Writing (unfortunately behind the fire-wall) in the NYT, John Tierney attacks the Republicans as being the Party of Pain. With their attempts to stop the Oregon assisted suicide law, and the relentless attack of the DEA on pain doctors, the Republican conservative Christian establishment that captured the DOJ in 2001 continues to defy rationality. Tierney is hopeful, however, following the Supreme Court’s ruling in Oregon’s favor.
Of course we never needed to engage in this ridiculous vendetta against pain doctors anyway. In his harrowing long and excellent issue brief on the subject Ron Libby at Cato points out that Oxy wasn’t that big a deal anyway
A final problem with the DEA’s claims of an OxyContin epidemic is the agency’s inflated estimate of risk of death. In 2000 physicians wrote 7.1 million prescriptions for oxycodone products without aspirin or Tylenol, 5.8 million of them for OxyContin.55 According to the DEA’s own autopsy data, there were 146 "OxyContin-verified deaths" that year, and 318 "OxyContin-likely deaths," for a total of 464 "OxyContin-related deaths."56 That amounts to a risk of just 0.00008 percent, or eight deaths per 100,000 OxyContin prescriptions 2.5 "verified," and 5.5 "likely-related." Even those figures are calculated only after taking the DEA’s troubling conclusions about causation at face value.
So this is just a classic case of the DEA acting like the drunk looking for his keys under the lamp-post because that’s where the light is. And who suffers? Obviously the doctors in jail or ruined. And it’s not a issue for just a few pain doctors. Libby points out that between one in five and one in three pain doctors has been investigated by the DEA or local authorities. Would you keep doing your job if there was a one in three chance that you’d be investigated, maybe have your assets seized, and possibly be sent to jail for very long time just for doing it?
And why is it being done? Well the DOJ and local police departments get to keep all the money from asset forfeiture. In other words this is essentially theft with patients, doctors and the taxpayer picking up the tab
Tierney hopes that there’ll be a resolution to this:
The Supreme Court’s decision is a victory for patients and their doctors – including, I hope, some of the ones in prison for violating the federal legal theory that has now been rejected by the court. The doctors should go free, and Republicans in the White House and Congress should restrain the drug warriors who locked them up. When this year’s budget is drawn up, it’s the D.E.A.’s turn to feel pain.
These loonatics need to be stopped and whatever my political differences with Tierney and the Cato crowd I applaud them for getting this in the public eye. Unfortunately I think he’s being far too hopeful that any good will come of this given the number of
theocratic fascists social conservatives still in the Administration and heading to the Supreme Court, and the current DOJ attempt to promote laws already overthrown by a (slightly) more liberal Superme Court.
Jonathan Cohn takes a good look at the Medicare implementation now and then, in What Bush could learn from LBJ on Medicare. Not too surprisingly the current screw-up wasn’t evident in 1965, even though the Johnson Administration had only 11 months to implement an entire new program, as opposed to the Bush Administration’s 25 months to add a new one on.
It does have to be said that McClellan’s golden boy image is starting to look a little like his brother’s — he of the “I know nothing” attitude (If you don’t know what I’m talking about look under N here)
John Cohn finds the December GAO report that says that CMS wasn’t ready for Part D’s launch, and also McClelland’s response that the GAO was underestimating CMS. Make that “mis-underestimating”, I think.
Here’s what the GAO Report says would be some likely problems with Part D’s introduction for the dual eligibles:
For dual-eligible beneficiaries who do not have Medicare drug coverage because they were either not identified and enrolled on January 1, 2006 or are newly qualified dual-eligible beneficiaries, CMS has developed a point-of-sale enrollment mechanism designed to enable pharmacies to assist these beneficiaries in obtaining immediate Part D coverage. The agency signed a contract with a designated PDP on November 22, 2005 to implement this mechanism. Because these arrangements were completed less than 6 weeks before the transition is to occur, limited time remains to educate all pharmacies about its availability and details of its operation.
For beneficiaries who were enrolled in a PDP but do not have their PDP information, CMS has facilitated a new information-technology process, known as the Eligibility Transaction, that will allow pharmacies to identify a beneficiary’s PDP and provide the beneficiary with the PDP’s contact information. As with the point-of-sale enrollment mechanism, it is unclear to what extent pharmacies are informed about the Eligibility Transaction and will use it. Despite CMS efforts to publicize this tool to industry organizations, a pharmacy industry association representative stated that it is unclear how many independent drug stores, which dispense the majority of the nation’s retail prescription drugs, plan to use the Eligibility Transaction.
