I have a pet theory about the medical industry in the USA. The US is the most pure-capitalist nation on the planet, and medical services are as bad a fit as it gets for a market economy: * interactions with the market are ideally as few as possible * there is massive information asymmetry * people can't "shop around" during medical emergencies * the externalities are orders of magnitude more potent than the forces di…
The majority of medical care and expenses are not emergency.
The parent comment never implied that every medical interaction is an emergency. I can see why they mention it, as emergencies are usually the most expensive medical transactions by far.
I pursonally took Vyvance brand name for over 1.5 years by opening the capsule and mixing it in a bottle of water. Never did it have a smell or taste. Even if Vyvance is manufactured with compounds that often have a smell or taste associated with them, the fact that this generic smelled almost certainly speaks to lower quality controls than the brand name based on my experience. At the very least it would speak to th…
> Even if Vyvance is manufactured with compounds that often have a smell or taste associated with them Just to be clear: it's not "associated" -- the drug itself probably smells, and you just didn't notice it. It's very, very common with drugs containing amines. Metformin, for instance, has a distinctly fishy odor (but it also has a couple more amines): https://en.wikipedia.org/wiki/Metformin#/media/File:Metformi...
Yes, that could be true, it even likely is.
The point I was making is that if I can take apart the capsule and drink the contents mixed with water without noticing a smell or taste, there is a significant difference between brand name Vyvance I aquired during that time and what the other commenter acquired.
Given the odor is undesirable, I would say the meds they acquired were much lower quality than the brand name ones I had (which of course I am just assuming are reletively representative).
I'm so angry right now. I did a deep dive into this at one point after being prescribed some generic Vyvanse through Sun via Dillons/Kroger. The pills smell like fish and seem like they didn't work at all. I checked some records from the FDA and Sun wasn't listed. I brought it up to my doctor and they just brushed it off. I really hope another class action lawsuit is brought against Sun.
The "fishy odor" is a classic hallmark of amine-containing compounds [1], of which Vyvanse has three [2], including a terminal amine, which is so infamous (at least in the di-amine form) for being smelly that they have delightful names like "Cadaverine" [3]. I don't know if the completely purified drug officially has an odor, but usually you get some free amines that come along for the ride. More likely, some got out…
Good info. Thank you. Only one batch had that very distinct fish odor. Was right after the Vyvanse patent lapsed and went generic.
For more on this, I highly recommend Bottle of Lies by Katherine Eban. Fantastically written book that goes deep on this topic and will absolutely horrify you about everything related to the manufacture of generic drugs.
My mom was a hospital pharmacist when she was still working and was beating the drum on this all my life as far as I can remember. All it accomplished was getting her called racist and xenophobic and losing friends :(
Good for her - I'm just astounded that I didn't know any of this. Even the fact that generics only have to be within something like 20% of the active ingredient of the non-generic was surprising to me; I thought they were basically identical.
But the quality of manufacturing stuff is just unbelievable. You take for granted that our medications are highly regulated and it turns out to not be remotely true...
> if continuing education has to be mandated, it is likely a symptom of a system that lacks proper incentives I’m a pilot and work in finance. They both have continuing-education requirements. The ones in the former are practical and helpful. The ones in the latter are mostly performative. (In some cases, arguably counterproductive.) The existence of continuing-education mandates per se tells you almost nothing about…
Point taken. Interesting example. Do you have some theories about why continuing education requirements are so different in aviation compared with finance? Some factors might include: individual skin in the game, observability, feasibility, and the temporal and causal distance from action to consequences.
> Do you have some theories about why continuing education requirements are so different in aviation compared with finance?
Culture of professionalism. That’s kind of a bullshit answer, but it’s the closest phrase I can come to that encapsulates pilots taking the rules seriously, both because they’re there for a good reason and the FAA isn’t afraid to yank your wings, but also because the FAA isn’t usually making rules to seem tough on pilots or otherwise infantilise them, it’s following an evidence-based approach that’s explicitly endorsed by pilots. (After a crash, you aren’t trying to find who to blame. You’re trying to prevent the next crash.)
these agencies had funding and competent staffing. they correctly identified that the factories were producing dangerous products.
The funding comes in because they didn't have the funds to test the drugs. That's something I'd hope was happening with all drugs. The competence comes in because they put availability above safety. That's an incompetent trade-off.
the real irony is that price and availability cannot be a consideration in approving indications for new drugs
> 150 million people still shit in the open in India. Yet they landed on the moon [1], how about that. I assume they're theoretically capable of producing medicine. https://en.wikipedia.org/wiki/Chandrayaan-3
-Who funded the moon mission? What are their incentives? -Who owns the pharmaceutical plants? What are their incentives?
Ask the US companies to pay more to the contract drug manufacturers in the third world. But these US companies want the cheapest bidder. You get what you pay for. Pay more, inspect more. It is as simple as that. You can't have the cheapest guy to deliver on every metric. Instead, you get contract manufacturers, who cut corners after a few good batches.
Ask the US companies to pay more to the contract drug manufacturers in the third world. But these US companies want the cheapest bidder. You get what you pay for. Pay more, inspect more. It is as simple as that. You can't have the cheapest guy to deliver on every metric. Instead, you get contract manufacturers, who cut corners after a few good batches.
If it's worth anything, I keep telling Sam's Club managers to hire more staff. I also tell the employees at Dillons to unionize. I'm pretty sure I'm going to get banned from their stores soon.
150 million people still shit in the open in India. Is that a sufficient explanation? It’s substantially better than it used to be. FWIW I believe the people of India deserve to have proper sanitation.
> 150 million people still shit in the open in India. Yet they landed on the moon [1], how about that. I assume they're theoretically capable of producing medicine. https://en.wikipedia.org/wiki/Chandrayaan-3
I'm not sure that's the brag you think it is.
It's the same kind of brag the USA has. We have this giant military but have a broken health care system.
India has a space program, but a huge portion of their population doesn't have toilets.