Category: Health Tech

Donald Light sticks it to PhRMA and Tauzin, again

Aug 26, 2009• 5

By Matthew Holt

Over the years PhRMA must be getting pretty sick of Univ of Medicine and Denistry of New Jersey Professor Donald Light. He’s made a cottage industry of pissing on the commonly-trumpeted propaganda that only American drug research is effective, and that high prices for drugs in the US cross-subsidize lower prices elsewhere in the world. And in Health Affairs this week he does it again. Essentially Light shows that the added R&D spent in the US compared to Europe doesn’t give much bang for the buck, and that not many breakthrough drugs have been created anyway—something that PhRMA knows all to well as it looks at its shrinking pipelines.

In global NCEs, European research productivity was about the same as U.S. productivity in the first period but increased by 30 percent in the second period (1993-2003), while U.S. research productivity declined 26 percent (Exhibit 3). In first-in-class drugs, European relative innovativeness moved from well behind the United States in the first period to well ahead in the second. These are the most commercially and therapeutically important types of new chemical entities.

Now personally I think that, in an era in which all drug research is pretty much international, the basic premise of the argument about which system does more effective drug research is pretty silly. But of course it’s a one-two punch. And the upper-cut that would leave pharma staggering if it didn’t have control of the microphone is this quote from Light:

Congressional leaders and others concerned about high prices of new patented drugs will be heartened by this analysis, because lower European prices seem to be no deterrent to strong research productivity.²⁰ A previous analysis using industry-based data showed that pharmaceutical companies recover all costs and make a good profit at European prices.²¹ Europeans are not “free riders” on American patients–another myth promoted by industry that assumes that countries are separate R&D/market silos that should each pay for themselves.

Given that Billy Tauzin at PhRMA has already cut a deal with the Obama Administration (albeit one that seems to be unofficially official), none of this matters very much. But it’s good to see that it might just be possible to reduce the very high margins earned by big Pharma without necessarily ending scientific advancement as we know it.

CODA: Read Michael Cannon’s amusing take on PhRMA’s Billy Tauzin’s performance here.

JSK & Joe DeLuca on KQED

Aug 21, 2009• 1

By MATTHEW HOLT

One of the best local talk shows anywhere is Michael Krasny’s Forum on 88.5 KQED, San Francisco’s establishment NPR station (SF of course has a rebel NPR station KALW which has had me on a couple of times but I’m too scruffy for KQED!).

At 10 am PST Forum has a show about health IT which has Robbie Pearle from the Permanente group and 2/3 of my old HIO project team at IFTF, Joe DeLuca and Jane Sarasohn-Kahn.

You can listen in here

Interview: Bob Wachter on reform, safety, primary care and everything

Aug 19, 2009• 4

By MATTHEW HOLT

Robert_wachter

One of the best commentators around on the issues of patient safety, health care quality and basically everything to do with health care organizations is UCSF Professor Bob Wachter. Bob has been in the trenches as one of the leaders in the hospitalist movement, a major driver behind improving patient safety, and has also straddled the worlds of medical practice as a PCP, academia at UCSF, and been publicizing this all to a wider audience–particularly with his 2005 book Internal Bleeding and his more recent book Understanding Patient Safety. Then of course there are his occasional blog posts both on Wachter’s World and here on THCB.

This was a really fun conversation and somehow Bob remains an optimist. Here’s the interview.

I am shocked, shocked that Rick Scott would twist the truth

Aug 16, 2009• 12

By Matthew Holt

Surprise, surprise, the British women who appear in the so-called Conservatives for Patients’ (so-called) Rights” propaganda are complaining that their words were twisted completely out of context. ‘We were duped’: Two British women tricked into become stars of campaign to sabotage Obama’s healthcare reforms. Further the British oncologist featured was told that he was appearing in a documentary, not in a right wing advertising campaign.

And most disingenuously of all—whether you agree with it or not—at no point have the Congressional leaders running the process or Obama introduced legislation calling for either serious single-payer (Canadian-style) or nationalized government provided care (UK-style).

So Rick Scott is conning people to twist their stories to run adverts to oppose something that no one is proposing.

Perhaps there should be $1.8 billion dollar fines for misrepresentation…

Voices from the deserving mob

Aug 15, 2009• 15

By Matthew Holt

From the (UK) Independent. Real quotes from real people attending the free care in LA this week:

“I had a gastric bypass in 2002, but it went wrong, and stomach acid began rotting my teeth. I’ve had several jobs since, but none with medical insurance, so I’ve not been able to see a dentist to get it fixed,” she told The Independent. “I’ve not been able to chew food for as long as I can remember. I’ve been living on soup, and noodles, and blending meals in a food mixer. I’m in constant pain. Normally, it would cost $5,000 to fix it. So if I have to wait a week to get treated for free, I’ll do it. This will change my life.”

