One Free Bite 

By Michael Applebaum, MD, JD, FCLM

There is a “principle” in the law that a dog gets “one free bite.”  After that the owner is on “notice” of the dog’s proclivity to violence and will evermore be held accountable for subsequent unprovoked tastings.


“Notice” is a legal concept not limited to doggie justice.  It is applied to other areas of the law.  “Notice” implies that one has been formally warned or notified.  Its effect is to remove “I didn’t know” as an excuse, reason or defense.


In July 2003, Families USA published a study called Out of Bounds which dealt with rising drug prices.  Specifically, it analyzed the rise in costs for the 50 drugs most commonly prescribed to seniors.  The results were striking, saddening and maddening:


The total spending of senior citizens on prescription drugs rose an estimated 44 percent from 2000 to 2003.

The prices rose 3.4 times the rate of inflation in 2002.

On average, the cost of these drugs increased 6.0 percent from January 2002 to January 2003, while the rate of inflation, excluding energy, was 1.8 percent during that same period.

Of these drugs:

One-fourth (12 of 50) did not increase in price

Nearly three-quarters (37 of 50) rose in price one and one-half or more

times the rate of inflation

More than half (27 of 50) rose in price three or more times the rate of



Unfortunately, as consequences of rising prices:


“For seniors on fixed incomes with no drug coverage, increases at that level make it impossible to continue purchasing the medications they need. For low-income seniors, rising drug prices too often mean that necessary medications go unfilled. The result: greater emergency room and hospital use and higher overall costs to the health care system.


Fortunately, Families USA provided solutions to this crisis:


“The rise in the price of drugs most frequently used by seniors from January 2002 to January 2003 highlights, for yet another year, the need for a prescription drug benefit in Medicare. The stark difference in prices among the top 50 drugs also points to the need for strong measures to ensure that consumers have timely access to generic drugs. With expanded coverage and access to generics, broader strategies for price moderation must also be considered. Without moderation in drug prices, employers, governments, and other health care payers will cut back on coverage and pass costs on to consumers -- costs that consumers will not be able to bear.”


However, these are incomplete solutions, ergo lousy solutions.  None address the root of the drug prices crisis.


Let’s take a look at these Top Drugs and what they treat:


14 for coronary artery disease

10 for hypertension

6 for hyperlipidemia

3 for osteoporosis

3 for depression

2 for arthritis

1 for Type II diabetes


What is so interesting about this grouping is that 39 of the Top Drugs, almost 80%, are used to remedy conditions that we cause ourselves or can treat without drugs, i.e., these are largely diseases of overeating and inactivity.


The failure of Families USA to call for disease prevention through personal responsibility undermines its credibility.


So let me help it gain integrity.


Here are a few other things for them to advocate:


1.  Drug manufacturers must include in their advertising:

information on how to avoid needing the promoted drug,

the costs to society of the disease being treated and

the type of death and diminished quality of life one can expect from the disease.

This is similar in concept to many of the public service spots sponsored by the “responsible” tobacco companies.


2.  Support the drug companies in their quest for fair profits which are used for research and development and education.


3.  In return for pricing concessions, back the “one bite doctrine.”  This states that after a fixed period of time, the public has been given notice about the behaviors that lead to diseases of choice.  Afterwards, the drug companies will be free to sell these medications for self-induced indications at “fair market value.”


The real issue is not medication costs.  The real issues are self-destructive behaviors and making the rest of us assume the costs.  Promoting the use of societal resources and providing pecuniary rewards in support of bad conduct are strategies designed to perpetuate problems, not solve them.