You say tomato, I say drug importation

07/23/2008 02:44 PM |

Since June, at least 1,200 Americans have been diagnosed with salmonella poisoning.

Early on, the Food and Drug Administration believed that the culprit was tainted tomatoes. It spent weeks trying to locate the source and failed to turn up any definitive evidence. Officials announced last week that tomatoes are safe to eat.

The agency now suspects that another kind of produce — perhaps Mexican-grown jalapeño peppers handled by a small Texas produce shipper — may have caused the outbreak.

But things could be worse. Imagine if the contaminated goods weren’t produce but instead prescription drugs, coming in from all over the world.

Sound far-fetched? It’s more likely than you might think.

Here’s the rest of the story in today’s edition of the Ft. Worth Star-Telegram:

Ft. Worth Star-Telegram Op-Ed

As the FDA struggles to find the source of contaminated produce, Congress should take time to reconsider the problems with legalizing prescription drug importation.

If it doesn’t, the results could be much worse than food poisoning.  Read More & Comment...

Rhetoric is Easy. Healthcare Reform is Hard.

07/23/2008 02:29 PM |

If there’s, as some claim, a “media love fest" going on with Senator Obama, then the Man from Illinois’ healthcare rhetoric isn’t part of it.

Consider today’s story in The New York Times, “Health Plan from Obama Spurs Debate.”

Except that after you read the article, you realize that the headline should have more appropriately been, “Health Plan from Obama Spurs Derision.”

According to the Times:

“While there is consensus that the American health care system is bloated with waste, eliminating enough to save $2,500 per family would require simultaneous and synergistic solutions to a host of problems that have proved intractable for decades.”

And:

“Mr. Obama … is offering a precise “chicken in every pot” guarantee based on numbers that are largely unknowable. Furthermore, it is not completely clear what he is promising.”

And:

“But the health policy advisers who formulated the figure say it actually represents the average family’s share of savings not only in premiums paid by individuals, but also in premiums paid by employers and in tax-supported health programs like Medicare and Medicaid.

And, according to Harvard’s David Cutler (an unpaid advisor to the Obama campaign and a certified smart guy), “Our attempt to lay out one plausible scenario for the savings had created more problems than it had solved.”

And:

“But whether employers and governments respond that way cannot be guaranteed, particularly in a difficult economy. And a number of health policy experts have questioned whether the $2,500 projection is either fiscally or politically realistic. Reducing health care costs, they emphasized, means taking money from someone’s pocket and rationing care that Americans have come to expect, a recipe for stiff resistance.”

Here is a link to the complete NY Times story:

New York Times story

Well gosh, you mean that healthcare reform is going to be hard? Stop the presses. (Or, perhaps, start them.)

Another regularly bandied about “solution” is for the United States to adopt “free” healthcare, “like in Europe.”

Let’s address that shibboleth.

People in other healthcare systems often pay more than Americans do, sometimes in the form of taxes. And they may also incur high costs if they need a drug that is not covered by their health system or want to see a specialist.

In the US, a family of four with an employer-based PPO will have around $15,609 total this year in healthcare costs. Of this amount, the employer will pay $9,442 and the employee will contribute $3,492 in premiums and $2,675 on co-pays, etc. That’s about 6 percent of average family income.

In Canada, while the percentage of taxes used to provide healthcare varies, it is estimated that 22 percent of taxes collected went to the health system in 2004. Several provinces, including Quebec, Ontario, Alberta, and British Columbia, also charge additional premiums. Canadians also may spend money to receive private treatment for procedures or drugs that are not covered by the government system.

Citizens of the UK pay 11 percent of each pound they make in weekly income between £100 - £670 for the NHS, plus an addition 1 percent of income over £670 a week. Though the co-pay for drugs is low, many drugs are not covered, often because they not considered cost efficient. And anyone who uses their own money to buy powerful but expensive drugs not paid for by the NHS finds him or herself shut out of the NHS for having gone outside the system.

In Germany, coverage from a public sickness fund currently can range significantly in cost, from around 12.2 to 16.7 percent of income, with the employee paying a bit under half. As of fall 2008, premiums are to be standardized from the federal level and healthcare experts anticipate that they will be set around 15.5 percent. Private patients can generally expect to pay more than they would in the public system.

In France, employees contribute only to 0.75 percent of their salaries towards medical care, but also pay a 7.5 percent General Social Contribution, the majority of which is earmarked for the health system. This base coverage reimburses people for the majority of costs for doctor visits and for a portion of the costs of medications. On top of the government coverage, almost all French residents have supplementary coverage from a mutuelle, costing approximately 2.5 percent of salary.

For a more complete look at “myths vs. facts” of “free” European-style health care, have a look at this new article in the Journal of Life Sciences:

Journal of Life Sciences article


And if you’re ready for a barrage of reality about how patients fare under various European systems (Canada too), click here:

www.biggovhealth.org

And let the debate over real reform begin.  Read More & Comment...

