Latest Drugwonks' Blog
From today's edition of The Wall Street Journal ...
Prescription for Trouble
By Scott Gottlieb
Inside the federal agencies that oversee parts of the health-care system, there is a palpable view that doctors can no longer be trusted to do the right thing.
The Food and Drug Administration, Medicare and even the Justice Department all believe they cannot rely on many doctors to heed safety warnings, wisely weigh new medical information, or follow treatment approaches that maximize health benefits or lower costs. So in recent years, these agencies have hatched rules that dictate when treatments should be delivered and even how they can be administered -- especially when it comes to new drugs.
The result is increasing federal regulation of medical practice that constrains health-care providers and limits the choices patients have. It might get worse. New legislation offered by Sens. Edward Kennedy (D., Mass.,) and Michael Enzi (R., Wyo.,), intended to make drugs safer, would raise this regulatory burden by reducing a physician's discretion to exercise clinical judgment and erecting barriers that will exacerbate disparities in access to care.
The legislative proposal extends the FDA's ability to restrict which physicians can prescribe a medicine, and which pharmacies can dispense it, through risk-management plans that would accompany the approval of many new drugs. These "RiskMAPs," as they are called inside the FDA, already guide the use of about 30 marketed drugs as part of "voluntary" arrangements with drug companies.
Right now, pharmaceutical companies propose the plans to better balance the risks and benefits of their drugs, in order to secure FDA approval. But these plans impose burdens, especially on patients who already face difficulty obtaining the specialist care that many RiskMAPs require for the dispensing of new drugs. Thus the FDA and the pharmaceutical industry have mostly confined RiskMAPs to drugs with unpredictable and potentially deadly risks, such as anaphylaxis or rapid organ failure.
That sense of restraint is lifting. New proposals by Congress and the Institute of Medicine advocate RiskMAPs for mitigating a wider set of less-serious problems and to constrain the off-label prescribing of new drugs, even though such prescribing is the standard of care for many diseases. The proposals are gaining traction. Once the FDA is granted the authority to simply impose these RiskMAPs on drug companies, there will be a lot of political pressure on the agency to constrain prescription writing in the name of drug safety.
What would this mean? Consider the RiskMAP recently imposed by the FDA on the use of the diabetes drug Symlin. The new medicine can help very serious diabetics control swings in blood sugar and is one of the few drugs that promote weight loss. But Symlin has a narrow therapeutic margin and can sometimes cause dangerously low blood sugar. The FDA did not trust ordinary generalist doctors -- who treat most diabetics, especially poor or rural patients -- to properly prescribe the medicine or to limit its use to the labeled indication. So Symlin's RiskMAP tries to keep the drug out of generalist hands by, among other things, limiting promotion to doctors specializing in diabetes and who are also supported by certified diabetes educators.
Reflecting this pervasive mistrust of medical practitioners, Medicare is increasingly tying payments to the choices doctors make, compensating doctors more to follow certain cookie-cutter treatments or practice guidelines that are promoted by the agency because they are believed by government experts to maximize benefits or reduce health-care costs.
The Drug Enforcement Administration is also intruding into medical practice. Waging a campaign to cut down on prescription-drug abuse, the DEA has sought legislative authority that would give it a role in limiting the approvals of new pain products -- even though the agency has no ability to appreciate the public health considerations that create a medical need for better drugs to treat serious pain.
Meanwhile, the Department of Justice's war on off-label promotion by drug companies ends up criminalizing the exchange of truthful, non-misleading medical information with doctors on new uses for medicines. This even includes information derived from studies funded by other arms of the government such as the National Institutes of Health. Such was the case in the litigation DOJ recently waged and won against information exchanged on promising new anti-cancer uses for the osteoporosis drug Evista -- some of those uses are now standard care.
All of these approaches harm patients because they impose one-size prescriptions in an area of science that is marked by variation. Furthermore, parameters on the prescription of new drugs, like those imposed on the use of Symlin, create obstacles for patients who already face significant problems getting access to the latest drugs or the specialists who are ordained by FDA's RiskMAPs to prescribe them.
Medicare's treatment guidelines are not the right answer for everyone, because there is a need for judgment in medicine that attunes treatments to individual variations and preferences. DOJ's restrictions on the exchange of medical information deny doctors updated data on the most cutting-edge and specialized uses of new treatments.
