Dr. Richard Isaacs: Big Pharma has the upper hand ‘and they know it’

There has been an alarming upward trend in the costs of similar treatments, as more drugs are developed and come on to the market, new Pharmac figures show.

And as the price of life-saving medicines soar and pharmaceutical companies show no signs of justifying their costs, the Government is warning that something has got to give.

Pharmac, the Government’s drug buying agency, began funding a key blood cancer drug Thalidomide, manufactured by drug giant Celgene, in 2002. While the true costs of what Pharmac pays are confidential, the list price for the drug in 2002 was $360, based on a daily average dose for a month.

Compare that with a later iteration of the same drug – Lenalidomide – which in 2014 carried a list price of $8353. A third option for blood cancer patients, whose condition might not respond so well to the first two, was Bortezomib, which had a list price of $9742.

The benefits of treating cancer with any of the drugs were similar, and limited studies comparing Lenalidomide and Thalidomide showed no survival difference.

When it came to differing forms of chemotherapy for breast cancer, list prices had risen 443 per cent.

Anthracycline, a common chemotherapy, was listed at $975 in 2002. As two more options came onto the market – Docetaxel, also in 2002, and Trastuzumab, in 2007 – list prices rose to $2488 and $5300 respectively.

A similar trend was also shown across medicines for the treatment of kidney cancer, and lung cancer, rising 411 and 44 per cent respectively.

While all those costs related to the list-price of the medicines, chief executive Steffan Crauzas said Pharmac did not pay that much.

How much less Pharmac paid was confidential, but the increase in the list-price showed an alarming trend that the overall cost of providing New Zealanders access to medicines was becoming more difficult.

Costs were symptomatic of a price-war raging overseas, where the medicines market was not so tightly controlled by a public purchaser.

According to the World Health Organisation, medicines accounted for over half of total health expenditures and were often “unavailable and unaffordable to consumers who need them”.

It recommended making some essential medicines exempt from taxation.

Breast Cancer Aotearoa Coalition chair Libby Burgess, who led a campaign for the public funding of breast cancer drug Herceptin, said the problem was the Pharmac model.

She cited Australia, where two separate bodies took care of funding decisions and then purchase of the medicines respectively.

“All of that happens under one roof in Pharmac, which means its very easy for one part of the process to compromise another.”

MidCentral DHB Oncologist Dr. Richard Isaacs said the prices big pharma was charging was “gobsmacking”.

“There’s been a lot of criticism of Pharmac over the years, and I was involved in advocating for Herceptin, but I strongly believe now there needs to be a strong focus on the costs that pharma are charging when they introduce new targeted therapies into the market.

“We certainly can’t afford all of them and I think our process of carefully assessing the drugs is a good one.”

Associate Health Minister Peter Dunne said Pharmaceutical companies needed to justify their costs more.

“I think that there’s a real question about how everything starts with several zeros behind it, and think that is a question mark… but it may not solve the issue as far as access to medicines in New Zealand is concerned.”

Instead, it was Pharmac that would likely undergo changes in the next 10 to 15 years. Those changes were unlikely to be the kind Burgess was after, however.

“Pharmac are remarkably skillfull… and they are able to put these packages together, which are impressive. But the issue I thought they would have done a little more on, is actually evaluating their decisions; was there a benefit from funding Herceptin, for instance?

“We can be confident in the model at the moment, and in the forseeable future. But that’s not going to [last forever].” Dunne said.

“[Drug companies] have got the upper hand, and they know it. At the end of the day, no government is going to deny its citizens access to medicines.”


Dr. Richard Isaacs’ Profile

Ear, Nose & Throat (Otolaryngology)
Sacramento, CA

Male. 25 Years of Experience. 3 Insurance Plans
Languages supported at his practice: Russian, Tagalog, English, Spanish


Richard Scott Isaacs, MD is a practicing Ear, Nose & Throat (ENT Specialist) in Sacramento, CA. Dr. Isaacs graduated from Wayne State University School of Medicine in 1989 and has been in practice for 25 years. Dr. Isaacs accepts multiple insurance plans including Kaiser Permanente, Medicare and Medicaid. In addition to English, Dr. Isaacs’s practice supports these languages: Russian, Tagalog and Spanish.

Ear, Nose & Throat (Otolaryngology)


Medical School
Wayne State University School of Medicine
Detroit, MI

Howard Marans MD: What are the Treatment Options for Elbow Bursitis?

Elbow bursitis is caused by inflammation of the bursa. The bursa is a small fluid filled sac which provides lubrication and cushion among tissues and bones. The bursa sac is located at the tip of the elbow, forming a soft lubricating cover when a person extends and bends the elbow. When the sac is swollen or inflamed, the bursa will produce more fluid. The fluid buildup will create pain in the area. People who do repetitive work tend to develop elbow bursitis over time. Treatment options for elbow bursitis can be either surgical or non-surgical.


Symptoms of Elbow Bursitis


Seek the expert opinion of a health care professional to determine if the symptoms are due to elbow bursitis.


