My doctor recently gave me a prescription for Abilify, a fast-acting antidepressant for patients with major depressive disorder. I couldn’t shake a depression that had kept me in bed for most of a month. Although I’d been taking a maintenance dose of Zoloft for years, it wasn’t potent enough to prevent this episode. I needed a drug that would supplement the Zoloft.
Abilify was developed by Bristol-Myers Squibb for patients with major clinical depression resistant to treatment with standard antidepressants. (It’s used for other psychiatric indications, too.) Abilify is intended to serve as an add-on treatment.
After 5 days of 10 mg of Abilify nightly, I felt my depression start to lift. I was regaining my motivation to move around and get things done. By day 7, I was pretty much back to normal, working on writing projects, talking with friends, and running errands. My enthusiasm for life was returning
By day 8, I was a bit too enthusiastic. My mood was slightly manic. My speech was pressured. At the same time, my body felt clumsy and my balance shaky. I took two falls in a week. Also, I was becoming surprisingly forgetful. In the middle of a conversation, I’d lose track of the topic. When going to another room to get something, I’d forget what it was by the time I got there. According to clinical studies, impaired memory is sometimes reported by Abilify users. My other symptoms weren’t listed among adverse events associated with taking the medication, but they felt like side effects.
Since my mood was lightening, the doctor suggested lowering the dose to 5 mg by splitting the pills in half. Then, if the improvement continued after several days, I could take one quarter of a pill. After that, I could stop altogether.
While the effects of Abilify were gratifying, the cost of the drug was daunting. My pharmacist told me a 30-day supply would cost $834.00. When he saw my shock, he asked whether I had insurance. I said no. He suggested that I apply to Bristol-Myers Squibb online for a discount coupon. I did that and found that the application could take up to two weeks to process—too long for me. I bought a 7-day supply of Abilify for $199 from my pharmacist and ordered the rest from a Canadian pharmacy, where the cost was only $165 for a 30-day supply. It would arrive by the time my initial supply was used up.
Abilify comes in six dosage strengths, ranging from 2 mg to 30 mg. In the U.S., a one-month supply of any of the four lower doses is the same—about $800. The two higher doses sell for about $1200. In Canada, the same branded product costs 80% less.
Why Canadian Prices Are Lower
The reason Canadian prices for Abilify are so much lower is that Canada, like many other countries, imposes price controls on retail medications. In the U.S., the sky’s the limit. Pharmaceutical lobbies in Washington have persuaded Congress that the high prices are justified by the cost of research and development. While this is true, the profits are often many times the amount needed to reach this goal. It’s true, too, that drug companies need to be compensated for their risk in developing new drugs that never come to market because FDA approval can’t be obtained. When this happens, they rely on the profits from other branded drugs to make up for their losses.
After Abilify sales had been tallied for the last 10 months in 2013, Bristol-Myers Squibb was found to net $16.4 billion. Only $3.7 billion of this was needed to recoup research costs. The company is undoubtedly currently maximizing profits before generic products are introduced in the U.S. in mid-2015.
Why Are Abilify Tablets So Tiny?
The tiny size of Abilify tablets may have been a measure of Bristol-Myers Squibb to deter users from sectioning high-dose tablets into pieces; pill-splitting is a money-saving exercise. A doctor may prescribe 5 mg of an expensive drug per day, but write a 15-mg prescription so the patient can score the tablets in thirds and cut costs. Sectioning is difficult with the tiny Abilify tablets. Using a pill crusher is an option, but even this is tricky for a patient trying to divide a 30-mg pill into sixths to achieve separate 5-mg doses.
Bristol-Myers Squibb warns consumers to “take tablets whole.” There’s no pharmacological need for this, as the density and composition of each tablet are uniform throughout. The Discmelt formulation of Abilify is the exception.
Is Abilify Worth It?
Who wouldn’t pay a lot of money to recover from a severe clinical depression? It’s like death to many of us. We’re convinced that it’s permanent. Knowing that a rescue drug is available is priceless.
If I need the Abilify again in the future, I’ll buy ten 10-mg tablets from Canada ($55.00) and take one pill a day for six days. I’ll cut two pills in half and take the half-pills for four nights. I’ll quarter one and take the quarters for four nights. (This will leave one pill just in case.) Abilify will then most certainly be worth it.
