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Abbott's decision to raise the price of AIDS drug Norvir 5 fold in 2003, and how it undercut Glaxo's drug Lexiva which is used in combination with Norvir. Abbott included Norvir ingredients in a new drug Kaletra and this was priced cheaper than other AIDS drugs when it increased the price of Norvir. Glaxio is now suing Abbott for this pricing practice.

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CEO Shigetaka Komori of Fujifilm Holdings Corp. describes how Fuji responded to the technological changes that made photographic film obsolete. Kodak recently filed for bankruptcy protection. Fuji made the transition to other products to cope with the change. Komori became president in 2000. He says one of the responses was to reduce costs. In 2005 and 2006 Fujifilm reduced costs by $2.5 billion mostly in photographic film. Fuji's management asked the question what technologies the company possessed and how they could be applied in new business areas. This led to new businesses in making the films used for making LCD panels used on PC's, televisions and other devices. These materials generate 10% of sales. The other areas are in medical equipment, drugs and cosmetics. Fujifilm acquired health care companies Toyama Chemical for $1.4 billion in 2008 and agreed to buy SonoSite for $995 in Jan. 2012. Health care now makes up 12% of sales.

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How do you setup a vaccine business. Consider Mr. Adar Poonavalla in the city of Pune in India. His company Serum Institute of India, remains family owned. Founded in 1966 by Cyrus Poonavalla, it produces billions of doses of vaccines for measles, polio and other diseases. It is expected to be one of the key sources of vaccines because of its expertise and the stocks of vials and other supplies that it has in stock for the next 2 years of vaccine production. It is working on a separate facility for coronavirus production that could turn out 800 million doses of vaccine at a price of about $13 a dose over 2 years. Serum Institute is working with 3 companies that are doing the research on the vaccine for coronavirus in the U.S. and Europe, and will play a key role in the manufacturing of vaccines. To respond to the question how do you setup a company to produce vaccines for the people of the world. This is what Mr. Poonavalla says- he will only work with ethical long term funds and sovereign funds because he does not want to be in the situation where he has to charge high prices to give them returns. Unlike most countries in the world, India is unique in making certain that most of the basic pharmaceutical drugs are available to over a billion people at a low cost. Serum's goal is low cost quality vaccine production so that over a billion people in Asia can be "protected from the birth onwards." As the U.S. and Europe and large parts of Asia, Africa and Latin America, face the second vaccine phase of the coronavirus response following difficulties in PPE, Ventilators, and Masks in the first phase, they can have confidence because of companies such as Serum and the research centers in U.S. and Europe like the one at Oxford University. ...

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Estimates show the 50 million Americans enrolled in Medicare today will increase to 80 million by 2030, according to the program's actuaries. Simple demographics as the baby boom generation ages is making controlling the deficit without controlling increase in health care costs as both sides in the fiscal cliff negotiations are attempting to do can only lead to defunding critical areas such as education, R&D and infrastructure, and breaching the safety net for lower income Americans. Health care spending took up 7% of GDP in 1960, increasing to 17.9% of GDP in 2010. Federal spending on healthcare has grown to about 25% in 2012 from 10% in 1960, and is projected to increase to about 33% in ten years by the Congressional Budget Office.

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Elizabeth Rosenthal looks at Obamacare's contribution to cost containment in 2013-2014. Rosenthal says its is a kind of delicate maneuvring at the edges, because serious work needs to be done. The fee-for-service and many of the drivers for increases in medical costs, the old system of pricing, are still in place. In 20 years at the current rate and after Obamacare health care will still take 25% of the U.S. budget if nothing is done. Healthcare costs are about half that of the U.S. in some of the advanced European countries. She calls Obamacare a trickle down theory of cost containment becaue it leaves most of the drivers for cost increase in place and works at the margins. Princeton economist Uwe Reinhardt calls it an ugly patch on a somewhat ugly system. Rosenthal cites the armies of consultants anticipating every move to reduce prices, and working on "strategic billing'' to increase revenues for hospitals and doctors. For those who say the prices are now up more slowly than in the past, Michael Chernew of the Harvard Medical School, has this to say- its like a diet, reminding us that that we haven't even lost weight, just gaining weight slower than before. ...

