Latest Drugwonks' Blog
Here is Berwick claiming that the US can ratchet down cost to UK levels and be just fine.....
"..... It is manifestly possible for a Western democracy to give all the care its population needs for about 10 percent of GDP. It is possible. You can't say it's not possible because it's being done. We're at 16 percent or 17 percent. We're wasting probably 40 percent or 30 percent of the dollars we're putting into health care. That's true and I don't understand, Michael I know will come at me on this, why we just don't target that as an aim, reduce the total cost. Thirty percent waste easily in our system. I think he wants to get there by working on quality and value and that's probably right, but don't take your eye off the ball. "
"...integrated care for chronic illness and the gaps there in. The Commonwealth Fund is now our lead, I guess, scrutinizer of that problem. Seventy percent of costs go into chronic illness care. Probably half of it is pure waste. And a lot of it happens because we don’t have the integrated flows that we need for a restructured care system.
"The third really might be American exceptionalism. It’s our inability to learn from successful models outside of this country. Countries that function with better care than we have; we are 19th out of 19. That’s OECD data, that’s what Senator Baucus said and he’s right, compared to countries that are functioning at 60 or 70 cents on our health care dollar.
"We’ve got to learn from these other models and not throw them away because we assume that stuff like that doesn’t work here. It will. It’s our decision, what we choose we can choose to change."
So we should ration access to new drugs and treatments? Is there any evidence that care -- where waiting times are longer and primary care is vastly overused -- is more "integrated?"
"My wife is Under Secretary for Energy in Massachusetts and she has taught me about decoupling in the energy world where utilities now in at least 20 states or so, aren’t paid for volume. They can make as much money by saving a kilowatt as by making one. We need to do that with care. You ought to be able to somehow treat an empty bed as an asset. Right now we don’t do that at all. "
An empty bed as an asset? What does that mean? Should we fill beds to make money?
No media scrutiny whatsoever and yet more than $1 billion of tax dollars to be spent in the stimulus....
Way to go. The media is complicit in the creation of a slush fund for Daschle that pales in comparison to whatever tax filing mistake he may have made.
That's the incoming Secretary for Health and Human Services, Tom Daschle, speaking at a national conference on health care reform in December.
Daschle is right to be optimistic. Too many Americans lack health insurance, and there are many opportunities for reform.
Unfortunately, his reform ideas center on the government's playing a larger role in the health care market. This concept is popular among voters, as there's a widespread perception that health care systems abroad are a runaway success. The media tends to present those systems in the best light possible, highlighting their apparent benefits and ignoring their downsides. As a result, many Americans have overly positive visions of what life is like under universal health care -- and so support its creation here at home.
The truth is that government-controlled health care is not free. It comes at a great cost in the form of high taxes, long waiting lines and frequent denials of coverage.
French citizens pay about 20 percent more in income tax than Americans, according to the Organization for Economic Cooperation and Development.
The Fraser Institute reports that Canadians face an average wait of almost 18 weeks between a general practitioner's referral and actual treatment by a specialist.
In the United Kingdom, the national health care agency won't cover treatments with a yearly cost of more than $46,000. British citizens pay 11 percent to 12 percent of their weekly income to finance the country's health care system. Many popular pharmaceutical drugs aren't covered by public insurance.
It's estimated that about one- fifth of taxes collected in Canada go toward funding the country's health system.
So much for "free" health care.
Most universal health care systems also impose strict price controls on pharmaceutical drugs. But, as a new study from the Rand Corp. finds, introducing similar price regulations in the U.S. would stifle drug innovation, resulting in reduced average life expectancy.
The costs of universal health care are real and substantial. It's imperative that voters and legislators see the other side of the story before any reforms are implemented.
For the rest of the story, have a look at this op-ed from the Chicago Sun-Times.
The other day, some oncologists in Denmark did a similar thing. According to some new authority, there is no evidence that the benefit from the cancer medicine Avastin outweighs the negative impact of side-effects. This would justify the decision not to make this product the first choice when treating lung cancer.
The oncologists begged to differ, and circulated a letter to the concerned patients to inform them of their view.
According to the Swedish website Dagens Medicin, the central authority Danske Regioner will now stop this letter from being sent.
Said the politician in charge : "It would be very unethical to distribute such letters now that we have done so much to build confidence in Danish cancer treatments."
Really ? Is it more "ethical" to silence doctors who actually believe in the benefits of a certain treatment ? Probably not; but this is about saving money, sorry, rational use of drugs.
