I had a comment in the Red Meat, Global warming post that asked me to describe how the various health care systems stack-up. This, in response to my statement that socialized medicine tends to become a serious mess. My response to that question, instead of weighing the merits of the US system vs say the Canadain system, was to point out that veterinary medicine is a pretty good example of what the real costs of medicine are when we do not have a 3rd payer system inflating costs. Here is that response:
Sure V-
Veternary medicine. it reflects the REAL costs of treatment, people pay as they go, even in installments and there is not a sense that one should get treatment for free. What about the poor? I have never seen a vet that did not have some sliding fee scales or who did not do some percentage of free work for folks who actually are in significant need.
(Interestingly, they CAN do this because their business is profitable, they WANT to do this because of a deep sense of compassion…hence their chosen profession. Perhaps this will be the case for human medicine one day…)
V- This is almost comical. but you are wanting me to compare one fucked up system (ours in the US) with another fucked up system (lets say the UK or Canada) this is the same path to endlessly chasing one’s tail as comparing the french diet with the american diet…one might be slightly better than the other, both are woefully sub-optimal.
The direction health care is going would be like home insurance that covers your light-bulbs and lawn maintenance or auto insurance that covers gas and oil. The purpose of insurance SHOULD be to offset catastrophic occurrences. If medical insurance was like this, then we paid out of pocket for health maintenance…ya know, the REAL cost, the system would be like auto insurance. I’m not saying it’s perfect, but its infinitely better than medical insurance…interestingly, it got BETTER when one was allowed to shop around and find the best policy for YOU. You know…that free market stuff again. Also, no one is talking about an “auto-insurance” crisis. Why? because it’s market based and it works.
Here is an irony that ties into the earlier global warming post. Glaxosmithklien unleashed Lovaza last year. For those unfamiliar with the product, it is a PRESCRIPTION fish oil. Andy Deas sent me this link to Dr. William Davis’ blog. Dr. Davis has a great analysis of the situation which boils down to this: Prescription Lovaza is $3360/year for the recommended dosage, Costco’s Kirkland brand (which I’ve recommended for over 5 years…Brad and I put their QA/QC department through the ringer….their product is legit) is $150/year for the same amount of EPA/DHA.
As Dr. Davis points out, Lovaza is a prescription and thus eligible for insurance reimbursement. He also points out that those costs do not disappear, we all take it in the fanny. If people had to pay out of pocket (or from a Health Savings Account) they would REALLY want to know why they should pay $3360/year vs $150/year. The bullshit of “Lovaza is a prescription drug which has been studied and is USDA approved” sounds pretty hollow when you look at the disparity in price. Especially when there are thousands of studies showing significant health benefit from fish oil, none of which happened to be Lovaza.
You know what would be funny? to get glazosmithklein to go kick the collective asses of the people saying fish oil is not as effective for health as was thought (all the while changing tactics and talking about sustainability). Let big pharma go after the anti-fishoil-nutters while we promote grassfed meat, single payer medicine and lululemon pants for all hot women (lululemon is scientifically proven to make averages asses look amazing, amazing asses almost too good to view).
Adendum:
I forgot that Andy sent a follow-up post from Dr. Davis. I get some fishy comments that I can not figure out if they are spam or something like this…an industry shill who is trying to shed some doubt on the obvious.
The product thing is interesting…I want to sell a book off this blog, perhaps a DVD or two at some point. We’ve had a food product in the works for YEARS. I’d like to develop and sell that. Perhaps one day I will have some kind of fish oil offered from the site and in the gym, but I’ll never hype that product as the end-all. There are no magic pills or solutions (well…unless you can hit a pharmacy in central America…ohhhh winstrol…). I’m not super familiar with Dr. Davis but he seems like a pretty stand-up guy. He appears to send his patients to Costco to get their fish oil…what I like about that is you are paying the person for their expertise/coaching. Not an overhyped, overpriced product. If you recall I love open markets, I’m all for people making money but I have serious issues with entities that prety on peoples fears and ignorance to make a buck.
80 Comments
Frakkin’ great post Robb…….. as usual. Can’t wait for the book.