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Landler and Barry say in this report in the NYT that the situation of government paralysis in the U.S. parallels the one in the UK with no-deal Brexit around the corner. President Trump wants a border wall (steel or other kind) on the border with Mexico as a campaign pledge. In the UK Conservative party faction supporting Leave from the European Union, including supporters of Boris Johnson, seek Leave at all cost. Johnson called the shortage of Mars bars a small inconvenience, as the Theresa May government prepares to push its own Brexit deal through Britain's parliament. In a separate report the NYT tries to show that over 80% of the drugs come in through entry ports and the border crossings are largely families or unaccompanied children. For the first time -since the 1950's and the segregation struggles in the U.S. -populists battle the elites in the large cities, say Barry and Landler. The rural urban divide, is seen in both sides of the Atlantic, in Europe and the U.S. ...

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The House healthcare bill that just passed by amargin of 220 to 215. The cost would be $1.055 trillion over 10 years, with cost of $894 billion factoring in penalties for individuals and businesses that don't buy insurance. Adding increased coverage for Medicare prescirption drug coverage for seniors its around $1.2 trillion. $460 billion is from new taxes on single people with income of over $500,000 or couples with inocme of $1 million. There are $400 billion in cuts to Medicare and Medicaid, and additional money coming from penalties for not buying insurance. First column here is Senate version, second for House version and third President's version. Other features individuals must have insurance or pay afee of 2.5% of income, hardhip waivers will be available. Employers must provide insurance to employees or pay a penalty of 8% of payroll. Small businesses with fewer than 10 workers get tax credits. The threshhold is $500,000 of payroll. To help families with lower incomes and the poor the bill provides: families earning $29,000 a year pay no more than 1.5% of income for premiums. Families with incomes of $88,000 ayear would pay no more than 12% of income for premiums. ...

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Just as the drug industry is more getting more dependent on the government with the medicare drug benefit raising the retail drug purchases paid by government to 34% in 2006 from 28% in 2005, the industry is facing more governmental scrutiny, from the FDA, from Congress from the public, and during this election campaign. Rep .Rosa DeLauro, who heads the House appropriations subcommittee that has oversight over FDA funding compares the drug industry to the tobacco industry saying that it requires the same amount of scrutiny. At the same time the drug industry is aware of the changes in the public mood and the recent controversies over drug studies, such as the one on Vytorin and other controversy. It is initiating some voluntary changes, registering clinical trial results, submitting commercials to the FDA before they air, and under pressure from medical journals registering trials before they are performed. A new law will requires and its not clear whether the drug industry is dragging its feet and then making changes when there is increasing public pressure. This is the feeling of the medical journals like the Journal of the Medical Association and the New England Journal of Medicine. JAMA's editors will be keeping up this pressure as they have more articles showing how the drug industry manipulates data and the need for public skepticism of information that comes out of the drug industry. The New England Journal editors expressed the need to publish information that helps doctors get all the available information, and not just the information from the drug industry that makes the drug look better than it really is, such as the information and analysis it provided on antidepressant medications. The chairman of the energy and commerce investigations subcommittee Rep. Stupak, finds the advertising for drugs contains information that cannot be backed up and not true ethically, medically, or legally. As this reflects the public mood look for more investigations in Congress and investigative research by the journals. On the issue of importation of drugs from Canada there is bipartisan support as both Senator McCain and Senator Clinton support importation. Clinton supports legislation that allows the FDA to approve new generic versions of biotech drugs which would lower prices of biotech drugs. And with the US consumer budget facing strains in a recession there will be increasing pressure and demands for relief in the area of drug prices, especially for the elderly and uninsured and from corporate payors. ...

