TIME medicine

Generic Drug Discount Programs Work — for Everyone

Americans are increasingly participating in programs that fill cheaper versions of prescription drugs

More and more Americans are buying the cheaper generic versions of prescription drugs, new research published in JAMA Internal Medicine shows.

In 2006, Walmart introduced what would become one of many generic drug discount programs that allowed people to pay just $4 to fill prescriptions of generic drugs. The program was meant to help people meet difficult medical costs–especially more vulnerable groups like the elderly and low-income populations.

At first, the program didn’t appear to gain a lot of traction. In 2007, only 3.6% of patients receiving prescription drugs were partaking in a program. But similar programs popped up at other pharmaceutical retailers like Rite Aid, CVS and Walgreens and has since gotten much more popular.

The researchers looked at a 2010 national household survey of health care usage among patients over age 18 who had at least one prescription during that year. They found that among the 13,486 adults identified in the survey as having at least one drug prescription, 3,208 were users of generic drug discount programs, and overall program use was at about 23%–much higher than the 3.6% participation rate three years earlier.

Researchers also found that people who were elderly, sick, uninsured and living in rural areas were more likely to participate in the programs, but interestingly, there were no significant differences across education levels or race/ethnicity groups. “Generic drug discount programs were not considered inferior despite the common perception that generic drugs are of poor quality,” the study authors write. “In fact, generic drug discount programs offer convenience by not requiring insurance claims to be filed.”

The researchers think the mere fact that more pharmaceutical retailers have offered similar programs is one of the reasons there’s greater uptake across the board, and while participation could still be higher, plenty of people of different backgrounds are taking part in the cost savings programs.

TIME medicine

5 Signs Your Hormones Are Out of Whack

backlit woman
Getty Images

When it's normal, and when to see your doctor

Raise your hand if, in the last few weeks, you’ve felt tired, bloated, or cranky. Sound familiar? Then you know the drill: Every month, your hormones—the body’s itty-bitty secret weapon—come out to play, wreaking havoc on your mood, skin, and mind. While levels generally stabilize after your period, various factors, like stress (yup, keep those hands raised) and anxiety can throw them off balance. So how can you tell if your symptoms require an office visit? Alyssa Dweck, MD, an OB-GYN at the Mount Kisco Medical Group in New York shares the five red flags that might merit a doctor’s note.

Fatigue

Exhaustion is one of the most, well, exhausting symptoms to a doc, since it has so many possible causes. “If you’re tired after a week of final exams or late nights at work, then you’re probably fine,” says Dr. Dweck. “But if you constantly feel worn out and notice weight gain, appetite fluctuations, and a change in bowel movements, it could be a sign of an underactive thyroid.” Yes, fatigue happens to everyone, but if yours doesn’t feel logical, then it’s worth getting it checked out.

Skin changes

You’re breaking out—again. While those sudden zits could be caused by one too many nights of going to bed without washing your face, they may be indicative of something more. “Adult acne or cystic acne around the lower half of your face could suggest a high level of testosterone,” says Dr. Dweck. Although not a life-threatening problem, breakouts can take a toll on your psyche. Luckily, your doc can prescribe you medication to stabilize your hormone levels and clear up skin.

Hair growth

We’re talking really fast hair growth. “If you all of a sudden grow a beard within a month or notice coarse, dark hair popping up on your chest, back or arms, that could be indicative of a testosterone-secreting tumor,” explains Dr. Dweck. But don’t freak out: Tumors are rare, she notes, and can often be treated with drugs or surgery.

Weird periods

Just like fatigue, a messed-up menstrual cycle can be the result of many factors, like stress, thyroid issues, low estrogen, or polycystic ovary syndrome (PCOS). “The hallmark of PCOS is irregular or absent periods, but it could also present with difficulty losing weight or strange hair growth,” says Dr. Dweck. Generally, PCOS is managed through diet, exercise and birth control pills, but your doctor will work with you to develop a multi-faceted plan if she finds this to be the cause of your period problems.

Night sweats

Unless it’s unusually warm in your bedroom, waking up feeling overheated and sweaty could be the result of lower estrogen levels and infrequent ovulation—aka perimenopause. “Perimenopause can occur up to 10 years before you’re even near the age of menopause,” says Dr. Dweck, “so unless you’re having major menstrual issues before age 40, there’s a good chance your phantom sweating could actually be early menopause.” Either way, Dr. Dweck recommends making an appointment with your doc to make sure it’s nothing more serious.

