Latest Drugwonks' Blog
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?
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?
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.
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.
“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.
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.
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?
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?
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
Officials with California's state Board of Pharmacy recently announced that they're pushing back the implementation of a controversial law to create an electronic chain of custody for pharmaceuticals. This is welcome news, as the law would have created a logistical and financial nightmare – and significantly raised the price of medicines in California.
Passed in 2004, the law's aim was noble – beat back the rising tide of counterfeit drugs by establishing a statewide system for tracking prescription drug shipments from point-of-production to point-of-sale.
The law's problem, however, was that it would have imposed back-breaking costs on pharmaceutical manufacturers and dramatically inflated drug prices for consumers – while doing little to undermine counterfeiters. That's why, rather than just delay the law, officials should scrap it entirely.
A universal tracking requirement is a shotgun-style solution to a problem better suited for a precision, SWAT-team approach.
Constructing and maintaining tracking technology is expensive. Under the law, every pharmacy in California would have to install equipment costing $10,000 to $40,000 – with no help from the state. Every other business along the distribution chain (drugmakers, hospitals, shipping companies, etc.) would also have to install this technology.
Those increased production costs mean higher drug prices for consumers, and less money for research and development and other promising technological investments like electronic medical records.
It's also unwise for state officials to dictate what kind of tracking technology companies should use. Counterfeiters are devising increasingly sophisticated ways to copy and sell brand-name pharmaceuticals. Drug carriers need to be given the freedom to respond in kind. This law locks them into a technology that could soon be antiquated.
Here's a real solution: Increase the criminal penalties for counterfeiting. As is, punishments aren't proportional to the threat posed to public health. Today, counterfeiting a prescription drug label is punishable with a decade of jail time. Counterfeiting the drug itself? A maximum of three years. That's just not acceptable.
Here’s the rest of the story as it appeared in the Orange County Register:
Orange County Register Op-Ed
Tracking legislation should come from the federal level – a single, uniform system administered by the FDA. A mishmash of state laws is wildly inefficient and will only create weak links in our national chain of custody that will certainly be exploited by criminals who don't think twice before putting counterfeit drugs into Americans' medicine chests.
Passed in 2004, the law's aim was noble – beat back the rising tide of counterfeit drugs by establishing a statewide system for tracking prescription drug shipments from point-of-production to point-of-sale.
The law's problem, however, was that it would have imposed back-breaking costs on pharmaceutical manufacturers and dramatically inflated drug prices for consumers – while doing little to undermine counterfeiters. That's why, rather than just delay the law, officials should scrap it entirely.
A universal tracking requirement is a shotgun-style solution to a problem better suited for a precision, SWAT-team approach.
Constructing and maintaining tracking technology is expensive. Under the law, every pharmacy in California would have to install equipment costing $10,000 to $40,000 – with no help from the state. Every other business along the distribution chain (drugmakers, hospitals, shipping companies, etc.) would also have to install this technology.
Those increased production costs mean higher drug prices for consumers, and less money for research and development and other promising technological investments like electronic medical records.
It's also unwise for state officials to dictate what kind of tracking technology companies should use. Counterfeiters are devising increasingly sophisticated ways to copy and sell brand-name pharmaceuticals. Drug carriers need to be given the freedom to respond in kind. This law locks them into a technology that could soon be antiquated.
Here's a real solution: Increase the criminal penalties for counterfeiting. As is, punishments aren't proportional to the threat posed to public health. Today, counterfeiting a prescription drug label is punishable with a decade of jail time. Counterfeiting the drug itself? A maximum of three years. That's just not acceptable.
Here’s the rest of the story as it appeared in the Orange County Register:
Orange County Register Op-Ed
Tracking legislation should come from the federal level – a single, uniform system administered by the FDA. A mishmash of state laws is wildly inefficient and will only create weak links in our national chain of custody that will certainly be exploited by criminals who don't think twice before putting counterfeit drugs into Americans' medicine chests.
Here’s Senator Chuck Grassley on the APA’s use of money for medical symposia and other activities….
"I have come to understand that money from the pharmaceutical industry can shape the practices of nonprofit organizations that purport to be independent in their viewpoints and actions," Mr. Grassley said.
