I’m up over at the Health 2.0 Blog talking about my favorite drug interaction checker. Meanwhile if you (yes, that means you) want to write on the Health 2.0 Blog, please *******@*********lt.net” target=”_blank”>email me and let me know.
POLICY: Why you shouldnt be interviewed over the phone…
Apparently in an interview I had with journalist Thomas Day from Medill reports news service which showed up in this article I said:
If you look at California and Blue Cross-Blue Shield, their biggest provider, they came out against the Schwarzenegger bill because it essentially said the same thing [as Democratic proposals],” said Matthew Holt, a San Francisco-based health-care advocate.
What I hope I meant to say was this:
If you look at California
andBlue Cross-Blue Shield,theirthe biggestprovider, insurer in the small group markettheycame out against the Schwarzenegger bill because it essentially said the same thing [as Democratic proposals], such as limiting underwriting in the individual market and limiting the amount of money insurers could make” said Matthew Holt, a San Francisco-based health-careadvocate.blogger/consultant/wise-ass
There’s that’s better!
WSJ Editorial on Liver Transplants Cherry-Picks the Numbers
Dr. Scott Gottlieb, a resident fellow at the conservative American Enterprise Institute, published an op-ed in the Wall Street Journal last week that returned to the much-exploited story of Nataline Sarkisyan, the 17-year-old Californian who died before receiving a liver transplant. Gottlieb used the story to make the argument that “the U.S. has the best health care in the world.”
Gottlieb is squaring off against John Edwards, who has been suggesting that if Nataline had lived in a European country she might have lived. Edwards blames CIGNA, her for-profit insurer, for refusing to cover the procedure. Dr. Gottlieb, who is a former FDA official, responds with a double-barreled argument: “Americans are more likely than Europeans to get an organ transplant, and more likely to survive it too.” He sounds confident, and at first glance, his argument seems persuasive.
But a closer look reveals that Gottlieb makes his case by carefully culling the numbers that fit his argument, while omitting those that don’t. Unfortunately, too many people involved in the healthcare debate play fast and loose with the facts. Everyone interested in reform should be on the look-out for those who don’t cite solid evidence for their assertions. If they don’t give you their source, it may be because they don’t want you to look it up—and because they realize that they are cherry-picking the numbers.
Before engaging Gottlieb’s argument, I should acknowledge that, as I have said in an earlier post, I think Edwards has picked a bad case to make his argument for healthcare reform. I am not at all certain that the transplant would have helped this particular patient. And while Edwards puts all of the blame on CIGNA, Nataline’s insurer, I am bothered by the fact that the hospital asked for a $75,000 down payment on the surgery and then refused to go forward without it. As one physician/blogger from the very same hospital where Nataline was treated asked: “Why didn’t the hospital simply perform the surgery and defer payment from the family or CIGNA [Nataline’s insurer] until later? If it was such a great idea, why didn’t they exhibit the outrage and strength of conviction to go ahead regardless of CIGNA’s assessment?”Continue reading…
PHARMA: Talking of gotcha’s…
Schering Plough is coming under multo criticism the last two days for sitting on data for up to a year that shows that the anti-cholesterol drug Zetia, when combined with Merk’s Zocor in the combo drug Vytorin, not only didn’t work but may have caused harm. Here’s the story in the NY Times and here’s the op-ed in the same paper saying:
It was still very disturbing to learn this week that a heavily promoted cholesterol-lowering drug had flunked a clinical trial of its effectiveness in reducing fatty deposits in arteries. The two companies that reap billions from the drug had been cynically sitting on the results for more than a year.
But trust Peter Rost to find the wrinkle—Schering-Plough’s President dumped $28 million in stock before Vytorin controversy erupted.
So where is the SEC investigation (and for that matter, what about their investigation into similar activity at Wellcare)?
Four Big Trends – Brian Klepper
Several events and trends emerged over the last year that will reverberate throughout the health care
marketplace in 2008 and going forward. While none of these dominated the trade press like some other issues – electronic and personal health records, RHIOs, the evolving labor shortage, pay-for-performance reimbursement – these manifestations of change are occurring in the marketplace as well as through policy, and are moving health care forward in fundamentally positive and far-reaching ways.
Health 2.0The most significant for the long term in terms of its capacity to change how health care works is the Health 2.0 movement, which Matthew Holt and Indu Sabaiya have played a central role in facilitating and explaining. In some ways, Health 2.0 is simply a continuation of what has come before: companies creating new value through information and connecting with customers over the Web. Health 2.0 takes this approach into every area of health care data, often driven by companies outside of or at the margins of health care, who have no financial stake in perpetuating inappropriateness and waste, and who see an opportunity to make money by rationalizing the system.