This article originally appeared on Health.com.

TIME Innovation

Five Best Ideas of the Day: September 22

1. A global transformation from a carbon-based economy to a cleaner, more sustainable energy future will create jobs and add wealth.

By Christiana Figueres and Guy Ryder in Project Syndicate

2. Antibiotic resistance causes 23,000 deaths and two million illnesses every year. Concerted government action is necessary to fight the crisis.

By the Editorial Board of the Washington Post

3. China can improve its global standing and U.S. relations by joining the fight against Islamic State.

By Dingding Chen in the Diplomat

4. The economic future of manufacturing is to be an incubator of innovation: “where new ideas become new products.”

By Nanette Byrnes in MIT Technology Review

5. In the future, a book could be a living thing.

By Wendy Smith in Publisher’s Weekly

The Aspen Institute is an educational and policy studies organization based in Washington, D.C.

TIME medicine

China Fines GlaxoSmithKline $485 Million for Bribery

The pharma company admits it's at fault and will not appeal

After a one-day secret trial, a Chinese court has fined pharmaceutical company GlaxoSmithKline (GSK) $489 million for bribing hospitals and doctors to use their products.

According to the New York Times, the court also sentenced GSK’s former country manager Mark Reilly as well as four additional managers to prison time of up to four years. However, the sentences were suspended, and the managers will avoid prison with good behavior–though Reilly must leave the country. The is the largest ever corporate fine in China, reports the Wall Street Journal, though some analysts had expected the fine to be even higher.

GSK issued a statement of apology, writing:

GSK fully accepts the facts and evidence of the investigation, and the verdict of the Chinese judicial authorities. Furthermore, GSK sincerely apologizes to the Chinese patients, doctors and hospitals, and to the Chinese Government and the Chinese people. GSK deeply regrets the damage caused. GSK plc also apologizes for the harm caused to individuals who were illegally investigated by GSKCI [GSK China Investment Co. Ltd].

You can read GSK’s full apology here.

GSK says they fully cooperated with the authorities and are reducing and changing the nature of their activities with health professionals, as well as growing the process the company uses to monitor payments and invoices. “We will also continue to invest directly in the country to support the government’s health care reform agenda and long-term plans for economic growth,” said GSK CEO, Sir Andrew Witty in a statement. The fine will come from existing cash resources, the company says.

According to IBISWorld Global Pharmaceuticals analyst Sarah Turk, GSK’s 3% market share in the global pharmaceuticals and medicine manufacturing industry will likely drop over the next five years, and the fine will significantly hinder the company’s research and development funding, thus increasing its competition with global companies like Pfizer and Novartis.

“As [GSK] seeks new investment opportunities in the coming years, the $489 million fine will limit the company’s leverage to acquire other companies and remain competitive in an industry that is increasingly looking for methods to harness new drug development pipelines,” writes Turk in an emailed statement. “Additionally, other pharmaceutical companies will likely tread carefully in the Chinese market, due to GSK’s fine possibly indicating that Chinese regulators are increasingly cracking down on corporate malpractice.”

This is not the first time GSK has been fined significantly for wrongdoing. In July 2012, the U.S. State Department fined the company $3 billion for marketing drugs for unapproved uses.

TIME medicine

Your Doctor Should Reveal Biases and Pharma Ties, Says Group

Should your doctor reveal their positions on contraception and whether they accept money from drug companies?

Studies have reported that around 94% of doctors have some sort of relationship with pharmaceutical companies. One study published in the New England Journal of Medicine found that more than one third of physician respondents received reimbursement from drug companies for costs associated with meetings or continuing education, and over a quarter received payments for enrolling patients in trials, or for consultations and lectures. Patients can already see if their doctor has received compensation from drug companies on ProPublica’s database, Dollars for Docs—but one physician wants to take that a step further.

Dr. Leana Wen, director of patient-centered care research at George Washington University recently launched “Who’s My Doctor,” a platform where doctors can sign a Total Transparency Manifesto and disclose what outside funding they receive, what proportion of their pay comes from where and, if they’re willing, details about their family, political affiliation and philosophy of practice. For instance, a woman may want to know how her doctor feels about contraception, or abortion, or early breast cancer screenings. Parents might want to know how a doctor feels about routine vaccination. They can also, of course, see which drug companies, if any, the doctor has ties to.