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Questions about the true cost of the Obama health care legislation and the assumption that the legislation cuts the deficit by billions of dollars. This WSJ editorial says one has to look at this closely, and not merely look at CBO projections, which may be based in a certain context and not reflect the true costs, especially because many accounting gimmicks and use of numbers to present a particular picture is taking place. The information this editorial cites is that: it uses 10 years of taxes to fund six years of subsidies, Social Security and Medicare revenues are double-counted to the tune of $398 billion, a new program funding long-tem care frontloads taxes but backloads spending, and the assumption of an automatic 25% cut to physician payments that Congress is unwilling to authorize. Rep. Rand Paul has tried to present an alternative view which needs to be studied just as closely, because of the enormous impact of a jump in spending at a time when the public finances are fragile. WSJ also cites the work of Richard Foster, the chief Medicare actuary, as an alternate perspective of how things could turn out, Doug Holtz-Eakin, and Eugene Steuerle. It calls for common sense in evaluating programs, entitlements, defense or other government spending. They not only cost money, but costs escalate over time as history has shown over decades, till they eventually are discovered to be not affordable unless the middle class is willing to dig deeper into its finances to pay for them. Alternate perspectives from a range of informed opinion, Howard Dean, Martin Feldstein, and the head of Harvard's Medical School show that the issue needs to be looked at closely and carefully and cannot be something in which CBO numbers can be trusted to tell the whole story. Especially when common sense, history, and informed opinion across a spectrum of thought advises caution, and fragile public finances also suggest caution. Howard Dean, former Governor of Vermont, says the health care bill is not real reform, and may do more harm than good. He says in a Washington Post article, December 17, 2009, the Obama health care bill does not insert competition into insurance markets, does not significantly reduce costs, and does not improve the delivery and use of health services. It was he says done with a political calculus and crafted for votes not real reform. Jeffrey S. Flier, Dean of the Harvard Medical School, gave the Obama health reform bill an "F" grade, saying in a Nov 18, 2009, WSJ article, that it was disingenuous to call this reform, Congress and the White House were simply deceiving the public. He said the bill will accelerate US health care spending, postpone most of the major health care problems, expecially the ones that drive cost, including the "fee for service" system and delivery of health care. He says in his discussions with economists and other health care leaders the opinion was unanimous that the bill will accelerate health care spending. He cites Massachusetts as an example, where access to care was expanded under the same dysfunctional system, and spending went up, and it doesn't work. Feldstein, who in early 2008 suggested proactive solutions to the mortgage debt crisis which were never adopted, says that the Obama health care law means higher taxes in the long run to pay for the $1 trillion cost of health care for the uninsured group over 10 years. Feldstein says that the Obama plan is to cut Medicare to cut spending, and will reduce the amount of medical services, as reduced spending comes from fewer services, not reducing payments to providers. And he asks if the cost reductions are weighted too heavily towards reduced services and not reduced payments to providers ,would this result in large cuts to services to affect the quality of healthcare for the 85% of the American people who are accustomed to a different pattern of healthcare. ...

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The Washington Post gives the green light to most of the nominees of DJT except Pete Hegseth at Defense, RFK Jr. at Health and Human Services, Tulsi Gabbard for National Intelligence, and Russell Vought for Office of Management and the Budget (OMB). RFK Jr has support for his stand on obesity and drug costs, if he convinces the Senate on vaccines. Jamieson Greer was Deputy Trade Representative under USTR Robert Lighthizer, Greer and Stephen Miran at Council of Economic Advisers give DJT the resources to create a level playing field for America in world trade, business and manufacturing at home, to reverse the lack of government support of three decades that destroyed much of American manufacturing. Elise Stefankik is a good choice of young Congresswoman from upstate NY who has potential to put America's position before the world.  Kristi Noem brings good experience at Homeland Security as 2 term governor of South Dakota, and experience in Congress. Dough Borghum is a two term governor of North Dakota and is a good choice for Interior Secretary. Tom Homan as Border Security Head complements Noem and Borghum as a Border Patrol Agent who has worked, the WSJ says, under 6 administrations including the Obama administration and is likely to combine immigration goals of DJT with realism. Homan would focus on getting immigration right so that the migration issue is resolved cutting out crime, illegal migration, and restoring the southern border.    ...