Thanks Rob,
I enjoyed your reply to my question. Valid points around veterinary medicine. Not sure i agree with it all in totality but I definitely agree with the observation around lululemon pants.
Have a good day, and keep the blog rolling.
On the topic of Canadian health care:
I am a Political Science major in Ontario and we discuss the huge costs of health care sometimes in class. It is literally the largest Federal and Provincial expenditure. Free health care has its benefits but as the baby boomers age its going to cost an arm and a leg to take care of all the smokers and fatties that neglected their health for 50 – 60 years.
When I recommend a two tier system to save money and create an ability to invest in preventative health care (educating children in proper healthy lifestyles), the left wing hippy kids I go to school look at me like i have two heads. God forbid we take the fucking pop machines and candy machines out of the schools and promote kids getting off their ass and exercising.
Canadians have to realize there is going to be a massive strain on our health care system because people don’t give a shit about their health. I personally don’t want to keep paying for this.
On another note Robb, I am really looking forward to your seminar coming up in Chicago.
Hey Robb,
Howz it? Only in America would a drug company charge 20 times the amount for a product, that is readily avail at any health food or grocery store, the sad thing is that the “sheep” will pay this high price. What’s next, a prescription for grass fed beef?
Aloha
Scott Pauly
Crossfit Phoenix
Insightful stuff on some hot-button issues. Prescription fish oil? Sheesh… Have you seen the documentary “Fat Head”? Noticed both Eades and Taubes contributed to the film so I’m ordering a copy.
btw, I heard a rumor you were bringing the Nutrition Cert up to Scotty’s gym in the near future. Hope I heard correct.
I’d like to add that Costco has a coupon for said fish-oil right now so I would suggest getting as much as you can afford, $3 bucks off $9 400 caps 9-12 caps a day 365 days a year, you do the math and stock up. It’s the genie in a bottle that you’ve been looking for.
A tangent off fish oil but….It always cracks me up (or more accurately makes me want to puke) when “they” (who are they really anyway) talk about health care reform. What we need is health reform. Robb you are right on with your analogy of auto insurance, and the that if routine maintenance such as gas, oil changes, wiper blades, tires, etc. were covered, obviously, auto insurance rates would skyrocket exactly the way health care/insurance prices have. People think health insurance is designed for “maintenance”. It is not! The average cost for annual health care is now at over $8000.00 per person in the US. I believe there needs to be a financial incentive for healthy behavior and a financial dis-incentive for the opposite. As an example in Colorado, the legislature recently passed legislation that effectively stops heath insurance companies from charging smokers and fat people more than non-smokers and non-fat people for group health coverage. I’m sorry but while I completely respect the right to do whatever you want to, to your own body, you need to also accept the consequences. Higher medical/insurance costs are one. There is certainly plenty of blame to go around for the mess we are in. Big Pharm, Big Government, Doctors, Hospitals, Big Media and just as guilty is every single person that doesn’t take personal responsibility for there own good health and for that of their family. While a 3rd party payer system has lots of room for fraud, God help us if we go to a single payer system i.e. nationalized health care, socialized medicine…it will be great for every person without a pot to piss in, it will suck for everyone else. Well maybe not. The government is going to own all the banks, all the investment houses, the auto makers, the insurance companies, heck lets let them make decision about our health care and medical procedures too. That would be like barack giving us all a sigmoidoscopy…at least it would feel like one! a I’ve been CrossFitting for about 6 years and in the insurance business twice as long. I talk to people every day about health insurance and interestingly, about health & fitness every day as well. Oy can I tell you stories…I digress. Let’s model our Western medical system on Eastern Medicine…Pay the doctor for keeping you well, not when you get sick
Robb,
Did you analyze any other Costco/Kirtland brand supplements? That would be a huge cost savings in our house if we could get Vit C, Cod oil, Fish oil from Costco.
Duder,
I agree 100%. Common medical services need to be exposed to free market forces.
I dont give a shit how much the medical services I render cost as long as my insurance pays for it. So long as consumers don’t care how much services cost, then costs can’t be controlled (unless by the gov’t). There’s a good Frontline piece on the problems with even the best socialized healthcare systems in the world.
