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  1. “Fifth, some doctors and pharmacists are paid cash bonuses by some drug companies for prescribing certain drugs.”

    This is a false statement! It is malicious in it’s intent and has a clear liberal bias. I have been a physician for over 20 years; I know and associate with other physicians professionally (many hundreds) ; I have met physicians from around the world. I do not know of any who have ever taken a bribe from a pharmaceutical company. It is illegal to do so. Before making such a comment, get your facts straight and stop listening to liberal media.

      1. The article by Old Bobbert and the references provided by JWR make it sound like doctors receive a monthly check for prescribing a particular drug. That is definitely not the case! Such payments would be illegal and result in prosecution with headlines in newspapers and lead stories on the nightly news. Anything a healthcare provider receives from a drug company must be educational in nature, and less than a specific dollar amount, at one point $100. Such items could be reference texts or textbooks(hardcopy or digital), patient education charts (anatomical charts often seen in exam rooms), anatomical models (organs, joints, etc), and meals where an education presentation is given. Some may say what is the difference, cash or a meal, but everything of value must have an educational purpose, and be reported annually. These items may be given whether or not a provider prescribes a particular product. There cannot be a quid pro quo. Patients have the right, and should always ask, if there is a generic or less expensive alternative. I am comfortable asking my provider why they chose a particular drug, but some patients may not be comfortable doing so as it may appear they are challenging the provider.

      2. This too is a very complicated field.
        First, let me say – for the lay reader, doctors are not paid more simply for prescribing one drug over another. That is completely illegal, as the above physician points out.

        What they are being paid for is “expert consultant services” or the like. While the accusation can be made that these “consultation fees” are just a front – just as they are for the clinton foundation….. in this case – what the data show in the above linked two articles is that there is an association with “expert advisory” or consulting, or speaking fees of some type – AND being more likely to prescribe name-brand medication instead of generics.

        Upon reading those articles it looked like docs who are paid above $5,000 by drug companies for speaking fees, or expert advisory services (or the like) are 30% likely to prescribe name-brand medication, as opposed to 20% for all other doctors….
        I would like to point out a fact that many not in the industry will likely not know. That is – the doctors that are being paid for expert advisory services (or the like) are frequently considered “experts in the field”. They are therefore more frequently seeing more complex (more sick, or refractory to treatment etc) patients than the “average” physician. Name-brand drugs and generic drugs are not EXACTLY the same, and sometimes (rarely but sometimes) those differences matter when applied to a certain disease, or a certain disease / comorbidities combination.
        We can expect that experts in the field would be more likely to see highly complex patients that have been referred to them from other physicians – and we might expect the patients disease state and comorbidities to be such that name-brand drugs would be indicated in a higher percentage of cases than on average.

        As JWR has pointed out many times, association does not prove causation.

        My best guess is that what we are seeing in the industry is some combination of medical need for name brand being more likely to be appropriate AND also, some “brand loyalty” engendered by the relationship between the drug company and the doc. This brand loyalty comes not just from the money exchanged for services, but also from the exposure to the scientists working at, and the cutting edge research being conducted by the drug companies. Brand loyalty in this manner is frequently not totally unfounded… it is these non-generic drug companies that are risking billions in experimenting with potential new drug candidates in clinical trials – many of which do not result in success. They take the business risk of trying new drugs, not the generic knock-off companies… and the brand loyalty that some docs MAY exhibit may reflect a respect for innovation in the field and the struggle to advance medical science for the betterment of patients worldwide.

        The biggest problem I see in the drug field is the crafting of clinical trials to “ask the right questions” to be successful in some possible way… to result in a New Drug Approval. There is – as I see it – a tendency to game the system in that manner. The FDA, as bureaucratic as it is, DOES have a role in fighting this.

  2. Last year I accidentally left my travel bag at the hotel along with my monthly supply of daily medication. Next trip to the Dr for my annual, I asked her if she could write me an extra scrip for an extra 30 days, just so I could have some “safety stock” on hand to carry me thorough such an event next time.

