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POLICY/POLITICS: Personal angst on research

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There are sometimes when two contradictory thought streams start charging through my brain and I can’t cope. This is one.

I got an email from a PR person for this website http://www.yourcandidatesyourhealth.org/ which tells you your local candidates record essentially for or against embryonic stem cell research. As you might guess, the idea from Research!America and the Lasker Foundation is to encourage people to vote against candidates opposing stem cell research (or at least get them to change their mind. The Research!America folks are a cross-section of business and academic types who like medical research.

And honestly how can any rational person be against them? When the choice is between them and the creationists who were only happy when we all lived in the dark ages, and don’t believe in the Enlightenment, personal liberty, the scientific method, et al. (Not of course that they won’t use the technological fruits of the movements they despise, particularly Talk Radio!).

But on the other hand, any really rational assessment of the health care system shows that we are spending way too much on medical research. The NIH alone is $30 billion a year, and that’s about doubled by private industry. Now we’re adding billions more at the state level. The problem is that the application of the products of that research is downright shoddy, and we’re spending almost nothing comparatively to figure out how to make it better.

It would be much better for the country and the health care system if we took the $30 billion spent on the NIH and the $300 million spent on AHRQ and flipped them. Then we’d really figure out how to apply the stuff we already know evenly and appropriately. We just don’t need more me-too cancer drugs at $4,000 a pop, when we can’t figure out how to get an Rx for aspirin in to the hands of discharged cardiac care patients (or whatever the appropriate cheap therapy is).

I’m convinced that if we put a ten year moratorium on all new medical research today, and spent all the money figuring out how to apply—and then actually applying—our medical knowledge across the board, we’d be much better off. Of course that’s never going to happen, and we need to save science from the hands of the anti-Enlightenment Philistines. But I remain to be convinced that the Research!America folks are applying their scientific resources in the most appropriate way possible.

Meanwhile, Steve Parker tells me about the launch of a new site called www.BreastCancerAwareness.com  which is pretty self-explanatory and looks like it’ll be a useful resource.

BLOGS: Is the AMA getting angry?

When THCB started I lived two buildings down in the same block where this happened in SF yesterday.

2006.10.01 Fire on 5th Street 001 I assume that my change of address wasn’t picked up in Chicago and that this is a word of warning from the Capos at the AMA to tone it down a bit.

(Just kidding, guys…)

PS I dont want to denigrate local journalism, but the pictures in the SF Chronicle were clearly taken from their office building at 5th and Mission (the one on this page was taken by a friend of a friend). Was the Chron photographer too busy to walk 3 blocks for a better one?

JOBS: Product manager health IT, SF Bay Area

And in today’s job announcement. A SF Bay Area company is looking for a Product Marketing pro to work at the intersection of technology and healthcare—Think improving the supply chain within the hospital.

The ideal candidate will have direct clinical/hospital setting experience as a nurse or other direct practitioner in the setting, but will have moved on from that environment to a track record in marketing, product and brand management. The company is not a start-up – they’re public, profitable, and have a substantial installed base of customers using and loving the systems.

If you’re interested *******@*********lt.net“>email me and I’ll pass it along.

 

QUALITY/THE INDUSTRY: DM powerhouse nixed by spreadsheet error

First the merger was delayed for some vague reason. Now it’s off. LifeMasters and Healthways nix $307M merger basically because of over-reported value of a certain contract — presumably one of the larger ones, and my guess would be a Medicaid one (But that is just a guess). And the difference was important enough that they couldn’t get to a new price

The termination followed a data and reporting error made by the unidentified actuarial firm regarding a LifeMasters’ contract, the companies said. That error “was unknown to LifeMasters at the time the parties entered into the Merger Agreement.” But the correction of the error “materially impacted period revenues” and financial projections that Healthways relied upon when it entered into the agreement.

“We are also disappointed that the merger could not be completed,” said David Strand, LifeMasters’ president and CEO.

Disappointed? I suspect that’s putting it mildly!

PHARMA/POLICY/POLITICS: November comes after September

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Interesting article in the WaPo about the impact of the donut hole in Part D on the Senior vote. I think it will matter, it will hurt the Republicans and the signs seems to be point that way in one House race in Florida. Of course whether it will matter enough to push the House over to the Democrats is another matter. But the most interesting stat in the article is buried on the second page.