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Foreign investment in the auto industry is having a significant impact in the growth of Mexico's middle class. VW has plants in Puebla, General Motors in Silao, Chrysler in Toluca, Nissan in Aguascalientes. Production increased by 24% in February 2012 over the prior year. The growth is likely to continue. Facilities in Mexico have high productivity and are technologically equiped comparable to plants in the U.S., Europe and Japan. Nissan plans a $2 billion investment in a plant in Aguascalientes. Because of the lower cost of living, with food, transportation and health care costing less, even though household appliances cost more, workers at a Mexican plant earning $4 an hour in pay and benefits or $130 a week can still have a decent standard of living. Foreign investment is likely to grow with Mexico's emphasis on technical education - about 130,000 engineers graduating each year according to Mexico's president Calderon- the work ethic of young Mexicans joining manufacturing plants, the productivity of these lower cost plants, and a growing market in Latin America. Nissan plans to produce 1 million cars in Mexico with an investment of $2 billion in Aguascalientes. Nissan has succeeded in taking over from VW as the preeminent manufacturer in Mexico, and has 32,000 workers in the Aguascalientes area, once a small town but now a thriving city of 700,000. Drug cartels have no interest in places like Aguasalientes, which is why foreign investment continues to come into Mexico. The lack of economical credit- interest rate on car loans is about 10%- and the flow of about 600,000 used cars each year into Mexico from the U.S. has restricted growth in Mexico's automobile market. Jose Munoz, Nissan's senior executive for Latin America sees this changing as more credit including Nissan's new financing center in Aguascalientes make lower cost credit easily available to a growing middle class....

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Andrew Witty, a 43 year old Briton, is taking over as CEO of GlaxoSmithKline. Before this he was in charge of European operations. His first moves include strengthening Glaxo's presence in the emerging markets of Russia, India and China. He has put new managers in charge of these efforts. He sees more opportunities to sell consumer health products in India and other emerging markets where people buy most of their medicines over the counter. He also hopes to make new pricing deals with insurers and governments to persuade them about linking the price of the drugs to how effective they are in treating patients.

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A sense of how the U.S. Supreme Court Justices viewed key aspects of the Obama Health Care Law after three days of hearings on March 28, 2012.

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Are high prices for pharmaceutical products and healthcare services putting a severe burden on U.S. finances and defunding education, infrastructure, R&D in new technologies, which provide the underpinnings for future U.S. competitiveness? Yes say experts. In 2009 Americans per person cost of healthcare was $7,960. By comparison Canada was $4,808, Germany $4,218, and France $3,978. And without necessary efforts for educating people about caring for health and preventive care, the health conditions of Americans are no better than these countries, and poorer in some dimensions. Klein says deficits would not be a problem for the U.S. if prices for pharmaceutical products and healthcare services in the U.S. were similiar to that of the largest developing countries. Experts say the Obama healthcare law simply postponed the addressing of this problem.

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A health care practitioner says the real problem is the high cost of medical care in the U.S. when compared to other countries. She points out that the Obama bill in 2008 did not take effective steps to bring down the cost of health care before enacting legislation to cover the uninsured, leading to higher premiums for the middle class. The link between healthcare and profits is seen as the main problem. 

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Jack Hough points out the problem with TIPS, Treasury Inflation Protected Securities. The CPI-U that is used to calculate the inflation for TIPS is not representative of inflation for the average household. It understates the cost of gasoline, tution increases for kids in school, and price increases for prescription medicines. Prescription drugs have a weighting of only 1.25%, college tution only 1.53%. The CPI-U index went up by about 3.9% in 2011, and at the same time the gasoline portion increased by 33%, for households spending a lot on commuting to work. Another problem is slowing inflation- with inflation slowing to 2%. Compared to TIPS the alternative of dividend payments by cash rich companies with secure market positions are a better hedge against inflation.

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A trial by Merck and Schering Plough that lasted 2 years with 720 patients in the Netherlands found that while Vytorin helped reduce cholesterol more than Zeta taken alone, the plaques of patients on Vytorin grew twice as fast as the one on Zeta alone. Vytorin is a combination of Zetia and Zocor in a single pill. About 60% of patients take Zetia in the Vytorin form. Zetia by itself reduces cholesterol by 15-20% but its not clear if it reduces the plaque formation in arteries at all. The trial was completed in April 2006 but released now only after articles were written about it in the media. Zetia and Vytorin account for 20% of the overall cholesterol lowering drug market. Its about 70% of Schering's earnings and about 100 million prescriptionhave been filled in US so far. The drugs cost $3 a day. For Merck its reputation after the Vioxx issues would be affected by these results leaving some doubts in the public mind.