    She said “oh, you want a ‘travel script!'”

    So she wrote me a 30 day script – plus SIX REFILLS that I could take with me to an out of town pharmacy if needed.

    I now have an extra 210 day supply of daily medication, purchased for cash at less than the insurance price at a no-name keep-my-name-off-the-grid pharmacy. This time next year I will have a 420 day supply.

    That is all.

  3. For those on a LOW DOSE of drugs such as Diovan (valsartin) for blood pressure, Lipitor (atorvastatin) for cholesterol, and Finofibrate for triglicerides you might wish to cut these tablets in half a couple of days before regular blood tests. By so doing, the physician will likely see decreased response and double the dosage. The doubled dosage can then be cut in half which yields your original dosage and allows you to rapidly build up a surplus of medication. Please remember the restricter LOW DOSE. If you experience discomfort, immediately take your normal dosage and go to your physician and mention the discomfort. You will probably be given a greater dosage regardless of your blood chemistry. PR

  4. I keep my surplus meds in a .50 cal ammo boxes along with desiccant. These ammo boxes are in turn kept in a dedicated refrigerator at 50F. Temperature is certainly a limiting factor in age related efficacy of medications; likewise is humidity (which is why so many prescriptions state, “Do not store in bathroom.” Remember low (but not freezing) temperature and low humidity work together to extend the viability of most medications. PR

  5. Buying your meds online from India? Really?!

    Actually it’s probably safe. Many reputable pharmaceutical companies over there and many of the medications you are buying from our USA based companies are being sourced from overseas.

    If you live on our southern border many of the medications you need a prescription for here are available at the pharmacerias without one. Not all but many. Customs is going to confiscate anything you mange to get that will be abused but will likely ignore a bulk bottle of your high blood pressure medication.

    There is a chance that the medication is counterfeit so caveat emptor.

    I’m fairly certain that ALL of the big box pharmacies get most of their dirt-cheap medications from oversea.

    I’ve considered going to one of the cheap in store clinics typically staffed by a nurse practioner or a physicians assistant for duplicate prescriptions. You pay up front and see the practioner. Look homeless and don’t have any ID, pay in small bills. Tell them you are running out of your medications and need refills. The first thing will be that the staff will think you are seeking opiates but they will take your money and let you see the provider. The provider will think the same thing and be set to deny you. They will actually be relieved when you tell them you’re almost out of your beta blockers or diabetic meds. I’ve never tried this but I believe it will work.

    One more caveat. Be selective where you shop. Call around and find out what the pharmacy is charging. Prices can be very different. A friend lost his benefits at work and his local big name pharmacy wouldn’t refill his beta blocker prescription as he no longer could afford it.
    THEY DID NOT TELL HIM THERE WAS A CHEAPER ALTERNATIVE. INSTEAD THEY PUT HIS LIFE IN JEPARDY BY TELLING HIM TO COME BACK WHEN HE HAD THE MONEY! He told me what was going on and I told him call the pharmacy and tell them you want it transferred to Wal-Mart. His $60.00 a month medication dropped to $9.00 a month.

    Lastly there is always the dog ate my homework excuse. that’s what we could call it in the ER when people came in looking for refills on their opiates. Typically the patient would claim the medication was stolen and they had made a police report. It never worked for opiates but it did work for non-abusable medications. Calling your pharmacy and telling them you left your prescription in a bathroom while traveling could work but it’s unlikely the insurance company will pay for it. Once again, a reason to always shop around for where you get your medications as you will probably be paying out of pocket.

    1. Probably should have added asking the provider to prescribe a medication that it double the milligrams so that you can cut it in half might be helpful. You might add that you are afraid you’re going to lose you benefits and would like to get ahead on the medications. NOTE! Not all medications can be cut in half and doing so could be very dangerous. Mostly I’m thinking of the extended relief medications here. If a pill is “scored” has a line pressed into it is designed to be cut in half. Although the medication might have twice as many milligrams the price is usually the same.