Ultimately, we need a better system for accumulating new information about the risks and benefits of treatments, and for communicating this information to providers and patients so people can make more informed choices. The key to improvement is not direct regulation of patient care, but better tools and approaches for evaluating the pros and cons of the many choices patients confront.
Doctors share some blame for inviting this kind of regulation. Agencies have plenty of data showing that some doctors do not heed safety warnings or follow sound advice. Professional societies like the American Medical Association, the various medical journals, and even licensing boards have grown self-interested and have failed the first tenet of an autonomous profession: the ability to regulate itself.
The solutions to any of the health-care problems that government is trying to mitigate will not rest in Washington's constraining "fixes," but with these organs of medicine working with agencies to promote practice standards and safety measures that do not sacrifice medical autonomy and patient choice.
Dr. Gottlieb, who was deputy commissioner of the FDA from 2005 to 2007, is a resident fellow at the American Enterprise Institute.
Prescription for Trouble
By Scott Gottlieb
Inside the federal agencies that oversee parts of the health-care system, there is a palpable view that doctors can no longer be trusted to do the right thing.
The Food and Drug Administration, Medicare and even the Justice Department all believe they cannot rely on many doctors to heed safety warnings, wisely weigh new medical information, or follow treatment approaches that maximize health benefits or lower costs. So in recent years, these agencies have hatched rules that dictate when treatments should be delivered and even how they can be administered -- especially when it comes to new drugs.
The result is increasing federal regulation of medical practice that constrains health-care providers and limits the choices patients have. It might get worse. New legislation offered by Sens. Edward Kennedy (D., Mass.,) and Michael Enzi (R., Wyo.,), intended to make drugs safer, would raise this regulatory burden by reducing a physician's discretion to exercise clinical judgment and erecting barriers that will exacerbate disparities in access to care.
The legislative proposal extends the FDA's ability to restrict which physicians can prescribe a medicine, and which pharmacies can dispense it, through risk-management plans that would accompany the approval of many new drugs. These "RiskMAPs," as they are called inside the FDA, already guide the use of about 30 marketed drugs as part of "voluntary" arrangements with drug companies.
Right now, pharmaceutical companies propose the plans to better balance the risks and benefits of their drugs, in order to secure FDA approval. But these plans impose burdens, especially on patients who already face difficulty obtaining the specialist care that many RiskMAPs require for the dispensing of new drugs. Thus the FDA and the pharmaceutical industry have mostly confined RiskMAPs to drugs with unpredictable and potentially deadly risks, such as anaphylaxis or rapid organ failure.
That sense of restraint is lifting. New proposals by Congress and the Institute of Medicine advocate RiskMAPs for mitigating a wider set of less-serious problems and to constrain the off-label prescribing of new drugs, even though such prescribing is the standard of care for many diseases. The proposals are gaining traction. Once the FDA is granted the authority to simply impose these RiskMAPs on drug companies, there will be a lot of political pressure on the agency to constrain prescription writing in the name of drug safety.
What would this mean? Consider the RiskMAP recently imposed by the FDA on the use of the diabetes drug Symlin. The new medicine can help very serious diabetics control swings in blood sugar and is one of the few drugs that promote weight loss. But Symlin has a narrow therapeutic margin and can sometimes cause dangerously low blood sugar. The FDA did not trust ordinary generalist doctors -- who treat most diabetics, especially poor or rural patients -- to properly prescribe the medicine or to limit its use to the labeled indication. So Symlin's RiskMAP tries to keep the drug out of generalist hands by, among other things, limiting promotion to doctors specializing in diabetes and who are also supported by certified diabetes educators.
Reflecting this pervasive mistrust of medical practitioners, Medicare is increasingly tying payments to the choices doctors make, compensating doctors more to follow certain cookie-cutter treatments or practice guidelines that are promoted by the agency because they are believed by government experts to maximize benefits or reduce health-care costs.
The Drug Enforcement Administration is also intruding into medical practice. Waging a campaign to cut down on prescription-drug abuse, the DEA has sought legislative authority that would give it a role in limiting the approvals of new pain products -- even though the agency has no ability to appreciate the public health considerations that create a medical need for better drugs to treat serious pain.