That’s rich, coming from someone who said: "everything about ethanol is good, good, good."
I have come to understand that money from the soybean and biofuels industry can shape the practices of a Senator from Iowa that purports to be independent in his viewspoints and actions and who makes a career implying that money alone is the sole factor in forming judgments.
Or how about taking responsibility for creating and propping up this monster called ethanol?
“According to the Global Subsidies Initiative of the International Institute for Sustainable Development, ethanol tax credits and incentives will cost U.S. tax payers between $6.3 and 8.7 billion dollars annually between 2006 and 2012. Additionally, according to a study conducted by the Center for Agricultural and Rural Development (CARD) at Iowa State University, the price of ethanol is being held artificially high by import tariffs imposed on foreign producers of ethanol. According to one of the authors, “Removing trade distortions would decrease the price for U.S. ethanol, while the world price would increase, as U.S. demand — and ethanol imports — would increase.” The drop in domestic ethanol prices could be as much as 18%.”
Now, I might be mistaken. But for a guy who is stressed about governmenet officials being too cozy with industry Grassley might want to start with himself. Here’s the record:
“Agribusiness giant Archer Daniels Midland Co. (ADM), the single largest beneficiary of a controversial federal ethanol tax subsidy, contributed more than $3 million in unregulated "soft money" to Republican and Democratic national party committees during the past 10 years, according to a study by Common Cause.
ADM gave direct political action committee contributions to congressional candidates: $700,170 to Democrats and $529,276 to Republicans from Jan. 1, 1987, to Dec, 31, 1997, according to the report.
The top recipient in the Senate was Richard J. Durbin (D-Ill.), who got $34,500. The Senate Republican who received the most was Charles E. Grassley (R-Iowa), with $17,000.”
ADM has been a prime beneficiary of the federal tax credit on ethanol, which the refiner can apply to the tax it pays on corporate income. First implemented in 1978, the tax credit currently stands at 51 cents per gallon of ethanol sold. The Government Accounting Office estimates the subsidies to the ethanol industry from 1980-2000 at $11 billion. As the biggest ethanol producer in the US, ADM has received the largest portion of the government's generosity.
According to the Heritage Foundation:
Senator Charles Grassley (R-IA) has extensive farm interests, as do some members of his immediate family. Listing his home address as Arlington, Virginia, Grassley received $225,041 in USDA subsidies for corn and soybeans and disaster assistance between 1995 and 2005.[8]
In New Hartford, Iowa, Senator Grassley's son Robin has received $653,833 in subsidy payments, mostly for corn and soybeans.[9] Patrick Grassley, the Senator's grandson, who also lives in New Hartford, received $5,964 in subsidies in 2005.[10]
In 2003 an energy bill authorized $1.75 billion over seven years in "transition" assistance to MTBE manufactures, including oil companies and refiners, as they scaled back production because of state bans on the product. The bill extended a Senate-proposed federal MTBE phaseout from four years to 10 years.
The largest GOP recipient of cash who in turn supported the measure?
Chuck Grassley.
http://www.firstcoastnews.com/news/news-article.aspx?storyid=10915
Over the years Grassley has received $1.5 million in direct campaign contributions from agribusinesss and energy interests, the largest source of cash next to health insurance companies which has been part of a quid pro quo for all sorts of goodies for Iowa.
Here’s the Washington Post’s Steven Pearlstein on Grassley who objected to parts of the housing bill that might be used to underwrite failing investment banks:
Well, isn’t this rich: Max Baucus of Montana and Chuck Grassley of Iowa, chairman and ranking member, respectively, of the Senate Finance Committee are suddenly in a lather that taxpayer funds might be implicated in the Federal Reserve’s rescue of Bear Stearns.
Would that be the same Max Baucus and Chuck Grassley who have made careers out of protecting and enhancing the lavish system of import restrictions, price supports and other subsidies that have transformed American farming and ranching into a vast socialist enterprise? You betcha.