All things considered, the attraction between the ESTJs and INFJs isn’t surprising. Because ESTJs are conventional people, they prefer colorful partners to make their lives more interesting. They aren’t drawn to other ESTJs. INFJs have creative minds and supply the friendly, playful traits ESTJs are missing. The INFJ, in turn, is rewarded by an appreciative audience.
An INFJ may find ESTJ friends too direct and outspoken. They tend to overlook polite ways of dealing with others. Often, they forget to say “please” and “thank you.” To build a good relationship with an ESTJ, it’s best to let the person know up front that these courtesies are important to you.
You’ll avoid frustration in friendships with ESTJs if you make an effort to understand how their minds work. They aren’t like you—a person who would rather act on hunches than gather detailed information. ESTJs are guided mainly by rules, principles, and traditional values. INFJs adopt novel approaches to problems and bypass convention. INFJs are rare enough (one percent of the population) that most ENFJs (over ten percent) haven’t met enough of them to understand them.
Getting To Know an ESTJ
Don’t expect much spontaneity from a new ESTJ friend. For them, work and play are kept separate. Activities are scheduled, and work comes first. Play must be earned. Even then, it should have a goal, such as walking to lose weight or attending concerts for cultural improvement. Since INFJs need a purpose in their leisure activities, too, you’ll have this in common.
You’ll find that ESTJ friends are quick to take charge and give advice, whether it’s asked for or not. When something goes wrong, the first thing the ESTJ wants to know is what happened, why, and who caused the problem. Only then is he or she ready to think about a solution. As a result, the INFJ may find this type judgmental and hard. The compassionate INFJ’s position is that mistakes are part of the game and it’s best to move on to a remedy.
ESTJs generally expect to share expenses on outings. They’re not comfortable letting others pay their way. The exception is when the ESTJ is a female. She’ll allow a date to buy dinner or pay for a movie because it’s the conventional thing to do. Her way of reciprocating may be to buy a new dress that pleases her companion. ESTJ men often give candy and flowers. They remember birthdays with cards or gifts. These actions serve to replace the flowery expressions of love they have a hard time expressing.
Working with ESTJs
ESTJs function best with structure. They want to know what’s required of them and what the deadlines are. Unlike INFJs, they don’t improvise easily. Because ESTJs are so focused on the concrete aspects of things, they sometimes lose sight of their underlying purpose. When asked to judge entries in a science fair, for example, an ESTJ may be so caught up in the technicalities of the assignment that the overall goal of encouraging children to explore scientific interests is forgotten.
Under stress, ESTJs make decisions too hastily. They don’t give themselves time to reflect on alternatives. Even when things start going wrong, they’ll stick with their original plan and resist new information, vetoing suggestions for change. Their motto is, “That’s the way we’ve always done it.”
ESTJs who supervise INFJs may wonder why their employees dislike them. The reason is that INFJs have a horror of being micromanaged. They like to figure out their own ways of doing things. However, because bluntness is not their style, they tend to nurse grudges rather than confront ESTJ supervisors directly. Differences in the two types can be a source of irritation, although the INFJ will suffer more from any misunderstanding than the matter-of-fact ESTJ.
Loving an ESTJ
In a new relationship with an ESTJ, you’re likely to find him or her spontaneous and easy-going at first. As time goes on, the ESTJ will revert to type and become more matter of fact. If you disappoint the person in some important way, he or she is likely to get angry and self-righteous. This is because ESTJs expect others to honor their standards.
INFJs who are troubled and seek sympathy from an ESTJ partner are in danger of feeling short-changed. The partner is more comfortable looking for a practical solution than listening with a sympathetic ear.
When conflicts arise in a relationship, efforts to explore underlying causes are generally ignored by the ESTJ. Insights are not the person’s long suit. If an argument gets heated enough, the ESTJ may explode and need help rebuilding their control. Tactfully, the INFJ can remind them of what’s really important. If the INFJ suggests counseling, the ESTJ will probably resist.
Don’t expect romantic emotional displays from an ESTJ. The ESTJ will feel that his or her loyalty is the only proof of love that’s needed. Eloquence is not their style. They aren’t given to creative lovemaking, either. Once a routine for physical intimacy has been established, the ESTJ will resist attempts to introduce new techniques.
Living with an ESTJ
If you move in with an ESTJ, you’ll find that there’s a place for everything and everything is in its place. Your ESTJ partner will want clear arrangements about who does what. If the ESTJ volunteers to walk the dog, you can depend on it. No prodding will be needed. If you have children together, the ESTJ will send them off to school with lunch money, permission slips, and anything else they need for the day. If you’re behind in your own commitments, you can be sure you’ll be reminded of them.
