Latest Drugwonks' Blog
Just participated on a "blogger conference call" with Mark Fendrick (University of Michigan) and Michael Chernew (Harvard University). They are the co-directors of the Center for Value-Based Insurance Design.
The VBID Center sounds like an interesting proposition. For more detail check out their website:
http://www.sph.umich.edu/vbidcenter/
Many interesting points were brought up -- not the least of which was the issue of whether or not -- considering the relatively truncated lifespan of any individual's relationship with a given private payer -- Big Insurance can be convinced to offer more efficient programs that incent aggressive preventative and chronic care.
And, since the VBID program is based in the Wolverine State, I asked if they thought the new GM/Union agreement over health care would result in more patient-centric programs. Both Dr. Fendrick and Dr. Chernew demurred from making a prediction. Typical academics!
I think it will. Because (1) These are union employees who (at least in theory) will be with the insurance plan for an extended period -- so additional up-front costs (aka "investments") can be recouped over a longer period of time via enhanced productivity and fewer acute health care events and (2) Unions exist to serve their members rather then themselves (I know -- at least in theory) and should, therefore, be more willing to spend more money upfront.
Whether or not my prediction turns out to be correct -- it's a good initial litmus test for the general theory.
The VBID Center also said all the right things about the value of reimbursing for appropriate diagnostics (genomic and otherwise) -- specifically giving the thumbs up to genetic tests for Warfarin and the BRCAs.
The call lasted about an hour with many intelligent questions from the blogger audience. Strangely though, the VBID folks said their "consultant" had told them to expect a blogger call to last for only 20-25 minutes. Peculiar. But, in any event, it was time well spent.
The VBID Center sounds like an interesting proposition. For more detail check out their website:
http://www.sph.umich.edu/vbidcenter/
Many interesting points were brought up -- not the least of which was the issue of whether or not -- considering the relatively truncated lifespan of any individual's relationship with a given private payer -- Big Insurance can be convinced to offer more efficient programs that incent aggressive preventative and chronic care.
And, since the VBID program is based in the Wolverine State, I asked if they thought the new GM/Union agreement over health care would result in more patient-centric programs. Both Dr. Fendrick and Dr. Chernew demurred from making a prediction. Typical academics!
I think it will. Because (1) These are union employees who (at least in theory) will be with the insurance plan for an extended period -- so additional up-front costs (aka "investments") can be recouped over a longer period of time via enhanced productivity and fewer acute health care events and (2) Unions exist to serve their members rather then themselves (I know -- at least in theory) and should, therefore, be more willing to spend more money upfront.
Whether or not my prediction turns out to be correct -- it's a good initial litmus test for the general theory.
The VBID Center also said all the right things about the value of reimbursing for appropriate diagnostics (genomic and otherwise) -- specifically giving the thumbs up to genetic tests for Warfarin and the BRCAs.
The call lasted about an hour with many intelligent questions from the blogger audience. Strangely though, the VBID folks said their "consultant" had told them to expect a blogger call to last for only 20-25 minutes. Peculiar. But, in any event, it was time well spent.
Per Dr. Bob's post below on vaccines, let me relate what my pediatrician buddy says to parents who don't want their children vaccinated --
"It's your choice. But if you choose not to have your child vaccinated then you cannot be my patient."
This is serious business folks. Voodoo science that scares parents away from accepting childhood vaccinations (and the lawyers who would fan those false flames for profit) is one of the most serious public health risks our nation faces.
And certainly one of the most avoidable.
"It's your choice. But if you choose not to have your child vaccinated then you cannot be my patient."
This is serious business folks. Voodoo science that scares parents away from accepting childhood vaccinations (and the lawyers who would fan those false flames for profit) is one of the most serious public health risks our nation faces.
And certainly one of the most avoidable.