Jim Jam

07/22/2008 06:55 PM |

I just came across a new web site, www.thoreau-fda.com/index.php.

It defines itself as “a website launched and operated by current and former US Food and Drug Administration staff who believe public health is being put at unnecessary risk. These concerned civil servants and ex-civil servants have either experienced or are aware of wrongful directives by US FDA upper management – directives that put public health at avoidable risk.”

That’s nice.  But when you check out to whom the site is registered, it turns out to be Jim Dickinson of FDAWeb.com – no fan of the FDA and no former FDA employee.

Oh well, so much for transparency.

Perhaps Jim should heed the words of Mr. Thoreau, to wit:

“If you would convince a man that he does wrong, do right.”

  Read More & Comment...

How Novel Managed Care Managing Care

07/22/2008 05:59 PM |

Nearly 40 years to the date they were conceived, managed care plans come together to come to the realization that to stay in business they should focus on patients not on cutting costs...

amednews.com

Insurers are the new worried well (America's Health Insurance Plans annual meeting)
In the wake of declining profits, health plan executives discuss what they need to do to remain viable. Their solution: focus on changing patient behavior.

By Emily Berry, AMNews staff. July 28, 2008.

Reports from conferences important to physicians

Paul Wallace, MD, a Kaiser Permanente medical director, stood before other health plan leaders during a packed session at the annual meeting of America's Health Insurance Plans in San Francisco in June and told them their job is no longer to pay bills, but to manage members' health.

Paul Wallace, MD, a Kaiser Permanente medical director, stood before other health plan leaders during a packed session at the annual meeting of America's Health Insurance Plans in San Francisco in June and told them their job is no longer to pay bills, but to manage members' health.

They got the message. As Dr. Wallace concluded, he asked the audience: "Is anyone here not in the behavior-change business?"

No hands went up.

The admonition that health plans are meant to manage care might not sound new, given that back in the early 1970s HMOs were created to do just that. But health plans are now talking about managing care not only as essential for their members' health, but essential to their own.

That message echoed throughout the AHIP Institute, the name for the annual meeting of the trade group representing health plans.
http://www.ama-assn.org/amednews/2008/07/28/bisa0728.htm


But let's not get too enthusiastic....just a couple of months ago the HMOs said they would dump patients to protect profit margins...
BUSINESS
Health plans say they'll risk losing members to protect profit margins
Meanwhile, businesses and individuals are dropping coverage in the wake of higher insurance premiums.

By Emily Berry, AMNews staff. May 19, 2008.

The nation's largest publicly traded health plans say they don't plan to temper premium increases for the sake of keeping members on their rolls -- particularly not while they are under pressure from Wall Street over what it sees as their disappointing earnings.
Article here


And let's not forget how AHIP and CBO are working together to "bend the curve" on health care by setting up a comparative effectiveness institute run by government bureaucrats....  Read More & Comment...

NICE stiffs RA patients

07/22/2008 02:38 PM |

Still think that “government” care = “universal” care? Think again.

According to a report in The Guardian:

Potentially life-changing drugs for rheumatoid arthritis could be rationed for the UK's 60,000 sufferers, patients' groups warned today. Potentially life-changing drugs for rheumatoid arthritis could be rationed for the UK's 60,000 sufferers, patients' groups warned today.

NHS patients should not be allowed to try a second inhibitor if their first attempt fails, the National Institute for Health and Clinical Excellence (Nice) has decided.

Charities said that could leave sufferers with pain and the possibility of long-term disability.

Trying different anti-TNF therapies (tumour necrosis factor alpha inhibitors) is common. The British Society for Rheumatology Biologics Register showed around 70% of patients will get a good response from a second anti-TNF if the effects of the first start to wane.

Now charities and patients' groups are preparing to appeal against NICE's ruling before final guidance is issued to the NHS in September.

Rob Moots, clinician for the Arthritis and Musculoskeletal Alliance, and professor of rheumatology at Liverpool University, said the ruling flew in the face of clinical judgment.

"It's almost impossible to know which anti-TNF will work for a patient at the outset," he said.

"Before this decision we could try patients on each of the three treatments in turn to find one that was effective for them - now we only have one shot at success.

"Many patients will be left in astonishing pain, while knowing we haven't explored all the options for them."

Rheumatoid arthritis is an auto-immune disease for which there is no cure. It occurs when the immune system attacks the joints, causing swelling and damaging cartilage and bone.

Ailsa Bosworth, the chief executive of the National Rheumatoid Arthritis Society, said today's move, combined with a NICE decision in April to reject the drug abatacept, meant effective therapies had been cut from five to two.

For more reasons to be afraid, very afraid, of government healthcare, visit www.biggovhealth.org.

  Read More & Comment...

Doctor -- reveal thyself

07/22/2008 12:43 PM |

Yesterday I attended a seminar (sponsored by Pfizer) at the New York Academy of Sciences. (40th floor at 250 Greenwich Street -- what a view!)

But the views offered on the inside were equally stimulating.

