The EPA - Keeping us breathing since 1970!

[Enoch the Red]

Except when they don't...

OTC inhalers to be phased out to protect ozone layer

Asthma patients will need to switch to prescription-only alternatives by Dec. 31 as part of US efforts to protect environment

WASHINGTON — Asthma patients who rely on over-the-counter inhalers will need to switch to prescription-only alternatives as part of the federal government's latest attempt to protect the Earth's atmosphere.

The Food and Drug Administration said Thursday patients who use the epinephrine inhalers to treat mild asthma will need to switch by Dec. 31 to other types that do not contain chlorofluorocarbons, an aerosol substance once found in a variety of spray products.
The action is part of an agreement signed by the U.S. and other nations to stop using substances that deplete the ozone layer, a region in the atmosphere that helps block harmful ultraviolet rays from the Sun.

But the switch to a greener inhaler will cost consumers more. Epinephrine inhalers are available via online retailers for around $20, whereas the alternatives, which contain the drug albuterol, range from $30 to $60.

The FDA finalized plans to phase out the products in 2008 and currently only Armstrong Pharmaceutical's Primatene mist is available in the U.S. Other manufacturers have switched to an environmentally-friendly propellant called hydrofluoroalkane. Both types of inhalers offer quick-relief to symptoms like shortness of breath and chest tightness, but the environmentally-friendly inhalers are only available via prescription.

"If you rely on an over-the-counter inhaler to relieve your asthma symptoms, it is important that you contact a health care professional to talk about switching to a different medicine to treat your asthma," said Badrul Chowdhury, FDA's director of pulmonary drug division.

Chowdhury told reporters and doctors via teleconference that "in the worst case scenario we are looking at 1 to 2 million people using" Primatene, adding that most of those patients likely use multiple medications to treat their asthma.

Obama Administration to Ban Asthma Inhalers Over Environmental Concerns

Remember how Obama recently waived new ozone regulations at the EPA because they were too costly? Well, it seems that the Obama administration is would rather make people with Asthma cough up money than let them make a surely inconsequential contribution to depleting the ozone layer:

Asthma patients who rely on over-the-counter inhalers will need to switch to prescription-only alternatives as part of the federal government's latest attempt to protect the Earth's atmosphere.
The Food and Drug Administration said Thursday patients who use the epinephrine inhalers to treat mild asthma will need to switch by Dec. 31 to other types that do not contain chlorofluorocarbons, an aerosol substance once found in a variety of spray products.
The action is part of an agreement signed by the U.S. and other nations to stop using substances that deplete the ozone layer, a region in the atmosphere that helps block harmful ultraviolet rays from the Sun.
But the switch to a greener inhaler will cost consumers more. Epinephrine inhalers are available via online retailers for around $20, whereas the alternatives, which contain the drug albuterol, range from $30 to $60.

The Atlantic's Megan McArdle, an asthma sufferer, noted a while back that when consumers are forced to use environmentally friendly products they're are almost always worse:

Er, industry also knew how to make low-flow toilets, which is why every toilet in my recently renovated rental house clogs at least once a week. They knew how to make more energy efficient dryers, which is why even on high, I have to run every load through the dryer in said house twice. And they knew how to make inexpensive compact flourescent bulbs, which is why my head hurts from the glare emitting from my bedroom lamp. They also knew how to make asthma inhalers without CFCs, which is why I am hoarding old albuterol inhalers that, unlike the new ones, a) significantly improve my breathing and b) do not make me gag. Etc.

I'm not necessarily the biggest proponent of CFC's, but surely the amount of damage caused by asthma inhalers is negligible.

Feel free to ignore the inflammatory headline in the second article. This decision to phase out inhalers using CFC's was made in 2005.

[Dreadnaught]

I guess the whole "The EPA is strangling our economy" Republican line just got more literal.

But in all fairness, when it comes to things like CFCs and many pollutants, it really is about the aggregate damage done from a lot of seemingly-small actions. If the non-CFC inhalers are substantially worse, that's one thing. But it seems like many people simply haven't used these non-CFC inhalers because they are more expensive.

