Month: August 2011

Don’t Stop Medical Innovation

Aug 1, 2011• 8

By EVAN FALCHUCK

The New York Times says “In Medicine, New Isn’t Always Improved.”

Who can argue with this?

“In Dining, New Restaurants Aren’t Always Better.”

Yes, that’s true, too. But does it mean anything?

The article is about a type of hip that is apparently going to be the focus of a lawsuit. The story goes that a lot of people wanted the new hip when it came out, because it was thought to be better than the older ones. Unfortunately, the hip seems to have hurt some people, some of whom may have been better off getting the older one in the first place.

A doctor quoted in the article suggests it’s part of a uniquely American tic. We want all of the latest and greatest things for ourselves, it seems. This story is supposed to be a cautionary tale of what can go wrong when we do.

On the other hand, the latest and greatest things don’t appear out of nowhere. In America, when people demand something, there will be someone who supplies it.

It’s true. Doctors, researchers, the government, and, yes, for-profit companies, create things. They invent diagnostic tests and treatments for disease that never existed before. One reason why the U.S. has a trillion-dollar health care economy is because there are so many people creating so many new things that people can sanely talk about curing – or at least managing – all disease. This is a good thing.

But all these breakthroughs are a two-edged sword.

Off-base Optimism

Aug 1, 2011• 6

By PAUL LEVY

I like to view myself as an optimist, but two recent reports demonstrate the danger of misplaced or premature optimism. I fear that they are influenced by what the authors hope will be the case rather than what has proven to be the case. I find this generally to be the situation in the health care arena, where public policy is often based on shallow interpretations of data and on people’s political wishes rather than rigorous analysis.

The first comes from Karen Davis at the Commonwealth Fund, in a blog post entitled, “Health Spending Continues to Moderate, Cost of Reform Overestimated.” We should know from the title alone that the conclusions cannot be accurate: It is just too soon to reach them. It would be like drawing a picture of climate change from one year of data about temperatures.

Here’s an excerpt:

A recent report from the Centers for Medicare and Medicaid Services (CMS) shows that national health spending grew at a historically low rate of 3.9 percent in 2010, almost paralleling the 3.8 percent increase in our gross domestic product (GDP) last year. This is . . . good news for the federal government as the slowdown indicates that the cost of health reform has been overestimated.

Now, let’s look at the possible reasons:

First . . . continuing declines in employment and private health insurance coverage have contributed to fewer people receiving both essential and nonessential treatment. [F]ewer people have received needed preventive and acute care. And people have increasingly gone without prescriptions, tests, and elective procedures.

Continue reading…

Chinese Research: Not Quite the Juggernaut?

Aug 1, 2011• 1

By DEREK LOWE

A perennial topic around here has been the state of scientific research in China (and other up-and-coming nations). There’s no doubt that the number of scientific publications from China has been increasing (be sure to read the comments to that post; there’s more to it than I made of it). But many of these papers, on closer inspection, are junk, and are published in junk journals of no impact whatsoever. Mind you, that’s not an exclusively Chinese problem – Sturgeon’s Law is hard to get away from, and there’s a lot of mediocre (and worse than mediocre) stuff coming out of every country’s scientific enterprise.

But what about patents? The last couple of years have seen many people predicting that China would soon be leading the world in patent applications as well, which can be the occasion for pride or hand-wringing, depending on your own orientation. But there’s a third response: derision. And that’s what Anil Gupta and Haiyan Wang provide in the Wall Street Journal. They think that most of these filings are junk:

As if we needed further proof…

Aug 1, 2011

This weekend tells us three things. One, American government is beyond broken. In this completely artificial debate, a minority opinion that after all represents a minority of the opinions of a party that only controls one third of the government dictates the terms of the deficit reduction compromise. A compromise that is pure fantasy anyway. Two, no one in DC gives a shit about the economy and particularly no one cares the lowest 30% of Americans who are un- or marginally employed or relying on support from society. We heard nary a peep even from any Democrats about them as we insanely cut spending in the middle of a recession. It’s 1937 all over again. Third, health care is for sure a government business, according to Wall Street, with the stocks of most major insurers and hospitals off 5-10% this morning on fears of cuts in Medicare.

Deficit And Debt Politics: A Wake-Up Call For The Health Care Industry?

Aug 1, 2011

By JONATHAN OBERLANDER

The 2010 Affordable Care Act (ACA) called for significant Medicare savings. All told, the Congressional Budget Office projected that the law would trim over $400 billion from Medicare spending during 2010-2019, reducing the program’s annual growth rate from 6.8 percent to 5.5 percent.

Those savings were enabled, at least in the case of hospitals, by the promise of expanding insurance coverage that would bring in more insured patients (and thus more revenues to help offset the Medicare cuts). Yet some observers in the health industry no doubt assumed that the ACA’s payment reductions could be reversed over time. After all, they had seen Congress repeatedly cancel scheduled payment cuts to Medicare physicians in the annual melodrama surrounding the Sustainable Growth Rate.

Why couldn’t the health care industry similarly expect to evade the ACA’s cost controls? In coming years, the industry could argue that any payment cuts would jeopardize patients’ access to care. And given that Medicare’s own actuary cast doubt on how realistic the projected savings were, the odds must have seemed good to hospitals and other providers that they could sooner or later count on SGR-like relief from Washington. Health reform offered an appealing political and business strategy: initially accept the projected cuts in the ACA, then gain more paying customers through the implementation of insurance expansion, and, finally, work to reverse the cuts and “unbend” the cost curve.