A few examples:

Elizabeth Teisberg (Professor, Darden School of Business, University of Virginia):

"Today pay-for-performance" means "pay-for-process-compliance."

Dr. J. Edward Hill (Past President, American Medical Association):

"If we believe in evidence-based medicine, then we should consider the evidence of what government run healthcare provides."

Dr. Hill also posed this interesting question, "Can we really have personalized care provided by the government?"

Dr. Michael McGinnis (Senior Scholar, Institute of Medicine):

"40% of deaths in the US are caused by the behavioral choices we make," led by lack of diet, not enough exercise -- and tobacco.

He also pointed out that "what happens at the intersections of the domains of influence" is what drives both health and care. McGinnis defined the relevant "domains of influence" as Behavioral, Genetic, Social, Environmental, and Healthcare.

There was much heated debate and audience participation -- but the most memorable comment was also one of the pithiest and it came from Dr. Hill who said, "People need to quit being complacent."

And included on that list of people needs to be doctors.

(Yes, doctors are people too.)

I asked Dr. Hill why we only hear from doctors when it's about their payment schedules. His reply was honest -- "I was afraid someone was going to ask me that question."

And that's when he offered the remark about complacency.  Read More & Comment...

Deutschland's Doctors Outta Options

07/22/2008 05:48 AM |

From a 2006 Spiegel International article....

GERMAN BRAIN DRAIN

Sick of Bad Pay, Doctors Flee Germany

By Udo Ludwig

German doctors are packing their scalpels and seeking their fortunes abroad, lured by the prospect of far higher pay and driven away by stifling bureaucracy in their country's health service.http://www.spiegel.de/international/0,1518,399537,00.html

Where are they going? Take one guess...

"The NHS is flying in doctors from Germany to provide out of hours cover for GPs, at a cost of up to £650 a day.

The news comes a week after it was revealed that a health board hired a doctor from Italy to cover a remote practice over Christmas.

Such doctors are being used to work shifts, including holidays and weekends, that British GPs no longer have to cover following contracts introduced in 2005.

A Scottish health board is using GPs from Germany to provide out of hours care, sourced through a foreign recruitment agency.

NHS Grampian has used at least two doctors from Germany through the agency, which charges between £60 and £65 an hour for shifts that can last for up to 10 hours. Over Christmas, another Scottish health board, NHS Highland, flew Dr Annibale Bertollo from Venice to provide cover for a practice in Wester Ross for five days."

Read Article

Here's wondering if Obama will praise the German health care system as a model for reforming our own....

  Read More & Comment...

Fellowship-shape

07/21/2008 12:21 PM |

The FDA said Thursday it will launch a two-year fellowship program for physicians, chemists, statisticians and other science professionals interested in food and drug regulation. About 30 to 40 fellows will be accepted for the first program, which begins in October. Some of those accepted are expected to stay on as full-time employees after completing the program, which includes course work and seminars.

This is crucial since the average age of the FDA's work force is 54, and about 30 percent of general staffers already are eligible to retire.

That’s why “a strong FDA” is part of the agency’s five year strategic plan.

FDA’s most proprietary and valuable resource comes through the door each morning. There are almost 1,500 people with PhDs at FDA and well over 400 with medical degrees – and that’s without double counting.

An organization that can keep up with the rapid changes in the industries that it regulates, and that is capable of developing and implementing effective and innovative public health measures, requires a very special workforce. The FDA’s mission depends more than ever on a solid cadre of experienced physicians, toxicologists, chemists, statisticians, mathematicians and other highly qualified and dedicated professionals. Their expertise is essential for making regulatory decisions that are balanced and fair and timely -- and for keeping the agency on the cutting edge of the technology and sciences used by industry.

Agency leadership must make it a priority to encourage creativity, efficiency, and superior performance - an environment that attracts and retains top-quality scientists, and enables them to do top-quality work as part of an effective team.

  Read More & Comment...

Insta-Think in Medical Research

07/20/2008 09:52 PM |

Another trend with disturbing implications for the quality and conduct of medicine: online publication of research is creating memes that rapidly lead to consensus absent any validation with older research. ( "Richard Dawkins, in his book The Selfish Gene, recounts how and why he coined the term meme to describe how one might extend Darwinian principles to explain the spread of ideas and cultural phenomena. He gave as examples tunes, catch-phrases, beliefs, clothing-fashions, and the technology of building arches" . en.wikipedia.org/wiki/Meme. )

"Over the last decade or so, access to scientific literature has changed radically. Reading a research paper no longer requires a trip to the library, as the research journals are only a web browser away. A paper in the current edition of Science looks into whether this transformation has triggered a corresponding change in how that literature is used. Its author's statistical analysis suggests that the ready availability of scientific information has a counterintuitive result: a smaller pool of articles are referenced in the scientific literature."

Using Thompson's citation index (CI), which indexes articles and references from the 6000 most highly cited journals, and Information Today's Fulltext Sources Online (FSO), sociologist James Evans has examined what effect the availability of online articles has had on how researchers cite previous work. The combined data from CI and FSO hold over 26 million articles and an additional 8 million distinct articles that referenced them through 2006.