Meanwhile, the Department of Justice's war on off-label promotion by drug companies ends up criminalizing the exchange of truthful, non-misleading medical information with doctors on new uses for medicines. This even includes information derived from studies funded by other arms of the government such as the National Institutes of Health. Such was the case in the litigation DOJ recently waged and won against information exchanged on promising new anti-cancer uses for the osteoporosis drug Evista -- some of those uses are now standard care.
All of these approaches harm patients because they impose one-size prescriptions in an area of science that is marked by variation. Furthermore, parameters on the prescription of new drugs, like those imposed on the use of Symlin, create obstacles for patients who already face significant problems getting access to the latest drugs or the specialists who are ordained by FDA's RiskMAPs to prescribe them.
Medicare's treatment guidelines are not the right answer for everyone, because there is a need for judgment in medicine that attunes treatments to individual variations and preferences. DOJ's restrictions on the exchange of medical information deny doctors updated data on the most cutting-edge and specialized uses of new treatments.
Ultimately, we need a better system for accumulating new information about the risks and benefits of treatments, and for communicating this information to providers and patients so people can make more informed choices. The key to improvement is not direct regulation of patient care, but better tools and approaches for evaluating the pros and cons of the many choices patients confront.
Doctors share some blame for inviting this kind of regulation. Agencies have plenty of data showing that some doctors do not heed safety warnings or follow sound advice. Professional societies like the American Medical Association, the various medical journals, and even licensing boards have grown self-interested and have failed the first tenet of an autonomous profession: the ability to regulate itself.
The solutions to any of the health-care problems that government is trying to mitigate will not rest in Washington's constraining "fixes," but with these organs of medicine working with agencies to promote practice standards and safety measures that do not sacrifice medical autonomy and patient choice.
Dr. Gottlieb, who was deputy commissioner of the FDA from 2005 to 2007, is a resident fellow at the American Enterprise Institute.
Per my post from yesterday ("Giving EBM the Boot"), our friend John Kamp offers the following:
Why indeed?
As your blog item notes, we better stop "saving" money by restricting formularies and delaying treatment, or there may be fewer lives to save and less money to treat the survivors.
Let me elaborate with one example, Type II diabetes, a condition I follow closely because I have it.
I spent much of the weekend catching up on the new research presented late last year at the World Diabetes Conference in Capetown, South Africia, supporting more aggressive treatment of Type II diabetes.
The research results are exciting. First, earlier and more aggressive treatment will improve blood sugar control and delay the progression of the disease to where becomes ever more difficult to treat and to where complications proliferate. Second, new drugs and new ways to deliver existing drugs provide exciting evolutionary, though not revolutionary, advances. Recently approved and promising new drugs could delay progression of the disease for five to ten years. That could well mean that a 60 year old like me may never go blind, lose a foot, become impotent, require a liver transplant, have a premature heart attack, or face many of the other common complications of this dreaded, deadly disease.
Avoiding these things saves a lot of money in the long run, but requires time, attention and money. Right now -- not a few years from now -- I, my health plan, my doctor and the goverment must focus on more aggressive treatment. That requires pain and money.
For me, it means a significant personal committtment, including:
1. even more aggressive diet and exercise,
2. careful adherence to drug regimines, and
3. giving myself shots of insulin or insulin boosters.
Ouch!
For my doctor, it means education and monitoring much of which is not fully compensated.
Ouch!
For my health care plan and the government, it means spending more money today on treatment and drugs.
Ouch!
For me today's pains are worth the investment. I will work hard with my doctors and my payment partners to keep me healthy and make the investments needed. I will make up any shortfall from the others if needed. I'm fortunate enough to have the means and committment to do so.
Meanwhile, medical policy makers who review this new research must make a similar committment, and lead us to find the means to act on it.
Time is short. We are looking down the barrel of an epidimic of Type II diabetes that may dwarf the personal and social costs of the treatment of things like AIDS and cancer. Unfortunately, denial is the all too common reaction to the social danger of diabetes today.
Right now, medical policy makers must stop denying the cost and trouble of treating Type II diabetes. We must mobilize health care professionals, patients and government, take advantage of existing and developing science, and take a much more aggressive stance.
Denial of treatment at today's pace will mame and kill our bodies and bankrupt our treasuries.
Enough already.
John -- keep those cards and letters coming.
Why indeed?
As your blog item notes, we better stop "saving" money by restricting formularies and delaying treatment, or there may be fewer lives to save and less money to treat the survivors.
Let me elaborate with one example, Type II diabetes, a condition I follow closely because I have it.