Washington Post Article
Setting aside the hypocrisy of Grassley’s inquisitions what about their legality or constitutionality. On what grounds does he request information about the funding sources or uses of funds from non-profit organizations, including churches. Should the dislike of a practice be sufficient? Should the assertion “"I have come to understand that money from the pharmaceutical industry can shape the practices of nonprofit organizations that purport to be independent in their viewpoints and actions" be grounds enough to engage in a witch hunt?
Has anyone else found it peculiar that Grassley has gone after psychiatry and churches? Is this the same as going off the deep end?
There are some on Grassley’s staff, what’s left of it, that think so:
(S)enior staffers….have have expressed profound discomfort with Senator Grassley’s actions, and wondered, rightly, whether this was not a simple assault on American religious freedom. If the United States Senate can de facto audit these preachers at whim and absent evidence of wrongdoing, what’s the barrier to doing the same to Catholics, Baptists, Anglicans, Jews, Muslims, or Mormons? Is the standard now one of mere Senatorial dislike? How is this standard not inherently politicized? The conversation ended with both of them expressing displeasure with the Senator, and grave reservations on his sense of proportion — and Constitutional propriety.
Senator Grassley is a fixture in Washington, D.C., and in Iowa politics, and so he is used to getting what he wants. But when even his own office is riven with doubts on his pet causes — on Constitutional grounds, no less — it’s time to ask the good Senator to step back, and check the hubris.”
Then again, as others have noted, you can get Grassley to see your way by making sure your solution is “Iowa-based” if you know what I mean…
The American Psychiatric Association and pharma might be able to solve their problem by dumping every dime of CME into a new Grassley Center for Continuing Medical Education at the University of Iowa which would be run out of a new building that would rise up in flood ravaged downtown Des Moines.
I bet then Grassley’s understanding of how money from pharma shapes nonprofit practices would be transformed….
"I have come to understand that money from the pharmaceutical industry can shape the practices of nonprofit organizations that purport to be independent in their viewpoints and actions," Mr. Grassley said.
That’s rich, coming from someone who said: "everything about ethanol is good, good, good."
I have come to understand that money from the soybean and biofuels industry can shape the practices of a Senator from Iowa that purports to be independent in his viewspoints and actions and who makes a career implying that money alone is the sole factor in forming judgments.
Or how about taking responsibility for creating and propping up this monster called ethanol?
“According to the Global Subsidies Initiative of the International Institute for Sustainable Development, ethanol tax credits and incentives will cost U.S. tax payers between $6.3 and 8.7 billion dollars annually between 2006 and 2012. Additionally, according to a study conducted by the Center for Agricultural and Rural Development (CARD) at Iowa State University, the price of ethanol is being held artificially high by import tariffs imposed on foreign producers of ethanol. According to one of the authors, “Removing trade distortions would decrease the price for U.S. ethanol, while the world price would increase, as U.S. demand — and ethanol imports — would increase.” The drop in domestic ethanol prices could be as much as 18%.”
Now, I might be mistaken. But for a guy who is stressed about governmenet officials being too cozy with industry Grassley might want to start with himself. Here’s the record:
“Agribusiness giant Archer Daniels Midland Co. (ADM), the single largest beneficiary of a controversial federal ethanol tax subsidy, contributed more than $3 million in unregulated "soft money" to Republican and Democratic national party committees during the past 10 years, according to a study by Common Cause.
ADM gave direct political action committee contributions to congressional candidates: $700,170 to Democrats and $529,276 to Republicans from Jan. 1, 1987, to Dec, 31, 1997, according to the report.
The top recipient in the Senate was Richard J. Durbin (D-Ill.), who got $34,500. The Senate Republican who received the most was Charles E. Grassley (R-Iowa), with $17,000.”
ADM has been a prime beneficiary of the federal tax credit on ethanol, which the refiner can apply to the tax it pays on corporate income. First implemented in 1978, the tax credit currently stands at 51 cents per gallon of ethanol sold. The Government Accounting Office estimates the subsidies to the ethanol industry from 1980-2000 at $11 billion. As the biggest ethanol producer in the US, ADM has received the largest portion of the government's generosity.