In her excellent piece about the Merck vaccine recall Linda Johnson anticipates -- correctly -- the coming storm from the crazies who believe that we should really be scared and angry about how the fact that kids don't even need vaccines to begin with:
"The recall is likely to heighten a debate over childhood vaccines, their safety and whether too many are required. Some parents are distrustful and suspect some vaccines of being linked to autism, although scientific studies have not shown a connection. "
Sad but true. And Johnson forgot to mention the barrage of bottom feeding trial lawyers who will try to sue Merck in the wake of the recall.
http://news.yahoo.com/s/ap/20071213/ap_on_he_me/vaccine_recall
"The recall is likely to heighten a debate over childhood vaccines, their safety and whether too many are required. Some parents are distrustful and suspect some vaccines of being linked to autism, although scientific studies have not shown a connection. "
Sad but true. And Johnson forgot to mention the barrage of bottom feeding trial lawyers who will try to sue Merck in the wake of the recall.
http://news.yahoo.com/s/ap/20071213/ap_on_he_me/vaccine_recall
If the recent report of the FDA's Subcommittee on Science and Technology ("FDA Science and Mission at Risk") wasn't enough of a wake-up call -- you should (1) check your pulse and make sure you are still breathing and (2) read the very un-sugar coated comments of Advisory Board member Peter Barton Hutt. They're must reading.
And here they are:
Download file
But Peter, what do you really think?
And here they are:
Download file
But Peter, what do you really think?
There is no punchline...yet. Only the hard work of dedicated scientists seeking a serious answer.
http://news.yahoo.com/s/livescience/20071212/sc_livescience/womenevolvemorespinetocarrybabies
Meanwhile, this guy brings new meaning to the word "suicide bomber"
AP: Man nearly dies downing vodka at airport
A man nearly died from alcohol poisoning after quaffing two pints of vodka at an airport security check instead of handing it over to comply with new rules about carrying liquids aboard a plane, police said Wednesday.
http://news.yahoo.com/s/ap/20071212/ap_on_re_eu/airport_vodka
http://news.yahoo.com/s/livescience/20071212/sc_livescience/womenevolvemorespinetocarrybabies
Meanwhile, this guy brings new meaning to the word "suicide bomber"
AP: Man nearly dies downing vodka at airport
A man nearly died from alcohol poisoning after quaffing two pints of vodka at an airport security check instead of handing it over to comply with new rules about carrying liquids aboard a plane, police said Wednesday.
http://news.yahoo.com/s/ap/20071212/ap_on_re_eu/airport_vodka
More examples proving that managed care companies are run by people that could never run a real business...
The Wall Street Journal on Wednesday examined how hospitals have begun "taking steps to prevent the most common risk to patients after discharge: landing back in the hospital due to complications that could have been prevented with better follow-up care." According to the Journal, a "revolving door of readmissions is driving up costs for hospitals and causing needless harm to patients, especially elderly people with multiple chronic diseases."
Almost 18% of Medicare beneficiaries who are admitted to a hospital are readmitted within 30 days at a cost of $15 billion, according to the Medicare Payment Advisory Commission. As a result, "readmission rates are coming under increasing scrutiny from regulators, insurers, employers and quality-measurement groups, who are considering methods to tie payment to lower readmissions," the Journal reports.
The Institute for Healthcare Improvement has partnered with several hospitals to reduce readmissions through programs that identify patient risk for readmission, schedule follow-up visits with patients before discharge, send nurses on at-home visits to ensure patient adherence to medication regimens, monitor patients at home, and educate patients and families on adherence to medication and self-care regimens.
Most hospitals currently "don't provide such services" in part because they "aren't paid to coordinate care once a patient leaves," the Journal reports.
However, "that may change" as managed care companies and health insurers experiment with programs that cover the cost of coordination of patient care, according to the Journal. Randall Krakauer, medical director at Aetna, said, "We believe this can improve the quality of care for members and more than pay for itself by reducing the costs of care by a larger amount than the cost of the home visits" (Landro, Wall Street Journal, 12/12).
Don't hold your breath...
Here's how the biggest health plan in Rochester, NY -- along with the VA, a Hillary Clinton model of health care excellence, is now rationing care in penny-wise, pound foolish fashion....
Democrat and Chronicle, Dec. 12, 2007
Doctors seek fair role with Excellus
BY: Patrick Flanigan
Rochester-area doctors must work together and demand "a seat at the table" on the issue of balancing the need for expensive radiology exams with the need to control rising medical costs.