“Dozens of studies have shown that when docs receive money from drug companies—even a free lunch—it does affect prescription behavior,” she says. Indeed, despite doctors’ assurances that pharmaceutical relationships don’t interfere with patient care, other research and investigations has showed it does.

“As doctors we need to be able to establish and maintain that trust,” says Wen in an interview with TIME. “I think financial interest is a big problem. If we are ashamed to tell our patients about our financial conflicts of interest then we should question why we have them in the first place.” Wen spoke about her pledge at the TEDMed conference in early September. Part of her motivation came from watching her mother, who was battling breast cancer, discover that her physician was financially tied to the chemotherapy regimen he prescribed.

Not all doctors support the idea of asking physicians to declare personal preferences and background. Some posted criticisms about Wen’s platform when she launched it in spring 2014. “I devoted 12 years of my life to being a slave. I have loans and mortgages…. I depend on lunches from drug companies to serve patients,” wrote one doctor. Another commented: “I find it an invasion of my privacy to disclose where my income comes from. My patients don’t disclose their incomes to me.”

Other doctors are on-board, though. “I want doctors to see this as a positive thing for them and I want patients to be asking for it too,” says Wen. “This is the right thing to do.”

TIME Research

Quiz: Can You Answer 5th-Grade Science Questions?

Most Americans lack a basic understanding of science

A new survey on scientific literacy from the Center for Accountability in Science found that most respondents failed to correctly answer questions designed for a fifth-grade science class.

“Most Americans are not armed with the basic facts about science,” said Dr. Joseph Perrone, chief science officer at the Center for Accountability in Science, in a statement. “This alarming lack of scientific literacy makes it easier for the public to be duped by the scary headlines and junk science.” You can get the results of the survey here.

Take our quiz to see if you can answer fifth-grade-level science questions.

TIME Diet/Nutrition

Artificial Sweeteners Aren’t the Answer to Obesity: Here’s Why

80356781
Artificial sweeteners may be contributing to the very health problems they were supposed to prevent, say researchers Tetra Images—Getty Images/Tetra images RF

They’re supposed to be the sweet alternative to high-calorie, diabetes-causing sugar. But the latest science shows that artificial sweeteners may actually set us up for obesity and diabetes

Aspartame, saccharin, sucralose—sugar alternatives go by many names, but share an almost irresistible promise: all the sweetness of sugar without the calories, weight gain and increased risk of diabetes that comes with uncontrolled amounts of sugar in the blood.

But studies on artificial sweeteners and weight loss—as well as research about whether sugar substitutes helped people avoid metabolic disorders like diabetes—have been mixed. And in a paper published Wednesday in Nature, Dr. Eran Elinav from the Weitzmann Institute of Science in Israel found that the sugar stand-ins actually contribute to changes in the way the body breaks down glucose. How? Fake sugars aren’t digested and therefore pass directly to the intestines, impacting the millions of invisible bacteria that live in our gut. And when he and his colleagues gave seven people who didn’t normally use artificial sweeteners the sugar substitutes for seven days, about half of the people showed higher blood glucose levels after just four days.

MORE: 5 Steps to Quitting Artificial Sweeteners

“What our comprehensive genetic profiling of the microbiome pointed to is that exposure to artificial sweeteners directly impacts the microbes,” Elinav says. “We found that the artificial sweeteners we think of as beneficial and that we use as treatment or preventive measures against obesity and its complications are contributing to the same epidemics they are aimed to prevent.”

In the intestines, gut microbes are hard at work, pulling out some nutrients from food that are helpful in stopping tumor growth, for example, and squirreling away others to store as energy for later use. But while artificial sweeteners aren’t absorbed by our own cells, they may be absorbed by our bacteria—and when that happens, things appear to go haywire.

Higher amounts of the sweetener substitutes, Elinav and his team found, can change the makeup of these bacterial communities. And that in turn can change how those bugs behave, leading to weight gain and poorer glucose breakdown. These alterations in intestinal bacteria were the same as those in a group of 400 people who reported using artificial sweeteners—and those changes were the same in mice as well.

MORE: Why Your Brain Isn’t Fooled By Sugar Stand-Ins

In the mouse studies, Elinav’s team found that the artificial sweeteners pushed one particular group of bacteria, Bacteroides, to thrive, while inhibiting growth of another, Clostridiales. Bacteroides are the microbial equivalent of hoarders, hungrily pulling energy out of food and squirreling it away as fat. The end result of a Bacteroides-heavy gut is a physically heavy gut as well. In studies by other research groups, its dominance, and the resulting drop in diversity of other microbes, is typical of obese people compared to normal weight individuals.