His conclusion?

"Fewer and fewer distinct articles were cited even as more publications could be accessed online... "

"The conclusion of all this statistical work was that, as more and more articles are readily available online, researchers, on average, cite fewer articles. The articles that are cited are newer, and fewer distinct articles receive attention. The results of the explosion of easily available articles, according to Evans, is that "researchers can more easily find prevailing opinion, they are more likely to follow it, leading to more citations referencing fewer articles." As a side effect of this, a scientific consensus will typically form more rapidly. The other side of this is that papers containing ideas that don't catch quickly will be forgotten by the scientific world much faster. "

Which stifles debate, discussion, error correction. Someone who is not careful or wishes to unduly influence medical opinion would merely have to publish a handful of articles -- bereft of previous research so as to reduce the chances for comparison -- in a handful of journals to change thinking and consolidate consensus quickly all the while evading serious scientific scrutiny. And once a rash conclusion reaches the public it is quickly disseminated -- online again-- where it whirls into common use. Meanwhile minority opinions -- even those with more solid scientific support -- can be ignored or attacked.

Sound familar? How about the vaccine-autism controversy or the Avandia or SSRI scare? I would like to see what percentage of articles are now actually original research as opposed to meta-analysis or combing through of databases which is easier and quicker to publish and which "leading publications" are more eager to run with to generate attention.

The internet can rapidly distribute new information. But not all information is new knowledge, which is information that advances understanding.

Insta-think can lead and does lead to Tabloid Medicine.

Science, 2008. DOI: 10.1126/science.1150473

  Read More & Comment...

Mr. Stupak, apologize now!

07/18/2008 01:25 PM |

Reps. John Dingell and Bart Stupak on Thursday questioned whether FDA officials knew about the potentially fraudulent information but approved Ranbaxy's products anyway.

Stupak said the Ranbaxy case "may be another example in which FDA found it inconvenient to assure the safety and effectiveness of drugs before approving them."

The Rambaxy situation is very unsettling and certainly worthy of investigation. Casting such snide unfair aspersions on the hard working career staff of the FDA is not.

Mr. Stupak -- apologize now!

 

  Read More & Comment...

Rancid Ranbaxy Investigation on the Hill

07/18/2008 12:40 PM |

Want a preview of how the idiots in Congress will deal with a tidal wave of tainted medicine if drug importation becomes reality?

Take a look at the response to the allegations that Ranbaxy was hiding data from the FDA about the safety and integrity of their products. Large company is accused of willingly conspiring to evade and avoid FDA scrutiny even as it submits the "right" data and who is hauled before Congress?

FDA, the same FDA that has been lambasted for being short of staff. It is now being all but accused of conspiring with Ranbaxy.
If importation becomes a free trade zone for counterfeiters, you will see more evasion as the opportunities for profit and piracy pile up.

Don't expect Congress to take the blame for poisoning our medicine supply.

Read more here
  Read More & Comment...

All Paul is divided into three parts

07/18/2008 12:38 PM |

Here's our interview with Congressman Ron Paul:

Ron Paul videocast

Not surprisingly, he has a lot to say -- but we tried to keep him focused on healthcare.

And we were almost successful. You be the judge.



  Read More & Comment...

Pen ultimate reflections

07/18/2008 11:42 AM |

It’s surprising how much ink is being spilled over the revised PhRMA code – considering it bans free pens.

Less surprising are the indignant musings of those whose only metric of the code’s “success” is a decrease in marketing efforts. Consider the opinion of Robert Restuccia, Executive Director of the unbiased and entirely unconflicted Prescription Project.

If spending is up, he figures, then voluntary compliance is a failure.

That’s pretzel logic.

The whole issue of whether drug marketing spending goes up or down is a non-sequitor when it comes to PhRMA marketing code compliance. Linking spending to compliance is like linking sunshine to gas prices. No relation at all.

What it does demonstrate is the frustration of Mr. Restuccia and his fellow travelers, who believe that drugs shouldn’t be marketed at all. Those who preach the inadequacy of voluntary marketing codes believe that “compliance” should result in, de minimus, reduced marketing and, ultimately, no marketing at all.

And if you don’t think this is their pen-ultimate goal, it’s time to wake up to reality.

Note to Prescription Project: “Good for sales” and “Good for the public health” need not be mutually exclusive.

Regulation (via voluntary codes or government legislation) doesn’t mean what is being regulated is bad. It means that it needs to be done in a certain way.

And that benefits everyone.

  Read More & Comment...

CCHIT Happens

07/17/2008 03:35 PM |

From the pen of Secretary of Health and Human Services Mike Leavitt:

Commission’s rigorous testing helps ensure interoperability of technology

As Congress takes up the subject of health information technology, it must take great care to enable accelerated progress rather than sending the process back to the starting line.