"Darvon should not be used by people who are suicidal or who easily become addicted to medicines, alcohol, or other substances. Do not take more of Darvon than the dose your doctor prescribed. Taking excessive doses of Darvon by itself, with other medicines, or with alcohol may cause serious side effects and could be fatal. Limit the amount of alcohol you drink while you are taking Darvon . Tell your doctor if you have a history of any substance abuse, mood or mental disorders, suicidal thoughts or attempts, or if you take any medicines that cause drowsiness such as tranquilizers, sleep medicines, muscle relaxers, or antidepressants."
And here is an Time Magazine article about Darvon and the efforts of Sid Wolfe, now an offical pain the you know what as a member of the Risk Benefit advisory committee for the FDA, to ban the drug:
"... Wolfe asked for an immediate ban on the sale of the widely prescribed pain reliever propoxyphene, best known as Darvon. He claimed not only that Darvon is an ineffective painkiller, but also that in excessive doses it produces a euphoric high, which he says, "makes it attractive as a drug of abuse. This is tantamount to legalized dope." Further, said Wolfe, Darvon-related deaths in the U.S. have been increasing, rising in major cities to about 600 last year and making the compound "the deadliest prescription drug in the United States." Eli Lilly and Co., of Indianapolis, the principal manufacturer, promptly branded Wolfe's charges "irresponsible and clearly not supported by the facts."
Darvon-related deaths have often involved intentional misuse, either by overdosing or mixing with alcohol and other drugs. Lilly notes that the average person would have to take 30 large-size Darvon capsules at one time (the usual dose is one every four hours) to cause death, 15 if he were intoxicated. Further, the drug is a controlled substance—a prescription is good for only five refills within six months. (If HEW will not ban Darvon, Wolfe wants the drug reclassified so that prescriptions cannot be refilled.)
Lilly also says that Wolfe's claim about Darvon's effectiveness is misleading because it is largely based on studies of single, rather than multiple, doses of the drug. Doctors prefer Darvon for some patients because, unlike aspirin, it does not cause gastrointestinal bleeding or lower the body temperature. Concludes Lilly's Dr. Robert Furman: "Used as directed, Darvon is really very safe. The fact that some people are intent on abusing it shouldn't be used to indict it."
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That article was written 40 years ago. Wolfe was petitioning the FDA then.
I can't say I totally disagree with Wolfe's motives. Darvon and Darvocet were and are the drug of choice for people who seek to commit "peaceful suicide' and is pushed as such by pro-suicide groups and chat rooms. The problem is, banning the drug will remove another effect medicine for menstrual cramps that does not cause internal bleeding and if the UK is any guide those seeking to commit suicide or use painkillers recreationally will use medicines that are stronger or have worse side effects than liver toxicity.
Wolfe's persistence is an example of ideology overriding science and the doctor-patient relationship. The Sid Wolfe fan club (Alicia Mundy, President) might delight in his longstanding effort to drive drugs he detests off the market but for many people, including me and family members, his personal choices would come at the expense of our very lives.
The same members introduced similar bills in 2005 and 2007. Bad idea then. Bad idea today. At least they didn’t try to bury it in the stimulus package.
In addition to gutting the Non-Interference Clause (originally authored, it should be remembered – by Senators Kennedy and … Daschle) HR. 684 would create a federal drug plan option to compete with privately offered Part D plans.
"We have many reasons to be optimistic about the passage of this legislation," Schakowsky said. "It is very much in line with [President Barack Obama's] overall plan in that it gives people an option of a public plan or sticking with a private plan."
When combined with the "Federal Coordinating Council for Comparative Effectiveness Research" (a $1.1 billion earmark in the stimulus package that won’t create a single job on “Main Street”), there's the real potential for Uncle Sam to dictate that Part D prices be tied to prices in other countries -- a kind of Medicare reference price and a big step towards overall price controls.
And price controls = choice controls.
This new “Federal Council” (under the Agency for Healthcare Research and Quality and with zero patient group, industry or academic representation – it’s 100% government) would be responsible for "assessing the clinical benefit of covered Part D drugs and making recommendations to the secretary on which drugs should be included in the formulary."
In addition, an advisory committee can request AHRQ conduct clinical effectiveness and comparative effectiveness studies on drugs.
That means bureaucrats in Washington will be able to tell doctors how to practice medicine by dictating formulary options.
