POLICY: How dumb is the NY Times?

Like a dog licking an open sore, the  NY Times again returns to the "we spend so much on health care because it’s worth it" meme in a ridiculous article called The Choice: A Longer Life or More Stuff. (This post was about a different NY Times author’s stupid article on the same subject last month). They then print a bunch of reader responses, sadly few of which point out the fact that compared to countries who spend less money we’re not getting "longer life" (although the first one does).

But none of them point out the simple truth. We spend that much because the system has been politically rigged so that it’s virtually impossible not to. There is no causal connection between the vague desire for increased life expectancy on behalf of the public, and the increase in health care system spending. But there is a huge causal connection between the desire for greater health care system revenue on behalf of the system stakeholders and the increase in health care spending– because we have a funding system set up on their behalf. Has the NY Times not heard of, say, Medicare Part D? Have they not heard of 30 years of Wennberg’s Dartmouth works which proves that high cost care has bugger-all to do with improved outcomes? This is like saying we need 5,000 nuclear warheads or a brand new attack fighter 15 years after the end of the cold war, or that the drug war is effective. It’s patently not because we need those things, but it’s because there are strong interests that have gotten them funded!

Why can the NY Times, which does occasionally notice the rape and pillage of the ecoonomy by the health care system (though not as well as the WSJ does), not leave this open sore alone? Perhaps Judy Miller has been reassigned to the health beat and is ghost writing all their stuff, being fed lines by the health care equivalent of the Iraqi National Congress. What other explanation makes sense?



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  1. Abraxane: Hope at $4,200 a dose?
    Abraxane (a taxane) is a new form of Taxol. Abraxane combines the drug paclitaxel with Albumin, a protein found in human blood. Taxol combines paclitaxel with Cremophor, a combination of castor oil and alcohol. The delivery mechanism is different, however, they are basically the same drug.
    Despite its effectiveness, paclitaxel has some drawbacks. Paclitaxel targets the fastest-growing cells, but it isn’t specific to cancer cells. It also kills hair cells and cells in the stomach lining, leading to hair loss and nausea that are associated with chemotherapy. It is possible for many patients to be resistant to it, and also to develop a tolerance, limiting the drug’s ability to fight future occurrences of cancer.
    Patients taking Taxol receive a steroid and an antihistamine to reduce the risk that Cremophor will cause harsh allergic reactions. Patients taking Abraxane do not need to take a steroid or antihistamine, and can be given at higher doses than Taxol. However, more of the women on Abraxane had numbness and tingling in their hands and feet. And more suffered nausea and vomiting, diarrhea, muscle and joint pain and anemia.
    Some taxane-induced side effects are so common, and in some instances so severe, that patients and their physicians may delay treatment, reduce the dose or discontinue therapy altogether. While medications designed to prevent or treat nausea, vomiting and decreased white blood cell counts are available, there are currently no treatments for other serious taxane-induced side effects, particularly nerve damage.
    Despite the broad antitumor activity of taxanes, their clinical usefulness has been limited by common side effects such as painful nerve damage, reduction of white blood cell counts, liver damage, allergic reactions, nausea and vomiting, and other toxicities (Bionumerik).
    According to clinical trials, although it does shrink tumors in more patients, Abraxane does not help patients live longer than the older treatments. Dr. Ramaswamy Govindan, a Washington University professor who was co-author of a December 2006 article in the Annals of Oncology about Abraxane and other, as-yet- unapproved Cremophor-free versions of Taxol, said that none of the new drugs had shown significant advantages over the older medicine. In general, the novel formulations so far have not stood out as distinctly superior.
    Shrinking tumors is a totally inadequate measure of the effectiveness of a drug. German investigators, using the CellSearch system, shown that Taxol produced the greatest degree of tumor shrinkage, but also the greatest release of circulating tumor cells, beginning the most life-threatening aspect of cancer, metastasis. With cells remaining in the circulation, this observation corresponds with results found in patients that tumor response does not mean increased survival (Oncol News Int’l, Vol 14, #5, May ’05).
    Then add in the price shock of the drug! Charging $4,200 a dose for a new version of an old cancer drug. Two studies have documented a clear association between reimbursement to oncologists for the chemotherapy and the regimens which oncologists select for their cancer patients. In other words, oncologists tended to base their treatment decisions on which regimen provided the greatest financial remuneration to the oncologist (Jacobson, M.,O’Malley, A.J., Earle, C.C., et al. Health Affairs 25(2):437-443, 2006) and (Patterns of Care: 2005,Vol 2,Issue 1).
    U.S. Oncology played a role in getting this drug approved. U.S. Oncology took a hit in its latest SEC Form 10-K report. It reported a first-quarter net loss (oops!). They said a number of factors impacted their results, including reduced pre-tax income due to lower use of certain supportive care drugs used to treat cancer-induced anemia (F.D.A. Warning Is Issued On Anemia Drugs’ Overuse), and the discontinuation of the Medicare Demonstration Project (the project HHS’ inspector general’s office found gave providers an extra $130 to simiply forward data that already was collected).
    And one other seemingly unrelated bit of information in the SEC Form 10-K. In 2005, U.S. Oncology was subpoenaed by the U.S. Department of Justice about contracts and relationships with pharmaceutical companies. Coincidence?

