Experience is not the Answer

Bradley Flansbaum

First posted 8/25/11 on The Hospitalist Leader

I assume, incorrectly perhaps, that mechanics have a basic knowledge of their craft such that routine auto repairs require little effort.  The tasks do not supersede the expected competency of the repairperson, and the customer can expect a car that operates at the time of pick up.  A small percentage of jobs may stretch that assumption, but that is okay by me.  Just like medicine, some mends are complicated. You need assistance from another mechanic or you refer the auto to a specialty garage.  No one is superman.

How does this relate to the practice of medicine?

I frequently notice pharmaceutical ads on Sunday AM television broadcasts, as well as newspaper articles that advertise a medical product, or report on a new device, surgery, or therapy—usually of the latest and greatest vintage.  As the data for these interventions is incomplete, or the costs unknown, the story concludes with a riposte conveying that the reader need not concern themselves with the alien facts—just “consult your health professional” and all will be well.

I also observe that politicians object to “meddling” when EBM-based policies from expert committees passively (or actively) affect the doctor-patient relationship, especially as it relates to decision-making and the counsel we provide.  Just watch the nightly news—sound bites abound.  This relationship is sacrosanct after all, and our advice is authoritative and 98.7% correct.  Who would question a physician after all?

Continue reading “Experience is not the Answer”

So Cheap, I’ll Take Two!

Paul Levy

WBUR/CommonHealth reporter Rachel Zimmerman went shopping recently for a pelvic ultrasound.  She summarizes the results on a great new website called Healthcare Savvy.  Here’s an excerpt:

I called each facility, and here are the prices I was quoted for a pelvic ultrasound:

–Mass. General: $2847 or $2563 (more on this later)
–Mt. Auburn: $971.96
–Diagnostic Ultrasound Associates: $516

All three quotes were for the imaging only and did not include professional services or other additional costs, I was told.

So, is it just me, or is a five-fold difference in price for the same procedure at three greater Boston facilities kind of shocking?

I called MGH back to make sure I heard right. Weirdly, on Wednesday, the ultrasound price was $2,847, but on Thursday it was $2,563. (Do I hear $2,000?) I called the hospital’s PR office for a comment on why it costs so much more. Here’s the statement they sent me from Sally Mason Boemer, Senior Vice President of Finance: “MGH typically benchmarks our gross charges with like institutions and find our charge levels to be consistent with other urban medical centers that have a significant amount of complex care, teaching and research missions, and a high uncompensated care burden.”

Paul Levy is a former large hospital CEO and now, an advocate for patient-centered, efficient care. He writes at Not Running a Hospital.

The Fallen Souffle Economy and the Health Care Bubble

Jeff Goldsmith

First posted 8/10/11 on The Health Care Blog

It is increasingly clear that the United States’ economic troubles are far from over.

The stock market plunge that began in earnest last week reflects the market’s belief that we’re not going to recover fully from the recession that began in 2007. As a Wall Street Journal commentator said mid-Monday’s plunge:  “The market is pricing in a double dip recession”. In reality, the 2007 recession (caused initially by $150 a barrel oil) never really ended.

Past remedies for recession basically involved nearly free money and Keynesian pump priming to stimulate demand with either borrowed or freshly printed money. The most recent (bipartisan) stimulus effort, nearly a trillion worth of extended Bush tax cuts, unemployment extensions, payroll tax cuts, etc. which Congress and the Obama Administration negotiated in December, seems to have disappeared into thin air, producing a whopping 0.8% economic growth in the first half of 2011 and a July unemployment rate of 9.2%. This Economist analysis argues that the political system has exhausted its remedies for our economic problems.

Continue reading “The Fallen Souffle Economy and the Health Care Bubble”

The Difference Between Health Care Costs and Investments

Kenny Lin

First posted 7/27/11 on Common Sense Family Doctor 

Now that the NFL lockout has ended, even sports fans can follow without distraction the ongoing spectacle of federal gridlock leading the government ever closer to defaulting on its more than $14 trillion in loans. With the abundance of fiery, uncompromising rhetoric and arcane terminology such as grand bargains, caps and balances, you may be forgiven for feeling, as I do, we are watching a rerun of the health reform non-debate in late 2009 and early 2010. Indeed, decisions over the next several days have almost as much potential to affect the quality of health care in the U.S., as funds for graduate medical education (and training of family doctors) are on the chopping block in proposals from both parties. While I hope that the advocacy efforts of primary care organizations and their supporters are enough to #SaveGME, the outcome is far from certain.