That was the message delivered Tuesday night to about 100 doctors and other medical professionals meeting at the Monroe County Medical Society to discuss a controversial radiology management program.
Excellus BlueCross BlueShield launched a program in October that requires doctors to obtain the insurance company's approval before scheduling exams such as PET scans, CT scans or MRIs.
Those exams, which diagnose conditions including cancer and heart disease, are among the most expensive procedures in modern health care.
Excellus officials have defended the program as a way to cut the rising cost of health care by asking doctors to be more judicious. The insurer spends about $560 million a year on radiology exams.
The doctors said Tuesday they recognize that costs are a problem. But in this case, they said, the quality of patient care is being threatened.
Dr. John Genier, president of the Rochester General Physicians Organization, said doctors must be participants in the discussion about the issue. He also urged his fellow physicians to keep the focus on their patients.
"It's easy to get angry. It's easy to insurance-bash. That will not benefit us," Genier said. "When you get frustrated and feel like you just can't beat a 700-pound gorilla, remember the patients."
Here's the rest of the story:
http://www.democratandchronicle.com/apps/pbcs.dll/article?AID=/20071212/BUSINESS/712120341/1001
The Wall Street Journal on Wednesday examined how hospitals have begun "taking steps to prevent the most common risk to patients after discharge: landing back in the hospital due to complications that could have been prevented with better follow-up care." According to the Journal, a "revolving door of readmissions is driving up costs for hospitals and causing needless harm to patients, especially elderly people with multiple chronic diseases."
Almost 18% of Medicare beneficiaries who are admitted to a hospital are readmitted within 30 days at a cost of $15 billion, according to the Medicare Payment Advisory Commission. As a result, "readmission rates are coming under increasing scrutiny from regulators, insurers, employers and quality-measurement groups, who are considering methods to tie payment to lower readmissions," the Journal reports.
The Institute for Healthcare Improvement has partnered with several hospitals to reduce readmissions through programs that identify patient risk for readmission, schedule follow-up visits with patients before discharge, send nurses on at-home visits to ensure patient adherence to medication regimens, monitor patients at home, and educate patients and families on adherence to medication and self-care regimens.
Most hospitals currently "don't provide such services" in part because they "aren't paid to coordinate care once a patient leaves," the Journal reports.
However, "that may change" as managed care companies and health insurers experiment with programs that cover the cost of coordination of patient care, according to the Journal. Randall Krakauer, medical director at Aetna, said, "We believe this can improve the quality of care for members and more than pay for itself by reducing the costs of care by a larger amount than the cost of the home visits" (Landro, Wall Street Journal, 12/12).
Don't hold your breath...
Here's how the biggest health plan in Rochester, NY -- along with the VA, a Hillary Clinton model of health care excellence, is now rationing care in penny-wise, pound foolish fashion....
Democrat and Chronicle, Dec. 12, 2007
Doctors seek fair role with Excellus
BY: Patrick Flanigan
Rochester-area doctors must work together and demand "a seat at the table" on the issue of balancing the need for expensive radiology exams with the need to control rising medical costs.
That was the message delivered Tuesday night to about 100 doctors and other medical professionals meeting at the Monroe County Medical Society to discuss a controversial radiology management program.
Excellus BlueCross BlueShield launched a program in October that requires doctors to obtain the insurance company's approval before scheduling exams such as PET scans, CT scans or MRIs.
Those exams, which diagnose conditions including cancer and heart disease, are among the most expensive procedures in modern health care.
Excellus officials have defended the program as a way to cut the rising cost of health care by asking doctors to be more judicious. The insurer spends about $560 million a year on radiology exams.
The doctors said Tuesday they recognize that costs are a problem. But in this case, they said, the quality of patient care is being threatened.
Dr. John Genier, president of the Rochester General Physicians Organization, said doctors must be participants in the discussion about the issue. He also urged his fellow physicians to keep the focus on their patients.
"It's easy to get angry. It's easy to insurance-bash. That will not benefit us," Genier said. "When you get frustrated and feel like you just can't beat a 700-pound gorilla, remember the patients."