POLICY: Do mandates matter? with UPDATE
Former Labor secretary Robert Reich has appealed to Democrats (in other words Paul Krugman and Obama’s
camp) to stop squabbling over healthcare mandates. Basically he says that Clinton would have to let some people who couldn’t afford health care out of the mandate (as is happening in Massachusetts) and that Obama’s plan would get us close enough to universal coverage that the difference isn’t worth arguing about.
Writing in THCB last week Robert Laszewski pointed out that the cost of buying insurance is sufficiently high that a subsidy would have to be so large and go so high up the income scale that it wasn’t politically realistic — and certainly wasn’t working in Massachusetts. So in his view Obama and the Republicans (Robert is actually generous enough to give some of them credit for having thought about this) are right not to push for a mandate.
But then of course, with no mandate you’re not getting everyone into the pool. So what do you end up doing with those who don’t have insurance when they need care? You end up with what happened in Hawaii, where universal pay or play ended up in 90% insurance.
QUALITY: Mental health–any ideas?
I was highly struck by something Dr David Sobel said in his great speech at the Ix Therapy conference last October—he suggested some 50% of primary care office visits are the result of background mental health issues. That sounds intuitively right. After all a British GP once told me that his most frequent symptom was “TATT” (tired all the time”).
Meanwhile I’ve been getting to know a homeless childrens’ organization in San Francisco, which specializes in mental health services for those families. And not surprisingly those kids have issues that result in wide social and health problems later on (but not too much later on) in life.
Then today a reader asked me if there was any evidence on whether more care overall, and specifically more specialty care, would help those with mental illnesses? And whether providing more treatment manages to save money down the line (presumably in other areas).
Mental health has not been an area we spend much time on at THCB, other than perhaps to acknowledge that we over-medicate some populations. But Vic Fuchs did say to me once, “remember, the head is connected to the body”.
So does anyone have any data or conclusions about whether specialty mental health care is a) effective and b) a good investment? Please comment below.
TECH: Telepresence–very cool & that’s official!
I’ve mentioned a couple of times on THCB that Telepresence from Cisco is a really cool technology that had a big future in health care. But now it’s official! Healthcare’s coolest CIO, John Halamka has proclaimed it his Cool Technology of the Week. You should read the piece, as he actually gives lots of details—especially about the potential reduction in price that will make full time always on telconferencing much more available. BTW you may have noticed an excess of BIDMC on THCB today. Must be fun hanging out in the executive suites in Beantown, having nothing to do all day but write blog posts (just kidding guys!!).
HOSPITALS: Sunshine is the best disinfectant by Paul Levy
Our mail room staff called today to say that over 500 letters had arrived from the SEIU to doctors in
the hospital. One of the doctors was kind enough to share his with me,
a letter from Mike Fadel, Executive Vice President. I’ll spare you most
of the details, but I will give you a small quote:
"BIDMC’s CEO
recently has complained that he has been singled out for public
criticism on the ‘question’ of whether hospital workers should be
promised that they will not be threatened by executives on the decision
of unionizing. Be he has singled out his own institution by essentially promising to fight against BIDMC’s own caregivers as if they were adversaries."
Those
of you who are regular readers of running a hospital know that all of the above
is not true. You know the high regard and respect I have for our
employees, and you know of my personal efforts to improve the work
environment at this hospital — both for their sake and in support of
providing better care to our patients. You can also see exactly what I
have said about union organizing in general and the tactics of this union in particular.
HEALTH 2.0: Health 2.0 NorthEast Networking Meeting
The Health 2.0 movement continues to grow and in the north-east it now has a new "chapter"! Mark Modzelewski, from Bang Ventures & Vince Caprio, from NYNBA, are organizing its first networking meeting on January 23rd! The meeting is from 5.30 to 8.30pm on Jan 23 at the Cambridge Marriott.
Indu Subaiya & Matthew Holt will be there along with other familiar names from the Health 2.0 world, there’ll be some brief remarks and a panel Q&A but this is intended to be a networking event. (There’s a small charge to pay for the drinks, but all the money will stay in the chapter to pay for drinks at the next one.) So bring your colleagues working in Health 2.0, Web 2.0 or anywhere else, and sign up on this form!
And of course feel free to forward this to anyone who might be interested