Translation: a) Pharmacies are supposed to be able to immediately register dual-eligibles if they’re not already in a PDP but that was only developed in November and wouldn’t be ready. b) GAO was unsure how many pharmacies would use the eligibility transaction system.
GAO didn’t seem to predict what apparently is the major problem — the data on eligibility from the PDP’s that the transaction database is hitting against is wrong or it’s just not working.
We will find out more, but they had two years to get this right! And it seems to be getting worse!
Some slightly good news in the DEA and DOJ’s continued campaign to get into the practice of medicine in the guise of preventing “drug trafficking”, or more accurately imposing the extreme morals of the religious right on the rest of us.
The Supreme Court upheld Oregon’s one-of-a-kind physician-assisted suicide law Tuesday upheld Oregon’s one-of-a-kind physician-assisted suicide law Tuesday, rejecting a Bush administration attempt to punish doctors who help terminally ill patients die. Justices, on a 6-3 vote, said that federal authority to regulate doctors does not override the 1997 Oregon law used to end the lives of more than 200 seriously ill people. New Chief Justice John Roberts backed the Bush administration, dissenting for the first time.
Of course the dissenters were Scalia and Thomas, both unreconstituted theocratic & social
fascists conservatives. They were predictably joined by new Chief Justice Roberts. It’s no secret that Alito would have voted with them had he been confirmed. And this is for something the voters of Oregon have passed twice by large majorities. In other words the will of the voters is irrelevant in cases where social conservatives want to restrict freedom, including the freedom of physicians to practice in the way they like. And after Alito is confirmed, this will happen more and more…watch out Roe vs Wade.
The Maryland legislature enacts a Wal-Mart specific pay-or-play bill. It says that any company with more than 10,000 employees which doesn’t spend 8% of payroll on health care benefits needs to pay into a state fund. What’s not to like about this bill? It allows attacks on the big discount retailers and the fast-food chain while leaving small and medium businesses out of the legislation.
Of course, it doesn’t really help much in terms of reducing the number of the uninsured…..but I can hear Bugs Bunny even now.
Finally there is some word getting out about the reign of terror the DEA has been running against pain doctors and its awful impact. This article, called Let’s Get Serious About Relieving Chronic Pain picks up from the NEJM article I wrote about last week. We have known at least since the HHS report in the early 1990s that pain medication is massively under-prescribed. In this article, Jane Brody notes that :
"Pain is a common symptom in patients nearing the end of life," with up to "77 percent of patients suffering unrelieved, pronounced pain during the last year of life," Dr. Timothy J. Moynihan wrote in The Mayo Clinic Proceedings in 2003.
But the news is that the DEA, on its messianic quest to prevent us all going to hell or whatever the theocratic fascists think they’re doing, is not only wasting our time and money, and condemning innocent doctors and patients to prison. They are also helping most people to suffer in their last year of life. Well I’m sure the DEA think it’s a deal worth taking, but I can’t believe any rational person does. If there’s one government agency that ought to be abolished and have all its employees sent to fill in prairie dog-holes in Nebraska (or wherever), it’s surely the DEA.
THCB contributor, radio talk show host and occasional orthopedic surgeon Eric Novack (just kidding, Eric!) sent me this story about the problems that Medicare recipients will be having getting access to doctors in California if the projected cuts in Medicare reimbursement for Part B actually materialize. So far the cuts for this year have been rescinded by the Senate and the arguing is still going on in the House. Eric has written on THCB recently about the possible bad effects on patient access from cutting physicians fees, and I do agree with him that it’s unjust that only physician fees get cut when hospitals and managed care companies get an increase.
But the problem physicians face is that they don’t really have an alternative. Sure some will retire early, some will move to cash only practices. But given that Medicare is about a third of the money in the system, realistically they can grumble all they like but they’ll end up taking it, and of course doing more things to those patients to make it up on volume. And that’s not just my opinion, it’s the findings of this five year study by the HSC folks. After all, they went to medical school and residency for all those years, what else are they going to do? There’s only so much room on the poker circuit and only so many of them can run health plans.
That’s why I say that physicians should be figuring out how they collude with government to reduce overall spending while maintaining as good a position as they can. That’s what’s happened in other countries, and one day it’ll happen here. Of course there’s lots of time for gnashing of teeth and entrepreneurial end-arounds before then.
THCB’s favorite vituperative contributor, The Industry Veteran, is back with some New Year thoughts. He got what I was up to on NY Eve a little wrong, but may have a closer idea about what the long term effects of the New Year will bring to Big Pharma. The Veteran writes:
A healthy and prosperous New Year to you!! For some reason I have a picture in my mind’s eye of you sitting in a pub, raising many pints to toast in the New Year. At 2:00 a.m. I see you wearing a thick turtleneck sweater beneath a Harris Tweed sport-coat as the proprietor gives his inevitable call, “glasses, gentlemen.”