When you get frustrated by your partner’s lack of sensitivity, take comfort in the knowledge that ESTJs show their love by actions more than words. They’re loyal and keep their promises. If you feel that your needs are being ignored, the best approach is to explain tactfully and clearly what you’d like from them. They’ll probably try to improve communications. The more you can help an ESTJ relax and expand his or her views, the more you’ll enjoy each other.
Famous ESTJs and INFJs
ESTJs known for their quick tempers include Lyndon Johnson, Bette Davis, and Herbert Hoover. In heated situations, they responded best to people who would hear them out and then suggest new insights. INFJ leaders famous for their ability to listen thoughtfully to others include Nelson Mandela, Eleanor Roosevelt, and Ghandi.
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INFJs are often drawn to INTPs because of their intelligence and ability to apply logic to every situation. Eventually, though, INFJs tend to find most INTPs distant because of their unemotional approach to life. The INTP is attracted to INFJs because of their compassion and spontaneity. But the qualities that drew them to an INFJ in the first place can eventually get on their nerves. To them, it’s sloppy to let feelings override logic. Because they’re so reserved, INTPs may have few friends.
This personality type is more attuned to impersonal systems and technical subjects than intimate topics. If you’re an INFJ who’s an animal lover, don’t expect the INTP to share your emotional bond with pets. Are your favorite causes fueled more by compassion than logic? The INTP is unlikely to be enthusiastic about them. INFJs are idealists and INTPs are rationalists.
Privacy and Space
If you are close to an INTP, it’s important to give him or her plenty of space. INTPs need more time alone than other types. They don’t like being interrupted when they are focusing on something they’re doing. If their feelings are hurt, they won’t want to talk about it right away as INFJs do. They need time to process their feelings. Being pestered for a discussion of the problem only makes them more upset.
Small talk is not the forte of INTPs. They want to discuss things that are important, amusing or thought-provoking. They’d rather sit in silence than chat politely. Should the conversation turn to something they’re interested in, though, they can become long-winded and even boring. When apparently easy-going INTPs are challenged about their beliefs, they can be downright hard.
Friends sometimes get the impression that the INTP is aloof and judgmental. That’s because INTPs are impatient with faults both in themselves and others. When they’re critical of something you’ve done, they probably haven’t meant to hurt you. In their problem-solving mode, they’ve forgotten to consider your feelings. Their perfectionism causes them to be hard on themselves, too. Personal failure is likely to make them depressed. Because they have trouble opening up to others, they suffer alone. They may not even be clear about what they feel or why they’re depressed.
Work and Play
The INTP’s mind may be organized, but his or her personal environment is not. INTPs make clear, logical plans to put things in order but seldom get around to it. Nothing changes and the mess remains.
INTPs need plenty of private time to read, think, work at their computers or watch television. They’re partial to solitary activities although they enjoy companionship at times. When they play games, they prefer bridge, Monopoly, chess or other challenges to their problem-solving skills. They talk very little as they play, preferring to concentrate on their moves. They’re also competitive. When they get involved in a project, they’re more interested in the planning phase than in the actual execution. If the project involves drudgery, their motivation evaporates and they put it off.
Falling in Love
When INTPs fall in love, they fall hard. Passion consumes them. They step out of character—writing poetry, reading to their lover, and buying gifts. They ignore obstacles to romance such as distance, weather, and prior commitments. However, their common sense usually returns within a year. Even though they remain committed, they may seem to pull away and become more matter-of-fact. They still appreciate their partners; they just don’t talk much about their feelings. They’ve returned to their familiar pattern of solitude.
When INTPs fall out of love, the decision is almost always final. A line has been crossed. The INTP allows the relationship to deteriorate and end, with no attempt to revive it. Break-ups can be messy, damaging the lives of many people.
INTPs strive for logical purity. They are clear and quick-thinking, never accepting ideas that don’t make sense to them even though everyone else might regard them as the truth. They’re good at connecting unrelated thoughts and put considerable effort into analyzing and solving problems. They don’t want the help of others. For this reason, most have a distaste for meetings. They’d rather come up with ideas on their own and make plans independently. They also have a strong need to continue learning about areas that interest them. They’re committed to the life of the mind. Many prolong their formal education for years.