      The VA prescribes some medications at a double dose and provides the veteran with a pill cutter to cut it in half with. Pill cutters are available at any pharmacy. Example, Viagra comes as a 5mg and a 10mg pill. The VA sends the veteran a 10mg pill and instructions to cut it in half. Don’t ask me how I know about this!

      1. One more thing and you should discuss this with your provider. It is safe with some medications to skip an occasional dose. This allows you to slowly build up an emergency supply. Mostly I’m thinking of the SSRI class of antidepressants. Stopping then abruptly can be VERY unpleasant. Skipping the occasional dose is probably safe and will allow a slow buildup in the medication to allow one to taper it in the event the medication no longer is available. These medications are usually started at a low dose and gradually increased Once again asking for a higher dose and cutting the pill could be a viable option. I have to say that I wonder abut what happened in Puerto Rico with their disruption in supply.

        Many medications will have a therapeutic blood level that the doctor will check on. Cutting these pills in half should not be done as it is dangerous. I’m reminded of one patient who took digoxin and had to come to the ER as he was trying to stretch his supply while on vacation. He was taking half of a pill and the results were as if he was taking nothing at all. Seizure medications are another one that comes to mind as well as blood thinners.

        To the anonymous doctor who gave the first comment on this thread. I’d enjoy hearing your thought on these comments.

  6. A pharmacy will refill a med 4-5 days early. If you get your refill 4-5 days early every month, you’ll have an extra month’s supply in 6-7 months. I’ve read that if you get a 90-day supply of your meds thru mail-order, you can request a refill 2 weeks early. This is an easy way to stock up extra prescription meds.

    1. I’m in the UK and have been doing this, getting around three days extra every time, for seven years with my blood pressure meds and in three weeks time I’ll be up too eight months. I find most years I can get a extra week at Christmas.

      1. There has been a lot written about (It reads to me any way) about doing this is wrong. As I say I’m in the UK and we have the NHS (National Health Service) which I have to pay into even if I never use it. Under the NHS rules you can use the NHS or go private, but under the NHS rules if you ever go private for any medical care you can never (someone has told me it’s now two years) go back to the NHS for that treatment, but you still have to pay into the NHS. I’m more than happy to pay for a years meds myself – the are some of the cheapest out there. In fact the cost of the NHS prescription (£8.60 per item) is more than the cost of the item (which have to be on a private, even if you buy them for your dog) on a private prescription (but then I have to add the private Doctor costs about £80 a month), but this is the only way I have of getting them.

  7. JWR, years ago, turned me on to the Shelf Life Extension Program conducted by the DoD to determine the effectiveness AND ALSO safety of various drugs at several intervals past the labeled expiration date.
    The existence of this data is known by some, but certainly not the majority of physicians.

    People stating that the expiration has nothing to do with safety are wrong. As drugs degrade over time the breakdown and oxidation products in some cases are harmful. This is a very complex field and frequently even the drug manufacturers do not fully understand what happens far after expiration dates – as it is often very expensive to fully analyze finished drug product (the whole pill, for instance, and not just the single isolated active ingredient) in what is essentially a “fishing expedition” looking for the unknown breakdown products or contamination, such as microbial growth.
    Drug companies and clinical trials usually do not conduct extensive testing on far-expired drug. There are sometimes tests preformed on far-expired drugs to look for certain known hazards – such as microbial growth, and also to assess the EFFICACY of the drug by looking for integrity and percentages of certain “active ingredients”. Many inactive ingredients also impact how a drug is delivered or metabolized, and often these are not required to be tested for identity, strength, quality, and purity, especially for expired drugs.
    For those who are medically inclined, please look up the DoD SLEP (Shelf Life Extension Program) as this is the most through and comprehensive examination with real data on how drugs hold up to long term storage under different temperature,humidity, and light exposure conditions.
    Also, those with an academic interest, can read what the FDA considers an adulterated drug: https://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfcfr/CFRSearch.cfm?CFRPart=211&showFR=1