MORE: 7 Not-So-Sweet Lessons About Sugar

The metabolic consequences were also dramatic in both the mice and people studied. In the mouse experiments, animals who were fed the same dose of saccharin that the U.S. Food and Drug Administration considers safe for daily use showed a drop in their ability to break down glucose. When he gave those mice antibiotics, their ability to break down glucose returned to normal, suggesting that wiping out the abnormal balance of bacteria could return the animals back to a healthier state.

And to confirm that the changing microbial communities were indeed responsible for the glucose changes, he also transplanted fecal samples from the people using artificial sweeteners into mice whose own guts had been wiped clean. These mice then developed the same abnormalities in glucose breakdown that the human donors and the mice who were fed saccharin did—even though they never actually ate artificial sweeteners. Simply harboring the microbes that had been exposed to the sweeteners was enough to disturb their glucose metabolism.

MORE: Can Sugar Substitutes Make You Fat?

The good news is that as easily as the gut microbiome can shift toward an unhealthy state, it can just as easily be brought back into line with the proper balance of bacterial communities. The best way to do that isn’t clear yet, but, says Eran Segal, a co-author of the study and a professor of computer science and applied mathematics at the Weitzmann Insttitute, “We believe that the situation today at the very least needs to be re-examined. We were able to induce glucose intolerance in a few days in some individuals, so this massive, unsupervised and unregulated use [of artificial sweeteners] should at the very least be reassessed and perhaps re-examined in additional studies.”

Elinav, for one, isn’t waiting. Based on his findings, he’s stopped adding artificial sweeteners to his coffee.

 

TIME Cancer

Our Global Cancer Report Card Is Here

In its annual cancer status report, the American Association for Cancer Research highlights new tumor-fighting drugs, and the inevitable spike in cancer cases expected in coming years

The Food and Drug Administration (FDA) approved six new cancer treatments between July 2013 and July 2014, five of them representing innovative ways to target tumors more precisely with fewer side effects. Thanks to those therapies, and advances in understanding how the body’s own immune system can be co-opted into fighting cancer, patients diagnosed with any of the 200 or so forms of the disease have never been in a better position to survive it. In fact, the number of cancer survivors has increased nearly five-fold from when Congress declared a war on cancer in 1971 and 2014. But despite advances in diagnosing and treating cancer, incidence and death rates may start to rise again, say experts in a new report.

That’s in part because most cancers emerge in older age—and the population of people over-65 is expected to double by 2060. “We face a future in which the number of cancer-related deaths will increase dramatically unless new and better ways to prevent, detect, and treat cancer can be developed,” according to the 2014 American Association for Cancer Research (AACR)’s Cancer Progress Report 2014. “These trends are being mirrored globally, and the number of people dying of cancer worldwide is expected to increase from 8.2 million in 2012 to 14.6 million in 2035.”

The (AACR), which has been compiling the report every year since 2011 as an educational tool to update Congress and the public on the progress and needs in the fight against cancer, also provided a “prescription” for addressing this coming wave, and for maintaining the momentum of recent victories against the disease. Noting that research grants from the National Institutes of Health (NIH), the largest funder of basic biomedical research that has contributed to many of the new anti-cancer therapies now on the market, are $3.5 billion lower than where they should be even if the funding only kept up with the rate of inflation for biomedical equipment and personnel, the AACR urges more federal investment in cancer research.

That money, they point out, can also be directed toward training the next generation of cancer researchers, since fewer grants are turning promising young scientists away from the field. They write:

We are now at a crossroads in our country’s long struggle to prevent and cure cancer; we must choose between two paths, but there is only one viable path forward to continue transforming lives.

On the viable path we seize the momentum at this exciting time in biomedical research by committing to budget increases for the NIH and NCI so that the remarkable progress of the past can continue at a rapid pace.

To take the alternative path is simply unacceptable. This particularly dangerous path leads us to a place where federal funding for biomedical research remains stagnant, or even worse, declines, seriously jeopardizing the rate at which we are able to make progress. On this path, breakthroughs and discoveries will be slowed, meaning that delivery of the cures that patients and their loved ones desperately need is delayed.

…Our federal government can do no better than invest robustly in the NIH and NCI so that the path forward will lead us to a brighter future for the millions of people whose lives have been touched by cancer.