Hopefully that price increase will narrow over time -- something like this should really be accompanied by making the products available over the counter.

[Draco]

The only solution is for all of humanity to revert to the pre-industrial age. Life was great back then, no pollution, no global warming catastrophies, no hippies, no terrorists, but the lower standard of living and shorter life expectancy is a trade off. So long as the planet lives on, it's OK.

[Dreadnaught]

How is it pre-industrial to make people switch to inhalers that don't deplete the ozone layer? CFCs are serious shit. And while there should be workarounds for the price issue (EG expediting approval for competing non-CFC inhalers, as there's only one brand at the moment), it's not as if all environmental regulation is evil and economy-destroyinh.

[Draco]

I didn't mean it in regards to the topic, just overall, to save the world from global warming etc.

Btw, I agree that carbon emissions need to be reduced, just not at our expense.

[Aimless]

Btw, I agree that carbon emissions need to be reduced, just not at our expense.

Specifically, CFC emissions, which we neglect to reduce at our own expense.

I hope asthma care in the US has improved to the point where this won't result in deaths

[Khendraja'aro]

Btw, I agree that carbon emissions need to be reduced, just not at our expense.

And how do you reduce something without expense, you genius?
If you have an existing technique/method and you need to change that - then you will always incur at least an inital cost.

You're expressing the NIMBY syndrome - change is just fine as long as it doesn't happen to me.

[Khendraja'aro]

And here's some more information on why that alarmism is quite misleading:

http://www.yourlunghealth.org/health...cles/inhalers/

According to several lung experts, the coming change provides the perfect opportunity for respiratory patients to talk with their doctor or respiratory therapist about epinephrine’s downsides and learn why it is a good thing these inhalers are being removed from the market. Pediatric respiratory therapist Brian Walsh, RRT-NPS, RPFT, FAARC, from Children’s Hospital Boston in Boston, MA, notes that while the drug is inexpensive and can afford quick relief of symptoms, it is not the safest option for people with asthma because it only offers brief relief. Larger doses are required for continuing relief, and larger doses put patients at risk for serious problems. Epinephrine is not a primary rescue medication, he says, and taking it off the market can protect people from serious cardiac side effects such as arrhythmia, hypertension, and possible heart attack.

[Enoch the Red]

And here's some more information on why that alarmism is quite misleading:

http://www.yourlunghealth.org/health...cles/inhalers/

Selectively quoting from the article?

Myers notes that one possible danger is that “people who cannot afford their medications may attempt to go without their reliever medications for longer periods of time, leading to a loss of asthma control, increase in symptoms, and more exacerbations.” Relatively inexpensive albuterol inhalers containing CFCs were pulled from the market last December, requiring patients to purchase much more expensive hydrofluoroalkane (HFA) alternatives. While the overall objective is a good one (to reduce ozone-depleting CFCs in the atmosphere), the reality is patients may be relying more heavily on OTC medications right now.

The problem is expected to impact families with lower incomes and the uninsured more than others. Patients may be at increased risk for unscheduled emergency room visits and hospital admissions because they are not financially able to refill medications. Asthma educators are making a difference for these patients. “Asthma educators and other health care providers can provide information to patients about prescription assistance programs and pharmaceutical companies offering coupons for financial support,” says Gregory.

Brian Walsh says, “When money gets tight for whatever reason, many patients will refill their rescue medication but not their controller medication.” This could be dangerous. Walsh believes it is a partnership between the asthma care provider and the patient that can do the most good. Patients need alternatives, and that means taking time to call the insurance provider, getting prescription justifications, and/or helping with applications for the multiple pharmaceutical assistance programs that are available.

[Aimless]

Of course if these people had access to proper care both they and you as a society would get away fairly cheap

[Khendraja'aro]

Selectively quoting from the article?

Oh, I'm sorry, did I disturb your ranting and posting a biased opinion piece? I mean, sure, you posted a whole article, how nice of you! Too bad it's entirely one-sided. I mean, the last one even prints useless anedotes...