According to the Heritage Foundation:
Senator Charles Grassley (R-IA) has extensive farm interests, as do some members of his immediate family. Listing his home address as Arlington, Virginia, Grassley received $225,041 in USDA subsidies for corn and soybeans and disaster assistance between 1995 and 2005.[8]
In New Hartford, Iowa, Senator Grassley's son Robin has received $653,833 in subsidy payments, mostly for corn and soybeans.[9] Patrick Grassley, the Senator's grandson, who also lives in New Hartford, received $5,964 in subsidies in 2005.[10]
In 2003 an energy bill authorized $1.75 billion over seven years in "transition" assistance to MTBE manufactures, including oil companies and refiners, as they scaled back production because of state bans on the product. The bill extended a Senate-proposed federal MTBE phaseout from four years to 10 years.
The largest GOP recipient of cash who in turn supported the measure?
Chuck Grassley.
http://www.firstcoastnews.com/news/news-article.aspx?storyid=10915
Over the years Grassley has received $1.5 million in direct campaign contributions from agribusinesss and energy interests, the largest source of cash next to health insurance companies which has been part of a quid pro quo for all sorts of goodies for Iowa.
Here’s the Washington Post’s Steven Pearlstein on Grassley who objected to parts of the housing bill that might be used to underwrite failing investment banks:
Well, isn’t this rich: Max Baucus of Montana and Chuck Grassley of Iowa, chairman and ranking member, respectively, of the Senate Finance Committee are suddenly in a lather that taxpayer funds might be implicated in the Federal Reserve’s rescue of Bear Stearns.
Would that be the same Max Baucus and Chuck Grassley who have made careers out of protecting and enhancing the lavish system of import restrictions, price supports and other subsidies that have transformed American farming and ranching into a vast socialist enterprise? You betcha.
Washington Post Article
Setting aside the hypocrisy of Grassley’s inquisitions what about their legality or constitutionality. On what grounds does he request information about the funding sources or uses of funds from non-profit organizations, including churches. Should the dislike of a practice be sufficient? Should the assertion “"I have come to understand that money from the pharmaceutical industry can shape the practices of nonprofit organizations that purport to be independent in their viewpoints and actions" be grounds enough to engage in a witch hunt?
Has anyone else found it peculiar that Grassley has gone after psychiatry and churches? Is this the same as going off the deep end?
There are some on Grassley’s staff, what’s left of it, that think so:
(S)enior staffers….have have expressed profound discomfort with Senator Grassley’s actions, and wondered, rightly, whether this was not a simple assault on American religious freedom. If the United States Senate can de facto audit these preachers at whim and absent evidence of wrongdoing, what’s the barrier to doing the same to Catholics, Baptists, Anglicans, Jews, Muslims, or Mormons? Is the standard now one of mere Senatorial dislike? How is this standard not inherently politicized? The conversation ended with both of them expressing displeasure with the Senator, and grave reservations on his sense of proportion — and Constitutional propriety.
Senator Grassley is a fixture in Washington, D.C., and in Iowa politics, and so he is used to getting what he wants. But when even his own office is riven with doubts on his pet causes — on Constitutional grounds, no less — it’s time to ask the good Senator to step back, and check the hubris.”
Then again, as others have noted, you can get Grassley to see your way by making sure your solution is “Iowa-based” if you know what I mean…
The American Psychiatric Association and pharma might be able to solve their problem by dumping every dime of CME into a new Grassley Center for Continuing Medical Education at the University of Iowa which would be run out of a new building that would rise up in flood ravaged downtown Des Moines.
I bet then Grassley’s understanding of how money from pharma shapes nonprofit practices would be transformed….
Tony Snow and Bobby Murcer had a direct impact on my life. I knew Tony a little or rather, he touched my life for the better the way he likely touched hundred of other lives. Over 25 years ago when, as a newly minted assistant to the director of the Civil Rights Commission, holdover radicals appointed by Jimmy Carter forced me to leave for having the audacity of letting the public know certain commissioners suggesting riots were a response to President Reagan's election. I was sitting in a vacant office at the American Enterprise Institute trying to figure out where I was going to get a job when I got a phone call from someone in the President's office named Tony Snow who then passed my name on to other people in the administration.