I spent much of the weekend catching up on the new research presented late last year at the World Diabetes Conference in Capetown, South Africia, supporting more aggressive treatment of Type II diabetes.
The research results are exciting. First, earlier and more aggressive treatment will improve blood sugar control and delay the progression of the disease to where becomes ever more difficult to treat and to where complications proliferate. Second, new drugs and new ways to deliver existing drugs provide exciting evolutionary, though not revolutionary, advances. Recently approved and promising new drugs could delay progression of the disease for five to ten years. That could well mean that a 60 year old like me may never go blind, lose a foot, become impotent, require a liver transplant, have a premature heart attack, or face many of the other common complications of this dreaded, deadly disease.
Avoiding these things saves a lot of money in the long run, but requires time, attention and money. Right now -- not a few years from now -- I, my health plan, my doctor and the goverment must focus on more aggressive treatment. That requires pain and money.
For me, it means a significant personal committtment, including:
1. even more aggressive diet and exercise,
2. careful adherence to drug regimines, and
3. giving myself shots of insulin or insulin boosters.
Ouch!
For my doctor, it means education and monitoring much of which is not fully compensated.
Ouch!
For my health care plan and the government, it means spending more money today on treatment and drugs.
Ouch!
For me today's pains are worth the investment. I will work hard with my doctors and my payment partners to keep me healthy and make the investments needed. I will make up any shortfall from the others if needed. I'm fortunate enough to have the means and committment to do so.
Meanwhile, medical policy makers who review this new research must make a similar committment, and lead us to find the means to act on it.
Time is short. We are looking down the barrel of an epidimic of Type II diabetes that may dwarf the personal and social costs of the treatment of things like AIDS and cancer. Unfortunately, denial is the all too common reaction to the social danger of diabetes today.
Right now, medical policy makers must stop denying the cost and trouble of treating Type II diabetes. We must mobilize health care professionals, patients and government, take advantage of existing and developing science, and take a much more aggressive stance.
Denial of treatment at today's pace will mame and kill our bodies and bankrupt our treasuries.
Enough already.
John -- keep those cards and letters coming.
According to Anna Wilde Mathews the Breckenridge Institute, a research and consulting firm in Breckenridge, Colo. said that the FDA "bungled" the ".. effort to build a new system for detecting the side effects of medicines after they go on the market, delaying its implementation by at least four years, according to a report commissioned by the agency itself."
But who and what is the Breckenridge Institute?
It is run by Mark Bodnarczuk who has written a book called "Diving In." Here's a description from the Institute's website...
http://www.divingin.com/
Set within the cultural context of Bali and Indonesia, the author uses scuba diving metaphors, interwoven with Jungian psychology and the Enneagram to weave a tapestry of complex characters’ lives and to teach fundamental principles of personal growth. DIVING IN penetrates beyond the superficial and obvious to a deeper analysis of relationships, professional satisfaction, and the ways in which people handle conflict in the workplace.
As for the work of the Institute...it uses Breckenridge Institute’s Harnessing Process™ and Breckenridge Culture Indicator™ (BCI™) to affect deep, sustainable, cultural change.
http://www.breckenridgeinstitute.com/
Here's what's on the Institute's web site....
The coral reef harnesses
the invisible power of
the sun and turns it
into a resource
that gives life to
the sea. Your
organization’s
culture is also an
invisible power -
so why not harness it?
Note to Breckenridge: The FDA just had $10 million cut out of it's IT budget. That's invisible. As we say in New York, harness THAT.
Oh, about Enneagrams...those are the nine points or gateways (some say seven points, linked to seven glands) to personality typing that have existed since the dawn of time. (To boldy go where no Institute has gone before..)
If you really need it, here's info on enneagrams from answers.com.
http://www.answers.com/topic/enneagram
Needless to say, Breckenridge is no McKinsey or Accenture.
Which explains why the FDA asked the institute to stay on, for free, to give them a real action plan instead of a lot of New Age speak about changing culture.
But who and what is the Breckenridge Institute?
It is run by Mark Bodnarczuk who has written a book called "Diving In." Here's a description from the Institute's website...
http://www.divingin.com/
Set within the cultural context of Bali and Indonesia, the author uses scuba diving metaphors, interwoven with Jungian psychology and the Enneagram to weave a tapestry of complex characters’ lives and to teach fundamental principles of personal growth. DIVING IN penetrates beyond the superficial and obvious to a deeper analysis of relationships, professional satisfaction, and the ways in which people handle conflict in the workplace.
