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Month: July 2004

POLICY: Scully guilty, but not legally, with BRIEF UPDATE

In a splitting of hairs in a report from the HHS inspector general, Tom Scully the administrator of CMS when the Medicare bill was passed, was found guilty essentially of lying to Congess. In fact while Scully pressured the main CMS actuary so that he didn’t reveal that the MMA would cost more than $500 billion rather than the $400bn that the Administration told Congress, he didn’t break the law in doing so.

The irony of all this is that despite the huge pressure the Administration and the leadership brought to bear mostly on House conservatives to vote for the bill, its passage has probably been a negative for the Administration, and will probably be a liability come November.

UPDATE: While neither this story nor the related ongoing enquiry into the bribery on the floor of the House while the bill was being voted on, probably won’t make much difference in real life (i.e. the election), The NY Times report on this story has a couple of juicy factoids:

    In recent weeks, Mr. Scully has registered as a lobbyist for major drug companies, including Abbott Laboratories and Aventis; for Caremark Rx, a pharmacy benefit manager; and for the American Chiropractic Association and the American College of Gastroenterology, among other clients. All are affected by the new Medicare law, which Mr. Scully helped write.

And Pete Stark gets his snide oar in there.

    Representative Pete Stark of California, the senior Democrat on the House Ways and Means Subcommittee on Health, said, "It sounds as though the Bush administration examined itself and found it did nothing wrong."

QUALITY: Hospitals remain dangerous, but talking about the issue makes them safer

I saw Michael Millenson doing Grand Rounds at UCSF last week. Michael, who has been mentioned in THCB a number of times, is a former journalist who has become something of a "bete noir" to organized medicine–or at least would be if they paid him any attention. While the AMA debates not offering care to trial lawyers, Millenson continues to point out the general "Silence" of leading medical organizations on the medical safety issue. The case he discussed at the UCSF Grand Rounds concerned a woman who’d had a double mastectomy for breast cancer that was later found to be a case of wrong identity on the pathology slides. The case was used by trial lawyers responding to Bush’s attacks on them over malpractice caps. Of course the AMA and its political allies have plenty of other human interest stories of counties where there are no obstetricians/brain surgeons/pediatricians because of the cost of malpractice insurance.

However, this fight between the lawyers and the doctors continues to miss the point, which is that we are a long way from achieving widespread use of evidence-based medicine. One little thing that might help is the "signing" of body parts by the surgeon prior to surgery, now as the Washington Post reports it is recommended as standard. I recall that before knee surgery in California at Stanford Hospitals in 1996 I wrote "Not This One" in marker pen on my healthy knee, and that got the admitting nurse very annoyed. At least the medical error debate is now in the open.

What’s not so in the open is the in-hospital infection issue. Millenson suggested last week that a nosocomial infection during on of Cheney’s heart procedures, or (my preference) perhaps during Ashcroft’s recent stay in hospital, would really put that issue on the front burner. (They could of course have a complete and full recovery afterwards!) Maybe not, but he found for me a really vicious example in the UK, where the medical safety debate has been even slower to develop than over here. This one concerns Claire Rayner, who is the British equivalent of Ann Landers. In this interview she hammers on the issue of infections caused by sloppy hygiene in hospitals. Take a read, And before you say it couldn’t happen here, be assured that it is happening here too — unless the IOM is making it all up.

Claire Rayner ascribes the problem to a decrease in standards of nursing care, directly associated with an increase in the number of less-well trained people dealing directly with patients. Interestingly enough Linda Aitken’s academic work has shown that there is a relationship in quality of care and outcomes based on the overall level of nurses’ education in a hospital staff. So Rayner may be on to something there. In any event, the more known about this issue, the better, and whatever Newt Gingrich and anyone named Kennedy say, IT is not a guaranteed standalone fix here. We need a system change.

TECHNOLOGY: Boston Scientific recalls stents

A while back THCB reported that there were some murmurs about problems with Boston Scientific’s Taxus stent. That followed earlier manufacturing problems with J&J’s Cypher stent. Now Boston Scientific has recalled about 200 stents with manufacturing defects.

This is probably a very minor hiccup in what has been a stellarly successful product launch. The Drug Eluting Stent (DES), which is on the way to being a $5bn market, has grown very fast to replace the bare-metal stent as a treatment of choice. This transition has helped over shadow research that showed that bare-metal stents (and the TCPA that accompanies them) were not as effective as by-pass surgery. Of course there are as yet no long term studies of the impact of re-stenosis from the new DES–but cardiologists and their suppliers have carried the day, and the drug-eluting stent (which incidentally is beginning to really negatively impact hospitals’ bottom lines) is the latest and greatest thing to hit interventional cardiology in ages. That’s a typical evolution of medical technology–put into mass use before it’s proved cost-effective compared to other treatment largely on implied promise. That’s the way health care works, and three decades of technology assessment work hasn’t changed it, and isn’t likely to soon. And minor manufacturing quality issues, if handled properly, won’t make any difference to that process.

TECHNOLOGY: Fuel Cells That Keep Going And Going…

A quickie for July 6th. I have been moving house (and office), had limited access to DSL and THCB has suffered a bit. Sorry, but the move is almost done (You must all come and visit!). My backlog is huge and there’s tons of interesting stuff coming!

Robert Mittman wrote about fuel cells last year and Forbes followed up last week. Hopefully PDA Fuel Cells That Keep Going And Going… will mean that we won’t be searching around for that socket in the departure lounge in a hopeless attempt to keep that phone or laptop going all flight.

HEALTH PLANS: Wellpoint merger wandering through California

While the shareholders have approved the Anthem-Wellpoint merger, it looks like state insurance commissioner John Garamendi is likely to oppose it, causing a little embarrassment for a certain Governator. Meanwhile, the public hearing has been set for later next week.

Again, look for a deal with at least some of the money once headed to the pockets of Wellpoint executives instead ending up in the (bankrupt) state’s coffers.

INDUSTRY: Is nothing sacred? Cardinal admits sinning

OK, not really, but serious bad news at what has been one on the health care industry strongest performers and best run companies. Cardinal Health anounced that it would miss profit forecasts, and was being investigated by the SEC. The stock is off 25%. The Street.com has (for them) a balanced article including this juicy quote from one analyst: ‘Multiple investigations, lowered guidance and a hazy outlook on growth have shaken our thesis that CAH is a ‘buy and hold forever’ stock,’ Wieland concluded.". Of course regular THCB readers know what’s coming next. I bought a small amount of Cardinal stock on a slight dip as part of my "sensible" portfolio last month! Oh well, back to crazy biotech companies with no revenue–they’re clearly safer!

POLICY: One in five households struggle with medical debt

I’m moving today and tommorrow so dont expect much real thoughtful action here until next week. However, I’ll list a few bits and pieces you should keep up with.

As you’ll recall in my comparisons of Canadian and US healthcare systems (in my Oh Canada piece and elsewhere) the major issue for lower income Americans is their problems paying the bills associated with medical care. This is virtually unknown elsewhere in the civilized industrialized world. HSC has a new report out showing that 20 million families, which is about 20% of households, in the US have serious problems with medical bills, including having to choose between paying them and paying rent.

With a little more of this rhetoric, health care just might become a slightly more important issue for this election cycle. It’s more likely though that this will continue to build up until the dam bursts in the latter part of this decade, and we engage in a full-scale national debate a la 1992-4.

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