Years later, when Tony was working both for USA Today and Fox he would either quote my articles or chat with me briefly. I called to thank him and still remember the joy and enthusiasm in his voice for doing battle as well as the genuine feeling of interest he took in me and my writing.
His turn on Fox News and as the President's press secretary gave him visibility he richly desevered. His first love was his family and that was the focus of his efforts in the remaining years of his life.
I never knew Bobby Murcer. As a Yankee fan I had hoped he would be the "next" Mickey Mantle. But being Bobby Murcer was good enough. Great clutch hitting, Excellent outfielder and team leader. Then being the voice of the Yankees for so many years.
What many didn't know, even until he was diagnosed with a brain tumor, was that he devoted much of his life after baseball, to raising money for cancer research and for people in the baseball community who needed help paying for mortgages, medical bills etc.
It has been said by some that new cancer treatments that "only" add a few months of life are not worth the cost. I think of Tony Snow, who I know did for many what he did for me and who was able to provide for his family with the time science and G-d gave him and of Bobby Murcer who did so much for others suffering from cancer and of limited means and wonder what yardstick is applied by those who would sit on high. We have lost two great men whose contribution to society and involvement with their families will endure and outweigh the claims imposed by people who would rob us of their presence out of cost considerations.
Years later, when Tony was working both for USA Today and Fox he would either quote my articles or chat with me briefly. I called to thank him and still remember the joy and enthusiasm in his voice for doing battle as well as the genuine feeling of interest he took in me and my writing.
His turn on Fox News and as the President's press secretary gave him visibility he richly desevered. His first love was his family and that was the focus of his efforts in the remaining years of his life.
I never knew Bobby Murcer. As a Yankee fan I had hoped he would be the "next" Mickey Mantle. But being Bobby Murcer was good enough. Great clutch hitting, Excellent outfielder and team leader. Then being the voice of the Yankees for so many years.
What many didn't know, even until he was diagnosed with a brain tumor, was that he devoted much of his life after baseball, to raising money for cancer research and for people in the baseball community who needed help paying for mortgages, medical bills etc.
It has been said by some that new cancer treatments that "only" add a few months of life are not worth the cost. I think of Tony Snow, who I know did for many what he did for me and who was able to provide for his family with the time science and G-d gave him and of Bobby Murcer who did so much for others suffering from cancer and of limited means and wonder what yardstick is applied by those who would sit on high. We have lost two great men whose contribution to society and involvement with their families will endure and outweigh the claims imposed by people who would rob us of their presence out of cost considerations.
FDA Approves New Genetic Test for Patients with Breast Cancer
The U.S. Food and Drug Administration has approved a novel genetic test for determining whether patients with breast cancer are good candidates for treatment with the drug Herceptin (trastuzumab).
The SPOT-Light HER2 CISH kit is a test that measures the number of copies of the HER2 gene in tumor tissue. This gene regulates the growth of cancer cells.
A healthy breast cell has two copies of the HER2 gene, which sends a signal to cells, telling them when to grow, divide and make repairs. Patients with breast cancer may have more copies of this HER2 gene, prompting them to overproduce HER2 protein so that more signals are sent to breast cells. As a result, the cells grow and divide much too quickly.
“When used with other clinical information and laboratory tests, this test can provide health care professionals with additional insight on treatment decisions for patients with breast cancer,” said Daniel Schultz, M.D., director of the FDA’s Center for Devices and Radiological Health.
The SPOT-Light test counts the number of HER2 genes in a small sample of removed tumor. The removed piece is stained with a chemical that causes any HER2 genes in the sample to change color. This color change can be visualized under a standard microscope, eliminating the need for the more expensive and complex fluorescent microscopes required to read assays already on the market. Unlike existing tests, the SPOT-Light allows labs to store the tissue for future reference.
Patients who over-produce HER2 protein are typically treated with the drug Herceptin, which targets HER2 protein production. This helps to stop the growth of HER2 cancer cells.
The FDA based its approval of the SPOT-Light test on a study using tumor samples from patients with breast cancer in the United States and Finland. These studies confirmed that the test was effective in determining how many HER2 genes were in these patients.
SPOT-Light is manufactured by Invitrogen Corp. of Carlsbad, Calif. Herceptin is manufactured by Genentech, of San Francisco, Calif.
