CVS No Longer Stacking Tobacco

In a huge PR move this week, CVS Caremark announced their stores will no longer carry tobacco products. The move takes effect October of this year.

 CRK's move surprised me, given that WAG recently fought and had the courts overturn a California law to this effect. While the tobacco-free pharmacy sort of makes since, these pharmacies are not really "health" facilities right now. They're drug dispensaries. You go there to pick up pills, not to lower your cholesterol. And based on this business model, you really want additional foot-traffic. That means "don't alienate 20% of America."

However, that's not what CRK wants to be, or Walgreen's for that matter. Both these places now run their own healthcare on-site. Both these companies want to capture an increasing share of the health-care dollar, and they might have a good shot at it given how most states are moving to deregulate primary care....for instance, substituting nurse practitioners for doctors for certain functions.

Just take a look at the picture, and see the potential sales for WAG and CRK:

Right now, pharmacies are taking that $1,106 dollars per person, and if they can squeeze in some extra sales from that $1,670 that's going to clinics and doctors right now....

Plus, that's expected to grow, while generic drug sales are expected to have weak growth. Given consolidation in PBMs, too, which might keep reimbursement rates down, you might expect pharmacies to aggressively re-invent themselves.

Which is what CRK is doing.

From a public health perspective? I don't see the big deal. The vast majority of tobacco sales take place at gas stations.

However, that does not mean people will stop trying to spin this as a great movement forward in the Great Progressive March of America, or whatever nonsense propels Obama forward ;)

"We didn't make this drug for Indians"

If you're tuning into the latest drama over expensive drugs, that might be all the coverage you hear. No rhetorical strategy works better than implying your opponent harbors deep hatred and violently racist thoughts, and wants poor brown-skinned people to die, just because they are not white.
Especially when we're talking about Germans. Just look at the guy. He's basically a Nazi!

I cure cancer and make toasters. Also, I'm Dutch, not German

The real issue lies in something called "compulsory licensing." Imagine that today you invent Time-Travelling Ninja Robots that are immune to magical spells, and it just so happens that tomorrow China declares war on us with an army of Gandalf the Gray clones leading the foray.

 

Under a regime of compulsory licensing, the Defense Department could force you to give up your Ninja Patent to Ford Motor Company. Why? National Defense, that's why.

 

But what about saving lives?

 

Modern drugs prove incredibly expensive, and, indeed, outside the reach of many patients. The treatment for this guy's cancer-killer comes out to $100,000 a year or something like that, which is just a weeeeeeee bit outside the price range of a nation with a per capita income 1/3 of China's.

 

 

The idea of a compulsory license is not new, and yes they are contentious. The general WTO rule, is that you can break a patent (and let's not be sissies and pretend it's not) for domestic consumption, but not for purposes of export. And then there's another exception, that nations that cannot possibly make the drug get a waiver. So India cannot export this cancer drug, except to Mozambique, because Mozambique can't make this stuff.

 

India, however, has only recently issued a compulsory license, for this one drug, back in 2012, and they are obligated to provide Bayer an appeal. Think of this as a test case.

 

Now, what did Bayer actually mean when they said "We didn't make this stuff for Indians"? He means that even though India screwed the market, it doesn't matter, because profit projections are based on sales in advanced economies.

 

So why do we care if India steals our stuff? I mean, doesn't hurt anyone, right?

 

Ever buy a US pickup truck? Probably, because foreign trucks are taxed at an incredibly high 20% because of some stupid chicken stuff back in the 1950s. But once enacted, policies have a habit of lasting forever, like some sort of mal-formed zombie that wears a bullet-proof helmet.

 

 

Pictured Above: Corporate Tax Reform

 

And while India is somewhat poor today, it is developing, and someday might be an essential market for our goods. And since we're a high value-added, R&D, intellectual property economy, we have an issue if India can simply extract the value of all our work. In the sense of, reimagine the entire economy, because we have nothing scarce anymore.

 

It might be necessary in some cases. The HIV crisis is a good example, along with other communicable diseases. It is not, however, immediately clear why prolonging a person's life 5.5 months instead of 2.8 months is a public health problem sufficient enough to break a patent. It is also not immediately clear why India cannot spend some of its $163 billion corruption and Su-30MKI budget on apparently life-saving drugs.

 

Probably too busy creating ballistic missile submarines to deter mighty China with its recessed nuclear arsenal, or a Pakistan too crippled to successfully deter the Taliban.

 

 

There ain't no such thing as a free lunch.

 

-Robert



Does Fox News make us more extreme?

We started this blog because we feel like lonely, lonely little boys. Where we come from, libertarians and communists toss bombs at each other, people discuss whether the US attacked itself on 9/11 to justify stealing oil, and don't even get me started on abortion.
The three of us? We feel stuck in the middle. Where's the space for the guys that think the rich might need to pay a little more, but think the far left loonies can't be trusted with a butter knife let alone the healthcare system?
That's a microcosm of society as a whole. Congress itself divides in a pretty extreme fashion, and increasing. And it isn't just Congress. People as a whole are sorting out, such that the number of "extreme" counties, IE, ones that vote for one candidate or the other by a margin of more than 10%, have pretty much doubled since the Carter era.
Yikes.
The question is why. Partly, the problem MAY be so-called "echo chambers." Sit in a cave and yell "universal healthcare is great!" You'll hear it back, 10,000 times, before that message goes away.
Okay, rename that cave MSNBC, and have a bunch of people yelling the same message, and see what happens.
The idea is that, if you immerse yourself in that kind of environment, you will end up confirming your own beliefs. Thus, us politically-motivated types become more and more extreme over time, especially since we don't even read the same books. And if Twitter mirrors society, then Republicans and Democrats do not even talk to each other.

Here's the thing. It's all bullshit.
At least for most people.

So says "Media and Political Polarization" by M Prior.

He points out an interesting statistic: only 5% of Americans even watch more than an hour of Fox News a week. Think about your last cocktail party or your kid's baseball game. How many people actually cared when you started your summary of minimum wage politics? And how many rolled their eyes?
The eye-rollers outnumber the interested by a lot. These kinds of channels just cannot radicalize most people, because most people simply do not care enough to radicalize. It's like reading the Communist Manifesto to your cat, or teaching advanced physics to your dog.
Instead what's happened is that you have a big mass of people who just don't care, and only watched the news because it was the only thing on television. Once cable kicks off, all the girls can watch HGTV, all the boys can watch ESPN, and the weirdos can watch 24 hour news channels.

And us weirdos? There's a ton of cross-over. Prior points out that almost a third of traffic at the NY Times comes from conservatives. I am not surprised: I kept Krugman on my blog-roll and read him religiously until NYT held me to 30 hits a month or whatever. Most of us are issued-based, which means we like to read things from different sources about issues we like.

Thus, if I like economics, I am going to learn about the minimum wage from the conservatives, but I am going to reach out to liberal websites to learn from them, too. You never know, they might know something!

That's not to say there is not a problem with polarization. We definitely have an issue with a radicalized Congress. Instead of looking to our media sources, though, what we should be looking towards are the incentives driving individual Congress-men to become more extreme. Reliance on donor financing and partisan supporters, for instance. Narrow, deep bases are like suction cups, that tie you down to a single space, while you reach out and try to grab as many flying independent "voters" as possible.

If anything, the problem is not one of people caring too much and becoming extreme, but most people caring too little, and therefore exerting little to no influence in the process...and therefore having no power.

-Robert