As for the work of the Institute...it uses Breckenridge Institute’s Harnessing Process™ and Breckenridge Culture Indicator™ (BCI™) to affect deep, sustainable, cultural change.
http://www.breckenridgeinstitute.com/
Here's what's on the Institute's web site....
The coral reef harnesses
the invisible power of
the sun and turns it
into a resource
that gives life to
the sea. Your
organization’s
culture is also an
invisible power -
so why not harness it?
Note to Breckenridge: The FDA just had $10 million cut out of it's IT budget. That's invisible. As we say in New York, harness THAT.
Oh, about Enneagrams...those are the nine points or gateways (some say seven points, linked to seven glands) to personality typing that have existed since the dawn of time. (To boldy go where no Institute has gone before..)
If you really need it, here's info on enneagrams from answers.com.
http://www.answers.com/topic/enneagram
Needless to say, Breckenridge is no McKinsey or Accenture.
Which explains why the FDA asked the institute to stay on, for free, to give them a real action plan instead of a lot of New Age speak about changing culture.
In the wake of the Grassley Knoll's meltdown over Vioxx (the drug that an FDA advisory committee recommended be returned to market in case anyone noticed) the White House took the $10 million allocated for new FDA IT systems (that would allow the agency to interface with health plans and stop passing the a tin cup to achieve interoperability and develop a common computer code that could be used for spontaneous and real time reporting of drug benefits and risks via electronic health records) was cut and re-allocated to hire additional paper pushers in the agency's Office of Drug Safety.... I have it on good authority that the decision was purely in response to Grassley. So the agency was left scrambling -- during the events described in the WSJ article -- to close a huge gap in its IT budget.
But somehow none of that is relevant. It is easier to piss all over the agency at time when it is under siege and make the hard working people who are seeking to put together a post market IT effort look like idiots. And of course we all know that consultants are the smartest people on the planet...Especially the Breckenridge Institute consultants... But that's the next post..
But somehow none of that is relevant. It is easier to piss all over the agency at time when it is under siege and make the hard working people who are seeking to put together a post market IT effort look like idiots. And of course we all know that consultants are the smartest people on the planet...Especially the Breckenridge Institute consultants... But that's the next post..
According to a Page One story in the March 3rd edition of The Wall Street Journal, "The Food and Drug Administration has bungled its effort to build a new system for detecting the side effects of medicines after they go on the market, delaying its implementation by at least four years, according to a report commissioned by the agency itself."
But what is entirely missing from the story (by the generally excellent reporter Anna Mathews) is that the FDA has never been given a budget to build a new system.
Want better adverse event reporting? Want better post-marketing surveillance? Want better data mining opportunities?
Show me the money!
But what is entirely missing from the story (by the generally excellent reporter Anna Mathews) is that the FDA has never been given a budget to build a new system.
Want better adverse event reporting? Want better post-marketing surveillance? Want better data mining opportunities?
Show me the money!
The NHS (the British National Health Service) is taking the threat of counterfeit drugs seriously. Health officials have warned that patients are being put at risk by counterfeiters targeting the UK's NHS supply chain.
According to Naem Ahmed the head of intelligence at the MHRA (the Medicines and Healthcare Products Regulatory Agency), counterfeiters have become more confident and bolder in their illegal activities. "If you trade over the internet the risk of detection is low, but you only sell a pack here and a pack there. If you penetrate the supply chain, there is a higher risk, but you can make a lot of money."
And the weak link in the chain? Parallel trade.
According to Naem Ahmed the head of intelligence at the MHRA (the Medicines and Healthcare Products Regulatory Agency), counterfeiters have become more confident and bolder in their illegal activities. "If you trade over the internet the risk of detection is low, but you only sell a pack here and a pack there. If you penetrate the supply chain, there is a higher risk, but you can make a lot of money."
And the weak link in the chain? Parallel trade.
Just returned from Italy where (as a guest of the Bruno Leoni Institute) I spoke in Rome, Genoa, and Milan on the issue of Evidence Based Medicine. Why Italy? Because, as in many other EU nations, the issue of "saving" money by restricting formularies has reached epidemic proportions. Patients are unhappy. Doctors are unhappy. And officials (both elected and career) are frightened -- as they should be after watching what's going in the UK and Germany --that denying health care will, inevitably, become a political hot potato. After all, as one Italian official said to me, "Why should the Heath Minister behave like the junior Finance Minister?"