If you are a high-maintenance INFJ, be prepared to look beyond an INTP partner to meet all your emotional needs. INTPs don’t like to feel crowded.
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As an INFJ, I don’t relate to ISTJs easily. They often seem to lack imagination, playfulness, and insight. They’re conventional and I’m not. ISTJs tend to be uncomfortable with me, as well. I think they find me too emotional and eccentric. The problem lies with differences in our intuition-sensing and feeling-thinking functions.
Here’s how Myers Briggs experts summarize the ISTJ:
ISTJs rely on logic, rules and consistency. Their outlook is traditional. They value loyalty and hard work, are uncomfortable with change, and tend to disapprove of unconventional behavior. They’re more grounded in facts than emotions. Because of this, they may be unaware of their own feelings and the feelings of others. They avoid talking about their emotions. As a result, many INFJs find ISTJs cold and oblivious of social nuance. If you’re an INFJ and want to talk about feelings with an ISTJ, you need to spell them out and describe how they affect you.
ISTJs are more at home with practical realities than abstract thinking and their conversation reflects this. They’d rather get their ideas across with anecdotes than couch them in broad abstract terms. The INFJ who wants to create a conversational bridge should use concrete examples to make his or her point.
ISTJs can be stubborn and resistant to change. The good news is that when they do change their minds, they commit themselves to their new view. It’s vital to pick your battles with an ISTJ carefully and agree to disagree when that seems advisable.
If you’re an INFJ, you’re likely to have co-workers, friends or even romantic relationships with ISTJs. You may even have an ISTJ child. How do you keep the peace?
The depth of some of these relationships may be limited by your personality differences. If you find ISTJs’ thinking limited, they’re probably baffled by what they consider your outlandish ideas. While you may find an ISTJ cold or lacking in compassion, he or she may see you as overly emotional and undisciplined.
When I’m in conflict with an ISTJ whom I like, I go slowly in order to reach a compromise. Resolving problems can be hard, given our personality differences. I try to remember that ISTJs aren’t necessarily doing things wrong. They’re just not doing them my way.
I’ve had ISTJ lovers, and these relationships always ended badly. My father was an ISTJ. Maybe I was looking for men like my dad. As a young woman, I admired the strong silent type, but I always ended up disappointed because the man wasn’t tender and sensitive enough. I expected him to act in a way he couldn’t. Maybe one or two of them did care about me deeply but I couldn’t appreciate it.
When the INFJ has an ISTJ child, that’s a different challenge. It’s one I don’t face because I have two daughters and both are INFJs. But my sister, an ENFJ, has one ISTJ daughter, who now has children of her own. I’ve watched my sister and her daughter grow to understand each other more fully over the years. Their secret is they’ve valued their commitment above all else and have handled disagreements with tolerance and compassion.
Not a bad idea.
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Today, one of my DrawSomething partners online didn’t believe me when I told her I was 81. She said I wouldn’t be on DrawSomething if I were that old.
She must not know many 81-year-olds. When I’m at my computer (about 4 hours a day) I play DrawSomething with several partners, sing on Smule (badly), and am addicted to the game BlocksAway. DrawSomething helps me dust off my sketching skills. In the 1950s I was an art major at the University of Wisconsin.
I move, too. I swim several times a week and walk my dog Trudy every morning. I have an electric scooter that I ride around the neighborhood in good weather and take on camping trips. About once a month, Trudy and I travel in my 21-foot camper to the beach and state parks in north Florida. It has everything–a microwave, gas stove, refrigerator, bathroom, running water, and AC. It has a TV, but I never use it. I camp to get away from civilization. I also travel outside the U.S. frequently. Since my 70th birthday, I’ve been to Alaska (once alone, once with my daughter), Antarctica, Ecuador, and Vietnam.
Before retirement, I was a science writer. Now I write self-help articles and books, and publications about animals. I am finishing “Wild Dogs of the World” and “Great Animal Escape Stories” for middle school readers as e-books. Another book, “The EZ Big Book,” has been selling well as a paperback and e-book for over 3 years. I have graduate degrees in social sciences research (MS) and counseling (EdS). Graduate school was an experiment. After a year of listening to clients, I decided to become a mole again and returned to writing. I attend concerts regularly and read about three books a week.
I play the guitar and keyboard, but not very well. I’ve been playing the piano accordion since I was a 10-year-old kid in Milwaukee, Wisconsin. I still pick that up when my fingering isn’t too stiff.