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Rads Are Good For You. Take Twice As Many

Paul Levy

First published 6/19/11 on Not Running A Hospital

Dear Mrs. Smith, I am writing to inform you that we exposed your body to an unnecessary level of radiation during your visit to our hospital. Oh, by the way, that was two years ago. We don’t intend to do anything about this for you. Also, we have known about this problem for a long time, and we don’t expect to change our procedures for future patients. Just wanted you to know. Yours in delivering the best health care in the world, Chief of Radiology and CEO. (Jointly signed.)

That’s the essence of this article by Walt Bogdanich and Jo Craven McGinty in the New York Times. Here are excerpts:

Continue reading “Rads Are Good For You. Take Twice As Many”

Heart Ring Slips Through FDA Loophole

Merrill Goozner

First published 5/23/11 on GoozNews

The Chicago Tribune had an important series over the weekend exposing conflicts of interest in the cardiovascular medical device industry, and the loopholes in regulatory oversight that allowed what appears to be a dangerous heart valve replacement part to escape Food and Drug Administration scrutiny. The latter story is by far the more important one. Here’s the details, from the Trib website:

Instead of being grouped with heart valves and implantable pacemakers, annuloplasty rings were put into a class with most catheters, sutures and hearing aids, which allows the medical device industry to gain approval for new rings without clinical studies.

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Specialty Drugs Will Drive Future Rx Spending Trend

Jane Sarasohn-Kahn

First published 5/19/11 on Health Populi

In the 2011 Medco Drug Trend Report, there’s good news and bad news depending on the lens you wear as a health care stakeholder in the U.S. On the positive side of the ledger, for consumers, payers and health plan sponsors, drug trend in 2010 stayed fairly flat at 3.7% growth. That’s due in major part to the increasing roster of generic drugs taking the place of aging branded prescriptions products. More than $100 billion (with a ‘b’) worth of branded drugs will go off-patent between 2010 and 2020, and the generic dispensing rate could reach 85% by 2020, Medco expects, especially looking at high-cost categories like statins. So generics are dramatically slowing drug cost increases overall.

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The Patent Cliff, Coupled with Value-Based Purchasing, Make For A Declining Branded US PhRMa Market

Two mega-trends are driving down branded pharmaceutical sales in the U.S.: switches from branded to generic prescription drug products for major chronic conditions; and, the lack of new-new branded Rx products that (could) command higher prices.

A down-market picture emerges from The Use of Medicines in the United States: Review of 2010based on market data analyzed by the IMS Institute for Healthcare Informatics (IMS). While U.S. market growth for pharma overall ranges from 3% to 5%, IMS says, protected Rx brands were negatively impacted through the switch to cheaper generic substitutes. Generics now comprise 78% of pharma market share.

The key sentence in the report that underlies this dark snapshot is: “The number of patients starting treatment for a chronic therapy was down 3.4Mn from 2009 levels, and increasingly these patients are starting therapy with a generic drug.”

Continue reading “The Patent Cliff, Coupled with Value-Based Purchasing, Make For A Declining Branded US PhRMa Market”

CABG in Decline

Merrill Goozner

First published 5/3/11 on Gooz News

The number of Americans with serious heart disease in need of hospital treatment is on the decline. A new study in today’s Journal of the American Medical Association shows the overall rate of coronary revascularizations — ranging from the coronary artery bypass graft (CABG) surgeries to in-and-out catheter-based procedures like angioplasties and stent insertions — fell from just under 1,500 per million adults a quarter in 2001 to less than 1,250 per million adults a quarter in 2008, a 15 percent decline.

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Should Pharma have Unrestricted Access to Doctors’ Prescribing Profiles?