Why indeed?
Here is how the Italian media reported on both my visit and this urgent transatlantic public health issue:
From Il Giornale:
http://www.ilgiornale.it/a.pic1?ID=161202
And Il Tempo:
http://www.iltempo.it/approfondimenti/index.aspx?id=1146342&Sectionid=8&Editionid=8
And, yes, the food was magnificent.
Why indeed?
Here is how the Italian media reported on both my visit and this urgent transatlantic public health issue:
From Il Giornale:
http://www.ilgiornale.it/a.pic1?ID=161202
And Il Tempo:
http://www.iltempo.it/approfondimenti/index.aspx?id=1146342&Sectionid=8&Editionid=8
And, yes, the food was magnificent.
Very disturbing article about how the new CBO direct appears to be pulling together a panel to apply evidence based medicine (EBM) and cost-effectiveness measures to decide how to squeeze spending out of the the federal health care budget. In essence he is proposing a CBO version of the the UK's National Institute for Clinical Excellence (NICE) with the added feature that unlike NICE, CBO will be in the business of making both clinical and budgetary decisions....
CBO Forming Panel to Examine Slowing
Health Care Cost Growth, Director Says
The Congressional Budget Office is forming a health care advisory group to help CBO craft options for slowing health care growth, with a first meeting set for May, CBO Director Peter R. Orszag said March 2.
In an interview with BNA reporters and editors, Orszag said the panel would be comprised of health care experts such as visiting fellows who will be charged with helping find options to limit health care cost growth.
Orszag in the past has said the advisory panel would be patterned after the CBO's current panel of economics advisers, and also would aid the agency in improving scoring of complicated health care proposals.
Orszag told BNA that rapidly rising health care spending is the biggest threat to the nation's fiscal health. The advisory group will help produce analytical papers on options for curbing rising spending in ways that will not adversely affect Americans' health, he said.
Rising Costs
"We have to take the cost growth out of health care without harming health," he said.
Rising health care costs are more of a threat to the nation's fiscal health than the expected influx of baby-boomers into federal health care programs such as Medicare, he added.
For example, the panel likely will examine such options as the benefits that health information technology and the comparative effectiveness information on medical procedures could have in slowing cost growth, Orszag said.
Orszag said there is a "substantial amount of evidence" that the health care spending has reached "the flat part of the curve" in which increased health care spending is not necessarily producing increased health care benefits.
Which evidence is that? Added quality of life from new drugs for cancer? Alzheimer's? HIV? New vaccines for HPV?
Orszag said he will spend "a very substantial share of my time helping to bend that curve."
How? By using an arbitrary cut of a 50K for a quality of life year like they do in the UK?
Reducing spending in Medicare and Medicaid likely will only shift costs to other parts of the health care system, doing little to sustain the overall health care system or those federal health care programs, he added.
In a budget options paper released Feb. 23, CBO put forward numerous options for trimming federal health care spending. For example, the report said paying Medicare managed care plans the same rate as fee-for-service plans could save $65 billion over five years.
Meaning, we can cut risk adjusted payments for the sickest seniors that are designed to treat them and keep them healthy and integrate their care....
I can't wait to see how many of the panel from from the left wing funded Prescription Project or IMAP. Any bets that Jerry Avorn, supporter of ALLHAT (the modern day Tuskegee experiment) will be annointed?
CBO Forming Panel to Examine Slowing
Health Care Cost Growth, Director Says
The Congressional Budget Office is forming a health care advisory group to help CBO craft options for slowing health care growth, with a first meeting set for May, CBO Director Peter R. Orszag said March 2.
In an interview with BNA reporters and editors, Orszag said the panel would be comprised of health care experts such as visiting fellows who will be charged with helping find options to limit health care cost growth.
Orszag in the past has said the advisory panel would be patterned after the CBO's current panel of economics advisers, and also would aid the agency in improving scoring of complicated health care proposals.
Orszag told BNA that rapidly rising health care spending is the biggest threat to the nation's fiscal health. The advisory group will help produce analytical papers on options for curbing rising spending in ways that will not adversely affect Americans' health, he said.
Rising Costs
"We have to take the cost growth out of health care without harming health," he said.
