Diagnosis A$thma

If you have asthma, you can breathe a sigh of relief disbelief.

First, Inhale
The August 2008 issue of Scientific American reports on the pending ban on CFC-propelled albuterol inhalers, which will go into effect December 31, 2008. The inhalers using chlorofluorocarbons are being made illegal as part of 1987’s Montreal Protocol on Substances that Deplete the Ozone Layer. The new inhalers will use hydrofluoroalkane (HFA) instead of the CFCs.

The part that is worth noticing in the article is where it mentions that not only are the CFC-propelled inhalers not a significant contributor to ozone depletion in the first place, but the people who will benefit most from the changeover are not asthmatics—they’re the pharmaceutical companies.

Scientific American explains:

Physicians and patients are questioning the wisdom of the ban, which will have an insignificant effect on ozone but a measurable impact on wallets: the reformulated brand-name alternatives can be three times as expensive, raising the cost of about $40 per inhaler. The issue is even more disconcerting considering that asthma disproportionately affects the poor and that, according to recent surveys, an estimated 20 percent of asthma patients are uninsured.

“The decision to make the change was political, not medical or scientific,” says pharmacist Leslie Hendeles of the University of Florida, who co-authored a 2007 paper in the New England Journal of Medicine explaining the withdrawal and transition.

[…]

The transition began quietly, but as more patients see their prescriptions change and costs go up, many question why this ban must begin before generics become available. At least one member of the FDA advisory committee, Nicholas J. Gross of the Stritch-Loyola School of Medicine, has publicly regretted the decision, recanting his support and requesting that the ban be pushed back until 2010, when the first patent expires.

Gross notes that the decision had nothing to do with the environment. Albuterol inhalers contributed less than 0.1 percent of the CFCs released when the treaty was signed. “It’s a symbolic issue,” Gross remarks.

Some skeptics instead point to the billions of dollars to be gained by the three companies holding the patents on the available HFA-albuterol inhalers, namely GlaxoSmithKline, Schering-Plough and Teva.

In their defense, Schering-Plough and Teva donated a million of the HFA inhalers to clinics around the United States (GlaxoSmithKline has not).

Now, Exhale
This is going to be interesting because it opens the doors for all kinds of political posturing. The first argument that could be made is the obvious one: this is a pile of symbolic horseshit that was designed to help the pharmaceutical companies make a few extra dollars. In this case, they’re going to be making the money off people who don’t have much to begin with: the poor.

That can lead us into the next issue: insurance and paying for the expensive inhalers. Since 20 percent of asthmatics are uninsured, the folks who want universal taxpayer-funded insurance are going to be saying that this is the perfect reason for such nationalized coverage. Never mind that the pharmaceutical companies will still be making a shitload of money while the taxpayers will be getting screwed.

The universal insurance issue is also one that has me thinking that the phrase “politics makes strange bedfellows” very applicable. The pharmaceutical companies stand to gain a lot when this ban goes into effect because generic inhalers won’t be on the market until at least 2010. One of the ingredients in the new HFA inhalers is ethanol, which is derived from corn and has been in the news quite a bit over the last few years for use as a biofuel to help the environment.

In this sense, corn farmers and ethanol manufacturers will see business pick up along with the pharmaceutical companies. At the same time, environmental groups like Clean Air Task Force, Environmental Working Group and Friends of the Earth have joined forces with conservative economists to speak out against ethanol.

Retired economics professor and author Walter E. Williams writes:

Ethanol is 20 to 30 percent less efficient than gasoline, making it more expensive per highway mile. It takes 450 pounds of corn to produce the ethanol to fill one SUV tank. That’s enough corn to feed one person for a year. Plus, it takes more than one gallon of fossil fuel—oil and natural gas—to produce one gallon of ethanol. After all, corn must be grown, fertilized, harvested and trucked to ethanol producers—all of which are fuel-using activities. And, it takes 1,700 gallons of water to produce one gallon of ethanol.

Not only does it take more energy to produce ethanol than the final product gives back (that means increased pollution if the energy used is from coal-fired power plants), but growing the corn has a heavy impact on soil degradation and cuts down on the number of acres used for other important crops (one of the reasons that wheat prices have skyrocketed over the last year). Lester Brown of the Earth Policy Institute has said that “the amount of grain needed to fill a 25-gallon tank would feed one person for an entire year.” That’s a lot of corn.

Now, don’t think that I’m saying that there’s going to be a run on ethanol because of HFA inhalers; I’m not. The amount is miniscule, as seen in the actual environmental impact of CFC inhalers. What I’m saying is that one more so-called environmentally-friendly movement is making a few more bucks off a crisis.

Keeping with the theme of corn, though, another issue arises: allergic reactions. Some HFA inhaler users who have corn allergies have reported problems from the ethanol-based propellant. Other problems have been come about as evidenced on Consumer Affairs’ HFA inhaler Website.

A Website called ecofriend.org listed the HFA inhaler as an “innovative, ozone-friendly gadget” and said that the “priority choice is yours: health or purse.” The only problem with that is that they didn’t back up what was “healthier” about the HFA inhaler. Maybe they meant the health of the Earth given the miniscule amount of CFCs that were even released in the first place.

Or maybe they meant the health of GlaxoSmithKline’s CEO pension plan.

References

Berger, Eric. “Environmentalist: Ethanol Isn’t the Answer.” Houston Chronicle. 4 Jan. 2007.

“Change in the Air.” Scientific American Aug. 2008: 20.

Chen, Michelle. “Environmentalists Burn Ethanol Hype as Empty Promise.” The NewStandard. 9 Aug. 2006.

“HFA Inhalers.” Consumer Affairs.

Irani. “5 Most Innovative Ozone-Friendly Gadgets.” Ecofriend.org. 15 Sept. 2006.

Michaels, Dave. “Perry Draws Environmentalist Support on Ethanol Stand.” Dallas Morning News. 21 July 2008.

Trendel, Deborah. “CFC vs. HFA Inhalers: Are You Ready for the Switch?” About.com. 24 July 2008.

Williams, Walter E. “Big Corn and Ethanol Hoax.” Human Events. 11 Mar. 2008.

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