And it's not as if the ban happened overnight, y'know? From your own article:

The FDA finalized plans to phase out the products in 2008

Maybe you should look at your industry to see why it's so expensive - I hear that the same medication can be had for a tenth of the price in Australia, for example...

... but please feel free to ignore the fact that this type of inhaler is not only bad for the environment, it's also dangerous for the people using it. Not to mention that, contrary to your opinion, something used by millions of people does not have only a negligible impact. Particularly when considering that the half-life of CFCs is very long.

[CitizenCain]

I guess the whole "The EPA is strangling our economy" Republican line just got more literal.

But in all fairness, when it comes to things like CFCs and many pollutants, it really is about the aggregate damage done from a lot of seemingly-small actions.

No it's not, it's a difference of several orders of magnitude, AT A MINIMUM. Every aerosol dispersal device on the planet spewing out CFCs for decades is what caused the damage. Compared to the CFC emissions from that, a miniscule number of uses of an "emergency" device by a comparatively insignificant number of people is like... well, it's like banning me from spitting in the ocean on account of worries about rising sea levels. Only, I don't need to spit in the ocean to continue living.

If the non-CFC inhalers are substantially worse, that's one thing. But it seems like many people simply haven't used these non-CFC inhalers because they are more expensive.

Hopefully that price increase will narrow over time -- something like this should really be accompanied by making the products available over the counter.

Well, really, there's absolutely no reason for them not to be available OTC anyway, but yes, if you're going to ban the most popular medical inhaler for idiotic reasons, you really should make sure there's a comparable alternative available, which there is not.

(When your inhaler runs out, it's out and you need to buy a new one post-haste... not schedule an appointment with someone so you can arrange to get permission to buy a new one from the same government that banned your old one, no less. )

And how do you reduce something without expense, you genius?

...followed two posts later by you being a jackass and berating EtR because you claim it's possible to reduce something without expense.

Good show, dumbass.

Oh, I'm sorry, did I disturb your ranting and posting a biased opinion piece? I mean, sure, you posted a whole article, how nice of you! Too bad it's entirely one-sided. I mean, the last one even prints useless anedotes...

And it's not as if the ban happened overnight, y'know? From your own article:

Maybe you should look at your industry to see why it's so expensive - I hear that the same medication can be had for a tenth of the price in Australia, for example...

... but please feel free to ignore the fact that this type of inhaler is not only bad for the environment, it's also dangerous for the people using it. Not to mention that, contrary to your opinion, something used by millions of people does not have only a negligible impact. Particularly when considering that the half-life of CFCs is very long.

[Aimless]

(When your inhaler runs out, it's out and you need to buy a new one post-haste... not schedule an appointment with someone so you can arrange to get permission to buy a new one from the same government that banned your old one, no less. )

Yeah unless you're on proper treatment in which case you can just buy it with regular haste.

[GGT]

[Aimless]

Glad you brought that up. It doesn't take much in the way of air pollution (eg. debris from road wear) to significantly influence things like asthma attacks on a population level.

[Enoch the Red]

Oh, I'm sorry, did I disturb your ranting and posting a biased opinion piece? I mean, sure, you posted a whole article, how nice of you! Too bad it's entirely one-sided. I mean, the last one even prints useless anedotes...

And it's not as if the ban happened overnight, y'know? From your own article:

I'll do you one better. From my own post!

Feel free to ignore the inflammatory headline in the second article. This decision to phase out inhalers using CFC's was made in 2005.

Maybe you missed that part, you know, hidden in my relentless, seemingly unending three-line-diatribe.

I know, I know, reading is just so hard.


What was your point again?

...it's also dangerous for the people using it.

Citation needed.

[Aimless]

Citation needed.

See Khen's second post in this thread.

[Khendraja'aro]

Citation needed.

Maybe you know it better as "adrenalin"? Y'know, the stuff they inject directly into the heart to get it to beat again?

Besides its relaxation effect on the bronchia, it also has a very huge range of effects on the body upon resorption.