Rising health care costs are more of a threat to the nation's fiscal health than the expected influx of baby-boomers into federal health care programs such as Medicare, he added.
For example, the panel likely will examine such options as the benefits that health information technology and the comparative effectiveness information on medical procedures could have in slowing cost growth, Orszag said.
Orszag said there is a "substantial amount of evidence" that the health care spending has reached "the flat part of the curve" in which increased health care spending is not necessarily producing increased health care benefits.
Which evidence is that? Added quality of life from new drugs for cancer? Alzheimer's? HIV? New vaccines for HPV?
Orszag said he will spend "a very substantial share of my time helping to bend that curve."
How? By using an arbitrary cut of a 50K for a quality of life year like they do in the UK?
Reducing spending in Medicare and Medicaid likely will only shift costs to other parts of the health care system, doing little to sustain the overall health care system or those federal health care programs, he added.
In a budget options paper released Feb. 23, CBO put forward numerous options for trimming federal health care spending. For example, the report said paying Medicare managed care plans the same rate as fee-for-service plans could save $65 billion over five years.
Meaning, we can cut risk adjusted payments for the sickest seniors that are designed to treat them and keep them healthy and integrate their care....
I can't wait to see how many of the panel from from the left wing funded Prescription Project or IMAP. Any bets that Jerry Avorn, supporter of ALLHAT (the modern day Tuskegee experiment) will be annointed?
Hillary takes credit for starting the health IT revolution at the VA. Given recent reports of health records being stolen and then showing up again unannounced, it sure looks like
it...
Last month, as the following article from computerworld.com shows, " a portable hard drive with information on up to 1.8 million veterans and doctors had been reported missing from its medical center in Birmingham, Ala., on Jan. 22."
VA slow to strengthen IT security
it...
Last month, as the following article from computerworld.com shows, " a portable hard drive with information on up to 1.8 million veterans and doctors had been reported missing from its medical center in Birmingham, Ala., on Jan. 22."
VA slow to strengthen IT security
Churchill defined a fanatic as someone who can't change his mind and won't change the subject.
Submitted for your consideration Henry Waxman, who continually grinds out studies showing that when government sets drug prices the prices will be lower because it is a monopoly buyer and who endlessly trots out the the case study against academic tenure, Gerard Anderson of Johns Hopkins, to say that other countries negotiate lower prices so we can too, ignoring how other countries systematically starve their systems of new medicines.
So what else is new? We can have low prices and fewer choices..just vote for it. But didn't Democrats scatter like pollen when it came time to put real teeth into a direct negotiation for Medicare?
Drain profits out of drug companies. No problem. Just watch capital flow out of biotech firms including stem cell investment.
I think Waxman might point out that drug companies warned of a loss of investment before generic drug competition and Medicaid rebates and R and D spending has done up. But he ignores the fact the companies were able to increase market prices to offset government policies and many new drugs came on to the scene during the 1990's that were first in class. In otherwords, pricing freedom and innovative products saved the day. What he's talking about now is capping prices and profits on breakthrough drugs now and in the future. And introducing patent stripping legislation with watered down safety standards that mandate generic biologics as 100 percent interchangeable to help them gain market share.
Now that's a fanatic.
Submitted for your consideration Henry Waxman, who continually grinds out studies showing that when government sets drug prices the prices will be lower because it is a monopoly buyer and who endlessly trots out the the case study against academic tenure, Gerard Anderson of Johns Hopkins, to say that other countries negotiate lower prices so we can too, ignoring how other countries systematically starve their systems of new medicines.
So what else is new? We can have low prices and fewer choices..just vote for it. But didn't Democrats scatter like pollen when it came time to put real teeth into a direct negotiation for Medicare?
Drain profits out of drug companies. No problem. Just watch capital flow out of biotech firms including stem cell investment.
I think Waxman might point out that drug companies warned of a loss of investment before generic drug competition and Medicaid rebates and R and D spending has done up. But he ignores the fact the companies were able to increase market prices to offset government policies and many new drugs came on to the scene during the 1990's that were first in class. In otherwords, pricing freedom and innovative products saved the day. What he's talking about now is capping prices and profits on breakthrough drugs now and in the future. And introducing patent stripping legislation with watered down safety standards that mandate generic biologics as 100 percent interchangeable to help them gain market share.
Now that's a fanatic.
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