Here's the rest of the story:
http://www.democratandchronicle.com/apps/pbcs.dll/article?AID=/20071212/BUSINESS/712120341/1001
Peter Rost just announced that he's hanging out his shingle as an expert witness for pharma marketing practices on behalf of plaintiff attorneys. Good for him.
Why? First, unlike David Healy and Curt Furberg and others, Peter is transparent about his work. The honesty is refreshing.
Second, as a gun for hire he is offering his services to defendants as well. No takers, yet. Here's his post:
"So I guess it is time to announce that in addition to my ongoing writing career for Brandweek and several international journals, a new business of mine is taking off . . . as litigation consultant and pharmaceutical marketing expert for plaintiff law firms.
Pretty amazing to sit in on those depositions of other marketing executives and read what they wrote in their memos.
So on my two-year anniversary of being fired from Pfizer, I'm getting a lot of use for my marketing experience in a most unusual way. Funny thing is, none of the defendant firms have asked for my help."
Why? First, unlike David Healy and Curt Furberg and others, Peter is transparent about his work. The honesty is refreshing.
Second, as a gun for hire he is offering his services to defendants as well. No takers, yet. Here's his post:
"So I guess it is time to announce that in addition to my ongoing writing career for Brandweek and several international journals, a new business of mine is taking off . . . as litigation consultant and pharmaceutical marketing expert for plaintiff law firms.
Pretty amazing to sit in on those depositions of other marketing executives and read what they wrote in their memos.
So on my two-year anniversary of being fired from Pfizer, I'm getting a lot of use for my marketing experience in a most unusual way. Funny thing is, none of the defendant firms have asked for my help."
The Wall Street Journal Online/Harris Interactive survey of U.S. adults age 65 or older, shows 87% of those enrolled in a Medicare drug benefit plan are satisfied with their plan, up from 75% last year, while 6% said they aren't satisfied.
Any questions?
Note to Families USA -- would you like your crow served with a side of humble pie?
Any questions?
Note to Families USA -- would you like your crow served with a side of humble pie?
Personalized medicine? Yes please.
Carbamazepine Prescribing Information to Include Recommendation of Genetic Test for Patients with Asian Ancestry
Connection of genetic information with medication use can improve safe use of product
The U.S. Food and Drug Administration today announced that the manufacturers of drugs containing the active ingredient carbamazepine have agreed to add to the drugs' labeling a recommendation that, before starting therapy with the drugs, patients with Asian ancestry get a genetic blood test that can identify a significantly increased risk of developing a rare, but serious, skin reaction.
The full FDA press release can be found here:
http://www.fda.gov/bbs/topics/NEWS/2007/NEW01755.html
"Science is now letting us individually treat patients based on how their body might react to a drug," said Janet Woodcock, M.D., FDA's deputy commissioner for scientific and medical programs, chief medical officer, and acting director of the Center for Drug Evaluation and Research. "When being considered for treatment with carbamazepine, genetically high-risk patients can be given a test that will help their health care providers make personalized drug treatment decisions and help avoid potentially serious skin reactions."
Carbamazepine Prescribing Information to Include Recommendation of Genetic Test for Patients with Asian Ancestry
Connection of genetic information with medication use can improve safe use of product
The U.S. Food and Drug Administration today announced that the manufacturers of drugs containing the active ingredient carbamazepine have agreed to add to the drugs' labeling a recommendation that, before starting therapy with the drugs, patients with Asian ancestry get a genetic blood test that can identify a significantly increased risk of developing a rare, but serious, skin reaction.
The full FDA press release can be found here:
http://www.fda.gov/bbs/topics/NEWS/2007/NEW01755.html
"Science is now letting us individually treat patients based on how their body might react to a drug," said Janet Woodcock, M.D., FDA's deputy commissioner for scientific and medical programs, chief medical officer, and acting director of the Center for Drug Evaluation and Research. "When being considered for treatment with carbamazepine, genetically high-risk patients can be given a test that will help their health care providers make personalized drug treatment decisions and help avoid potentially serious skin reactions."