My vision of health information technology in the United States is a world where medical information can be privacy-protected and managed in a way that produces better quality, lower costs, fewer medical mistakes and less hassle for everybody. Building such a system requires that clinics, hospitals, pharmacies, labs and patients have systems that speak the same language — that are “interoperable.”

Getting health information systems in various parts of the healthcare system to work together requires the adoption of common technical standards. I’ve often compared the problem to the building of railroads. Before the railroads of the East, West, North and South could be interoperable, they all had to agree on one standard track size. A similar process is required with health IT, except that the degree of difficulty is much harder than just agreeing on a track size.

There are more than 200 developers of electronic medical record systems in the United States.

Until three years ago, there was no process for harmonizing and coordinating the standards they used. To remedy this problem, we formed the American Health Information Community (AHIC). It has succeeded, and as time passes we are seeing an accelerating stream of solid and widely accepted health IT standards emerge.

People who buy systems need to know they are making an investment that will connect them with the rest of the medical world. Today, they can buy with confidence.

The Certification Commission for Healthcare Information Technology gives systems a rigorous testing to demonstrate interoperability. Those systems that pass the test are given CCHIT certification. When doctors buy systems with that seal, they know that they are on a pathway to interoperability. This has given many doctors the confidence to buy who were waiting before.

We have seen more progress toward interoperability in the past three years than in the previous two decades. This is because government agencies, the medical family, the insurance industry and the health IT sector are all working together collaboratively.  This type of collaboration is hard and requires great effort, but it is working, and its momentum is increasing.

As Congress begins to write a health IT bill, it is critical that it be crafted in a way that does not interrupt this success by imposing government controls. Government has to be at the table as a full participant, but if the bill prescribes the way these standards are to be set, or puts in place a politically controlled process that picks winners and losers, it will devastate a healthy but fragile process and lose three years of maturity and momentum.

I would offer three principles to members of Congress in dealing with legislation:

First, let’s protect the flexibility of those who are working to invent new tools, and let’s not undermine the work on AHIC that is already underway. Writing legislation to bias the process in one direction or another will constrict innovation and slow the process.

Second, let’s not try to solve all the privacy challenges of the 21st century in a health IT bill. We have to be careful to avoid penalizing early adoption.

Third, let’s respect the need for legitimate healthcare communications. We have to find the balance here. It is in the patient’s best interest for doctors and the patient to have information.

The most important thing government can do is adopt the standards ourselves. The adoption of standards by Medicare, the Veterans Administration, the Department of Defense, and Indian Health, is critical.

We’re making progress on health information technology. Let’s make sure that any legislation accelerates the progress already under way, rather than chilling it with requirements that the government dictate one-size-fits-all answers.

  Read More & Comment...

Culture Vulture

07/17/2008 01:23 PM |

Now here's a healthcare story that deserves to be on Page One. 

But since it's not about coffee mugs or pens, or adverse events -- it's not.

Hepatitis C, investigators report that they have developed the first tissue culture of regular human liver cells that can imitate infections with the hepatitis C virus (HCV).
 

"This is the first efficient and consistent model system for HCV to be developed," Martina Buck, assistant professor of medicine at the University of California, San Diego, School of Medicine, who developed the culture, said in a university news release. "There is a need for new treatments, and for development of a possible vaccine for HCV. Now we have a model system to support work by investigators in this area."

Some 170 million people worldwide are infected with hepatitis C, which affects the liver. In the United States alone, some 10,000 people die from cirrhosis of the liver, and thousands more die from liver cancer associated with infection.

The virus is usually transmitted by sharing intravenous drug needles and through sexual contact.

Right now, there is no animal model to test different therapies, according to background information in a paper published in the July 16 issue of PLoS ONE.

The therapy can also cause severe flu-like symptoms.

Researchers have so far been hampered in their efforts to understand HCV, because it hasn't been possible to infect normal human liver cells in a laboratory setting.

The new culture allows scientists to directly infect cells with virus from the blood of HCV-infected patients.

  Read More & Comment...

Disadvantage Medicare

07/17/2008 01:15 PM |

There is a lot of cheering about the fact that payments to HMOs under the Medicare Advantage program were cut to temporarily stave off an 10 percent cut in Medicare fees to doctors.

A few things:

First, the cut was inflated by those want to kill MA because it was a departure from the government run Medicare program. By pitting doctors against the HMOs it achieved what pitting kids against HMOs didn't do in expanding SCHIP since, as most people have forgotten, the MA payments were going to fund health insurance for kids. So much for the Hobbesian choice.

Second, these cuts will hurt seniors directly and soon. HMOs had to use the extra payments to bring in the sicker and more chronically ill patients and get them healthier...which is what health care is supposed to do. They did so with lower premiums, more care and better disease management. As Mark McClellan noted in Congressional testimony;

Overall, compared to fee-for-service Medicare, beneficiaries in Medicare Advantage plans have much lower out-of-pocket costs; they receive significantly more preventive benefits, drug coverage, and services to help them better manage their chronic diseases; they have very high satisfaction rates; and in most cases, their overall care costs (Medicare plus beneficiary) are lower.