The U.S. Food and Drug Administration has approved a novel genetic test for determining whether patients with breast cancer are good candidates for treatment with the drug Herceptin (trastuzumab).
The SPOT-Light HER2 CISH kit is a test that measures the number of copies of the HER2 gene in tumor tissue. This gene regulates the growth of cancer cells.
A healthy breast cell has two copies of the HER2 gene, which sends a signal to cells, telling them when to grow, divide and make repairs. Patients with breast cancer may have more copies of this HER2 gene, prompting them to overproduce HER2 protein so that more signals are sent to breast cells. As a result, the cells grow and divide much too quickly.
“When used with other clinical information and laboratory tests, this test can provide health care professionals with additional insight on treatment decisions for patients with breast cancer,” said Daniel Schultz, M.D., director of the FDA’s Center for Devices and Radiological Health.
The SPOT-Light test counts the number of HER2 genes in a small sample of removed tumor. The removed piece is stained with a chemical that causes any HER2 genes in the sample to change color. This color change can be visualized under a standard microscope, eliminating the need for the more expensive and complex fluorescent microscopes required to read assays already on the market. Unlike existing tests, the SPOT-Light allows labs to store the tissue for future reference.
Patients who over-produce HER2 protein are typically treated with the drug Herceptin, which targets HER2 protein production. This helps to stop the growth of HER2 cancer cells.
The FDA based its approval of the SPOT-Light test on a study using tumor samples from patients with breast cancer in the United States and Finland. These studies confirmed that the test was effective in determining how many HER2 genes were in these patients.
SPOT-Light is manufactured by Invitrogen Corp. of Carlsbad, Calif. Herceptin is manufactured by Genentech, of San Francisco, Calif.
An FDA Advisory panel voted not to put a black box warning on epilepsy drugs regarding the reporting of suicidal thoughts and feelings of some taking the meds. The reason?
"We have to be very careful about scaring the patients into not taking these drugs, and I think we have to be very thoughtful about that," says Rochelle Caplan, MD, a professor of psychiatry at University of California Los Angeles and a member of the expert panel.
Which is precisely why people like Jeanne Lenzer, Shannon Brownlee and the crackpots who cluster at pharmalot.com push for black box warnings on all meds for mental illness and pols like Bart Stupak and Chuck Grassley seek them. And it's why someone like Steve Nissen would use meta-analysis and press conferences to try to get them for Avandia and drugs for ADHD or demand that Vytorin be yanked from the market.
Fear mongering based on shoddy science advances a political agenda or a financial interest.
Sadly, I am sure the expert panel exposed themselves to both abuse and threats of physical violence, often stimulated by the kind of reporting or misreporting and blogs I have mentioned above. When chelation therapy becomes a subject of NIMH funding and black box warnings become a political tool to drive effective drugs off the market based on indiscriminate data amplified through the media and politician's press releases you know that Tabloid Medicine is replacing real science in guiding medical practice. Once in a while you have some brave souls who follow the facts. But for how long?
"We have to be very careful about scaring the patients into not taking these drugs, and I think we have to be very thoughtful about that," says Rochelle Caplan, MD, a professor of psychiatry at University of California Los Angeles and a member of the expert panel.
Which is precisely why people like Jeanne Lenzer, Shannon Brownlee and the crackpots who cluster at pharmalot.com push for black box warnings on all meds for mental illness and pols like Bart Stupak and Chuck Grassley seek them. And it's why someone like Steve Nissen would use meta-analysis and press conferences to try to get them for Avandia and drugs for ADHD or demand that Vytorin be yanked from the market.
Fear mongering based on shoddy science advances a political agenda or a financial interest.
Sadly, I am sure the expert panel exposed themselves to both abuse and threats of physical violence, often stimulated by the kind of reporting or misreporting and blogs I have mentioned above. When chelation therapy becomes a subject of NIMH funding and black box warnings become a political tool to drive effective drugs off the market based on indiscriminate data amplified through the media and politician's press releases you know that Tabloid Medicine is replacing real science in guiding medical practice. Once in a while you have some brave souls who follow the facts. But for how long?
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.