  2. Hello,
    I am physician, a child of aging medicare parents and in the medical service business. Nothing is more in the forefront than the issue of Medicare and how it’s coverage, policies and costs are affecting our aging society. Although this is dated today, it is worth emphasizing the need to embrace our system, albeit fractured, the system in many ways is still better than the others. I have written about this issue numerous times in my Keep Seniors Healthy blog at http://keepseniorshealthy.blogspot.com/ . While I address the issue of spiralling out of control medical costs, there is another issue that goes hand in hand and that is the medical liability crisis. It is not that frivolous suits are causing the problem, because most frivolous suits never get that far, it is the mentality of “fear” that doctors cannot avoid and thus practice in this manner. We, as physicians, are always concerned with doing the right thing, and not “missing the wrong thing”. Missing the wrong thing unfortunately weighs on us so much that defensive medicine becomes a ritual and as a result costs skyrocket. People need to take control of their own health, I have created a FREE service at http://www.KeepSeniorsHealthy.com where seniors can create their own FREE personal health record so that they reduce the likelihood of becoming a medical mistake or statistic. It is important that people take advantage of these services.

  3. > why do they put those halos around dog’s
    > neks after they have surgery
    Not to keep them from licking an open sore, but rather to prevent them opening a closed-with-sutures wound. Not the same thing. So there!!

  4. He John I, why do they put those halos around dog’s neks after they have surgery then? Ha gotcha! Of course health care is like defense as I’ll tell you on Spot on soon!

  5. I did a short look for life expectancies in Canada and Europe – looks like they can spend half as much on healthcare and get the same life expectancy as U.S. citizens. So who’e getting more bang for the bucks?
    One statement seems to defy logic:
    “The growing number of families without health insurance are, in effect, families who have been kicked off the country’s health care rolls. Many will go without available treatment, will get sicker than they need to get — and will thereby save the rest of us money. They are what now passes for a solution to the health care mess.”
    Now there’s a solution a Republican can really get behind. Actually it solves another problem of theirs at the same time – Social Security.
    I do think that the cost of healthcare does cause us to make decisions on what “stuff” to spend our money on – food or drugs, rent or healthcare, school supplies or healthcare, energy bills or healthcare. All good free market choices. Baby boomeers looking for that fat pension will find most of eaten up by healthcare, if they aren’t already caught in the other approaching storm – vanishing pensions.
    A recent report stated we’re now spending about 2 billion dollars a week on the war in Iraq but not getting any safer. Seems the same logic for healthcare is being applied to defense, another system that’s, “politically rigged”.

  6. Leonhardt’s way off on this one. As I note in my blog entry yesterday, he’s got both the math and the logic wrong: the incremental lifetime cost is about $1.65 million per person, and much of the 10-year gain in longevity is unrelated to improvements in health care. Even worse, Leonhardt dismisses the significant savings available immediately through the greater use of generic drugs.

  7. A National Coalition for Cancer Survivorship (NCCS) poll found that 89% of Americans said that the distinction between oral and intravenous applications should be abolished so that Medicare beneficiaries can have access to the best drugs to treat their form of cancer.
    According to a recent Health Affairs Study, apparently, Medicare has gone far in accomplishing that task. Nearly all generic cancer drugs and 70% of brand-name cancer drugs are covered by the Part D plans. Most of the brand-name drugs not covered had generic equivalents that are covered. And a number of trusted, old (generic) agents have been found to be just as effacious as the more expensive brand name ones.
    Oral chemotherapeutic agents are easy to use and offer the promise of less frequent visits to oncology office-based and hospital infusion rooms. This promise is not trivial, especially as we have come to realize that many forms of cancer may be managed with these drugs, especially when they offer the equivalent outcome as intravenous drugs.
    However, it is unconscionable that Medicare is actually prohibited from negotiating for lower drug prices for senior citizens. Even the U.S. Veterans Administration and Department of Defense negotiates prices far cheaper than what Seniors are paying for prescription drugs under Medicare Part D. No senior should have to sacrifice their life-savings because prescription medications are not affordable.
    Paying prices set by the drug companies results in 61% higher federal Medicare drug expenditures, and Seniors are left in the “donut hole,” which forces many to choose between buying their needed prescription drugs and having food on the table. According to a June, 2006 article in the NEJM, fatality rates increase 22% for Seniors with a gap in prescription drug coverage.
    The Medicare Prescription Drug Savings and Choice Act (HR-752/S-345), would eliminate Medicare’s dangerous “donut hole” which would protect each receiptient from thousands of dollars in out-of-pocket prescription expenses, and would also require Medicare to use its bulk-buying power to negotiate for lower drugs prices.
    Passing the Medicare Prescription Drug Savings and Choice Act would help millions of Americans who have worked hard their entire lives and deserve to retire with security and dignity.