    All this being said – I appreciate the guidance that experts in the field contribute to the general field of knowledge on survivalblog – and Jim’s efforts to make this possible — and in a smart, positive, God fearing manner.
    Therefore – I will provide some guidance for those in a pinch. Medication in dry pill form generally last longer without degradation than liquid stored medication. Can you take a two-year expired aspirin in an extreme emergency when no alternatives are available. Yes, probably, depending on the storage of the medication. Will it be some unknown percentage less potent than an unexpired aspirin. Yes, probably. You will not be able to guess how much less effective, and therefore not able to, without access to prior peer-reviewed published information, be able to properly titrate (adjust, slightly increase) the dosage. Those in the medical field with the requisite background knowledge are encouraged to search pubmed for information of this sort and compile a factual report of the subject on survivalblog.

    Jim has long cited “when there is no doctor” and I second that reference for those who are unable to lean on a physician for this type on information in a emergency situation. Also, please remember, even though specialists such as (not to pick on them) Dermatologists often get a TEOTWAWKI bad rap (not being trauma surgeons or ICU intensivists) – they did go to med school – perhaps a long time ago – and if YOU take the time to compile the resources (drugs, IV supplies, sterile instruments and bandages) and KNOWLEDGE ahead of time – they will likely have the background knowledge to properly put it to use when needed.

  8. For refrigeration of drugs such as insulin check into small propane refrigerators. They usually last decades with simple maintenance and are propane frugal especially if extra insulation layers of closed cell foam are glued to existing outside of fridge. Many campers have double 12vdc/propane,or triple 12vdc, 120vac or propane fuel fridges in them. I have a Dometic fridge and freezer combo that’s worked over 20 years without much hassle.

    1. duel or tri mode refrigerators are relatively efficient when running on propane, but horribly inefficient when running on electricity. They work by cycling through heat cycles to vaporize the coolant. This works well under LP because that is the most efficient way to utilize gas. However, it is a horrible way to use electricity. A normal apartment refrigerator (8 to 9 cu ft) will only use 60W of electricity when cooling and 120W of electricity when auto-defrosting. Since it doesn’t run all the time you can easily power it via a single 200W solar panel and a 12VDC battery with a small inverter. Adding the hard foam insulation makes it even more efficient.
      In this day and age, if you don’t need the mobility that an RV fridge is designed for, I’d opt for a normal fridge. You will be looking at about the same price and the normal fridge is far easier to work on with better availablity for replacement parts.
      Note: you have to be careful where you add extra foam. many modern fridges no longer have the coil in the back or underneath. They often just put them in the walls of the fridge and you can’t cover them without causing issues.

  9. STOP NOW! THERE IS NO REASON TO LIE OR CHEAT NOR DO THE STUPID THING SO AS TO DO WITHOUT!!!
    YOU GOTTA DO THE “DARN” GOOGLE SEARCH AS WE HAVE DONE. ALWAYS SAFETY FIRST

    FOOD & DRUG ADM AGENTS IN INDIA?

    FDA opened the India Office in New Delhi in 2008, to ensure that food and medical products exported from India to the U.S. are safe, are of good quality, and are effective.

    FDA’s goals in India are to obtain information to help make better regulatory decisions about the products from India that are being developed and exported for the U.S. market. This includes medical products being reviewed for marketing authorization in the U.S., and the safety assessment of products that are already on the U.S. market. In addition, the India Office helps verify that foods being imported into the U.S. are safe.