TIME Research

Here’s Why You May Be Better Off Taking Generic Cholesterol Drugs

Patients with cheaper drugs tended to take their medicine more consistently

A new study in the Annals of Internal Medicine found that the cost difference between generic and brand-name drugs seems to be a big factor when it comes to sticking with a medication–especially when it comes to statins, one of the most-prescribed drugs in the country. People who got the generic versions of the cholesterol-lowering medication were more likely to consistently take it and avoid cardiovascular disorders than those who filled the brand-name kind.

“Initiating a generic versus a brand-name statin seems to be associated with lower out-of-pocket costs, improved adherence to therapy, and improved clinical outcomes,” the study said.

The study, which looked at more than 90,000 patients over age of 65, found that people taking generic drugs were more likely to stick to their medication regimen. Price played a role in this disparity, the study suggests. The average cost to fill a prescription for the consumer was $10 for generic statins versus $48 for brand names.

“Given this substantial cost difference, it is perhaps not surprising that adherence and cardiovascular outcomes were worse among patients receiving brand-name statins,” study authors wrote. Overall, people who took generic drugs had 8% fewer incidents than people who used brand-name drugs.

The study received grant support from drug manufacturer Teva Pharmaceutical (which makes both generic and brand-name drugs) and acknowledges that the results may not be generalizable for certain populations: particularly those with greater incomes or access to insurance plans that provide better coverage for brand-name drugs.

TIME medicine

DIY Drugs: Antibiotics Could Soon Be Made Out of Your Own Bacteria

186805315
Our own gut bacteria may be the next source of antibiotics dra_schwartz—Getty Images

There’s a universe of friendly bacteria living within us, and they may be the next source of powerful drugs, including antibiotics

Scientists have known for a long time that there’s no better drug-maker than nature. A third of our medicines come from plants and microbes so it’s not such a surprise that the millions of bacteria that inhabit our gut, mouths, nose, skin and reproductive tracts—called our microbiome—might be an untapped resource for new drugs. That’s what Michael Fischbach, an assistant professor in the department of bioengineering at the University of California, San Francisco, was counting on, and, he reports in the journal Cell, he was right.

He and his team analyzed the genomes of microbes living in various parts of the human body, and using an algorithm they developed called ClusterFinder, they found 3,118 groups of genes that churned out drug-like molecules. This suggests that these groups of genes could be a rich trove of potentially new drugs or other important compounds that keep our bodies healthy. “When the results of the search came back, it was a eureka moment,” he says. “It was a big surprise to us, because in retrospect the human microbiome was one place we hadn’t thought to look,” he says of the results.

MORE: The Good Bugs: How the Germs in Your Body Keep You Health

Not satisfied with simply identifying the bacteria that make these small molecules, Fischbach also wanted to see if any of them were making drugs that could prove useful in treating human disease. And indeed, he found that some made antibiotics that mimiced those developed by pharmaceutical companies and are already on the market. To see how effective a human microbiome-based antibiotic might be, he isolated one of these gene products from the vaginal microbiome of a Texas woman.

Dubbed lactocillin, it turned out to be a strong antibiotic against some familiar infections, including Staphylococcus aureus and Enterococcus faecalis, but not against E. coli. In fact, a compound similar to lactocillin is being developed by Novartis as a new member of the antibiotic class.

The results were so robust, says Fischbach, that “we completely changed what we are working on. We stopped working on soil bacteria and started working on gut, skin and oral bacteria.” While he doesn’t expect that most of the genes will yield antibiotics, he is confident that they will produce other critically important compounds that are important in regulating our immune systems, for example, and in keeping our metabolism—the way we burn calories and store fat—in check. Those compounds may explain some of the other intriguing things scientists are learning about the microbiome: that the community of bacteria in the guts of normal weight people differ from those of obese individuals, for example, and that different bacterial communities might be responsible for everything from cancer to allergies and asthma.

That’s why he’s eager to move on to the next steps, triaging the thousands of genes he’s identified to tease out those that make drug-like molecules, and then systematically figuring out what those molecule do. That will lead to a better understanding of how we might be able to exploit them—either by making the same molecules in a lab or transplanting the right communities of bacteria to the gut or other places and putting the microbes to work for us.

MORE: Colon Cancer’s Newest Culprit: Gut Bacteria

Your browser, Internet Explorer 8 or below, is out of date. It has known security flaws and may not display all features of this and other websites.

Learn how to update your browser