I laugh a lot and my friends think I’m funny. The above photo was taken in Antarctica 3 years ago. I’m well preserved, and the illusion is supported by regular hair coloring at the beauty salon.
To be 81 isn’t the same as being dead. That will come soon enough.
In 2011, my 7-year-old dog Trudy lost her sight from SARDS (sudden acute retinal degeneration syndrome). I took her to veterinary specialists frantically seeking a cure for her blindness but there was none.
At first, Trudy bumped into walls trying to find her way around the house. She got anxious and confused easily. I thought our good life was over. I forgot that dogs don’t feel sorry for themselves. They don’t think about the future. They figure things out the best they can and get on with it.
Online experts agree that blind dogs shouldn’t be treated with pity. This makes them think that something really bad is happening. The experts say, “Don’t rush to help your dog because his blindness makes you sad.”
I followed their advice even though it was hard. When Trudy couldn’t find the door, I’d stand there and say in a cheerful voice, “Over here, Trudy,” until she found her way. If she missed a treat I’d thrown her, I’d let her sniff around until she found it. Like dogs everywhere, she has a great sense of smell.
Over the last two years, Trudy and I have grown closer and happier. Strange as it sounds, Trudy is more full of life than ever. She’s become more obedient, probably because I take more time with her. I never thought I could teach this crazy dog to “sit” and “stay,” but I did.
Since she became blind, Trudy—an escape artist—has found her way out of the yard at least four times. Her sight may be gone, but her love of adventure isn’t. After she ran off six months ago, I decided to paint the words “I am blind” on her harness. Since then, neighbors have either called or brought her home within an hour or two.
If you have a blind dog, here are some suggestions:
• Teach your dog to recognize words and phrases such as “Watch it!” or “Over here!” and important commands such as “Sit” and “Stay.” Trainers say that dogs can understand over 20 words and phrases. One blind border collie has been reported to understand more than 200 words.
• Spend more time walking your dog, going places, and playing games. Trudy likes to hunt for her supper outdoors. I make a ball of dry and wet dog food and throw it across the backyard. Her tail wags until she’s found the last crumb. Dogs love scent games.
• Buy a Kong and other toys that hold treats. Dogs enjoy working for their food. It keeps them busy and happy for long periods.
• Be sure your dog has plenty of water. Dogs with SARDS-related adrenal problems tend to be abnormally thirsty. They pee often and their urine is dilute.
• Install at least one doggie door in your house. Many dogs get upset when they can’t wait and have an accident in the house.
• If your dog has trouble getting to the doggie door in time, put down carpet runners or other cues that lead to the door.
• If your dog has an accident in the house, don’t scold. Just clean it up.
• Don’t leave your dog in places where it’s too warm. When dogs with adrenal problems get hot, they pant more than healthy dogs and are more prone to heat exhaustion.
• Don’t move furniture around or leave large objects on the floor that might confuse your dog. Blind dogs make mental maps of their environment and depend on them.
• Keep a collar or harness with an ID tag on your dog at all times. A microchip is a good idea, too. Many owners find harnesses more effective than collars, because they offer better support and give the owner more control in tricky situations.
• Label the harness “I am blind.” People will treat your dog with understanding without your having to explain. Also, it almost guarantees that some dog lover will bring your dog back if she wanders off.
• If your dog is older and can’t get around easily, use a sturdy harness with a handle when you’re going someplace he’s not familiar with. You can give him a lift when needed. These harnesses are made for dogs with arthritis and other mobility problems.
• Keep a short hand leash—12 to18 inches—attached to the dog’s collar to help guide her in confusing or upsetting situations when she’s too anxious to obey commands.
• When walking your dog, look for grates in the pavement or other things that might make him stumble. Get him used to words of warning such as “Watch it.”.
• When you approach a strange dog, take a slight detour. Your dog can’t see the stranger and doesn’t respond like a sighted dog. The other dog doesn’t understand why yours is acting funny. Dogs meeting each other send signals about who’s going to be dominant, and misunderstandings can cause trouble.
• Buy a pet gate and/or collapsible exercise pen to keep your dog away from dangerous areas.
• If your dog spends time outside in a fenced yard, be sure it’s escape-proof. Inspect it carefully for loose boards, gaps, and tempting openings between the fence and ground. If your dog likes to dig, install chicken wire from the bottom of the fence into the ground. This requires digging a trench for anchoring the chicken wire.
