News listed four ways to avoid dangerous drug errors and, following the death of actor Heath Ledger from an accidental overdose of prescription drugs, offered medication safety tips. Last year, Nancy Shute reported that shoddy and fraudulent pharmaceutical products are a growing threat.
“Health“ Foods Often Higher in Sodium
A new finding from Consumer Reports reveals that high amounts of sodium are packed into some so-called health foods, such as fat-free salad dressings and “heart smart” tomato sauces. By raising blood pressure, too much salt can make you more susceptible to heart attack, kidney disease, and stroke, Deborah Kotz reports. It may also boost your chances of asthma, kidney stones, osteoporosis, and stomach cancer. While some salt is good for us, she says, we should step up efforts to avoid overdosing, which means looking beyond the health claims on the label and actually reading the sodium content.
In April, U.S. News‘s Katherine Hobson reported on four old-fashioned diets that promote health and described the Mediterranean diet, Asian diet, Latin American diet, and vegetarian diets. In October, she listed eight fixes nutritionists want on food labels.
—January W. Payne
Future Direction of American Health Care
Making Use of Comparative Effectiveness Research
The End of Pharma’s Free Ride?
America’s Healthiest And Unhealthiest States
U.S. health gains stall, could reverse
American Public Health Association
TruthHugger 
Often when one goes to seek medical attention from a health care provider, that provider usually writes a prescription for that patient for medication to either treat the symptoms of the disease that may be present.
Or, the health care provider may actually cure the disease, as with the case regarding antibiotics.
Also, the provider may prescribe medications to delay the progression of a disease that may exist with their patient.
The actual cost of that medication the patient receives from a pharmacy can vary greatly, and here is why:
More now than in the past, generic medications have been encouraged and selected by prescribers at a much higher rate.
Health care providers are aware that generic drugs are less expensive than branded drugs that are equivalent to the generic drug prescribed as far as safety and efficacy are concerned.
Nearly two thirds of all medications prescribed to patients in the United States are now for generic medications.
Generic medications are bioequivelant copies of branded medications that previously existed, yet no longer have a patent on these medications, which allows generic drug companies to produce these formally expensive drugs and a much lower cost.
Why aren’t generic medications prescribed all the time, then?
The branded drugs have their company sales representatives who leave samples of these branded medications with the health care provider, with the intention and belief that this provider will select this branded drug as a result.
Generic medications, while much less expensive than branded medications, do not have samples of these drugs to be left with health care providers.
Around 4 billion prescriptions filled every year, so cost savings is rather important.
Generic medications are about two thirds of this total pharmaceutical market with the drugs included in this market.
However, while most prescriptions are for generic medications, this still is less than 15 percent of the total money spent on prescription drugs.
With branded medications, about 75 percent of these newly approved drugs by the FDA are similar in efficacy as drugs that already exist in this market, so there is no benefit with many of these expensive branded drugs.
Roughly half of all newly approved prescription drugs have had serious side effects soon after they have been approved, so newer is clearly not always better, of course, as it relates to safety for the patient taking the drug.
Most recently, certain managed health and prescription providers have been actually paying doctors to initiate if not switch their patients from branded medications they may be taking to generic medications, if possible.
This may be due to a reaction caused by branded pharmaceutical companies offering similar inducements to health care providers to select their promoted medications.
Both financial inducements that occur are remarkably legal, overall. Yet I find financial inducements in health care inappropriate and unethical when a health care provider treats a patient with prescribing medications for them.
Not long ago, generic drugs were not prescribed that often, or produced to a great degree, because of the cost of bringing such a med to the market, which at the time required the same clinical trial protocols as branded meds.
Fast forward to 1984, as this is when the Hatch-Waxman Act was introduced.
This Act only required generic meds to demonstrate bioequivalence to the branded med that they desire to reverse engineer.
So nothing else was now required in the approval process that is mandated by branded medications to be completely developed and approved by the FDA.
This reduced cost of generic manufacturing and approval allowed for more of these meds to saturate the pharmaceutical market, and doctors started prescribing more generic meds as a result.
Branded pharmaceutical companies were not pleased in large part with this new act.
So some drug companies devised schemes to extent the patents of their branded meds through such tactics as altering their existing branded medication by combining it with another generic drug from another class of medications.
This tactic is referred to as evergreening, and the tactic extends the patent life of their branded drug of concern.
Additional branded drug company tactics include frivolous patent infringement lawsuits, which delays generic availability for a longer period because of these lawsuits.
Also, branded pharmaceutical companies have been known to actually pay generic manufacturers to not release the equivalent of a branded medication they wish to continue to promote.
The pharmacies that fill the prescriptions for the patients written by the health care providers support generic use, as pharmacies make more money off of generic prescriptions they fill for others compared with branded drugs.
Generics seem to remain a concern to branded companies in spite of their efforts of avoiding their access into a market they believe to own.
Recently, branded pharmaceutical companies have either purchased smaller generic drug companies, or have started to produce generic medications on their own.
This is due to the progressive impact generic drugs are having on the business of branded drug companies.
Also, other reasons for increased generic prescribing may be due to the awareness and clinical experience of the previous branded med that has now been replicated by the generic medication.
Again, newer drugs at times are not a desirable choice of treatment for patients because of understandable concerns by the prescriber.
One particular concern is safety that has not fully established with a new medication.
The familiarity of the generic drug accessible to them after the patent expiration of a branded medication the prescriber has utilized often in the past with treatment success for their patients allows the prescriber to utilize the generic equivalent not that it is available often.
Many clinical studies have proven that generics are as effective compared with branded medications for particular disease states.
The cardiovascular disease trial called the ALLHAT trial showed this. In this trial, with surprise to many, the old class of drugs called diuretics showed equivalence if not superiority over the branded medication utilized in this trial.
This comparative effectiveness trial lasted over four years, and was funded mostly by the NIH.
Most encouraging for even greater use of generic meds is that at least one company has created vending devices for doctor’s offices for dispensing both generic and over the counter drugs.
This may discourage the use of branded equivalent drugs at a greater amount with generic samples available with this method.
In addition, and in some cases, doctors can order generic samples from the manufacturers directly.
Both mechanisms for obtaining samples of generic drugs by a health care provider remain quite rare, however.
Then there are some health care providers who insist that you get what you pay for, so they are convinced that branded drugs are always more efficacious and tolerable than generic medications.
This misconception is largely a fallacy, as both are determined to be bioequivalent, since the generic drug has to show this in order for the drug to be authorized for use by prescribers.
Efficacy differences may exist, but are thought to be minimal.
I’m sure it’s possible others have encouraged such doctors to take such a stance that is absent of evidence.
In the U.S. Health Care System, cost is a rather large concern for members of the public health, and those who attempt to restore their health as it needs to be at times.
Generic medications provide financial relief for patients in need of drugs to improve their health.
And both the health care provider as well as the patient can be assured that a generic drug prescribed to, and taken by, a patient will provide the efficacy needed to address the medical problems of the patient.
More importantly, the patient saves money, without compromising their safety,
Dan Abshear
You have some excellent content and a compelling writing style – keep up the great work!