    FDA activities in India include:

    Conducting inspections of medical products and foods facilities that export to the U.S.
    Engaging with Indian regulatory authorities to build confidence in each other and develop quality standards
    Partnering with Indian counterpart agencies on bilateral initiatives
    Assisting and training Indian regulators, Indian pharmaceutical and foods industries and stakeholders on developing and maintaining the quality, safety and effectiveness of medical products and foods
    Building and strengthening relationships with the Government of India by supporting the mission of the U.S. Embassy
    India Office staff is also located in Mumbai.

    Questions?

    Email: US-FDA-INO@fda.hhs.gov

  10. FOR THE UMPTEEN TIME – IT IS ALAYS BETTER TO GET WHAT WE NEED FOR EMERGENCIES WITHOUT A LIE AND DECEPTIONS.

    REQUEST TO THE BLOG READERS WHO HAVE USABLE INFO ON HONEST WEANS TO ACQUIRE A RESERVE SUPPLY OF MEDICATIONS, TO ESPECIALLY INCLUDE BEING TRUTHFUL WITH YOUR REGULAR PRIMARY CAREGIVER..

    PLEASE WRITE INTO THIS TERRIFIC BLOG SO AS TO HELP THERS …
    THANKS OLD BOBBERT

    1. It is sad that there might be need for deception. But is it wrong if it is what is needed to be done? We used to live for an average of 40 years. Modern medicine has greatly extended that. Somebody who is dependent on medication for their high blood pressure will probably die sooner without it. Many will say go to the herbal remedies but if those were truly as effective as the prescriptions everybody would be taking them as they are usually much more affordable. I pop a little pill twice a day that costs me $9.00 a month. without it I WILL die sooner than I would prefer to. If I have to use a little deception to get extras so be it. It is not like I’m not paying for this. I’m filling that extra prescription at the most affordable pharmacy I can find and I’m paying full retail at that stores price.

      1. Are you really asking if lying is OK sometimes? Here is just a sampling of why lying is not OK:

        • Lev 19:11 – “Ye shall not steal, neither deal falsely, neither lie one to another.”
        • Psalm 119:163 – I hate and abhor lying: but thy law do I love.”
        • Proverbs 12:22 – “Lying lips are abomination to the Lord: but they that deal truly are his delight.”
        • Proverbs 14:5 – “A faithful witness will not lie: but a false witness will utter lies.”
        • Proverbs 17:7 – “Excellent speech becometh not a fool: much less do lying lips a prince.”
        • Ephesians 4:29 – “Let no corrupt communication proceed out of your mouth, but that which is good to the use of edifying, that it may minister grace unto the hearers.”
        • 1 Timothy 4:2 – “…speaking lies in hypocrisy; having their conscience seared with a hot iron;”
        • Revelation 22:14-15 – “Blessed are they that do his commandments, that they may have right to the tree of life, and may enter in through the gates into the city. For without are dogs, and sorcerers, and whoremongers, and murderers, and idolaters, and whosoever loveth and maketh a lie.”

        1. Is deception necessarily a lie? A lie of omission is still a lie but do you feel compelled to be totally truthful if doing so will hurt another? As I let my dog run on the essentially empty beach the lone other visitor informed me i was breaking the leash law. Two of us on 1/2 mile of beach. I replied the dog needs to run and I’m elderly and can’t and didn’t I see you do 38 mph in the 35 zone last week?

          W.C. Fields once asked a lady if she would go to bed with him for a million dollars and she replied yes He then said would you do it for ten dollars and she asked if he though she was a prostitute. He replied, we’ve already established that now we are merely haggling the price.

          If I omit to tell my doctor that I’ve seen another provider who is also prescribing the same beta-blocker or I visit Mexico and buy a bottle of them at the pharmaceria I truly plead guilty to a lie of omission. I am not stealing them. I’m paying the asking price.

          Remember in “One Second After” the doc telling the colonel all of his heart patients died when their beta-blockers ran out. I don’t intent to be one of them. It will be a lie of omission if the PTB try to confiscate them for the greater good but would you freely give up your stockpiled food if your years supply would help your community survive an extra day?