It should actually be obvious as to why this stuff is dangerous when you take too much of it.

[Enoch the Red]

See Khen's second post in this thread.

Read the rest of the article, not just what Khen cherry picked.

It's far more dangerous to have no inhaler at all.

[Khendraja'aro]

Read the rest of the article, not just what Khen cherry picked.

It's far more dangerous to have no inhaler at all.

Then you take something which has better long lasting effects and less of dangerous side effects? Y'know, if your country wasn't fucked with its medieval health system.

[Enoch the Red]

Then you take something which has better long lasting effects and less of dangerous side effects? Y'know, if your country wasn't fucked with its medieval health system.

What keen insight.

[Aimless]

It's far more dangerous to have no inhaler at all.

Yeah but if you read this thread you'll realise that it's most dangerous to simply be semi-poor and/or uninsured in the US.

[Enoch the Red]

Yeah but if you read this thread you'll realise that it's most dangerous to simply be semi-poor and/or uninsured in the US.

And if you read the thread you'll realize that the government is making it more dangerous to be semi-poor and uninsured.

[Aimless]

And if you read the thread you'll realize that the government is making it more dangerous to be semi-poor and uninsured.

Hmm are you really one of those people who bemoans the dangers of not being able to afford resuce meds in one breath and then talks about the need for greater moral hazard in healthcare?

Anyway I thought your government was going to give those uninsured people some insurance.


Btw, some interesting trivia on asthma in the US:

http://www.aafa.org/display.cfm?id=8&sub=42

Every day in America:

40,000 people miss school or work due to asthma.
30,000 people have an asthma attack.
5,000 people visit the emergency room due to asthma.
1,000 people are admitted to the hospital due to asthma.
11 people die from asthma.


These facts signal deficiencies in regular asthma care, rescue meds are a distraction.

[Enoch the Red]

Hmm are you really one of those people who bemoans the dangers of not being able to afford resuce meds in one breath and then talks about the need for greater moral hazard in healthcare?

I don't think you can draw that conclusion from what I've said, no. I also don't find the two mutually exclusive. Being able to afford rescue inhalers does not preclude other forms of treatment.

Anyway I thought your government was going to give those uninsured people some insurance.

And I'm sure they'll be getting great, top o' the line care in the next few years here. Just you wait and see!

[Aimless]

I don't think you can draw that conclusion from what I've said, no.

Well you're doing some bemoaning here, and I thought you were one of those who were all about the moral hazard business from earlier posts. Now if you're sane enough to realise that it's stupid to applaud moral hazard when it comes to uninsured asthmatics then kudos

And I'm sure they'll be getting great, top o' the line care in the next few years here. Just you wait and see!

Is this your way of saying this will be okay once they actually have insurance but that it sucks right now when they don't have insurance?

Anyway albuterol can be had for fairly cheap at Wal-Mart, I hear. I'm not sure how true this is, of course. They may decide to raise their prices now that demand's likely to go up.


EDIT: For the record, I'm not convinced this was the best and brightest idea in the world. Certainly not if people will end up not having access to _any_ asthma meds while waiting for insurance. Your physicians and patients have enough difficult constraints to work under as it is. Of course maybe they should listen to Lewk and stop buying lottery tickets or being lazy.

[Enoch the Red]

Well you're doing some bemoaning here, and I thought you were one of those who were all about the moral hazard business from earlier posts. Now if you're sane enough to realise that it's stupid to applaud moral hazard when it comes to uninsured asthmatics then kudos

I'm not sure you're understanding the moral hazard argument fully, or how it would relate to this question. If you are saying that people who can't afford to treat the actual problem could use rescue inhalers as a crutch, you're right. Removing rescue inhalers isn't going to remove their obstacle to getting care though, and thus isn't really a moral hazard question. On the other hand, there are individuals who can afford proper treatment but don't get it because they feel like a rescue inhaler is all they need. I would bemoan their choice in that instance.

Is this your way of saying this will be okay once they actually have insurance but that it sucks right now when they don't have insurance?