Perhaps playing in Klein’s benefit: More seniors are finding themselves
in the doughnut hole as the election approaches. The Institute for
America’s Future, a group calling for the closure of the gap,
calculated that, on average, seniors who enrolled in the benefit at the
beginning of the year would have fallen into the doughnut hole on Sept.
22.

So this problem will get worse all the way up to election day, and the greed fest known as the Medicare Modernization Act (of which to be fair the greed of big Pharma was only one small part) may play a factor. And if it does, the obvious change that the Democrats would now put in the bill would be negotiated pricing.

That was not what Pharma wants, but of course it’s a maybe and the CEOs of big Pharma who pushed the bill through are leaving their posts and leaving the potential consequences to their successors. My guess is that those successors will wise up and figure out how to cut a more reasonable deal so that they are not so squarely in the gun sights when the nation has a real debate about health care costs in a few more years.

 

TECH/INDUSTRY/POLICY: Out with the trash

Just some quick Friday cleaning up of stuff I never got to but you should look at.

As you may have gathered I was crazy busy yesterday and am playing ubber catch-up on about 5 fronts today. Hopefully will have a little more insight for you on Monday. Have a good weekend!

POLICY: How dumb is the NY Times?

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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?

 

 

QUALITY/POLICY: Futurist’s forecast from Clem Bezold

Clem Bezold from Institute for Alternative Futures (kind of the alternative IFTF) gave an overview of the conference and an optimistic 2016 forecast for the availability of broadband to the home, better knowledge and personalized tools that will work on that information. Then he gets a little more controversial, including personal values, need for universal coverage, end of life care in context, etc — all as part of care in 2016

His main talk is about accelerating Disparity Reducing Advances project—wants to accelerate the technologies and process that reduce the social disparities in health care. They are not looking at the bigger picture of employment, education, etc, (consciously) and its impact on health, but they think that they can make a difference in the health care provision and tech part. They’re trying to pick their targets. And the first one is:

—Prevent obesity in poor populations. That leads to different levels of action in diff government and social programs. but we need to change the social environment, including getting the right foods into the right neighborhoods, as well as doing the health care screening and pre-diabetes initiatives. So there are a whole variety of factors you;d get to for any diseases, and information therapy is a big part.

Some things they’re trying—working with cell phones (LG has launched a diabetes phone this month which has a built in test strip reader. Also looking at biomonitoring activity, all connected to cell phones infrastructure. But needs to be connected to services. There are proposals to say that spectrum should not be auctioned off, but instead should be free (internet telephony over free wiMax?). That will be all added to patient and care giver “navigation”.

His forecast for monitoring. By 2008 standards for biomonitoring; by 2012 reimbursement has changed so it gets pay for; by 2016 common in us for monitoring the chronically ill and elderly. My feelings that this is about right, but it’ll require a whole hell of a lot of changes in the system…and of course there are huge infrastructure issues for the lower income providers (tech access, language, etc) which Clem spelled out clearly (and far too quickly to note down easily!)

Clem is an “aspirational” futurist who’s trying to change the future as much as explain it. At IFTF we were “analytical” futurists, and we derided the aspirational guys as the “personal helicopters by the year 2000” school of futurist — but his talk was really interesting, and frankly alot of analytical futurism is by definition wrong. So hopefully Clem provoked some big goals that we should all be going after.

I asked him about the norms of advertising for food and obesity—he thinks policy things can be done. And also about the system change required for home monitoring? How can the system change? He thinks that health care will be redesigned the hard way, otherwise it’s a perfect storm. It’ll get worse before it gets better. How do you get the patients and care-givers in the right place within the system. We will re-torque our use of health care providers to make that change.

Josh Seidman put up the Ghandi mantra “First they ignore you, then they laugh at you, then they fight you, then you win.” I think Ix is still being ignored, but soon it’ll be heading to the “fighting” part—and that is when it’ll get brutal.

Meanwhile in a moment of Ghandi zen, here’s a photo of a balloon over the canyons this morning

Photo_092706_001

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