For example, Medicare Advantage beneficiaries

For example, Medicare Advantage beneficiaries receive preventive services like mammograms, colorectal cancer screening, prostate screening, and immunizations at significantly higher rates than beneficiaries in traditional fee-for-service (FFS) Medicare.

In addition, compared to other Medicare beneficiaries without supplemental “Medigap” coverage, MA beneficiaries are only one-third as likely (6 percent versus 17 percent) to report delaying the use of needed care due to cost.1

MA beneficiaries also receive higher quality of care in many areas; for example, a study in the Journal of the American Medical Association found that beneficiaries in MA plans received higher quality of care than beneficiaries in traditional FFS Medicare in five of seven HEDIS quality measures studied.2 Quality is reflected in overall high beneficiary satisfaction rates with their coverage: Consumer Assessment of Health Plans Surveys (CAHPS) generally rate MA plans highest among a range of types of health plans.3

These quality of care results are the consequence of how most MA plans provide coverage. Plans receive a single, risk-adjusted payment from Medicare, and they compete to attract and keep beneficiaries by using this subsidy to provide the most attractive benefits at the lowest overall cost. In contrast, in traditional FFS Medicare, benefits are determined by statute and cannot easily include many innovative approaches to benefit design, provider payment, care coordination services, and personalized support for beneficiaries. Through MA plans, beneficiaries across the country have access to plans with lower or zero copays for preventive services; they have widespread acces to wellness programs; they have access to dental and vision services that not only reduce costs but also help beneficiaries live better and improve their overall health.

Importantly, MA plans are also providing drug coverage that is more extensive and much less costly than in traditional FFS Medicare. This difference in generosity and cost, which increased between 2006 and 2007 and may continue to increase in the future, is likely the result of several factors. First, most MA plans can manage the use of prescription drugs more effectively, as part of their efforts to support the overall coordination of care for a patient’s health. Second, higher compliance with drugs has been shown to reduce other health care costs,4 and because MA plans have incentives to keep overall costs down that do not exist in traditional FFS, they can capture the savings in hospital, physician, and other costs from the greater compliance that comes with more comprehensive drug coverage. Again, this is a more efficient approach to health care coverage.

Finally, most MA plans provide much more support for patients with chronic diseases than is available in traditional FFS Medicare. This is critically important, since the vast majority of costs in Medicare – and most of the cost growth in Medicare – relates to treating the complications of a limited number of serious chronic diseases. Our health care system has huge and persisting quality gaps in the prevention and treatment of chronic diseases. There is no population in this country that needs such personalized services to improve coordination and prevent complications from chronic diseases more than Medicare beneficiaries.

All of these features – better preventive care, lower out-of-pocket costs, better drug coverage, better support for quality care for chronic diseases – are signs of more efficient health care. Not surprisingly, they add up to very large savings for beneficiaries – on average, out-of-pocket costs are $86 a month less in MA, compared to traditional FFS. Medicare with Medigap (counting beneficiary premiums) or no supplemental coverage. That’s more than $1000 a year in savings. This is why a recent analysis by Adam Atherly and Ken Thorpe of Emory University concluded that even though MA payments increase Medicare costs, “the size of the increase in costs will be less than the value of the supplemental benefits provided to beneficiaries” – that is, overall costs to beneficiaries and the Federal government are lower in the MA plans.5 (Similarly, according to MedPAC testimony before the Ways and Means Committee in May, average bids across all Medicare Advantage plans for Part A and B services are lower than the average cost of traditional FFS Medicare6 - and when Part D benefits are included, the cost differences are larger.)

Now all this value in health care will dry up. Republicans -- at least those that voted against robbing seniors of better care to finance a short term extortion of doctors who are already being screwed by Medicare -- should make this a campaign issue.

Do we really want our health care decisions to be run from Washington?  Read More & Comment...

Where's Eliot Spitzer when you need him?

07/16/2008 10:46 AM |

At least they’re not giving doctors any pens or coffee mugs.

From today's edition of the NY Sun:

Insurers Pay Doctors To Push Generic Drugs

Some Physicians Resist Incentives While Taking Payments From Prescription Firms
By E.B. SOLOMONT,

Two New York health insurance companies are rewarding doctors with cash incentives for prescribing generic drugs.

The companies, Excellus Blue Cross Blue Shield of Rochester, NY and Independent Health, based in Buffalo, are offering higher compensation to doctors who increase their rates of prescribing generics instead of more expensive brand-name medications. The companies say the programs were designed to control the escalating cost of pharmaceuticals and to pass on savings to the patients.

Doctors say that generics sometimes can be safely substituted for brand-name drugs. But some of them also are skeptical of the payments from insurers, saying they could raise ethical questions and even jeopardize the safety of some patients.
"By offering incentives to prescribe generics, there's at least the appearance for an ethical conflict, steering toward the cheaper medication," an Albany cardiologist, Dr. Mikhail Torosoff, said. "That's upsetting."

Insurers defend the practice as a way to rein in costs.