Wither competition? The Bill sponsors expect that if the bill becomes law, it would ultimately limit the number of plans participating in Part D, as private plans would drop out from competing with a publicly run plan.
And to that point, a few things worthy of consideration:
"It is not obvious that allowing the government to negotiate with pharmaceutical companies will lead to lower prices than those achieved by private drug plans. Private plans like Kaiser or United are able to negotiate deep discounts with pharmaceutical companies precisely because of the plans' ability to say no – the ability to include some drugs and to exclude others, allowing the market to judge the resulting formulary. On the other hand, when the government negotiates, its hands are tied because there are few drugs it can exclude without facing political backlash from doctors and the Medicare population, a very influential group of voters. Neither economic theory nor historical experience suggests government price negotiation will achieve lower drug prices. Congressional Democrats need to be careful in making the logical leap from market share to bargaining power. Empowering the government to negotiate with pharmaceutical companies is not necessarily equivalent to achieving lower drug prices. In fact, neither economic theory nor historical experience suggests that will be the outcome. Members should think carefully before jumping on the bandwagon – this promise may bring just the opposite of what was ordered."
Stanford Business School's Alain Enthoven and Kyna Fong
"Both the non-partisan Congressional Budget Office and Medicare actuaries have said they doubt the government could negotiate lower costs than the private sector. The theory behind Part D is that market forces and competition among drug plans, overseen by government, can achieve better results than a government-run program. The multitude of plans allows seniors to pick one that best meets their needs. Government price negotiation could leave people without drugs that manufacturers decide aren't sufficiently profitable under the plan. Medicare recipients account for half of all drug prescriptions. With that kind of clout, government might try to dictate prices, not just negotiate them. This could leave people without drugs that manufacturers decide aren't sufficiently profitable under the plan. The VA plan illustrates the point. It offers 1,300 drugs, compared with 4,300 available under Part D, prompting more than one-third of retired veterans to enroll in Medicare drug plans."
"Our View On Medicare Part D: Put Brakes On Drug Plan 'Fix,'" USA Today, 11/13/06
The bottom line here is that Part D is a tremendous success – due in no small part to the Non-Interference Clause. Consider:
* The projected cost for Medicare Part D is $117 billion lower over the next decade than experts estimated just last summer. This means that over the 10-year period from 2008 to 2017, the estimated $915 billion cost of Part D fell to $798 billion.
Why? Marketplace competition.
* And, according to a study published in the Annals of Internal Medicine, the Medicare drug benefit led to a 17 percent decrease in out-of-pocket expenses, or $9 a month, for seniors who enrolled in the new Medicare Part D benefit in 2006, the first full year prescription coverage became available in the federal health insurance program for the elderly and disabled.
* And the savings amounted to an extra 14 days of medicine for those who signed up, or a 19 percent increase in prescription usage.
Can Part D be made even better? Absolutely. But this is good news worth sharing -- and not because it helps any particular partisan political agenda but because it means that more Americans -- tens of millions of more Americans -- are getting access to the medicines (largely chronic medicines) that will help them live healthier lives. And this, in no small measure, significantly reduces more drastic medical interventions -- which in turn reduces our overall national health care spending.
We shouldn’t interfere with success.
According to Senator Ben Nelson (D-NE), it's unclear whether President Obama's $819 billion economic stimulus bill will win enough support to pass in the Senate. "I don't even know how many Democrats will vote for it, as it stands today," he told FOX News.
Seems like the upper house is unhappy that the bill, passed by the other house on Wednesday, contains billions of dollars for programs that arguably won't spark much job growth. Senator Nelson wants to pluck out what he says are extraneous projects in the stimulus bill to pay for the amendment.
How about plucking out the “sneaking socialism of healthcare.” Specifically the $1.1 billion for a "Federal Coordinating Council for Comparative Effectiveness Research." Not only is this expense a slippery slope towards a NICE-like body for the U.S. – it wouldn’t create a single job for "Main Street."
Here’s a suggestion – give that money to the FDA to hire more scientists, reviewers, and inspectors, update their woeful IT infrastructure, and fund the agency’s Critical Path program.
That’s what I’d call a real stimulus package!
Center for Medicine in the Public Interest is a nonprofit, non-partisan organization promoting innovative solutions that advance medical progress, reduce health disparities, extend life and make health care more affordable, preventive and patient-centered. CMPI also provides the public, policymakers and the media a reliable source of independent scientific analysis on issues ranging from personalized medicine, food and drug safety, health care reform and comparative effectiveness.