The sad thing about discussing this is that our healthcare system won’t be reformed…costs will rise until doctors start to opt out of accepting insurance bc it makes more business sense for them. There are general practitioners who have already started doing this.
Agree in one way about the costings of systems but having lived in Canada(now) the UK for 20+ years, America 3.5, Australia 1.5, France for 2.5 and Africa 3 i would say hands down that a public health service a la Can-Ardour or the UK is far far superior to what America has.At least one doesnt have to worry about treatment if one doesnt have gold standard medi.insurance and the life changing costs of such treatment.
Of course the French system is bloody brilliant.I’m no real fan of Michael Moores work or his victim schtick but when recently watching ‘Sicko’ i had to agree the French system is not being exaggerated from my experience.
When are you in BC, Nobby ?
Fellows-
Not on the books yet! Likely in the fall. Thanks for the multi-national input!
Jeremy-
As best as I can telly the Costco stuff is legit. The folks selling Dr’s lines are not in agreement with this but…
Rob-
Yep! we will bea at a coffee house near you!
Sir thanks.
Is the Land of Kirk Fish oil pharm grade pleasum ?
Fellows-
Not pharm grade but unless folks have GI issues with fish, not real need.
I see .I always have taken pharm grade as i want less of the shee-ite pcb’s, etc in my body as assume amd riddled with anyways
Toot N Flute as they say in Bog Land
I have used Costco’s fish oil in the past. Right now I’m buying at Sam’s Club, as the Costco membership needs re-upping.
The Sam’s Club fish oil capsules, and most of the brands on sale at Vitamin Shoppe as well, have SOYBEAN OIL in them, something which I want to avoid. Not sure if Costco’s fish oil capsules have this in them, but when I re-up my Costco membership, I will check it out.
Barry Sears sells a pharmaceutical-grade, high-dose fish oil (capsules and liquid) which used to run about $55 per month. When my cash flow improves, I might go back to using that brand.
In the meantime, I am avoiding SOYBEAN OIL as much as possible, thank you very much.
I thought I heard about a fish oil that you can’t taste when you burp. Is there such a thing?
Speaking of health care / health crisis; do you know what kids are being served in school these days? I can remember eating corn chips and swiss rolls washed down with a cherry pepsi in junior high. And you could get Pizza Hut pizza and breadsticks and cheese fries everyday in high school.
They aren’t teaching about hyperinsulinism in high school.
quick one about the fish oil,
what about Dr Sears’ oil at 2:1 ratio, the kirkland is 180&120. whats the reasoning?
Hey Robb, I coulda swore that the Kirkland fish oil (400 softgel) bottle used to individually list EPA/DHA amounts (e.g. 180/120 mg), but my last two bottles have read “…(EPA/DHA and other Omega 3) 300 mg”. Is there any concern about the “other” sneaking onto the label (as I throw back about 15 a day)?
Mike-
No idea on that label change. I can give them another email/phone call salvo and see how they are doing.
Daz-
EPA is better for inflammation, DHA is better for cognitive issues. If you notice, most ADHA formulas for kids are mainly DHA. THere is a slow inner-conversion between the two but it’s inefficient.
Marshal-
Look for an enteric coated fish oil. Costco sells one, it is 2x as concentrated as the other variety.
Pam-
I REALLY like carlsons, nordic naturals and solece. All the DR lines are typically very good quality, typically soy free.
As an MD in this mess, I’d love to see a system as you propose. It would allow us to truly compete and let our skills and results attract patients and drive the charges we have, not CMS and “Big Insurance”. Likely it will all collapse before being rebuilt with a market driven system. I only hope those of us who truly love our profession and our patients will be able to stick it out through the upheaval.
My real question is one I asked at the Atlanta Nutrition Cert. Is their a difference in the absortion in the natural TG fish oiils such as Nordic Naturals and LifeGuard Health vs the Ethyl Ester form such as Kirkland. There is a difference in the cost, but if the TG absorbs much better it may be that we can drastically reduce the dose that you recommend for etheyl ester fish oil thereby making the total cost closer. Also this form seems to avoid the GI effects and reflux common with the ethyl esters. I’m also happy to see most of the the major brands are removing Mercury, dioxins, pcb’s, and other pollutants. Again thanks for your incredible efforts and insight, if only my colleagues in medicine could grasp your concepts. You are a true scientist.