• When your dog has to stay at a kennel or with a friend for a few days, leave her bed or blanket and perhaps an unwashed personal garment for comfort.
Two excellent internet forums for owners of blind dogs are http://www.blinddog.info and http://www.blinddogs.net. The highly rated book Living with Blind Dogs by Caryn Levin RN gives owners detailed practical advice about helping blind dogs adjust (2004, 188 pages).
BeaconStreetUSA.com blogs from 2011 describing Trudy’s and my early experience with SARDS appear at http://beaconstreetusa.com/wp/?s=sards&submit=Go.
If your dog has lost his or her vision from SARDS, you might be as heartbroken as I was. Hang in there. You and your dog can have a happy life together again. It will just be a little different. Blind dogs take advantage of their sharp senses and smell and hearing to make up for their lost sight. You’ll be amazed.
In 1952, I married a college sweetheart who joined ROTC and became an Air Force officer after graduation. After qualifying for pilot training, he started flight lessons in the Piper Cub, then graduated to a retired fighter plane, the Mustang. After that he learned to fly the famous B-17 bomber.
Training began at Gilbert Field in Bartow, Florida, where a class of twenty fresh young lieutenants had their first experience as pilots.
The little J3 Piper Cubs had tandem seats in the cockpit with dual controls, one set for the student and the other for the flight instructor. The plane was easy to pull out of spins and stalls because of its lightness. If the engine couldn’t be restarted, the plane continued to glide downward to a landing in the hands of a skilled pilot.
Despite the safety of the aircraft, one or two of each class of twenty fledgling pilots crashed due to pilot error, generally caused by panic. It was easy to get scared during training stalls, dives, and other death-defying maneuvers.
In 1954, the young lieutenants who survived the first phase of training packed off to West Palm Beach, Florida, where they learned to fly P-51 Mustangs, the fighter planes that shot down German Messerschmidts and Jap Zeroes in World War II. While flying Mustangs wasn’t for the faint of heart, fewer young pilots crashed because were more skilled aviators by this time.
Their flight instructors were old warriors from dogfights over Germany and Japan a few years earlier. By the mid-1950s, many were family men who missed the adrenaline rush of their youth. When they soloed for leisure or practice, some pulled forbidden acrobatic stunts when they could avoid identification. Since air-to-ground communications were still primitive in those days, former aces sometimes buzzed the tower, then climbed into the clouds before anyone could catch the ID on their fuselage. Or they did tight barrel rolls for friends on the ground away from the eyes of tale-tellers.
The last phase of training prepared pilots for the airplanes they would fly for the rest of their enlistment. My husband flew a former B-17 bomber—the Flying Fortress. During WW II, formations of twenty-five or more bombers flew missions over the Pacific, Japan and Europe. The B-17 stood as high as a two-story building and had a wingspan the length of three city school buses.
Enemy fighter planes had to inflict serious harm on a B-17 to bring it down. Even when one suffered extensive damage, it could usually limp home. As the war advanced, the Flying Fortress became even more impervious to enemy fire because Air Force strategists found a way to protect formations. They assigned P-51 Mustangs (“Red Tails”) to drive off enemy fighter planes. Called “Little Friends,” one squadron of Mustangs was flown by African-American pilots known as the Tuskeegee Airmen, whose story is told in the film “Red Tails.”
With a flight range of almost 2000 miles, B-17s were retired from their bombing missions after the war and served as transport planes, carrying servicemen and cargo to U.S. military bases around the globe.
Prilosec is a drug I started taking in 2001 for heartburn. It’s the best-selling drug in pharmaceutical history, netting billions of dollars in profits for AstraZeneca, the manufacturer. In early 2001, this branded version of generic omeprazole was available only by prescription–$4.00 per pill. Now the brand name is available for 63¢ each. The generic form is only 40¢.
What happened to Prilosec price?
The Prilosec patent ran out in 2001. Until then, AstraZeneca had a monopoly on omeprazole. Demand let them set the price sky-high. But in 2001 they had to scramble to save their cash cow. Generic companies would soon be able to sell the generic form of Prilosec and charge amounts more in line with production costs.
One corporate strategy was to develop a replacement drug for Prilosec, rename the drug, and get a new patent. Their R&D team came up with Nexium, an isomer of Prilosec. An isomer is a compound almost identical to the parent compound, with a molecule or two tweaked. Unfortunately, the new drug performed no better than Prilosec. It was basically the same compound with a new name and a higher price.