          What about thou shall not kill? Most of us on this site have considered the potential need and many of us have stockpiled accordingly.

          Hugh I truly enjoy this site and feel JWR truly got a gem when he took you on as editor. But for now i think we should respect each others beliefs, I personally tend more towards a Buddist leaning.

          1. AS I REMEMBER THE ORIGINAL LANGUAGE OF THE TEN COMMANDMENTS IN THE LESSONS IN CHURCH,THE “VERB” WAS MURDER, NOT KILL.

            THERE IS A HUGE DIFFERENCE IN THESE TWO WORDS.

            WE WERE ALSO TAUGHT THAT WHEN THERE IS AN OPEN AND HONEST MEANS TO AN END AVAILABLE, , AND WE CHOOSE TO GO THE SNEAKY OR DISHONEST ROUTE, IT IS A WRONG , A SIN, AN ASSULT ON INTEGRITY, A BAD EXAMPLE TO THE YOUTH, AND A WHOLE LOT OF OTHER ACCOUNTABLE ITEMS.

            REMEMBER THIS OLD SAYING,
            “I CAN’T HEAR WHAT YOU ARE SAYING BECAUSE WHAT YOU ARE DOING IS SO LOUD”

            AND THEN WE STILL HAVE THIS ONE,
            ” WHY SHOULD I TRUST YOU WHEN I SEE YOU BEING A LIER?

            AND WE STILL HAVE THIS ONE FROM MY GRANNY.
            “A LIER IS A CHEAT AND A CHEAT IS A THIEF AND A THIEF IS A LIER”.

            SO THE QUESTION FOR US IS THE SAME AS BEFOR. IF WE KNOW YOU TO BE A LIER, WHY SHOULD WE TOLERATE YOU IN OUR GROUP?

            KATHY JUST SAID, WOULD WE EVEN NEED THIS BLOG IF , IN GENERAL, SO MANY PEOPLE WERE NOT LIERS AND CHEATS AND THIEVES AND THEREBY PULLING THE NATION INTO RUIN.

            AND SHE IS RIGHT!! AND NOW SHE IS SAYING TO ME, ”

            BOB. DO YOU REMEMBER FROM THE DAYS OF RADIO ONLY,
            ” CAPTAIN AMERICA STANDS FOR TRUTH , JUSTICE, AND THE AMERICAN WAY.”

            “YES I DO, AND SOME OF US STILL HONOR THESE STANDARDS!”

    2. Od Bobbert, Okay you are right. I’ll just ask my regular doc for more of them diabetic pills and when he says no I’ll just go ahead and die. Far as I know I can’t get them pills for my poor old diabetic fish. Besides those fish taste really good with all that extra sugar in their blood.

      Seriously though. When your regular provider is not willing to help what should you do? When there is only one doctor in your town and every other one is to far to reasonably travel to, or out of your network what can you do?

      Unfortunately deceit is sometimes necessary and I truly wish it wasn’t. Under the vast majority of circumstances I’m one of the most honest people you have ever met.

  11. Back in the 80’s I worked as a pharmacy helper. We had the original bottles for pills on the back shelves that were used to fill the smaller bottles that were filled for the customer. Some of the larger bottles had an expiration date of 5 years later. But of course the clients bottles were only given a 1 year expiration date. I asked about this and they said legally they could only out a one year expiration date on the sold medicine. Compressed pills store well. Capsules not as long and liquids deteriorate the quickest. So I believe that many of the compressed type pills would store quite a while as long as they weren’t subjected to extreme heat or moisture. Herbal formulas can be quite effective but many people don’t know what to take and to be honest a lot of the formulas don’t taste good. It’s easier to just take a pill or capsule, especially when it’s covered by insurance. Herbs and natural remedies do cost money and are not covered by insurance. But it would be wise to learn about natural medicines because it could save lives.

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