***

She works for a major supermarket chain but can’t afford the $200 a month that would be deducted from her salary for insurance. “It’s a simple choice: pay my rent, or pay my healthcare. What am I supposed to do?” she asked. “I’m one of the working poor: people who do work but can’t afford healthcare and are ineligible for any free healthcare or assistance. I can’t remember the last time I saw a doctor.”

***

“You’d think, with the money in this country, that we’d be able to look after people’s health properly,” she said. “But the truth is that the rich, and the insurance firms, just don’t realise what we are going through, or simply don’t care. Look around this room and tell me that America’s healthcare don’t need fixing.”

And that last one is the money quote.

Which mob should we care about?

Aug 13, 2009• 16

By Matthew Holt

The one on the left one protesting against the extension of health care to the uninsured at Sen Arlen Specter’s townhall meeting? Or the one on the right–some of the 1500 un and underinsured queuing for 2 days for care in inner-city Los Angeles (both photos from NY Times)

Townhall

Fame! (In Canada only)

Aug 11, 2009• 1

By Matthew Holt

TV is fascinated by my views on American health reform. Well not American TV (you have to be called Michael Cannon to get on American TV).

Following my record-setting appearance on France 24 TV (record was fewest every viewers for a news show), today I’m going to be on CBC News. That’s CBC as in Canada. I think you can find it here and I should be on at 11.15 PST or 2.15 EST

Palin: Obama Health Plan “Evil”

Aug 10, 2009• 128

The strange plot of the national debate over health reform this took another twist over the weekend, after (now suddenly ex- Alaska governor) Sarah Palin posted a statement on her Facebook page on Friday denouncing the Obama administration’s plan to reshape the healthcare system as “downright evil.”

In a statement referencing Ronald Reagan and the economist Thomas Sowell, Palin warned of bureaucratic “death panels” that would decide “if my parents (or yours) or my baby with Down Syndrome” are “worthy of healthcare based on their level of productivity in society.”

The full text of the post:

“As more Americans delve into the disturbing details of the nationalized
health care plan that the current administration is rushing through
Congress, our collective jaw is dropping, and we’re saying not just no,
but hell no.

The Democrats promise that a government health care system will reduce
the cost of health care, but as the economist Thomas Sowell has pointed
out, government health care will not reduce the cost; it will simply
refuse to pay the cost. And who will suffer the most when they ration
care? The sick, the elderly, and the disabled, of course. The America I
know and love is not one in which my parents or my baby with Down
Syndrome will have to stand in front of Obama’s “death panel” so his
bureaucrats can decide, based on a subjective judgment of their “level
of productivity in society,” whether they are worthy of health care.
Such a system is downright evil.

The Master and I agree on the goals

Aug 8, 2009• 32

By Matthew Holt

Writing in his blog in the NY Times, Uwe Reinhardt sets out three overarching goals of health reform

1. Financial barriers should not stand between Americans and preventive or acute health care that they sincerely believe will address concerns over a troubling medical condition, in a timely manner, before that condition grows into a critically serious illness.

2. Having received needed health care, no American family should be so financially devastated by medical bills that it cannot meet routine daily living expenses — for example, make utility or mortgage payments on time or finance the education of the family’s children.

3. The future growth in national health spending should be constrained to fall significantly below currently projected spending growth, which has the United States devoting about 40 percent of its G.D.P. to health care by mid-century.

All other goals are subordinate to these three overarching goals, as are the means to reach them.

Last week I posted a very similar “Two rules by which to judge a health reform bill”.

Rule 1 A health care reform bill needs to guarantee that no one should find themselves unable to get care simply because they cannot afford it. Neither should anyone find themselves financially compromised (or worse) because they have received care.

Rule 2 A health care reform bill needs to limit the amount of GDP that is going to health care to its current level, with an overall aim of reducing the share of health care going to GDP.

Uwe is a touch more eloquent in his goals 1 and 2 which split apart my Rule 1, and he’s a touch less aggressive in his goal 3, which is my Rule 2. But other than that these are the same.

Unfortunately in his column of the previous week Uwe created a list of 8 (but it could have been 20) completely contradictory statements about the completely “confused state” of what Americans seem to demand from health reform.

And right now the confusion seems to be winning.

Dumb and Dumber

Aug 7, 2009• 18

By Matthew Holt

I can’t say that I’ve been fantastically impressed by the Democrats’ choice of this year to go after health reform, or their explanation of what it is. And I understand that the only interest of the Republicans is to destroy any political win in the hope that they get a repeat of 1994…although it is just possible that despite their confidence the voters also remember the 2000–2008 period which will also precede the 2010 election.

However, the amount of crap emanating from the right about what’s in the health bills and the evidence of that by what’s showing up in the “tea parties” now invading Democrat congressional members’ town halls is quite extraordinary and does require at least some notice.