This was a problem. The company had to find some reason to claim that Nexium worked better than Prilosec. So they surveyed patients taking Prilosec for signs of discontent. To their delight, only half of the patients were entirely satisfied and pain-free.
Drug company tricks
Using a tried-and-true industry move, AstroZeneca designed clinical trials to show improved performance of the new drug, no matter how slight. Data from two of four studies showed enough difference to build a weak case for Nexium. The other two showed no difference. The two favorable studies became the company’s marketing platform. Data from the other two studies were ushered out a back door.
Racing against the clock, the company got FDA approval for Nexium two months before expiration of the Prilosec patent in 2001. But they needed more time to build a customer base for Nexium before patients could buy low-cost generics.
Company lawyers found legal loopholes that gave them six extra months of exclusive Prilosec sales. They dug up a clause in their FDA contract that allowed only one generic competitor on the field at first. According to a former company executive, the idea is, “If you’re going to lose, you lose to one generic. Because if four or five come in, it gets really ugly.”
Corporate greed works
The company’s legal experts stalled the introduction of cheap knockoffs for several years. Delaying tactics, including a series of lawsuits against generic companies, bought AstraZeneca enough time to court U.S. doctors with promotional claims about Nexium, Prilosec’s child.
Although the last U.S. Prilosec patent expired in 2001, not until December 2007 did the first generic manufacturer get FDA approval to sell the drug. By that time, Nexium had a solid foothold. In both 2009 and 2010, AstraZeneca reported Nexium sales at $5 billion.
Today consumers pay ten times more for a heartburn medication (Nexium) no better than its parent drug Prilosec or generic omeprazole. As David Campen MD, a Kaiser physician and pharmacy executive, says, “Nexium clearly is a no-value-added drug.”
Winners Never Lose
This scenario is played out in the marketing and legal departments of most pharmaceutical companies facing the disaster of expiring patents for high-dollar drugs. Their ploys work almost every time.
Return of Bambi and Thumper
Tanja Askani, a Czech author, photographer, and animal scientist living in Germany, has disseminated a series of Bambi-Thumper photos that have gone viral on the internet. People find them adorable. When I received the series in my e-mail, I thought they looked too good to be true. They were.
After downloading the photos and examining them in zoom view, I found clear evidence that every photo had been altered substantially. We’re not talking about subtle adjustments in contrast or lighting. The “reality” of animal tenderness and bonding shown in the photos is the result of digital artifice.
Askani’s creative combinations of two more photos into one made me wonder. Were the deer and rabbit ever actually nose to nose? My hunch is that Askani got some good shots but could not resist tinkering with them. I think she ended up creating the photos she wished she had taken, not the ones she actually took. Being a Photoshop expert, I know the temptation to make a good image better. But pasting one image on top of another and passing it off as a miracle of interspecies bonding is fraud.
Arrows in the photos point to some of the areas of Photoshop fakery. The paste-ins, blending and use of line tools and brushes weren’t even done skillfully. Methinks Ms. Askani has got herself in a bind with her now-famous Bambi-Thumper photographs. How can she acknowledge her deception (which will surely be exposed) and maintain any kind of reputation as an animal photographer? Or animal scientist, for that matter.
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Nonverbal communication experts say that body language includes facial expressions, tone of voice, and noises made by mouth (sighing, grunting, etc.) Nonverbal messages substitute for words that people are afraid to use because of the consequences. Even though body language is as potent as spoken language, we allow people to offend us with it when we would not let them do it with actual words. The same thing applies sarcasm that’s used instead of a direct attack.
Most of us would punish a child who looked at us and said, “Fuck you.” But when the child rolls his or her eyeballs, sighs, and turns away, we might let it pass. Let’s face it. The child’s body language is saying, “Fuck you.” If we won’t tolerate spoken disrespect, we shouldn’t allow kids to use body language to get the message across.
Not many mothers would put up with comments like, “Your cooking sucks, Mom. I eat this stuff because I have to.” But we let the child make comments like, “Ugh, what is this, anyhow?” The message is the same.
Body language should be treated like spoken language. True, the child (or adult) is likely to deny any bad intent. But we both know the truth. And since we are the grown-ups, we should act on the truth we know, not the truth the child (or adult) is trying to disguise.
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