As an MD in this mess, I’d love to see a system as you propose. It would allow us to truly compete and let our skills and results attract patients and drive the charges we have, not CMS and “Big Insurance”. Likely it will all collapse before being rebuilt with a market driven system. I only hope those of us who truly love our profession and our patients will be able to stick it out through the upheaval.
My real question is one I asked at the Atlanta Nutrition Cert. Is their a difference in the absorption in the natural TG fish oiils such as Nordic Naturals and LifeGuard Health vs the Ethyl Ester form such as Kirkland. There is a difference in the cost, but if the TG absorbs much better it may be that we can drastically reduce the dose that you recommend for etheyl ester fish oil thereby making the total cost closer. Also this form seems to avoid the GI effects and reflux common with the ethyl esters. I’m also happy to see most of the the major brands are removing Mercury, dioxins, pcb’s, and other pollutants. Again thanks for your incredible efforts and insight, if only my colleagues in medicine could grasp your concepts. You are a true scientist.
Personally I have tried the Kirkland COSTCO Enteric coated fish oil ( and I mentioned to Katie too) and I felt horrible for 2mos. Then I ran out and switched brands… to a potent SUPER EPA by Now Brand which is excellent (EPA + DHA is 600mg per cap — very high concentration and more DHA than many brands out there; not that $$ being ~$10-12/month).
The enteric coating is acrylate which is a plastic. I don’t believe any form of plastic should be ingested because the of the hormone effects it can have on the human systems (just as we avoid microwaving in Tupperware, etc).
Hope that helps!!
-G
diablocrossfit.com
Auto insurance is not “market based.” You are required by law to purchase auto insurance if you operate a car. Perhaps medical insurance would be as efficient if everyone was required by law to purchase it.
So if the ratio of EPA & DHA is insignificant/or depending on why you are taking the fish oil, what not use Dr S’s as its provides more of both? Is it just a pricing issue?
Just one comment on the veterinary care vs. health care issue: people are a lot more ok with putting down Fido when you find he has end-stage pancreatic cancer (read: gonna suffer and die, soon) than letting Grandpa go when he has end-stage pancreatic cancer, even if Grandpa is ready to go. I am absolutely not in favor of “rationing healthcare” or making choices for people, but we do have to face the fact that end-of-life care is hugely expensive. My family has talked about this stuff and we know what each of us do and don’t want, and mostly we want to die in peace at our appointed time. It is easier to respect Fido’s wishes, though, than convince people that my great-grandma was ok with dying and let her stop all that medical treatment.
So, I’m a little late jumping into this, but a great post Robb! I have had this argument so many times. Health care in this country is so overinflated it makes me sick. I’ll never forget the time I was given 2 advil in an emergency room, and they charged me $250 for it. I realize that the insurance companies don’t actually pay that price, but if I hadn’t had insurance…. Or the fact that when I had physical therapy, my insurance paid $10 a visit, but once a ran out of my alotted visits (and no one told me how many I was allowed to go to), they charged me $400 a visit and it was non-negotiable. All I did was sit with hot towels on my leg and run on a treadmill. It’s things like that that just burn me up.
On the fish oil, has anyone tried the Carlson’s Cod Liver Oil? I’ve heard that capsules in plastic containers become rancid after a couple weeks, so I’ve been thinking about switching.
Carlsons is awesome, great company.
KT-
End of life care is expensive in part because it last so long…due in large part because of how sick people are. Centenarians, when they die, tend to be VERY healthy…then just die. It tends to be fast.
Daz-
EPA is more inflammation oriented, DHA more cognition. If it’s just a higher concentration of equal ratio then yea, Id just price compare.
Great post Robb. (I posted this the other day with my blackberry but it didn’t show up yet, so I hope I don’t repeat myself)
As an MD practicing in this mess, I think your suggestions are very valid. I only hope the coming “upheaval” in healthcare doesn’t run those of us who truly love our patients and profession away.
