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Low-Cost, Low-Tech Medicine
These FDA-approved medical devices are creepy and crawly, slimy and gooey. They suck out your blood, or feast on your garbage. Just what the doctor ordered: leeches and maggots! Leeches have been used medicinally for centuries, but they’re not for bloodletting anymore. Hirudotherapy, the therapeutic use of leeches, has expanded with skin grafts and microsurgery. Tiny veins in fingers or ears can become congested after reattachment, causing the grafted tissue to die. Sometimes surgery can’t fix this problem. The leeches help by sucking up excess blood, reducing swelling, and allowing oxygenated blood to flow until normal circulation is restored. Their saliva contains a medley of proteins, including an anticoagulant that thins the blood, an anesthetic to relieve pain, and a prostaglandin that reduces swelling. The relatively inexpensive leech therapy actually doubles the success rate of transplanted tissue flaps compared to drug treatment or additional surgery.

Maggot debridement therapy, or MDT, works wonders where antibiotics can’t. The drugs can’t reach wounds in areas of poor circulation in sufficient concentration, as with diabetics. Maggots are placed directly on the wound, devour dead tissue, leave healthy tissue alone, and excrete substances that inhibit and kill bacteria. Medical-grade leeches and maggots are farmed to ensure their sterility and species (avoiding maggots that burrow under the skin). Leech suppliers include Ricarimpex in France, Leeches U.S.A. in Westbury, NY, and Biopharm Leeches in the U.K. Monarch Labs in Irvine, CA, BioMonde in Germany, and the Japan Maggot Company in Okayama distribute maggots. Besides their appetite for blood and dead flesh, these critters have another advantage over some drugs; they’re cheap. Maybe in these hard economic times, more patients will come to appreciate the wormy squirmers’ significant benefits.
—Andrew Matthius

THE PRICE IS RIGHT

In his Strategic Pricing of Pharmaceuticals (PondHouse Press, 2009), PM360 columnist E. M. (Mick) Kolassa, PhD, discusses the thorny issues of price when it comes to drugs. Unlike Coca-Cola or Pampers, they are subject to derived demand—in other words, their sales are based on medical need and prescription by doctors who neither use nor pay for the products. Second, they are negative goods because consumers would prefer not to use them. Third, they are experience goods because their value cannot be determined until after they’ve been used. Another key to strategic pricing is understanding their value goes beyond dollars and cents. Pharmaceuticals can save lives, help avoid surgery, and increase quality of life. The most important questions to ask in determining value are: What problem does my product solve? And who owns that problem?

These factors are critical to developing a successful pricing strategy:

• Public Policy. Consider public perception and political attacks about a drug’s price, but don’t become paralyzed by them.
• Decision-Making Process. Determine the role price plays in prescribing or purchasing the product.
• Value of Therapy. Consider what the disorder costs the healthcare system and what this drug’s potential is for reducing that cost.
• Disease and Patient Characteristics. Consider the patients and their disorder. People with symptomatic diseases are less price sensitive than those with asymptomatic diseases are.
• Competition. Assess what steps your competitors might take in reaction to your product’s launch.
• Reimbursement Environment. Figure out who stands to make or lose money with this new product.
• Company Needs and Abilities. Each manufacturer has to decide on a price based on its own goals, whether those are focused on first- or fifth-year sales, innovative pricing approaches, or the price of related company products.

—A.M.

Burning Issues

A new sunscreen hit the shelves this summer with an SPF of 100. By the end of the year, the FDA proposes to issue new labeling rules, including capping claims for sun protection factor at 50. What gives? Bigger is not necessarily better.

Were you thinking: 100 is perfect! My skin will be 100% protected, my days of worrying about sunburn, wrinkles, and skin cancer are over. Well, you’ve figured wrong. “Actually, the difference between an SPF 100 and an SPF 30 is marginal,” said Nina Goad, of the British Association of Dermatologists in the Times. In fact, an SPF 100 deflects 99% of UVB rays, while an SPF 50 blocks 98% and an SPF 30 blocks 96.7%. And even these percentages are accurate only if a person applies the recommended amount. If underapplied, the higher the SPF, the steeper the drop in protection. According to a 2007 British Journal of Dermatology study, if someone applies one tablespoon of SPF 70, instead of the recommended two tablespoons, the protection provided is only SPF 8.4. Most dermatologists recommend SPF 30 with an application of about a fistful of lotion onto the skin every two hours.

Another problem with SPF? It only measures protection against sunburn-causing UVB rays. The sun’s UVA rays penetrate the skin deeply, and exposure can lead to premature aging and cancer. The FDA’s long-awaited update on sunscreens will address both types of rays. In the meantime, it’s smart to read the fine print on the label, looking for broad-spectrum or UVA and UVB protection and at least one broad-sprectrum ingredient such as avobenzone (or Parsol 1789), ecamsule (or Mexoryl SX), oxybenzone, titanium dioxide, or zinc oxide.
—A.M.

Did You Know...If You’ve Lost Your Job
Kimberly Lankford of www.Kiplinger.com, a personal finance Website, offers three money-saving tips to stretch your health-insurance coverage.

Don’t assume COBRA coverage is best. People like COBRA because they can continue on their former employer’s health plan for up to 18 months. For those out of work since September, the economic stimulus plan provides a 65% subsidy for premiums for up to 9 months. Once the subsidy ends, however, your premium will more than double. COBRA is your best option if you have immediate health issues, otherwise it may be better to find a deal on your own.

Shop around once your COBRA subsidy runs out. most states outside New York and New Jersey have a competitive health insurance market. get quotes at www.ehealth insurance.com or find an agent from the listings at www.nahu.org (national association of health underwriters).

Consider your options. Contact your state insurance department to see if you qualify for a high-risk pool. or visit www.coverageforall.org to check out low-cost alternatives. georgetown university’s health policy institute offers a state-by-state guide at www.healthinsuranceinfo.net. if you can’t afford an expensive prescription, look into the drugmaker’s patient assistance program, or go to www.pparx .org (partnership for prescription assistance).
—A.M.