Kenneth Lin

First published 4/25/11 on the American Family Physician Community Blog

For many years, it has been a common practice for pharmaceutical companies to use individual physicians’ prescribing profiles to tailor their marketing and sales strategies. For example, if a drug rep had access to data showing that a particular family doctor was prescribing more of a competitor’s anti-hypertensive drug, he or she might make a point of dropping off a batch of samples to change that doctor’s prescribing practices. As explained in a previous AFP Journal Club, this strategy is often very effective for the drug company, but ends up increasing patients’ out-of-pocket expenses in the long run.

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Serious Flaws and Conflicts Undermine Largest Anti-Depressant Study

Allison Bass

First published 4/25/11 on Alison Bass

In 2006, researchers first published results from a $35 million NIMH-funded study of antidepressants known as STAR*D, claiming it proved the effectiveness of second-generation antidepressants used alone and in combination with each other. The NIMH chimed in with press releases extolling “new strategies” that help depressed patients become symptom-free, and the findings became the basis for American Psychiatric Association’s guidelines calling for the open-ended use of antidepressants in treating depression.
Continue reading “Serious Flaws and Conflicts Undermine Largest Anti-Depressant Study”

Against All Odds: The Incredible Journey of a Drug

Out of Taiwan

Archeologists and historians have determined that migration from Southern China to Taiwan started about 12,000 years ago. About 3000 -4000 thousand years later (or about 8000-9000 thousand years ago) ancient Taiwanese inhabitants set out by canoes or catamarans, and about 3500 years ago reached the Bismarck archipelago, on the eastern edge of Melanesia. Within a mere three or four centuries between about 1300 and 900 BC, they spread 3,500 miles further to the east from the Bismarck Archipelago, until they reached as far as Fiji, Tonga, and Samoa which were populated around 2,000 years ago (1st century A.D). In this region, the distinctive Polynesian culture developed. About 800 A.D, the Polynesian explorers finally reached Easter island, or Rapa Nui in the Polynesian language, at the extreme east of the “Polynesian triangle.”

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Independent Drugstores – Facing Tough Health and Retail Economics – Are Still Beloved by Consumers

Jane Sarasohn-Kahn

First published 4/11/11 on Health Populi

In the pharmacy market battle between Davids and the Goliath, David wins in the latest Consumer Reports survey on best drugstores according to consumers: independent pharmacies come out on top, and Walmart ranks last on the roster.

The most highly-rated chains, highly indexed at 90 or more points, Health-Mart, The Medicine Shoppe, Bi-Mart, Publix, Hy-Vee, and Wegmans. Target, which was just ranked the #1 retailer in brand equity by the Harris Poll (where Target also beats Walmart in general retailing brand equity), ranked lower with an 88: much higher than Walmart with a 78 index, but below Walmart’s Sam’s Club and several grocery chain-based pharmacies.

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Who Owns Patient Data? (The Walgreens Edition)

Walgreens is being sued by customers who are not happy that their prescription information – even though it has been de-identified – is being sold by Walgreens to data-mining companies.

The data privacy and security concerns surrounding the transfer of de-identified data are significant.  To “de-identify” what is otherwise protected health information under HIPAA, some outfits will simply strip data of 18 types of identifiers listed in federal regulations.  However, the relevant regulation (45 CFR 164.514(b)(2)(ii)) also provides that this only works if “the covered entity does not have actual knowledge that the information could be used alone or in combination with other information to identify an individual who is a subject of the information.” Thus, the problem with this approach is that, these days, nobody can disclaim knowledge of the fact that information de-identified by removing this cookbook list of 18 identifiers may be re-identified by cross-matching data with other publicly-available data sources. There are a number of reported instances of this sort of thing happening. The bottom line is that our collective technical prowess has outstripped the regulatory safe harbor.

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Doctors Love iPads. What Does It Mean? What Does It Mean?

Vince Kuraitis

First published on e-CareManagement on 2/26/11

After attending the largest annual health IT conference of the yearHIMSS 11 –  John Moore reported that “nearly every EHR vendor has an iPad App for the EHR [electronic health record], or will be releasing such this year.”

Doctors love iPads…not surprising? But, how might you explain this?

There are at least two different possibilities:

  • Coincidence Theory
  • Conspiracy Theory

Continue reading “Doctors Love iPads. What Does It Mean? What Does It Mean?”