My real quetion is regarding the conversation you and I had in Atlanta at McDougal’s joint for the Nutrition cert. Is there a real difference in the absorption of the natural TG fish oil vs ethyl ester or is this just hype. I currently use Nordic Naturals b/c of this claim, but would love to save money by going to the Costco brand. Also I recommend this to many of my macular degeneration and dry eye patients, so would love to offer the savings to them if there is no difference in absorption. Thanks a ton for your work.
ok last question, i promise. So what about Dr S’s argument of a 2:1 ratio being important?
Joe-
True enough. For me auto insurance is I guess “marketesque” in that we can go out and really price shop and these companies compete against one another. AND if one lacks insurance you are the responsible party.
Jay-
Still not sure on ther ethyl ester absorbability…maybe Matt can chaeck on that if he sees this.
Daz! He wants that higher EPA for antiinflamatory action. Some of the kid formulas are heavy the opposite direction.
cheers Robb, from memory i thought there was some kind of absorbtion/beneficial effect with the 2:1 ratio. obviously not a big deal.
Robb, thanks for your comments re fish oil (including the one to me).
I have also used Solgar’s salmon oil (low amounts of EPA and DHA, though). Right now I have a bottle of Trader Joe’s fish oil capsules.
I did use Dr. Sears’s fish oil capsules in the past, and when my cash flow improves, might go back to it.
In the meantime, April and September are big sale months for Vitamin Shoppe’s house brand of supplements. Basically, if you pay regular price for the first bottle of their brand of anything (e.g., B vitamin complex), the second bottle (same size) is half-price. Good chance to save some $$.
I’ve found much of their stuff acceptable, and their house brand definitely costs less. Their oil-based supplements, however, seem to contain soybean oil in them, so if you’re worried, it’s something to watch out for.
Ahh! There may be an absorption benefit but I’ve forgotten all about it!
I eat sardines for breakfast, 5 days a week. My dog enjoys a big sloppy kiss from me before I head to work.
Often, a nice nightcap will contain a shot of vodka, 1/4 of a sardine, preferably the head, and a dash of spicy pepper sauce.
I rock.
Brad
BEAUTIFUL free-market reference. I adore your economic perspective and fitness perspective. I’m an econ major in Montana who also enjoys lifting heavy things just because I can, at my CF gym.
One thing I would add, which somewhat applies to the healthcare discussion, is the fact that people in the US subsidize medicinal advancements for the rest of the world. I don’t necessarily think that’s a bad thing, we are pretty much the richest country in the world, and I don’t think that what were doing is remotely socialist (something I would abhor). What we pay for new drugs is drastically higher than what they sell for in other, poorer, countries. Only because we pay so much do the companies have the incentive to go through hugely expensive research and development processes, thus supplying the world with new and better drugs. I know this isn’t the same as our ridiculous health insurance system, but it may help people understand why name-brand medicine prices are so high. If they weren’t, we would not have many of the innovative medicines we have today, working to help people with all kinds of ailments, from AIDS to pink-eye. It’s not price-gouging, it’s basic economic theory.
Brad-
Your dog and your wife are VERY tolerant!
Robb,
Since i started taking the Costco fish oil (which does have soy in the ingredients), i’ve felt very cloudy-headed (more than the normal level of retardation the wife accuses me of). Any thoughts of connection here? I had been using GNC or Vitaminne Shoppe house brands before. Thinking of just sinking the money into Carlsons if this continues
Jeremy-
No clue on that…I’d just run with what works best for you.
What ratio of EPA/DHA do you suggest per day?
50/50 in general.
Robb,
I take the Costco brand as you recommend…should I replace any fat blocks with the fish oil? If so, how many capsules per block? Thanks sir.
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[...] community has decided to cash in on this and released a new “drug” called Lovaza. As Robb Wolf points out, it is nothing more than a prescription fish [...]
[...] community has decided to cash in on this and released a new “drug” called Lovaza. As Robb Wolf points out, it is nothing more than a prescription fish [...]