"What we're focusing on here is how do we make health insurance more affordable, and one way of doing that is to promote more cost-effective health care treatments," the senior vice president of the New York Health Plan Association, Leslie Moran, said.

She dismissed the notion that physicians are being coerced. "Everyone likes to talk about the availability and accessibility of health care," she said, "but you can't expand access if its not affordable. A key component of affordability are costs like prescription costs."

Similar programs elsewhere in the country have come under fire. In Michigan, lawmakers and physician groups opposed an incentive program launched by a subsidiary of Blue Cross Blue Shield of Michigan, Blue Care Network, which ran a three-month program that paid doctors $100 for each patient who switched to a generic cholesterol-lowering medication from a brand-name drug.

In response to the backlash, the American Medical Association posted a position statement on its Web site that reads: "A physician accepting payment from an insurer in exchange for moving a patient from a brand name to a generic drug could potentially face both criminal and civil liability exposure under the federal antikickback statute."

Generic drugs that are approved by the Food and Drug Administration must be the "bioequivalent" to their brand-name counterparts, meaning their active ingredients must be the same, drug experts said.

But some doctors said they are wary about switching the drug regimens of patients who are doing well. Prescribing a different drug within the same class could harm a patient, some said.

"The more serious the drug, the more concerned I am about forced substitution," an associate professor at NYU School of Medicine, Dr. Marc Siegel, said.

In New York, the incentive programs offer doctors increased reimbursement if they change their prescribing habits. Under Independent Health's program, doctors who increase the rate at which they prescribe generics receive a cash reward based on their patient base. A physician who increases their rate to 70% from 40%, for example, would receive fifty cents each month for each Independent Health member whom they treat.

Under the Excellus plan, doctors who increase their ratio of generic drug prescriptions to brand-name ones by 5% receive higher reimbursement for patient office visits. The company declined to provide further details on how much doctors are paid, citing proprietary reasons, but officials said the overall goal of the program is to encourage patients and physicians to consider generics.

Officials from Independent Health said their program seeks to educate patients, but they are also rewarding doctors for doing the "extra work" associated with discussing generics with their patients. "Like it or not, physicians are in a business," the company's vice president of pharmacy services, John Rodgers, said.

Other health insurance companies denied plans to launch similar programs. But doctors said a number of companies issue "report cards" that include a tally of the prescriptions that physicians write.

At least one company, Cigna, said it issues quarterly reports to physicians as part of a "Save with Generics" program, which seeks to promote the use of generics by informing patients and doctors how much money they could have saved by avoiding costly brand-name drugs.

"The only purpose is to inform physicians of opportunities to help their patients save money on their prescription medications," the director of public relations for Cigna, Lindsay Shearer, wrote in an e-mail message.

Physicians said the letters and faxes they routinely receive from insurers, which inform them when they could have saved their patients money, amount to unwanted pressure to choose generics. Other tactics used by insurance companies to reduce costs include requiring patients to obtain prior authorization for more expensive drugs, drawing up "preferred" lists of medications, and placing medicines in tiers based on cost and requiring patients to pay more for certain drugs.

"This clearly puts the burden on the doctors to 'fall in line' with the prescribing wishes of the companies," a Manhattan cardiologist, Dr. Adam Deutsch, said.

Dr. Deutsch said most of the time there is no medical reason why a generic cannot be substituted for a brand-name drug. "In all honesty, there's like seven cholesterol drugs on the market. Does it matter? No, it doesn't," he said. "The key is interference. Why is this multi-billion dollar company writing me a letter about my relationship with my patient? To me, it's an ethical issue, not a clinical one."

In recent years, doctors have been scrutinized for accepting drug samples and free lunches from pharmaceutical companies. Both practices are common, and doctors interviewed for this article said they have accepted such gifts. But they distinguished accepting drug samples and lunches from cash incentives by describing the cash incentives as bribes.

Dr. Torosoff, the Albany cardiologist, said he has been paid to speak at events sponsored by drug companies. He declined to say how much he was compensated, but he said the practice is different from accepting a cash incentive from an insurance company because as a lecturer he is performing a service and because he only lectures on FDA-approved drugs and their intended uses.

Dr. Torosoff said pharmaceutical companies have also funded research at the hospital where he works, Albany Medical Center, but he defended such grants by saying he did not personally benefit from them. Regarding the free lunches he has accepted from drug companies in the past, he described the meals as an "advertising" opportunity for pharmaceutical companies. "It's laughable to think I will prescribe something that is harmful to my patients because I got a five-dollar lunch," he said.

Officials from the state's medical society said their position is clear regarding financial incentives given to doctors who prescribe generics: A doctor's primary focus should be on their patient's welfare. "I don't criticize the insurance companies for wanting to contain costs, that's a laudable goal," the executive vice president of the Medical Society of the State of New York, Rick Abrams, said. But he said when conversion is done solely for purposes of cost and not quality, "then we have a severe problem with a program like that."