That's the title of Matthew Arnold's cover story in the December issue of Medical Marketing & Media -- "Outlook 2008: Electile Dysfunction."
Here’s how it begins:
"A cautious FDA sweating product safety issues and going slow on new approvals. An election year in which healthcare tops the agenda. Increased oversight, increasingly demanding payors and ever more aggressive generic competition.
Throw in some gloomy global market trends, and 2008 promises to be a tough one for a pharmaceutical industry trying to dig its way out from under a mountain of looming patent expirations on key products. If 2007 was a year of disappointment—with hotly anticipated products like torcetrapib, rimonabant and Galvus failing to make it to market and safety jitters hitting others, like Avandia, Zelnorm and Exubera— 2008 looks like more of the same. For all the talk about acquisitions, big pharma firms sitting on large cash piles might look to Pfizer's inability to translate scale into lasting dominance and think twice—if there were even anything attractive left to buy. And the trickle of really innovative new products coming down the pipe will have to vault high hurdles to make the grade at the FDA, with Rep. Henry Waxman breathing down Andrew von Eschenbach's neck."
And here’s the conclusion:
"At least one FDA watcher is more sanguine. “In a political year, the FDA is going to understand that it needs to be apolitical,†says Peter Pitts, director of the Center for Medicine in the Public Interest. “FDA is in the business of protecting and advancing public health. It's not an agency that wants to deal with politics at all, but it's been buffeted by very potent political winds from the outside.â€
The Reagan-Udall Foundation established by the FDA Amendments Act will, together with the FDA's Critical Path Initiative, revolutionize drug development, says Pitts. “By streamlining and improving the science of drug regulation, we can bring drugs to market more rapidly and safely by helping companies fail faster, so that they can reinvest those resources in more successful propositions,†says Pitts. “Ultimately, Critical Path is like a game of Chutes and Ladders, helping companies avoid the chutes and scale the ladders.â€
Here's a link to the complete piece:
http://www.mmm-online.com/Outlook-2008-Electile-Dysfunction/article/99533/
And be sure to check out the predictions of the six health care cognoscenti interviewed for the story.
Here’s how it begins:
"A cautious FDA sweating product safety issues and going slow on new approvals. An election year in which healthcare tops the agenda. Increased oversight, increasingly demanding payors and ever more aggressive generic competition.
Throw in some gloomy global market trends, and 2008 promises to be a tough one for a pharmaceutical industry trying to dig its way out from under a mountain of looming patent expirations on key products. If 2007 was a year of disappointment—with hotly anticipated products like torcetrapib, rimonabant and Galvus failing to make it to market and safety jitters hitting others, like Avandia, Zelnorm and Exubera— 2008 looks like more of the same. For all the talk about acquisitions, big pharma firms sitting on large cash piles might look to Pfizer's inability to translate scale into lasting dominance and think twice—if there were even anything attractive left to buy. And the trickle of really innovative new products coming down the pipe will have to vault high hurdles to make the grade at the FDA, with Rep. Henry Waxman breathing down Andrew von Eschenbach's neck."
And here’s the conclusion:
"At least one FDA watcher is more sanguine. “In a political year, the FDA is going to understand that it needs to be apolitical,†says Peter Pitts, director of the Center for Medicine in the Public Interest. “FDA is in the business of protecting and advancing public health. It's not an agency that wants to deal with politics at all, but it's been buffeted by very potent political winds from the outside.â€
The Reagan-Udall Foundation established by the FDA Amendments Act will, together with the FDA's Critical Path Initiative, revolutionize drug development, says Pitts. “By streamlining and improving the science of drug regulation, we can bring drugs to market more rapidly and safely by helping companies fail faster, so that they can reinvest those resources in more successful propositions,†says Pitts. “Ultimately, Critical Path is like a game of Chutes and Ladders, helping companies avoid the chutes and scale the ladders.â€
Here's a link to the complete piece:
http://www.mmm-online.com/Outlook-2008-Electile-Dysfunction/article/99533/
And be sure to check out the predictions of the six health care cognoscenti interviewed for the story.
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.