The following article from Tuesday’s Financial Times says some interesting things about plausible effects of Medicare Part D. The author maintains it will push the US closer to the rest of the world in terms of a national payer system, greater transparency in drug pricing and cost constraints. To advance that last objective, he sees the feds pushing IT and more rational provider management patterns, a sort of revenge-of-the-nerds that should delight you and a segment of your readership. I suppose since neither a Republican or a Democratic administration is likely to enact the sort of changes I would prefer (e.g., tumbrels, guillotines and iron maidens for the Hank McKinnells of the world), the sort of temporized-neuterized change from the back office is better than nothing.
The thing that strikes me as amusingly ironic about Medicare Part D is that it shows the folly of leaving economic planning to the monopolistic corporations. The US throughout its history has disdained strategic economic planning by government because of the secular faith in the market among the country’s business leaders. So here we have the Medicare Modernization Act as developed by Big Pharma’s Pfizers, Mercks and their PhRMA lobby. They fashioned the MMA, with its confusing, competing PDPs, specifically to prevent Medicare from acting as a single payer that could make volume discount purchases. After all, if they could elect George by manipulating an electoral system to create the illusion that 3,000 elderly Jews in Florida voted for Pat Buchanan, a Rube Goldberg MMA could certainly boost their earnings at taxpayers’ expense. Now here we have consultants, journalists and equity analysts forecasting that by decade’s end, the MMA will do precisely what the CEO malefactors wanted to avoid. I dread to think what would happen if Big Pharma’s CEOs were half as bright as their sycophants in Pharmaceutical Executive and the other vanity rags claim.
Although as the Veteran has pointed out before, the crew running big Pharma in 2003 will be long gone counting their millions by the time those chickens come home to their successors’ roosts.
The NEJM has an article and an interview about the Oregon assisted suicide ruling that is coming up before the Supreme Court. Because theocratic fascist John Ashcroft was unable to overturn the will of the Oregon voters legally he tried to get around it by using the controlled substance act. If the Supreme Court rules in the Administration’s favor, it has very serious consequences for palliative care. Basically doctors will be even more in fear than they are now of prescribing opiates, and patients will suffer.
The interview is pretty interesting. Despite both wanting the Supremes to rule against Ashcroft, one of the authors is in favor of the assisted suicide law, one against it. Diane Meier opposes it because she feels (rightly) that the average physician doesn’t have the training or the time to properly evaluate requests for assisted suicide. Funnily enough America’s leading and crazed advocate of assisted suicide agreed with her, which is why Kevorkian advocated creating a medical specialty for helping patients who wanted it. The other author, Timothy Quill does approve of the Oregon law, citing that as an experiment it gives data showing that the law is working and that patients and their families are using it as the entrance to a discussion about what they actually need. And of course palliative care with opiates is one type of help those critically ill patients, who are often in tremendous pain, need. And of course the authors are terrified that the DEA will not understand that the line between proper palliative care and going slightly over that line to hasten a coming death is very fuzzy and one that often cannot be identified.
But in dealing with this issue, there are two massive problems faced by rational people in the US. First, the opponents of this type of care — including leading bloggers — are happy to start labeling any doctor thinking about this as a genocidal Nazi. Secondly, the DEA is already intervening with no regard to patient care in its insane prosecutions of doctors who are treating patients according to acceptable guidelines. Meier can claim that the DEA is good at intercepting illegal diversion of prescriptions, but it’s clear that the DEA couldn’t give a rats arse about diversions, they’re just out to impose themselves on anyone they don’t like. Consequently patients all over America are suffering already. The imposition of the DEA into end of life care won’t make much difference, other than the pain of those at the end of life will last less time than those living with chronic pain who can’t get the care they need because of the DEA’s appalling behavior. If you don’t believe me, read the comments on my last post on this subject.
I sincerely hope that the AMA looks past its nose and gets involved in this travesty of a public policy. Maybe this article is a start, but it may well be too late. The only hope is that this case will be decided by O’Connor, before the theocratic fascist that Alito appears to be gets on the court.
An apparently well funded website has decided to “take down” what it calls The Health Care Lies of Paul Krugman. THCB readers will quickly have fun spotting the 5 classic errors, the total bias, and the thinly veiled racism. Of course if you want to know something real and researched about the subject you could do worse than read this.