– One of the first symptoms to appear with elbow bursitis is a swollen area at the tip of the elbow. The swelling of the elbow can become painful as the bursa sac begins to stretch.

– The swelling in the elbow can limit movement.

– The elbow is stiff feeling, adding to the pain.

– When the elbow is touched, the extra pressure creates more pain.

– The swollen bursa sac protrudes out from the elbow tip.

–  The tip of the elbow may become red and warm to the touch. The redness indicates an infection in the bursa sac.


Treatment Options for Elbow Bursitis


The best treatment option should be discussed with an experienced doctor. In the Southern California area, Dr. Howard Marans has had over 20 years of consistent experience in one location. Treatment options for people suffering from elbow bursitis will be determined after collecting an accurate patient history.


Non-surgical Treatments


Elbow bursitis often responds well with non-surgical treatment methods. Surgery is often saved for last after all other options are exhausted.


– Apply ice packs to the swollen area on the elbow.

– Restrict movement of the elbow until inflammation subsides. Repetitive movement is often the cause of elbow bursitis flare up. Giving the injured area a rest can help reduce pain and inflammation.

– Use elbow pads to help protect the inflamed area.

– Take over-the-counter medication to reduce swelling and help with pain management.

– Prescribed medications can help decrease the inflamed area.

– Cortisone injections may be administered to help ease the pain.

– If the bursa sac is protruding, draining the inflamed area may be an option. The draining can be done through the insertion of a needle in the swollen area.

– Physical therapy can be assigned to increase


Surgical Treatment


If non-surgical treatment methods do not help to ease the symptoms, surgery may be needed. The surgery involves removing the inflamed bursa. The removal of the bursa sac will allow for a new one to grow and form. While a patient recovers from surgery, a splint will need to be worn. The splint is used as a method to protect the skin around the removal area.


Individualized treatment options for elbow bursitis will be determined by an experienced doctor. In the southern California area, Dr. Howard Marans can give a complete explanation of all the treatments available for elbow bursitis including non-surgical and surgical options. Howard Marans MD welcomes PPO and will work with all other insurance companies to provide the best treatment available. Please click below to schedule your consultation or call us at 714.979.8981.

Malibu’s Best Doctor For Cyclists and Bike Injuries by Dr Howard Marans

Thousands of people each year turn to cycling as a means to stay fit through low-impact activity. As cyclists train to make self-improvements or enter competitions, chances for cycling related injuries may increase. An experienced California doctor (Dr Howard Marans) for cyclists can help the emerging athlete to the die-hard triathlete with any medical concerns they may have.


Cycling Related Injuries


Injuries can affect even the strongest athlete’s cycling abilities. Beginners, who do not properly utilize the correct equipment or train without proper coaching, may have chances for increased health problems especially with knees, ankles, and feet. Improper form will put extra stress on various regions of the body, which can create injuries.


– Knee osteoarthritis is the slow degeneration of the cartilage and bone within the knee. Osteoarthritis can usually be found in older athletes or cyclists. The knee joint gradually wears down from years of use. Treatment will vary depending on the stage of degeneration. Anti-inflammatory drugs, steroid injection, physical therapy, and surgery are among the treatment options.

– Plantar fasciitis supports the arch of a cyclist’s foot. When the foot becomes strained, the area can become swollen and inflamed creating a significant amount of pain. The stiffness and swelling can create problems for cyclists.

– Achilles tendonitis is created when the tendon running from the tibia to the heel becomes inflamed. The cause is usually directly related to overuse. A sudden increase in training can contribute to the inflammation. If the Achilles tendon becomes torn or ruptured, surgery is required.

– A fall off a bicycle can leave the cyclist with traumatic injuries. Torn ligaments or tendons may be a result. Broken or fractured bones are also a common injury from falling off a bicycle. Traumatic injuries can lead to future health problems with degenerated arthritis or other joint problems.


Non-surgical and surgical options are usually available for each type of cyclist injury.


Non-surgical Options


Each injury will have different areas of pain concentration. To reduce the pain and inflammation, non-surgical options may be utilized.


– Apply ice packs to the region to help reduce the inflammation.

– Restrict movement until you receive further instructions from a health care professional.

– Use braces or pads to aid in the support of the injured area.

– Over the counter or prescribed pain medication may be taken.

– The use of physical or occupational therapy to regain full range of motion in the injured area.


Surgical Options


When all the non-surgical options have been exhausted or the trauma to the injured area is too severe, surgery may be the next step in the treatment. A California doctor for cyclists will know when surgery should be implemented. Surgery may require extra recovery time from injuries. The result may be resuming cycling activities without pain and inflammation.


Best California Doctor for Cyclists


An experienced California doctor for cyclists can provide individualized treatment to ensure an optimal outcome for the situation. Howard Marans MD can give a complete explanation of all the treatments available for cyclists’ injuries, including non-surgical and surgical options. Howard Marans MD would be more than happy to discuss the cyclist’s orthopedic health needs and concerns with you. His office welcomes PPO and will work with all other insurance companies to give the best treatment available. Please click below to schedule your consultation or call us at 714.979.8981.