Anyway albuterol can be had for fairly cheap at Wal-Mart, I hear. I'm not sure how true this is, of course. They may decide to raise their prices now that demand's likely to go up.

It's my way of saying they'll be in a bad situation regardless of government insurance. Do you think the inner city poor are going to be able to schedule and keep doctors appointments regularly? That their parents will be able to take time off of work to take their kids in? What about the clinics in those areas? Are they going to be able to keep pace with the influx of new patients wanting free treatment because they got their Obama Care?

EDIT: For the record, I'm not convinced this was the best and brightest idea in the world. Certainly not if people will end up not having access to _any_ asthma meds while waiting for insurance. Your physicians and patients have enough difficult constraints to work under as it is.

This is more or less my position.

[GGT]

I'm not sure you're understanding the moral hazard argument fully, or how it would relate to this question. If you are saying that people who can't afford to treat the actual problem could use rescue inhalers as a crutch, you're right. Removing rescue inhalers isn't going to remove their obstacle to getting care though, and thus isn't really a moral hazard question. On the other hand, there are individuals who can afford proper treatment but don't get it because they feel like a rescue inhaler is all they need. I would bemoan their choice in that instance.

It's my way of saying they'll be in a bad situation regardless of government insurance. Do you think the inner city poor are going to be able to schedule and keep doctors appointments regularly? That their parents will be able to take time off of work to take their kids in? What about the clinics in those areas? Are they going to be able to keep pace with the influx of new patients wanting free treatment because they got their Obama Care?

Then you'd support more broad EPA measures, like the Clean Air Act, that actually addresses air quality? How about a jobs bill that gets more people out of poverty, so they don't have to deal with cockroaches? Oh yeah, what about a really big environmental policy that would limit use of pesticides/herbicides or change the way we irrigate crops and divert water, so pollens wouldn't be reacting to man-made droughts?

[Enoch the Red]

Then you'd support more broad EPA measures, like the Clean Air Act, that actually addresses air quality? How about a jobs bill that gets more people out of poverty, so they don't have to deal with cockroaches? Oh yeah, what about a really big environmental policy that would limit use of pesticides/herbicides or change the way we irrigate crops and divert water, so pollens wouldn't be reacting to man-made droughts?

I don't support any EPA measures. I would support more and harsher legislation on polluters, (including removing the government mandated limitation on liability and damages) and more exacting industry standards.

I also don't believe that it is the government that will get us out of this recession, or provide the jobs you want. But if you say it often enough, it just might come true.

[GGT]

I don't support any EPA measures. I would support more and harsher legislation on polluters, (including removing the government mandated limitation on liability and damages) and more exacting industry standards.

By legislation you mean from congress, with their special-interest lobbyists to consider? And we also know how long a law suit can drag on when it's against mega international companies like Dow, and how dysfunctional congress has been. Besides, that's all intervention after the fact, nothing at all about prevention or protecting the public. Basically, deep pockets would prevail---polluters hiring lawyers to stretch out legal decisions, continuing to pollute, maybe paying a fine in the end. How do those fines make a dent in their ability to make money while polluting, or change practices?

"Industry standards" mean Regulations, something the EPA does. But if you mean polluting industries self-regulating, with more exacting standards, that idea has been shown to be a pipe dream. BP and Trans Atlantic as latest examples. As I've been reminded here hundreds of times, the purpose of any business/corporation is to make money. Not to have a social conscience or follow ethical community best-practices. In other words, your theoretical libertarian guidelines don't seem to work well when put into practice.

I also don't believe that it is the government that will get us out of this recession, or provide the jobs you want. But if you say it often enough, it just might come true.

Still, it's a question about poverty, poor living conditions (whether smog or cockroaches---both contribute to childhood asthma) and who is going to work on prevention at the front end, instead of litigation against polluters--or CFCs in asthma inhalers or covering uninsured with Medicaid--at the back end.

What a wonderful world it would be, if poverty, slum lords, and environmental polluters didn't exist. But they do. Would be great if the libertarian ideal worked in practice, but it doesn't. That's why it's an Ideal.