At least one New York lawmaker, a state senator of the Bronx, Jeff Klein, is proposing legislation that would require all medically necessary prescriptions to be covered by insurance companies. In May, Mr. Klein's office published a report that identified widespread restrictions placed on drug coverage by 19 health maintenance organizations in New York. Of the drugs surveyed, Lipitor, which is used to lower cholesterol, and Singulair, a medication for asthmatics, were the most restricted. Eight companies restricted Lipitor's use, and 11 companies limited Singulair's use.

Mr. Klein said restrictions do not benefit consumers, particularly those who take "single-source" medications, or drugs without a generic equivalent. "They're making it difficult for people to get the drugs they need," Mr. Klein said.  Read More & Comment...

Drat those unintended consequences!

07/15/2008 11:56 AM |

“Importation” would likely average out the cost of medicines by lowering U.S. prices and raising them in other countries. PhRMA?  No, McCain campaign advisor Gail Wilensky.

After all, “importation” is, ultimately, the importation of foreign price controls.

Oh yes – and then there are all of those pesty safety questions.

Drat those unintended consequences. So inconvenient for political rhetoric.   Read More & Comment...

DeBakey Hailed As Greatest Surgeon Ever As Grassley Launches Investigation Into Deceased Doctor's Ties to Device Industry

07/15/2008 05:25 AM |

Dr Michael DeBakey, the world famous heart surgeon who, according to the AP, "pioneered such now-common procedures as bypass surgery and invented a host of devices to help heart patients" died last week at age 99, was hailed by most as a pioneer for his 70 years of work and innovation.  At the same time, Senator Charles Grassley has launched an investigation into what, according to a report by Gardiner Harris of the NYT, might possibly be unreported consulting fees of millions of dollars that DeBakey received over that same time span from various medical device companies as well as contributions from such companies to the Michael DeBakey Heart Institute.

According to a letter released by Senator Grassley's office:  "I have it on good authority that money from device companies can corrupt research and actually turn devices and  procedures such a bypass surgery ineffective.  There are serious questions as to whether or not Dr. DeBakey's devices were actually needed and whether bypass surgery is truly safe and effective.  Indeed, there are questions as to whether Dr. DeBakey actually existed at all..."

As with other Gardiner Harris articles, the article on Dr. DeBakey consists of:

1. A leaked letter from Senator Grassley's office that is quoted uncritically
2.  Linked in ad hominem fashion to other "scandals" such as a device manufacturer giving hospitals grants which in no way are related to Dr. DeBakey but Harris wrote about and since he is too lazy to do real reporting he recycles the material
3.  Quotes from critics who never met Dr. DeBakey but hate industry in general and are on Harris' speed dial.

Grassley's office has issued a subpoena to Dr. DeBakey requesting he provide information relating to "all fees received from all device companies during periods specified by this office."  When reminded that Dr. DeBakey was deceased, Senator Grassley remarked: "That in itself is no excuse for evading the wrath and reach of my office.  Does anyone know if DeBakey was actually a ministry?    Read More & Comment...

It took me 4 days to hitchhike from Saginaw

07/14/2008 08:03 PM |

This election year, many will call for "universal health care" promising that it's a simple solution to problems we face. But the facts prove otherwise.

Those who advocate a government-run health system for the United States often point to the British National Health Service and the Canadian health system as models of state-financed -- and high-quality -- health care. Just look at the statistics and international rankings from groups such as the World Health Organization, they say.

Don't be fooled. As the saying goes, statistics are like a bathing suit. What they show you is interesting, but what they conceal is essential.

And what does the World Health Organization's data conceal? That the United Kingdom and Canadian health care systems focus more on saving money than on caring for patients. As a result, citizens of these countries experience long wait times, a lack of access to certain treatments and, in many instances, substandard medical care.

For example, a typical Canadian seeking surgical or other therapeutic treatment had to wait 18.3 weeks in 2007 -- an all-time high. Approximately 875,000 Canadians are currently on waiting lists for medical treatment.

Many Canadians can't even get routine care. Of those who sought routine or ongoing care in 2005, one in six had trouble even getting into a doctor's office for a routine procedure or check-up.

It's no better across the Atlantic. Patients with serious illnesses such as cancer face much longer odds of survival in government-run health care systems. In the United Kingdom, the five-year survival rate for patients diagnosed with breast cancer early on is 78 percent -- compared to 98 percent for similar patients in the U.S.

It's easy to understand why the public doesn't know the truth about universal health care. Politicians and polemicists have clouded the issue, deliberately ignoring the major problems with government-run health care and promising that "universal health care" will be "free."

But when it comes to health care, there ain't no such thing as a free lunch.

Here’s the rest of the story from a newspaper serving a part of the country that’s going to get a lot of attention in the weeks leading up to November 4^th -- The Saginaw News:

Read article

Our national conversation about health care has to advance beyond vague concepts and convenient political rhetoric. Government guarantees of universal care may sound appealing, but as universal systems elsewhere have shown, those guarantees are little more than hot air.

  Read More & Comment...